Abstract
Psychedelic treatments like MDMA can sometimes have side effects which persist despite management with Western medical approaches. In what follows, we present a case study of an individual who suffered from insomnia, anxiety, tinnitus, and more for months following MDMA therapy. Ultimately, her symptoms responded to management within the Traditional Chinese Medicine framework. We present this case in detail, and argue that psychedelic management, especially in the integration phase, can benefit from the incorporation of techniques which engage with energies that Western medicine do not address.
Introduction: MDMA, acupuncture, and clinical research
In this paper, we describe a case of MDMA therapy-induced adverse effects that were long term in duration and proved to be refractory to standard Western medical management. The symptoms ultimately responded to treatment with acupuncture administered in a Traditional Chinese Medicine framework that included explorations by patient and practitioner into the patient's balance of vital energies. We present a system for understanding and healing the potential adverse effects of MDMA treatment according to the principles of acupuncture and Traditional Chinese Medicine, and make an attempt to bridge the narratives of the multiple world views that are evoked when discussing these principles in the setting of Western medical practice. These longstanding healing traditions explore management of both material and immaterial components of health. They not only expand current notions of how to work with psychedelic or entactogen medicines and their undesired side effects, but also challenge us to integrate worldviews that are seemingly at odds with best scientific practices and empirical methods for determining Truth.
The FDA's near unanimous rejection of MDMA-assisted therapy in June 2024, based on its conclusion that the risks outweigh the benefits, points to an urgent need to address the nature, prevalence and treatment of adverse effects. Despite concerns, MDMA has shown significant promise in academic and some military research settings as a therapeutic tool to treat PTSD. Understanding and addressing how to conceptualize, label, and treat adverse effects, using a wider lens of interventions, is critical if MDMA-assisted therapy is to move from academic research settings to the wider public.
Psychedelic-assisted therapy can often initiate significant - even transformational - shifts in an individual's interface with their environment. Though research and clinical exploration in this domain are expanding at a rapid pace, modern Western psychedelic research is still in the process of developing guidelines and methodology for understanding and optimizing set, setting, and integrative practices in order to accommodate such shifts. The goal of this optimization is (1) minimization of risks, (2) maximization of benefits, and (3) recognition and management of adverse effects. We would like to suggest that our understanding of adverse effects from MDMA treatment would benefit from consideration of theory and practice drawn from Traditional Chinese Medicine broadly, and acupuncture in particular. Such energy-based interventions may have a legitimate place in clinical treatment of PTSD with MDMA-assisted therapy in the near future.
History of MDMA
MDMA (3,4-Methylenedioxymethamphetamine) is a psychedelic medicine, first synthesized by Merck in 1912 (Passie et al., 2016). It has been classified as ‘entactogen’ and ‘empathogen’ for its empathy-generating qualities (Nichols, 2022), and has found its way into recreational and psychotherapeutic circles. Increasingly, the use of MDMA as a psychiatric treatment is showing promise in academic and some military research settings. This growing research base indicates that adverse effects from MDMA-assisted therapy are usually brief and minor but potentially longer lasting and clinically significant. These adverse effects must be closely observed and explored as a central part of contemporary research design in order to understand and study how to treat them effectively. As we prepare for MDMA-assisted therapy to move out of academic research settings post-legalization and become more broadly available to patients, increased vigilance is required.
Early history of MDMA use in therapy (pre-1980)
MDMA has a long and complex history across many contexts. It has been used as a sympathomimetic agent, a psychotherapeutic adjunct, and a club drug, with anecdotal documentation of side effects such as autonomic dysregulation, anxiety, and insomnia in each of these capacities (Freudenmann, Öxler, & Bernschneider-Reif, 2006; Passie et al., 2016; Pentney, 2001; Shulgin, 1990). In recent decades of relatively more academic interest, its acute physiological effects and sustained adverse effects have been cataloged. While most adverse events resolve on their own, when they do become persistent, our ability to effectively treat them does not measure up to our ability to characterize them (Breeksema et al., 2022; Morgan, 2000; Quinton & Yamamoto, 2006).
MDMA was first synthesized in 1912 by the German based Merck Pharmaceutical, designed as a hemostatic agent and then marketed for use for various applications without achieving commercial success. Early research into its biochemistry demonstrated its sympathomimetic properties, and its effects on smooth muscle contractility, blood glucose regulation, and other physiological properties were studied sporadically over the ensuing decades (Freudenmann et al., 2006; Passie et al., 2016; Shulgin BAT, 1985).
Investigation into MDMA's psychopharmacological properties was reinvigorated in the 1950s as part of stimulant research at Merck and the classified governmental MK-Ultra program (Karch) and methods for its synthesis were published as early as 1960 (Passie et al., 2016). The compound began to attract interest as an adjunct to psychotherapy when it left the laboratory and entered the therapist's office as a facilitator of the psychoanalytic process. But this interest was somewhat sidelined to the more widely available MDA, which could be reliably synthesized and had been used recreationally and as a psychotherapeutic aide in underground circles for years. MDA was ultimately scheduled in 1970 as part of the Controlled Substances Act, and a boom in the use of MDMA ensued in the following decade, in part catalyzed by established interest in the role that psychedelic and empathogenic substances could play in therapy (Pentney, 2001).
Alexander Shulgin brought renewed interest to MDMA in 1965 (Shulgin & Shulgin, 1991), along with a host of citizen scientists with whom he shared chemical insights and personal experiences, and opened the new era of MDMA research (Shulgin, 1990). This era saw widespread underground synthesis and distribution of MDMA, as well as growing therapeutic use of it after psychologist Leo Zeff, having received samples of the substance from Shulgin in 1977, disseminated it among his psychotherapeutic circles. Though its characterization was not formalized in empirical research at the time, hundreds of underground individual and group sessions raised the opinion of many that MDMA might be useful for strengthening therapeutic alliance, enhancing trust and relaxation, and promoting a communicativeness and emotional openness which could help with the processing of trauma and relational distress (Grinspoon & Bakalar, 1986).
History of MDMA in the 1980s: Individual and couples' therapy, rave culture
In 1983, a clinical study self-published by MDMA practitioner Dr. George Greer showed positive effects of MDMA on therapeutic intimacy and communication (Greer, 1983). Two years later in 1985, he published manuals with guidelines for the implementation of MDMA-assisted psychotherapy (Greer, 1985a, 1985b), but that same year, MDMA was abruptly designated a Schedule 1 drug by the FDA and all above ground research on its psychotherapeutic use was curtailed. With the story of MDMA's scheduling making national headlines, information about the drug which had previously been transmitted only by word of mouth or in scientific journals now entered mainstream discussion. This invigorated the already growing recreational use of MDMA, which is estimated to have tripled in the 7 years leading up to scheduling and to have grown immeasurably thereafter (Beck, 1990; Pentney, 2001). This expanding user base reported considerable information about both the desirable and adverse effects of the drug. Data from the Haight-Ashbury Free Medical Clinic, for example, revealed that some users reported prolonged adverse effects, including anxiety, insomnia, and paranoia (Leverant, 1986). Because of the large variability in reported acute and chronic adverse effects in the absence of information regarding conditions of use, this data could not readily be codified and used for diagnostic and treatment purposes.
Contemporary interest in MDMA as therapeutic agent (post-1980s)
In the decades that have followed, the Multidisciplinary Association for Psychedelic Studies (MAPS) with Michael Mithoefer as the Principal Investigator has generated careful and comprehensive scientific research in this area and has formed the foundation of a now robust body of empirical data. These promising findings prompted the FDA to give MDMA “Breakthrough Therapy” designation in 2017. As a result, MDMA's effectiveness in treating anxiety disorders has been studied by several groups - social anxiety in autistic individuals (Danforth et al., 2018), end of life anxiety (Wolfson et al., 2020), social anxiety (Luoma & Lear, 2021) - alongside prominent research which indicated its safety and efficacy in treating PTSD.
To date, six Phase 2 and two Phase 3 trials have been conducted using MDMA-assisted therapy for PTSD (Mitchell et al., 2021; Mitchell et al., 2023; Mithoefer, Wagner, Mithoefer, Jerome, & Doblin, 2011; Mithoefer et al., 2013; Mithoefer et al., 2018; Mithoefer et al., 2019; Oehen, Traber, Widmer, & Schnyder, 2013; Ot'alora et al., 2018), with strong, statistically robust evidence for its ability to reduce core PTSD symptoms of nightmares, flashbacks, and hypervigilance. Numerous secondary analyses of these studies have demonstrated specific benefits of MDMA therapy for sleep quality, self-perception, as well as the ability to maintain relationships in patients with PTSD (Brewerton et al., 2022; Ching et al., 2022; Jerome et al., 2020; Ponte et al., 2021; van der Kolk et al., 2024). These effects are thought to be related to empathy-generating qualities of MDMA, which has been designated as an ‘empathogen’ or ‘entactogen’ due to the prominent effects of increase in feelings of oneness, compassion, love and self transcendence (Shulgin, 1990).
Physiological mechanisms of action for MDMA and its side effects
At a molecular level, MDMA functions in a way similar to all amphetamines: increasing release of serotonin, dopamine, and norepinephrine from monoaminergic neurons with subsequent binding to postsynaptic receptors. MDMA also regulates release of specific hormones such as oxytocin and serotonin (Dumont et al., 2009; Benningfield & Cowan, 2013) as well as other important neuronal signaling molecules like monoamines and brain derived neurotrophic factor (BDNF) (Abad et al., 2014). This large protein regulates dendrite growth and changes in receptor molecules in key stress-responsive regions like the amygdala and hippocampus (Bradbury et al., 2014; Kirkpatrick, Francis, Lee, De Wit, & Jacob, 2014; Martí et al., 2006; Mouri et al., 2017; Nardou et al., 2019; Sottile & Vida, 2022). Activation of these pathways can sometimes result in undesired physiological effects due to sympathetic overstimulation, which in turn brings about dysregulation of cortisol release.
Common immediate and short term adverse effects following comedown from MDMA include: anhedonia, depressed mood, anxiety, irritability, increased susceptibility to pain, insomnia, memory loss, headache, muscle tension, and mild temperature dysregulation. Documented but rarely seen adverse effects include: cardiac arrhythmia, hyponatremia, severe hyperpyrexia, rhabdomyolysis, seizures, dissociation and intolerable flashbacks (Breeksema et al., 2022).
Research on individuals self-administering MDMA in the community shows that weekly users have long term psychological and behavioral changes even following a period of abstinence - increases in anxiety, depression, and paranoia, dysregulation of appetite, sleep, and sexual interest, and maladaptive neurobiological changes including reduced 5-HIAA in cerebrospinal fluid (Parrott, 2002). It remains unclear which factors predispose an individual to the development of these side effects. They have been observed to arise after only a single dose (Ellis, Wendon, Portmann, & Williams, 1996), though there is some evidence that higher use (lifetime average 47 tablets vs. 3 tablets) is correlated with increased occurrence of adverse effects (Schifano, Di Furia, Forza, Minicuci, & Bricolo, 1998). The acute effects typically arise within hours of ingestion, peak during the few days of neurochemical depletion that follow, and tend to subside within 3–5 days after use (Cajanding, 2019). High-dose MDMA therapy, in particular, may cause short term post-treatment anxiety and tension in up to 70% of participants, and appetite changes in about 50%. These symptoms are generally self-limited and low intensity, but they can persist in a subset of patients causing lasting functional impairment for weeks to months (Breeksema et al., 2022; Morgan, 2000). Adverse effects have been noted in all clinical trials. The MAPS research protocol has a detailed system for identifying them, tracking their severity and duration, and choosing interventions (Mithoefer). Persistent side effects sometimes remain beyond the scope of this protocol, though, and current psychedelic research at large lacks an organized approach to them.
Approaches for management of MDMA adverse effects: Literature review (including allopathic and non-traditional medicines)
Large-scale trials to study management of MDMA's untoward effects are challenging to design and to carry out. While MAPS has a detailed protocol for tracking adverse events, interventions are not studied rigorously, simply recorded in the source document. Some suggestions for treatment of severe side effects are found anecdotally, such as dantrolene for the management of MDMA-induced hyperpyrexia, rhabdomyolysis, and consequent organ failure (Hall & Henry, 2006). Recreational self-administering individuals have reported mitigation of bruxism, muscle tension, and anxiety by pre-treatment with magnesium and calcium. Regarding psychological adverse effects of MDMA, most research to date has focused on the allopathic psychopharmacological interventions. Case studies indicate that acute MDMA-induced anxiety or panic disorder have been managed with benzodiazepines (McCann & Ricaurte, 1992), while more chronic manifestations of such symptoms may be treated with SSRI medication (Pallanti & Mazzi, 1992). Management of side effects seen in methamphetamine (“crystal meth”) users has been more widely examined in placebo-controlled studies, with evidence that the use of bupropion plus cognitive behavioral therapy may reduce associated depression in a subset of patients, albeit with high variability (Brensilver et al., 2012; Elkashef et al., 2008; Shoptaw et al., 2008).
The internet offers advice, much of it from addiction recovery sites, describing the efficacy of meditation and mindfulness in treating the untoward effects of amphetamine use, but rigorous data to support these interventions has not, to our knowledge, been published. There are, however, several case studies which point to the potential utility of TCM in the management of MDMA adverse effects. One paper includes three case studies describing the successful treatment of stimulant-induced psychosis, mania, anxiety and pain with traditional acupuncture alone (Nachmani, 2015). The author of this paper elaborates a framework for thinking about psychiatric symptoms according to TCM principles, mapping them to the five traditional elements (wood, fire, earth, metal, water). His treatment of the patients involves an individualized trauma-informed protocol including acupuncture and herbal remedies as well as psychospiritual recommendations (for example, “he needed to avoid any unnecessary burden on his Spirit, keep his routine and balance his life.”)
A 2014 review out of Baylor and Peking University collected the literature on management of amphetamine induced adverse effects in China. It describes a role for alternative TCM therapies, including acupuncture and herbal remedies, for both acute and chronic adverse effects of amphetamine use. The authors specifically point to acupuncture as a modality which can both mitigate acute and subacute adverse reactions and play a role in the management of prolonged psychiatric side effects (Sun, Chen, Yang, Lu, & Kosten, 2014). Even more impressive is a subsequent randomized clinical trial, published in 2018 that demonstrated electroacupuncture to be an effective intervention for reducing both positive and negative psychiatric symptoms in abstinent methamphetamine abusers (Zeng, Tao, Hou, Zong, & Yu, 2018).
The MAPS training manual for MDMA-assisted therapy raises the potential for adverse effects in a way that highlights a central tension: “Some of the challenges during the integration period stem from the fact that symptoms may increase temporarily as part of the healing process. It is important to anticipate and prepare the participant for this possibility…Normalizing, exploring, and processing these reactions is usually all that is needed for them to resolve and additional insights, healing, and growth typically arise as a result.” (Mithoefer)
This touches on interesting theoretic and ethical questions regarding the ‘adverse’ nature of these effects: must a certain symptom or set of symptoms be either adverse or therapeutic? Could it be both? The question is an important one, needing to be asked explicitly: might these actually be an uncomfortable but necessary part of the healing process? The MAPS manual suggests that ‘focused bodywork’ may be useful for some participants whose somatic symptoms remain despite psychic processing, with rather broad recommendations of yoga, exercise, meditation, breathwork and journaling. There is scant evidence for the efficacy of these well intentioned interventions. This reflects that these processes are undertheorized, and that our understanding of adverse effects of MDMA treatment relies on anecdotal interventions on the one hand, and partially successful, piecemeal allopathic treatments on the other. We suggest that energy-based rather than materialist/allopathic strategies for diagnosis and intervention might be a useful addition to the treatment and research process.
Thomas Kuhn and the incommensurability of scientific theories
Thomas Kuhn, PhD (1922–1996), an American historian and philosopher of science, posits that scientific progress occurs through a series of paradigms, each of which encompasses its own theories, methodologies, and standards for what constitutes valid knowledge. He argues that these paradigms can be incommensurable, or so fundamentally different that they cannot be directly compared or understood in each other's terms (Kuhn, 2012).
In the context of health and disease, the modern scientific paradigm relies heavily on empirical evidence, reproducibility, and a mechanistic understanding of the phenomenal world. This approach tends to focus on biochemical processes, genetics, and observable phenomena. In contrast, concepts like Qi or prana represent holistic views that highlight balance, energy flow, and interconnectedness, which are often considered unmeasurable, qualitative and subjective. This can lead to the dismissal of such discourse as trivial, childish, or imaginary. The ultimate result is that these approaches may be considered not real and not serious as part of academic scientific discourse.
This divergence leads to what is referred to as “essential decoherence” in narratives of health and disease throughout the history of medicine in the West. The conflict between these paradigms can result in miscommunication and misunderstanding between practitioners of modern science and those who adhere to more traditional healing practices. Kuhn's framework highlights the importance of dialogue between the paradigms, and the conflicts that arise in such a dialogue. It is through this process (dialogue & conflict) that we can cultivate integrative approaches that respect both scientific standards and holistic traditions, inviting a more comprehensive understanding of health and well-being.
Vital energy, life force, Qi, psychoanalysis and psychedelics
Notions of “energy”, psychic and somatic, have a long, complex history within the discourse of psychoanalysis, starting with the pre-psychoanalytic era. Franz Anton Mesmer (1734–1815) theorized a natural energy transfer between all animate and inanimate objects, which he called “animal magnetism (Lanska & Lanska, 2007). He brought his theories to his clinical work with patients that would likely be diagnosed today with conversion symptoms or a somatoform disorder, but also with diagnoses of dissociative disorders, usually related to trauma.
In 1843, James Braid proposed the term “hypnotism” for the technique derived from Mesmer's theories and treatments (Braid, 1845). These treatments sometimes involved magnets, but largely utilized trance states that Mesmer would evoke as curative procedures. Keenly attuned to the power of music, Mesmer often concluded his treatments with live music played on a glass harmonica among other theatrical or ritualized enactments. His theories and practices were held with suspicion by some scientists of the time, a pattern that persists to this day regarding healing methods that involve trance and altered states of consciousness. Braid later introduced the concept of auto-hypnosis and moved away from Mesmer's use of physical contact with the patient, emphasizing the patient's autonomy with a critique of the doctor's excess control or effect upon the patient's experience–another concern we see central to psychoanalytic treatments as well as psychedelic therapies.
Remembering that Freud trained as a neuropathologist, we see a tendency toward mechanistic discourses common in his time and central in his early theories: at this time, mechanics, gravity, speed were entering states of rarefied measurements. Freud seems observant of natural phenomena, using these narratives pitched in the discourse of drive and pressure, as well as building tension and reduction of tension. Following Helmhotz and Bruch, Freud embraced a model of the psyche that was based on emerging laws of chemistry and physics–that the human system was a dynamic one in which energetic forces could be understood in the same framework as machines and natural phenomena (classical Newtonian physics).
Freud suggested in “The Ego and the Id” that the id was the energetic source of psychic aliveness that powered the mind. At various times, terms such as ‘libido’, ‘eros’, ‘thanatos’, ‘instincts’, and ‘drives’ have all come to play a role in Freud's ongoing efforts to find universal energetic processes common to all humans. Intensely skeptical of supernatural forces, he wrote in his 1895 book “A Project for a Scientific Psychology” that all cognitive mechanisms of human beings can be explained by rigorous study of brain systems or will be so, in time. Ego psychology, a subsequent major reform of psychoanalysis that emerged in post WWII America, offers a compelling scheme for this: unruly, disruptive, primitive, regressive drives/wishes/libidinal and aggressive energy spring from “deep” within, and are socially destructive, punished, feared in their unmetabolized form. Defenses emerge to both gratify and transform these wishes, so that tensions and hunger are satisfied in a culturally acceptable and also gratifying way. Spiritual, oceanic feelings were seen by Freud (and many other analytic theorists) as regressive, emerging only as longing for a pathological return to infantile dependence, symbiosis, fusion and possible psychosis. We would like to suggest that this hunger is not necessarily regressive, but may contain elements of progression as well.
A subsequent evocation of energy in psychoanalytic discourse is the emergence of attachment as an organizing principle: the human drive to connect, the need to share mental processes with a trusted other for emergence into the world. The energy of attachment driving development can be seen in many sentient beings. It is believed by some to be the most primal and essential energy of all. Not only is it observable in behavior of living beings, but the attraction of non-animate objects to one another (what binds our planet to our sun) may also teach us about the universality and invisibile nature of certain types of energy. The earth revolves around the sun because it is attracted to the sun's mass. The earth's mass attracts us and holds us to it; without gravity, we'd fly off into space in a nanosecond. In the case of gravity, the energy is invisible and its nature mysterious, even though it can be measured with exquisite precision. How it works and why it works remain unknown, although its effects contributed to the scientific discovery of our (supposedly) universal laws of physics. This energy is invisible and mysterious: what is the attractive force of gravity? Because we can predictably measure gravity with great precision, we grant it a ‘realness’ status in a way that is withheld from Qi energy of TCM. We must remember that X-rays, gamma rays, microwaves and ultraviolet light waves existed long before we were able to measure them. Our human methods of knowing do not have a dominion over reality, itself.
The subtle energies affected by acupuncture and Qigong elude the measuring devices we use to make the claims of scientific realness. Subtle energy, cosmic energy, and esoteric energy are terms that are used to describe subjective experiences that feel real but are not measurable with current quantitative techniques. Such terms as ‘life force’, Qi, Prana, or ‘elan vital’ have a long, long history. These classifications are typically dismissed in scientific, rational discourse as not being of interest because of their escape from measure.
This type of energy emerges in some discourses as existing in a place (Stonehenge, sacred natural sites, burial grounds, etc), in inanimate objects (crystals, mandalas), in animate beings (psilocybin mushrooms, ayahuasca, peyote, holy animals), or as being caused by massive forces creating local effects (tides, eclipses, photosynthesis, electromagnetism).
Contemporary psychoanalysis has made several significant rapprochements with non-scientifically documented energies. In addition to the development of transpersonal psychologies (which carry an openness to spiritual and theistic narratives), analytic theorists such as Wilfred Bion and Christopher Bollas have brought the longing for the numinous to the center of psychoanalytic striving (Bollas, 2017; Grotstein & Wilfred, 2018). Both have put our yearning for that which is unknown and unthought at the core of the psychoanalytic endeavor. Bollas' evocation of “the unthought known” (1980) and Bion's ever receding but infinite attractor “O” each posit an energetic yearning and longing for something eternally desired: transformation. This transformative moment is infinitely of interest due to the innate disconnected state of individual existence, from which we seek to escape. This is the energetic core of the human condition, depicted with poetic and mathematical precision by Bion's concept of +K and −K. Abstract and yet deeply felt, energetic sensations are a central part of psychoanalytic theory and practice: longing for +K to know and to transform in response to knowing. While such energies may resist empirical measurement, their existence as real should not be dismissed on this basis. We limit our own creative imagination if we preclude energy psychologies that exists outside of our Western culture (Qi energy, acupuncture meridians, sacred locations or objects) from entering serious consideration.
In what follows, we describe a clinical case in which acupuncture treatments promptly ameliorated chronic adverse effects from MDMA therapy that were non-responsive to allopathic interventions. It is our hope to offer an inquiry into how the energy of MDMA therapy-induced adverse effects and the energy of acupuncture can meet and inform one another.
Vital energy/Qi in TCM, acupuncture
Apart from the modern Western psychedelic research movement, there are many traditions of psychedelic medicine around the world, which have been carefully developed over millennia with particular attention paid to methods of tuning vital energy (Ma, 2000; White & Ernst, 2004; Zhuang, Xing, Li, Zeng, & Liang, 2013). Critics may dismiss these as art rather than science, but these practices have been developed through many forms of knowledge, both intuitive and empirical. We use the term empirical because indigenous medicine practitioners use observation to determine best practices. It is false to assume that only our Western methods for developing treatments are upheld through use of the iterative process of trial and error. The Randomized Control Trial (RCT) is an extremely rarified concoction of Western medicine, but it does not hold exclusive rights to the scientific method of trial, error, careful self observation and so forth. We argue that we stand to benefit from studying and incorporating an expanded range of knowledge and methodology into psychedelic therapy. Such an integrative model could help bridge physical and non-material elements of psychedelic experience in order to promote healing and relieve suffering.
Energy-based healing exists in a different framework than the mind-body distinctions that we typically use in allopathic medicine and scientific discourse. It talks about the mind-body-spirit, a dynamic organization of physical and non-physical elements composed in a larger energetic body. This body can be healed through physical treatments and the use of mental-spiritual strategies to regulate vital energy. Dysregulation of such energy is an unbalance that is seen as in need of homeostatic self-regulation. In the Shipibo tradition for conducting ayahuasca ceremonies, for example, participants are required to follow a dieta, which includes abstinence from many foods, media, stimulation, sexual/erotic energy, and a withdrawal into relative solitude. This practice, one used in spiritual traditions throughout time and all over the world, is followed with the intention of cleansing the system of disruptive, toxic, stagnant and foreign energies, leading to enhanced sensitivity of an unusual sort.
On a spiritual/energetic level, there are substances and activities that are avoided in dieta. These are considered to be spiritually obscuring or disruptive of the spiritual effects of ayahuasca: alcohol, pork, recreational drugs, salt, sugar, vinegar, sexual behavior (including masturbation), all violent media as well as all digital media, and more. This dieta focuses on removing highly stimulating inputs and invites quiet self reflection, allowing the participant to attune to her own vital energy rather than the bustling energy of the external world (Fotiou, 2019; Labate & Cavnar, 2013; Ruffell et al., 2021).
A broad range of contemplative and spiritual traditions have a framework for talking about this vital energy, with guidelines for accessing it, working with it, and using it for healing. Among the most enduring is Traditional Chinese Medicine (TCM), which refers to the diagnosis of imbalances and movement towards harmony of five vital energies - Jing, Xue, Jin ye, Shen, and Qi, the last of which represents a life force which healers manipulate for the treatment of various disorders (Foley & Litscher, 2024; Jagirdar, 2012; Kaptchuk, 2002).
TCM is an empirical healing system with a history spanning two thousand years or longer. It encompasses a range of practices, including acupuncture, ethnobotany, qigong, and dietary therapy. TCM aims to diagnose and treat illnesses by viewing the body as a network of interconnected energy systems, with a primary focus on restoring harmony among them. The earliest known written record of Traditional Chinese Medicine is the text Huangdi Neijing (The Yellow Emperor's Inner Classic), written in the 3rd century BCE. This foundational work consolidated ancient medical experience and theory into a comprehensive compendium, encoding/documenting the essential concepts that are central to TCM as practiced today (Beinfield & Korngold, 1992). Traditional Chinese healers strive to restore a balance between two complementary forces known as Yin and Yang, that are essential to the smooth flow of Qi, the vital life force energy. These forces permeate the human being, mirroring their presence in the broader universe. The mirroring process refers to the concept of Yin and Yang as fundamental energies within the body, but also energies as they exist in an interconnected relationship between the human body, their community, the planet and the cosmos.
According to TCM, a person is healthy when harmony exists between these two forces; illness results from a breakdown in the equilibrium of Yin, the colder and more calming energy, and yang, which embodies the hotter and more invigorating energies. Equilibrium between the two is closely linked to the movement and flow of Qi and Xue which alter the balance of Yin and Yang. An individual is in a state of health and well being when harmony is maintained between these two forces. Conversely, illness is attributed to stagnation, deficiency, and excess or improper movement of Qi and Xue (Maciocia).
Yin and Yang represent intertwined forces that exist in a fractal way, with infinitely repeating self-similar patterns in humans, in life forms on the planet, and in our universe as a whole. When applied to the human body, Yin and Yang are associated with different organs or systems. The practitioner's diagnosis of the energetic patterns in the patient is the central organizing principle of the intervention. The objective of TCM, through diverse modalities such as acupuncture, herbal decoctions/tinctures/teas, dietary guidance, and qigong practices, is to restore homeostasis in the mind-body-spirit system. Health is a manifestation of balance and harmony among these energies, with the flow of Qi (vital energy) being smooth, and with Yin and Yang forces in equilibrium.
Acupuncture is a practice within TCM which has been adopted widely in many settings and cultures around the world. It is a standalone TCM modality that can be used independently of other TCM interventions.
In acupuncture theory and practice, there are 12 main meridians, or pathways, that are considered to carry vital energy. These meridians are fundamental to understanding how Qi (energy) flows throughout the body, influencing health and energetic balance. They include the six Yang (Small intestines, Stomach, Large intestine, Urinary bladder, Gallbladder, Triple Heater) and six Yin meridians (Heart, Spleen, Lungs, Kidneys, Liver, Pericardium).
Each meridian corresponds to specific organs and functions. Acupuncturists work with these pathways to restore balance and promote healing in the body. By understanding the nuances and functions of these meridians, practitioners can address conditions related to energy flow and overall health. Acupuncture can remedy illness in several ways:
- A.Restoring Qi Flow: Acupuncture needle insertion and manipulation can unblock stagnant qi, modulate, excess or deficient Qi, and allow Qi to flow freely throughout the body. By improving Qi movement, it may enhance overall vitality as a support to the body's self-healing.
- B.Balancing Yin and Yang. Depending on the specific pattern of disharmony, acupuncture can strengthen deficient Yin or Yang, disperse excesses, and restore equilibrium between these complementary forces.
- C.Regulating Organ Function: TCM equates specific acupuncture points with various organs and organ systems. By stimulating these points, the acupuncturist aims to regenerate superior function to those systems affected by illness.
- D.Promoting Circulation and Pain Relief: Acupuncture has been observed to have analgesic effects through stimulation of neurotransmitter release, including endorphins. It may also improve Xue circulation and alleviate energetic blockages, thereby reducing pain and inflammation (Zhang, Lao, Ren, & Berman, 2014).
- E.Formulating illness/unwellness in an integrative, encompassing way: TCM focuses on identifying and addressing the root causes of illness as defined within this particular diagnostic and healing system. Considering a patient's overall energetic balance of vital energies, Yin and Yang, and their interconnections within the organ systems of the body is crucial to treatment. The TCM practitioner develops a personalized treatment plan to identify and rebalance root disturbances that contribute to the patient's illness. With this holistic framework, the acupuncturist is capable of affecting both material and immaterial elements of disease, supporting the management of complex mind-body-spirit reactions. This integrative method of diagnosis and treatment, we suggest, has particular value in working with the energies activated in psychedelic treatment, and offers a new perspective for working with adverse effects that follow psychedelic experiences.
Clinical case and discussion
Case report clinical/demographic info
The material presented describes an MDMA session with one of the co-authors, Alison Locker, PhD, who will be referred to subsequently as AL. At the time of dosing, AL was a 53 year old caucasian female, divorced, and the mother of three children, ages 24, 22, and 19. AL is a licensed clinical psychologist in private practice in NYC. Her area of specialization includes Attachment Theory, early childhood development, and psychodynamically oriented parenting work. In addition, she completed the CIIS (California Institute for Integral Studies) certification for psychedelic-assisted therapy and research and received a certificate for Ketamine-assisted psychotherapy through the Ketamine Research Foundation. Part of her practice includes KAP (ketamine-assisted psychotherapy) in collaboration with a licensed medical doctor and psychedelic integration work.
Health/psychiatric/psychedelic history
The author has no psychiatric history or diagnosis and has never taken or been prescribed any kind of psychiatric/psychotropic medication, nor has she taken any other long-term medication. She has no significant medical history, and has no history of PTSD or complex trauma. AL exercises 5–6 days/week (running and strength training) and is in good physical shape. She has a daily meditation practice and a supportive network of close family and friends. She rarely drinks and does not use any other psychoactive substances. She had her annual medical check up two months prior to her MDMA experience and was determined to be in good health.
AL became interested in the field of psychedelics as a possible tool for working with early trauma in her clinical practice. As a way to prepare herself professionally and for personal growth, she had her first psychedelic experience with psilocybin at age 49 and a second at 51, both with a trained guide/facilitator in a safe set and setting. While neither would qualify as a mystical experience, both were deep and significant and profoundly meaningful, although neither reached what is referred to as mystical state. She did not experience any notable adverse effects during or after these psilocybin experiences. She had several ketamine-assisted therapy experiences as part of her training (one sublingual, the others IM), with no significant post-medicine adverse effects.
Reason for seeking MDMA-assisted therapy treatment
AL sought treatment as part of her ongoing training in psychedelic-assisted therapy. She is MAPS certified but had no prior personal experience with MDMA. It should be noted that the session being described was not affiliated with MAPS or any other program or clinical trial, and she was self-referred.
AL has been in several long-term psychodynamically-oriented therapy treatments and was not in treatment at the time of the MDMA session. Her guide was a licensed MAPS trained psychotherapist, and had been working in the field of psychedelics for more than three decades. They agreed to follow the protocol for a single dose treatment, exactly as conducted in a standard MAPS trial, which included two preparatory sessions and three post-medicine therapy sessions with the understanding that integration work would continue as needed.
MDMA session
AL arrived at 10am (no breakfast, black coffee only) and took the 100 mg dose after another brief preparation regarding intention, safety and informed consent. About an hour into the journey she took a 50 mg additional dose. She experienced the setting as safe, supportive and appropriate and continues to regard the frame of the session in those ways. All prompts and inquiries and touch during the journey (feet and shoulders and back, at various times) were experienced as comforting and therapeutic. AL wore eye shades and headphones; the guide was present throughout the day, checking in with her with care and support. The content of her journey activated feelings of deep emotional states, sadness and grief yet the psychological material was not overwhelming or unfamiliar.
Somatic experience during the journey
AL experienced some mild nausea and lower back pain (which she linked to the content and which did not persist post-session) but had no other acute adverse symptoms while lying on the couch or using the bathroom. She came out of the period of most intense effects at approximately 6pm but felt very dizzy and nauseated upon trying to stand up. The guide offered lemon water (which she drank) and some toast and soup but AL had no appetite and ate nothing. She went back on the couch, where she stayed for another hour with the guide checking periodically. AL continued to feel dizzy and nauseated; at 8pm she vomited but eventually felt steady enough to take a cab home at 8:30pm.
Emergent adverse effects
Acute phase adverse effects/symptoms (3 days post-dosing)
AL did not sleep the night of her journey and vomited twice more. She experienced strong waves of intense panic and anxiety throughout the night which lasted for hours, unlike anything she had experienced previously. Additionally, acute tinnitus set in. She spent the next several days at home with severe nausea, anxiety, heart palpitations, absent appetite and intermittent vertigo. She felt foggy, light headed and disoriented. She had difficulty sleeping through the night and continued to wake up with panic attacks. AL had suffered mild bouts of tinnitus intermittently for a decade (lasting no more than a few weeks) but had been symptom-free for two years.
Acute phase treatment/interventions.
AL had two integration sessions with her guide 24 and 48 h after the journey to process the material. The guide also made herself available by text to offer support. The guide's recommendations in this phase included walks (when not dizzy), gentle yoga, rest and hydration, which AL followed.
The guide normalized AL's experience as a somatic response to a powerful psychedelic session and suggested her system was in a process of intense recalibration after being “cracked open” by the medicine. The guide was reassuring but seemed mildly concerned, acknowledging the severity of the somatic response post-session was atypical. AL felt held and supported psychologically but disoriented and profoundly dysregulated in her body. She was fearful that she had permanently damaged her nervous system and would not return to baseline despite reassurances that time and her “inner healer” would allow her to stabilize and to grow.
AL also had a teletherapy session with the co-author, Abdi Assadi, with whom she has been working periodically (sessions once every three to six months by phone) for seven years. The nature of this work may be described both as teaching/mentoring and energetic healing. As AL's therapeutic orientation was expanding to integrate mindfulness, meditation, and psychedelic-assisted psychotherapy, Abdi served as a trusted guide and bridge between more traditional models of psychological healing (specifically psychodynamically oriented psychotherapy) and energetic practices which are highly somatic in nature and difficult to define with language. AL's felt sense after this session included reduction in fear of having damaged her nervous system and relief that flowed from Abdi's manner of working.
In this particular post-MDMA session, Abdi's professional experience with psychedelics, particularly working with clients after difficult psychedelic journeys, and his intellectual knowledge of the mechanisms of psychopharmacological action and common acute-phase symptoms as well as embodied knowledge of the holistic TCM framework provided a reassuring frame and validation for her adverse response to the medicine.
Sub-acute phase adverse effects/symptoms (3 days to 6 weeks post-dosing)
During this phase, AL had no appetite and continued to have episodes of nausea and intermittent dizziness. She had early middle late insomnia. and she experienced panic attacks both at night and during the day. Severe tinnitus persisted as an unrelenting high pitched ringing in both ears, which AL tried to ameliorate by using white noise machines in every room. She was able to work (seeing patients over Zoom) but felt light headed and foggy, with trouble concentrating. She experienced a “buzzy” feeling in her body and her head, as if her nervous system were frayed. She continued the belief that she had “broken” her nervous system; she worried that she had permanently compromised her intellectual functioning and overall sense of well being.
Sub-acute phase treatment/interventions
AL resumed her practice of running five miles daily and walked in nature as much as possible (daily, 5x/wk, 2 x/wk, occasional). She attended online yoga classes several times per week, since exercise had long been her primary tool for stress management. Being in motion offered some relief from the anxiety but when she stopped moving, the anxiety flooded back. She attempted to return to her regular meditation practice, but found meditation too difficult because of the tinnitus and anxiety. She tried to write in a journal, previously a useful tool for integration, but had no desire to write and found that solitary reflection increased her anxiety. AL continued to meet with the guide weekly and was able to create a meaningful narrative of her medicine experience, but these insights had no impact on her physical symptoms. She also reached out to friends and colleagues in the psychedelic space to continue to process her experience. Several seasoned colleagues in the psychedelic space reassured her that the adverse effects were both “common” and “normal,” but she could not find anything in the literature to help make sense of her symptoms or to find specific recommendations to help her heal them.
AL became increasingly concerned about her heart palpitations and overall sense that her system was “off.” She visited an MD friend two weeks after her medicine session to check her vitals signs, which were normal. She sought a full physical examination, including lab work, with her primary care physician three weeks after her medicine session (also a recommendation made by her guide). Her internist found nothing abnormal in a physical exam and her bloodwork was normal. He recommended ginger and vitamin B supplements for nervous system regulation and another for the tinnitus. Both medical doctors provided a sense of relief that nothing was medically amiss and projected confidence her system would heal over time. The internist referred her to an ENT and then to an audiologist for the tinnitus, but neither found anything remarkable and said that there were no effective treatments for tinnitus other than symptom management with white noise machines.
Three weeks after the MDMA treatment, AL had a session with a Reiki healer, which temporarily calmed her nervous system but had no lasting impact on the somatic symptoms after a few hours.
Chronic adverse effects (≥6 weeks post-dosing)
AL's acute panic attacks ended around the three month point (12 weeks) but the tinnitus, limited appetite, light/foggy headed feeling, fatigue, and generalized feeling of anxiety lasted an additional five months (about 20 weeks). Her nervous system had the persistent quality of feeling unfamiliar and stressed.
Chronic phase treatments/interventions: acupuncture and integration sessions
Approximately 5 months after the MDMA session, a physician friend and colleague in the psychedelic space suggested she try acupuncture and referred her to an acupuncturist in NYC. AL had a session with the acupuncturist and a second session two weeks later. Both sessions felt relaxing and therapeutic and led to some mild relief but no significant change in symptoms.
The week following her second acupuncture session, AL went to a bodyworker/massage therapist, whom she had known for a decade. The therapist shared that as a teenager she had taken LSD recreationally and had had one bad experience. She described it as “feeling like the regular lightbulb of my nervous system had been replaced by a buzzy, flickering fluorescent one.” That description of the “buzzy fluorescent bulb” fit exactly what AL had been feeling, and that relational moment of feeling understood unlocked a wave of relief and hope. It is worth noting that “focused body work” is one of the recommendations given by MAPS. In this instance, the body work itself was a balm for AL's system, but the most significant moment of therapeutic impact was the interpersonal mirroring of shared felt experience.
The third acupuncture session, two weeks after the last one and with the intervening relational mirroring experience, was physiologically transformational. When the acupuncturist finished placing the needles and left the room, AL felt energy move from the top of her head through her feet, a powerful wave pulsing through her body and clearing/balancing it. Thirty minutes later, when the acupuncturist returned to remove the needles, she found that the fog in her head had lifted and she no longer felt the buzzy and lightheaded sensations. Her energy became vibrant and strong, and she did not feel anxious. The acupuncturist provided TCM dietary recommendations to help facilitate continued healing. Over the next week, the tinnitus lingered but became notably softer in volume. Her appetite, which had been limited for 5 months, slowly returned to normal. Her sleep pattern also returned to her pre-medicine baseline and she was able to sleep through the night.
Following her third acupuncture treatment, AL had another session with Abdi Assadi which may be understood as an integration session for the acupuncture treatments. Abdi translated the mechanisms of acupuncture and TCM into language accessible to her, giving a theoretical frame to explain the physiological and energetic basis for her “frayed” and “buzzy” and “crashed” nervous sensations. He also offered an energetic explanation for the tinnitus and how it could be treated in a curative manner, a possibility Western medicine did not have. He described, specifically, where and how the energy was out of alignment and how acupuncture, energetic treatment, and nourishment from bone broth would help her heal. Two additional acupuncture treatments over the next month along with the two “energetic integration” sessions with Abdi led to complete cessation of tinnitus, and AL has remained free of adverse side effects for two years at the time of this publication.
AL met with the acupuncturist after her nervous system had returned to baseline to ask her to explain (in basic Western terms) the nature of the treatments she had performed and how they worked. The acupuncturist suggested that AL had experienced a “car crash” in her system and the movement of Qi energy through her meridians had become stuck, congested, in a state of disequilibrium. The acupuncturist said she used the needles “like policemen to tell the energy where to go.” She explained that the first two sessions had been the equivalent of clearing the car crash and the third created the proper flow to get the cars moving in the right directions again.
With this metaphor in mind, AL's energetic integration work with Abdi may be imagined as the process by which this “proper flow” was reestablished and then integrated into AL's system. It is likely that the pre-existing therapeutic relationship with Abdi established a familiarity with/attunement to AL, which helped to amplify the effects of the acupuncture, facilitating healing. The trust that had been established contributed to his accessibility into her system, creating a certain alchemy that supported greater healing.
Acupuncture, TCM and MDMA adverse symptoms: a TCM interpretation of the case study
From a TCM perspective, when amphetamines are introduced into the body, they are known to impact the flow and balance of Qi. The excessive stimulation from these drugs can cause an imbalance in the body's energy and potentially disrupt the delicate flow between Yin and Yang energies. The strong influence of amphetamines on the body's energy causes an upward and outward dispersion of Qi while depleting Yin (Liu, 2009). This imbalance leads to a pattern of dysfunction which is known as “rising fire”. Symptoms of rising fire, which correspond in allopathic medicine to sympathetic nervous system overload, often present as agitation, anxiety, loss of appetite, nausea, palpitations, panic attacks, tinnitus, and insomnia (Pilkington, Kirkwood, Rampes, Cummings, & Richardson, 2007). While these can be seen as individual symptoms in separate body systems, TCM views them as interconnected. The goal of TCM practitioners is to alleviate symptoms by restoring balance between Yin and Yang energies in the body, with the theory that homeostasis of these energies is the core of health and wellness.
TCM, and acupuncture in particular, can provide a supportive and holistic approach to managing side effects of psychedelic treatments by balancing Yin and Yang energies, enhancing the therapy's benefits while reducing potential side effects (Beinfield & Korngold, 2013). Numerous studies have demonstrated the effectiveness of acupuncture in addressing psychologically-relevant somatic symptoms. Below, we describe how TCM understands and treats specific symptoms which may arise as side effects of MDMA treatment.
According to TCM, tinnitus is often associated with rising fire due to Kidney system deficiency, and sometimes with an imbalance in the Liver and Gallbladder organ systems and corresponding meridians. Acupuncture, in this case, targets specific points like Kidney 3 (Tai Xi), Liver 3 (Tai Chong), and Gallbladder 20 (Feng Qi) to nourish the Kidney and calm the Liver to alleviate the symptoms (Hecker, Steveling, Peuker, & Kastner, 2005).
Nausea is commonly a result of disturbances in functioning of both the Stomach and Spleen. Acupuncture treatments would focus on points like Pericardium 6 (Nei Guan), noted for its effectiveness in treating nausea and vomiting. Additionally, Stomach 36 (Zu San Li) is a vital point in strengthening the Spleen and Stomach function (Hecker et al., 2005). Loss of appetite is seen as a complex condition that can involve the Spleen and Stomach systems, as well as the Heart and Lung systems. Treatment aim is to regulate digestion and appetite, and to calm the mind. Acupuncture points may include Stomach 36 (Zu San Li) to strengthen digestion and Spleen 4 (Gong Sun) to harmonize the “middle heater” (Jiao) (Zhang, Chen, Yip, Ng, & Wong, 2010).
Panic attacks are viewed as a manifestation of imbalances in the Heart and Kidneys, as well as stagnation of Qi or Blood. When Qi is stagnant, it means that its flow is obstructed. This can prevent the proper and balanced functioning of the body's systems, and lead to the expression of a variety of symptoms such as pain, emotional distress, fatigue, and digestive issues. The treatment aims to calm the mind, nourish the Heart, and ensure the smooth flow of Qi. Acupuncture points may include Heart 7 (Shen Men) for calming the mind, Kidney 6 (Zhaohai) for nourishing the Yin and calming fear, and Pericardium 6 (Nei Guan) for moving Qi (Pilkington et al., 2007).
Insomnia is attributed to various imbalances: Heart-Spirit disturbance, Liver Qi stagnation, or Yin deficiency. Acupuncture aims to regulate the Qi, and nourish the Yin. Acupuncture points would include Heart 7 (Shen Men), a well-known point for calming the mind and spirit, and Liver 3 (Tai Chong) to soothe the Liver and regulate Qi (Liu, 2009).
TCM provides a comprehensive framework for thinking about psychosomatic phenomena, and offers tools for working with energetic dysregulation. The presentation of the acupuncture points above is a sample offering of the core points commonly used. A myriad of additional points may be added depending on the nuances of symptoms presented. In TCM, two patients presenting the same clinical diagnosis such as tinnitus, can and do receive subtly differing treatments to address those nuances.
This energetic framework indeed maps onto to our material world, and evidence shows distinct molecular identities of ‘hot’ and ‘cold’ Chinese herbs (Liang et al., 2013; Liu, Feng, & Peng, 2021; Zhou et al., 2019). This, along with a number of compounds that have been adopted from TCM into Western medicine, suggests that the two views can be functionally integrated.
Discussion
In contemporary psychedelic healing discourse, there is a gap between Western allopathic, with its largely materialist frameworks, and traditional medicine frameworks, which incorporate intangible energetics. Psychological emotions - which are acknowledged by Western practitioners - occupy an “in between'' space, though do not easily bridge materialist narratives and the language of energy. We wish to suggest that immaterial energetics are very much at play in the body, mind and spirit as well as in the world at large, whether Western medicine acknowledges them through objective measurement or not. Further, clinical work which incorporates them makes a valuable contribution to healthcare by imagining energetic balance and imbalance with observable clinical consequences. There are terms, considered in clinical practices and some scientific discourse for these energetic forces: Qi, prana, ‘elan vital’, ‘morphic fields’, ‘quantum waves’. Numerous practices from around the world aim to characterize such forces and to provide a context with which practitioners can work in balancing them for the well being of patients.
Some may regard these vital energies as fundamentally incompatible with our Western rationalist systems of knowledge, including the diagnoses and treatments offered for human illness. The diagnoses used in traditional psychiatry and internal medicine predominantly guide pharmacological or other somatic interventions. We would like to suggest that rationalist and immaterialist world views can mutually inform one another.
What Western medicine may gain from openness to energy medicine is the ability to understand and to treat symptoms that have proven resistant to other recommended somatic interventions. All too often, allopathic clinicians find themselves doggedly treating “resistant symptoms” (or “resistant patients'') by cycling through or combining medications to offer relief. Clinicians sometimes dismiss the significance of somatic symptoms by labeling them as ‘functional’, which means to some ‘not real’, exactly because they have not yielded to medical treatments. This non-response could also trigger frustration in the clinician, whose need to be helpful may be thwarted.
This is a myopic aspect of Western medicine. Western medicine represents one of the greatest jewels of rational thinking since the Enlightenment; however, it systematically excludes forms of knowledge which resist a particular type of proof. This integrative perspective may offer an opportunity to weave together the tools of rational knowledge and rigorous scientific method with millennia of research by attuned clinicians practicing in various traditions of holistic energy healing.
The psychedelic medicine field, especially regarding adverse effects, is a natural environment to explore this integration. How can Evidence-Based Medicine (EBM), RCTs and data-driven knowledge integrate with energy medicine? One possible action step in this direction would be to include acupuncture treatment as part of MDMA-assisted therapy aftercare, especially when adverse effects are prominent or persistent.
In the case presented, the energy medicine paradigm for healing the adverse effects of MDMA therapy was a successful intervention that led to their resolution. There are several ways that this became evident. First, AL sought and worked carefully with Western medical practitioners without experiencing substantive improvement in her physical and psychological adverse effects. The connection of symptoms across multiple separate organ systems was conceptualized within a model that reframed the problem to a single energetic principle. This helped her begin to recover from a process through understanding a unifying model that pulled together disparate symptoms. Acupuncture, and the relational field in which it happened, evoked a balancing of immaterial energies, facilitating and changing their flow by the use of carefully placed needles at specific points along energetic meridians. These locations have been discovered through millennia of careful clinical experimentation and observation.
All of these modes of working with subtle processes ultimately freed AL's constricted energy and redirected energetic flow. Following this treatment, her persistent nausea, tinnitus, fogginess, psychological fragility, anxiety and insomnia resolved.
It is an act of imagination and trust in our own limits and capabilities that we engage with these energetic models of health and illness as psychedelic therapists in a Western scientific context, as this integrative perspective stands to benefit patients and teach clinicians. Furthermore, excluding this component of psychedelic integration may actually cause harm by limiting the use of healing practices because they are foreign or lack a particular type of empiric proof. This type of clinician or knowledge system countertransference constricts our vision and is ultimately a disservice to those we treat. If we open the aperture of therapeutic possibility, we stand to expand our ability to reduce human suffering.
Epilogue
In a very basic way, this paper is one story about one person's MDMA related side effects improving with acupuncture, TCM and a relationship with the practitioners who delivered those treatments. It is an anecdote, a narrative, it proves nothing. Its power is both limited and created by the way the events occurred, and by the four voices who wrote this paper. The paper describes an intervention that was successful, anecdotally, but lacks the rigor of a quantitative study. How powerful can we allow the paper to be? What are its persuasive effects? Has it taught the reader to see differently, better, in a more integrated way or more flexibly? Evidence based medicine rules might dismiss this anecdote as trivial or fanciful, with the seemingly benign demand: “Show me the data, then I'll believe.” The innocent arrogance of this statement speaks for itself; the speaker is appointing their system of proof as a Highest Truth, or at least Most Reliable Truth, above all others.
This conflict is subtly embedded in the energetic qualities, themselves. Our practical and clinical concern here is great: epistemological dominance of a psychedelic therapy model structured by RCTs (how a particular type of reliable knowledge is created) may lead to calcification of our therapeutic practices. The RCT-tested therapy structure will become a standard for clinical practice, with its possession of a type of legacy (it actually was done) or right to dominance (it showed a positive outcome against efforts to prevent that). This is a deep problem, since the therapy was designed for the very particular purpose of facilitating the generation of useful, reliable and valid data. It was not designed to accommodate knowledge on how to best adapt psychedelic therapy to each individual or how to develop the individual therapeutic alliance (the unique co-creation of one patient and therapist). The aim is, in fact, the erasure of such values. The EBM and RCT orientations have their purpose, but they do not generate knowledge cut from a finer cloth or one with Divine authority. As much as we may long for the scientific method to banish darkness, and generate truth, we must also recognize the deeper philosophy of science, which is the unending search into the unknown, the mysterious and the unseen.
Questions of uniformity vs. individualism are embedded in our paper. This paper offers no data; at its core, it is one person's story of persistent and disturbing experiences at physiological, somatic, and psychological levels. In that sense, it offers only a gentle bit of guidance: if your participant or patient has side effects similar to Alison's, acupuncture might help. But we hope that the various voices that have gone into writing this paper will prove persuasive, in various ways, for different readers, as each person reading this paper comes with questions, assumptions, blind spots and areas of obsessional focus. Have the readers of this paper developed a sense that the energy discourses of acupuncture and TCM are worthy of belief, or being believed, or a sense of truthfulness? If so, what is the epistemological basis for that?
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