Navigating the Challenges of Healing Crises
I have found that when a person is well-informed, they are better able to manage their expectations and avoid unnecessary anxiety. The focus of this blog is to shed some light on phenomena that may occur during the course of TCM treatment (acupuncture or herbal medicine).
Introduction: Why Understanding Matters
One of the most important responsibilities in healthcare is supporting the patient's peace of mind. In traditional Chinese medicine (TCM), it is not unusual for patients receiving acupuncture or herbal medicine to experience short term changes or temporary aggravations in symptoms. These reactions are often described as healing crises, a term used within complementary medicine to describe brief symptom intensification following treatment.
In Japanese Kampo medicine this process is known as mengen, and in Chinese medicine it is referred to as ming xuan. Although the terms differ, they describe a similar idea. As internal stagnation or pathological factors begin to move, a short period of symptom flare up may occur before improvement follows.
The mengen phenomenon has a long history in East Asian medicine and is explored in depth across several issues of the North American Journal of Oriental Medicine (NAJOM). These articles provide valuable insight into its classical roots, clinical meaning, and practical importance for both practitioners and patients. They are listed in the references as the end of this post.
Origins of the Mengen Concept
The classical understanding of mengen originates from the Edo period physician Yoshimasu Todo (1702 to 1773). Todo proposed the doctrine known as Manbyo Ichidoku Setsu, which is often translated as the idea that all diseases arise from a single toxin (Yokota, 2011b). He observed that when herbal formulas reached the site where a toxin was lodged, patients frequently experienced short term discharges or symptom intensifications before recovery. These reactions were seen as evidence that treatment had successfully begun to expel pathogenic material.
A NAJOM translation of classical writings describes mengen as the body's effort to expel internal toxins through actions such as sweating, vomiting, diarrhoea, or urination, depending on where the pathology is located (Wada, as cited in Yokota, 2011a). These reactions are not deliberately provoked by the practitioner. Instead, they arise naturally when treatment hits the target and mobilises internal stagnation.
While this idea originally developed in the context of herbal medicine, NAJOM authors argue that acupuncture and moxibustion can induce similar patterns of reaction (Yokota, 2011a, 2011b).
Mengen in Acupuncture Practice
In the NAJOM series, Yokota Kampo highlights that mengen is rarely discussed in modern acupuncture circles despite its clinical relevance (Yokota, 2011a). He notes that classical acupuncture texts contain descriptions of post treatment reactions similar to mengen, including temporary symptom aggravation, elimination responses, or fever like sensations, though they are not always labelled as mengen.
For example, one moxibustion case reported in NAJOM describes a patient who initially experienced diarrhoea, headache, and nausea during early treatment, followed by improvement once the reaction passed (Shirota, as cited in Yokota, 2011a). This aligns with the classical view that the movement of pathogenic factors can trigger a short but intense period of discomfort before improvement stabilises.
In another NAJOM article, Yokota describes his own multi year experience with moxibustion treatments that produced repeated episodes of vomiting bitter fluid before resolving severe cardiac symptoms (Yokota, 2011b). He identifies this process as a personal example of mengen.
These reports illustrate that mengen is not limited to herbal medicine. It can also arise in response to acupuncture, moxibustion, or other hands on therapies when root level pathology begins to move.
A Contemporary Interpretation of Healing Crises
While historical explanations focus on the idea of toxin release, modern perspectives offer additional ways to interpret these reactions.
Current clinical discussions propose that healing crises may reflect:
Detoxification responses
The body may temporarily intensify elimination processes as internal waste products are mobilised.Autonomic nervous system adjustment
Acupuncture may shift sympathetic and parasympathetic balance. As the system recalibrates, temporary sensitivity or fatigue may occur.Movement of Qi and Blood
According to TCM theory, stagnant areas becoming more active can momentarily increase pain or discomfort as circulation improves.Return of old symptoms
Some practitioners interpret this as layers of pathology resurfacing briefly before clearing.
Clinics offering acupuncture often note that healing crises may include tiredness, mood shifts, digestive changes, headaches, or short lived pain flare ups. These experiences usually last only a short time and settle as the body integrates the treatment.
Clinical Presentation of the Mengen Phenomenon
Based on NAJOM case reports and contemporary clinical observations, healing crises may manifest as:
Temporary worsening of an existing symptom
Reappearance of an old symptom
Feverish sensations, sweating, or chills
Digestive elimination changes
Mild skin eruptions
Emotional release or irritability
Tiredness or heaviness for 24 to 48 hours
Importantly, NAJOM authors emphasise that not all discomfort after acupuncture is mengen. For example, a dull ache after needle insertion or mild sleepiness may be normal and should not automatically be interpreted as a healing crisis (Yokota, 2011a).
When Healing Crises Occur
There is no predictable timeline. Both NAJOM and modern clinicians note that:
Some patients feel a reaction after the first treatment.
Others only experience it after several treatments.
Some may experience more than one healing crisis over the course of therapy.
Many patients never experience mengen and still respond well.
Reactions are most likely to occur when:
Treatment begins to reach deeper or root level pathology (Yokota, 2011a).
There is significant stagnation of Qi, Blood, or fluids.
Strong herbal formulas or direct moxibustion are used.
Patients have longstanding or complex chronic conditions.
Supporting Patients Through a Healing Crisis
NAJOM authors emphasise that the most important factor in managing a healing crisis is clear communication. Educating patients helps prevent unnecessary fear, confusion, or treatment discontinuation.
Helpful strategies include:
Preparing patients for the possibility of temporary symptom changes.
Encouraging rest, hydration, warmth, and light movement after treatment.
Reassuring patients that these reactions should be short lived and followed by improvement.
Advising patients to contact their practitioner if symptoms feel severe or prolonged.
Adjusting treatment if reactions are excessive or if the patient becomes distressed.
When patients know what to expect, their experience of these reactions is much calmer, and their confidence in the therapeutic process is stronger.
Conclusion
Healing crises, including the mengen phenomenon, represent an important but often overlooked aspect of traditional East Asian medicine. When understood correctly, these reactions can offer meaningful insight into the body's process of transformation and recovery.
By combining classical knowledge from Kampo and Chinese medicine, contemporary clinical reasoning, and thoughtful communication, practitioners can guide patients through these experiences with clarity and reassurance. Not all patients will experience mengen, but recognising its patterns helps clinicians differentiate between normal adjustment, therapeutic progress, and signs that treatment requires modification.
Ultimately, education and awareness allow both patient and practitioner to navigate the healing journey with greater confidence and understanding.
References
Acupunctures Australia. (n.d.). Healing crisis and post treatment reactions in Chinese medicine.
Healthline. (n.d.). Healing crisis: What it is and what to expect.
Light Centre. (2023). How to navigate a healing crisis after acupuncture.
Sunflower Centre. (n.d.). Healing crisis.
Wuxing Zhongyi. (n.d.). Explanation of ming xuan in Chinese medicine.
Wada, K. (as cited in Yokota, 2011a). Ikai no Tettui.
Yokota, K. (2011a). Mengen: The healing crisis in acupuncture Part 1. North American Journal of Oriental Medicine, 18(51).
Yokota, K. (2011b). Mengen: The healing crisis in acupuncture Part 2. North American Journal of Oriental Medicine, 18(52).
Yokota, K. (2011c). Mengen: Why it is not discussed in acupuncture Part 4. North American Journal of Oriental Medicine, 18(53).
