There’s a general principle running in the background of clinic at the moment that is to try and be a bit less doctor-y. I’m inclined to think that the less we get engaged with being mysterious experts, the better. I don’t think mystery really serves either us or our patients in any way. The truth of what we do is that the driving force behind acupuncture is the patients body and mind and all we are doing is trying to allow it to take over, so humility and avoiding any of the less appealing traits of the western medical profession is the order of the day. This is part of the reason for doing this blog. Acupuncture is interesting. Well it is to me and it’s processes are relatively unknown to most people. It’s also fairly simple, but when you look at it carefully it’s actually infinitely complex….Ok ,well I’ll try and explain it a bit.
The other day I was watching clinic and realized that a lot of what we are doing in there is strange looking and very expert. To this end I decided to write something about what it is we are doing when we do weird things like holding a patients legs or looking wise when we feel someone’s wrist.
I’ve been practicing pulse diagnosis for fourteen years. Which is a shockingly long period of time, given that my starting training seems like yesterday, I still feel like a teenager most of the time, albeit one covered in gray hair. I don’t think I’m much good at it really but then that goes for most things in chinese medicine, so I don’t fret about it so much anymore. Pulse diagnosis involves ‘reading’ the pulse on the radial artery as it goes near the head of the radius. Your three fingers go in the dip above the artery on the inside of the arm in the last place they possibly can before they are on your hand rather than your arm. Your thumb cantilevers against the other side of the head of the radius [that bony lump at the end of your wrist on the thumb side] Then you feel.
But what are you feeling for?
If you’re doing it at home then, no, you’re not reading the rate of the pulse. Well you do, but that’s not the most important aspect of it. You’re looking for the resonance as the blood washes through the arteries and what it tells you about the body. Now a sceptic would obviously say not a lot, but look at it as reading the ripples and oddities of a personally intimately familiar system, albeit one that is experienced by the unconscious mind. Echoes of problems or issues of significance elsewhere in the bloodstream can with practice be picked up at this point on the wrist. Irregularities in the beat or a pulse that’s conspicuously fast or slow do tell you things, but they tend to be less common and sometimes more serious. What you tend to be more engaged in clinical practice is looking at finer sensations: buzzing feelings, a liquid sensation, an area of the wrist feeling slightly thinner than the rest of the artery. If you try this at home chances are you’ll get a tiny shadow of this and spend a lot of time trying to work out where the artery actually is. It’s all about practice. The only way you get to be any good at pulse diagnosis is by doing it again and again on lots of different people. We had to do that at college, so much so that people were reduced to approaching people in launderettes [people are really bored in launderettes, they will do practically anything for a bit of light relief, even hold a complete strangers hand]. You’re looking where possible at the symptoms the person is experiencing, the state of their body and what the artery is revealing. It’s perhaps most analogous to learning to play a musical instrument and takes that level of input to get results. I briefly studied a very intricate pulse diagnosis technique, aspects of which I still use, with a teacher whom I saw diagnose breast cancer from careful observation of a patients wrist. I can’t do that, but he could and did, explaining each stage of his observation and working, before opening the envelope with the diagnosis which confirmed his results. He was a herbalist and the nature of herbal medicine dictated a close understanding of the impact of herbs on physical processes in the organs of the body. Acupuncture asks something a little different, so I stopped pursuing this technique, but it was interesting as well as somewhat disturbing as it accurately told you an uncomfortably large amount about your own state of health and likely eventual cause of death.
There are varying schools of thought on reading a pulse. Different ways of going about it, which yield different diagnoses. The main issue isn’t that one or other is right or wrong. What is important is that it works for you and offers a structure for observation that allows you to organize the sensations that you are feeling. Organization and classification of sensations allows you to develop a greater level of complexity of diagnosis more quickly.
When I’m taking a pulse I broadly speaking look at six basic positions on the wrist that go on the left furthest from the body to nearest heart, liver and kidney, and on the right lung, digestive system and pericardium, there are various depths to the pulse that I read which I can feel with various pressures of my fingers. These tell me something about the organs blood supply, state of its physical function and connection with the other organs of the body.
When I diagnose I’m often asked about the state of this or that organ. In a lot of ways that isn’t particularly relevant to acupuncture. Acupuncture, as opposed to chinese herbal medicine, is more concerned with the relationships between organs than the state of, say, the blood supply to the kidney or which atrium of the heart is damaged after a heart attack. In a treatment I’m looking for a harmonization between the various organs and associated channels as reflected in the pulse which indicates that the body is sorting itself out. Herbs ultimately similar concern but it is looking at the body/mind in a more visceral, physical way rather than acupuncture which looks at the body more as an information system. To an extent you could use the analogy of software and hardware on a computer here, but only very superficially, The metaphor collapses very quickly if you take it any further.
I’ve kind of gone off tongue diagnosis. I do it sometimes but I’m kind of less interested in what it tells me. Nik uses it a bit more, but I think he’s fed up with it too. You can though, tell a great deal about the body from various zones on the tongue. The tongue in chinese and western medicine is very closely connected with the heart and gives good indications of heart activity such as oxygenation of blood and strength of blood movement. As with the pulse there are zones on the tongue that tell you about specific areas of the body. Middle of the tongue tells you about the stomach. The sides, liver and gall bladder, the back the kidneys and activity of the gut. You can determine a great deal from the coating and moisture on the tongue, spots, tongue cracks [the one that a lot of people have mid tongue that doesn’t go to the tip] is stomach deficiency and often indicates eating too fast.] If anybody reading this is interested we have a quite disgusting book of hundreds of photos of tongues and the diagnosis that goes with them. Herbal medicine is more interested in tongue diagnosis than acupuncture.
After first writing this I got back into the tongue again.
Examining the channels
This has come in over the last couple of years. The channels are connections that go from the individual organs of the body out to the limbs and head. Although they are named after an individual organ, they connect with multiple organs in their journey across the body. So the kidney channel connects with the kidney but it also connects to the liver, bladder, lung and, indirectly, the heart. The way we look at the channels has changed a lot since I studied acupuncture. When I learned it, the overall view was more that the channels were some sort of mystical wire that carried this mysterious energy called Qi through the body. The wires eluded autopsy. Nowadays we are looking at the channels as big fat regions of the body made up of blood, lymph, fascia, skin, bone, Qi, interstitial fluid. Basically everything that makes up physical structure is in a channel. An arm or leg is made up of six of these channels and there isn’t any part that isn’t part of an acupuncture meridian. Along those are areas that are anatomically far more variable than the point diagrams on the charts on the wall, where the channel can be influenced in a variety of ways. These channels tell us about the state of the organs they connect to. They also represent layers of the immune system and aspects of the emotional outlook. The spiraling movements of chi kung and tai chi are based on exercising these channels so that you powerfully affect the organs downstream. The channels relate to examination of the legs and spine and postural diagnosis. Skin texture, vitality in the tissues, broken veins, lumps and bumps, oedema and swelling tell us things about the health of the body and guide treatment emphasis.
Pulling up through the legs and spine
I’m not sure where this really came from. Partly it was craniosacral osteopathy, partly Romi Romi massage diagnostic technique. Romi Romi is maori body work, which is basically an application of maori martial techniques to fixing a body rather than damaging it. It’s incredibly painful and involves things like walking on the backs of calves and using the entire body weight behind an elbow into the gut. We only do the diagnostic part of it. I also think a lot of it has been influenced by the skill set that goes with chi kung. Chi kung is chinese health cultivation exercise. I’ll write a big thing about it in the near future but it looks a bit like tai chi which is a form of chi kung being used as a health cultivation system and martial art. Basically chi kung is amazing. Spinal stretching is, I think, particularly derived from very soft tuina [chinese medical massage] technique where you are closely reading the body from what you feel through your hands and very gently encouraging pulsatory movement in locked up body tissue. Years ago we all did a seminar with Bruce Frantzis, a famous chi kung and tuina teacher, and after that everything seemed to change in terms of our ability to read bodies.
What we are doing with this is very gently pulling the legs until you are lightly opening the spine vertebra by vertebra and feeling what does and doesn’t move smoothly at that level of the body. Nik is fond of a variation where you lightly drop your weight through someone’s body as they stand which has the advantage of showing what they are doing as they move around.
Doing it feels a little like a scanner moving layer by layer up through the patient. You can feel an enormous amount as you do this. It reveals what the spine and muscles are doing and then the relationship between what is happening in the internal organs, spine and musculoskeletal system. It gives you an idea of the level of flexibility of the ligaments and fluid movement in the body. It tells you where anxiety and emotional tension are being held. When you lightly twist the legs you can feel what the individual channels are doing.
As far as I can see there is no theoretical limit to what can be felt when you are feeling the body in this way. The same is true of pulse diagnosis. Actually the same is true of any other diagnostic system you invest time and practice into, be it hara diagnosis [close palpation of the abdomen] pulse diagnosis of the arteries of the legs, observation of the eye, observation of the structures of the face. I have a hunch that you can observe any area of the area of the human body and with practice and investment make it a diagnostic system. The same truths are written through all our tissues like the lettering in a stick of Brighton rock. The limit is your sensitivity. The existing systems have some theoretical basis and cut down on some of the donkey work you would have to do if you decided to, say ,develop a diagnosis technique based on looking at a patients hands. Sensitivity is developed by continual practice. Meditation will enhance it because it vastly develops your capacity to feel increasingly refined aspects of your mental/emotional processes. This in turn is something you eventually start to feel in other people’s bodies when you work on them. It also helps you close down your own chattering mind and preconceptions about what you will feel so that you can actually come into contact with what is there. Chi kung enhances it because you learn to closely feel your own body processes,which in turn allows you to feel other people’s body processes. I would argue that acupuncture is basically an off shoot of chi kung and that the quality of your personal meditation/chi kung practice defines the quality of your acupuncture.
Acupuncture is all about refinement of your capacity to perceive. This is the engine of the medicine system and something that is simply not a part of the way we look at things in the west as an approach to healthcare. Naturally it is entirely subjective. Beyond a crude entry-level there is no basis for discussion, because so much of this is happening in a way that can’t be readily conveyed by the English language. It can’t be described. It is something that is happening entirely between the patient and the practitioner and while the practitioners interpretation might differ quite radically from the interpretation of another, the results of treatment might be equally valid. Essentially, there is no right approach, and no correct interpretation. Everybody is different and everybody will look at things in their own way. Every patient practitioner relationship is going to be different and will be different week by week. Every treatment is to some extent a new experience for everybody involved. The issue is the result you get, as there cannot be a defined approach beyond vague generalities.
So quite what is going on then with clinical trials of acupuncture on a western medically defined conditions is a bit of a mystery to me. For example, ‘back pain’. which I’ve been reading about this week: ‘back pain ‘isn’t a condition recognized by chinese medicine. It’s a vague western medical diagnosis that is treated with pain killers. Frankly speaking, ‘back pain’ is a lousy description for the variety of subtle variables leading to pain in the back. From a chinese medical point of view it could be qi stagnation, it could be kidney deficiency, it could be an organ deficiency leading to a musculoskeletal weakness in the upper back leading to the head being held badly pulling the spine out of shape and causing lumbar spinal problems. It could be tightness in the muscles of the legs pulling the spine about. It could be any number of different things and poorly defined shades of things. The individual practitioners diagnosis and treatment emphasis will be subjective and personally unique. It’s no surprise when the results on a ‘back pain’ trial are somewhat ambiguous. This just isn’t the way the medicine system works.
Watching people move their bodies is then another of those infinite journeys. Watching the way people hold their bodies and move yields a great deal of musculoskeletal information. Asymmetries in gait, collapses in areas of the spine explain body pain. Structural observation will go further and tell us something about the state of the internal organs. Weaknesses in the heart and lungs causing tightness or collapses in the chest. Kidney weakness leading to tightness in the lower back. Emotional states are visible. There is a constant subtext related to this underpinning all human interaction. Some aspects of structural observation we are all conscious of. People who look sad, people who look confident, people who look angry,but there’s a great deal more going on in the unconscious mind. Chinese medicine is a system of organization of observation that allow us to make more of the unconscious conscious. I have a working hypothesis that we know a great deal more about the world around us than our conscious mind recognizes. That the people we surround ourselves with as friends and lovers rarely truly true surprise us, because at a level below the conscious mind we already know an enormous amount about who and what they are. A relationship is really about bringing to consciousness what we already knew. In a sense a relationship is about getting to know ourselves as much as, if not more than, getting to know the other.
A great deal is derived from other levels of communication and body posture and movement is one of these unconscious levels. When we closely communicate, we mimic one another’s movement patterns, mirroring body postures. When we mimic one another’s body postures, we share an emotional space. One method of chinese medical diagnosis is to look at the way a person holds their body, mimic it and see where your body holds tension or locks up. Obviously there’s a bit of skill and awareness to be able to do this effectively.
The structure of your body defines who you are at a deep level. It reflects and amplifies who you are as you come into contact with the world. A lot of the difficult work in any soft physical opening technique such as yoga, tai chi, chi kung, Feledenkrais method, Alexander technique is dealing with the emotional material that becomes conscious when you challenge or address habitual movement patterns. In the early days of tai chi I passed out from the rush of emotion from releasing my hip during a workshop. I have no idea what it was, but it was utterly overwhelming and I woke up on the floor surrounded by a ring of concerned people.
In observing patterns in the body, the more you look the more you can see. Again chi kung or some other structural discipline and meditation play a big part in this. As with all the other diagnostic techniques the way it is applied, the way your structure responds to another’s structure as a therapist, is going to be a subjective, personal experience. everybody will be different and have a different perspective. There is not going to be a reliably repeatable process that can be defined in any kind of medical study. The important factors are sensitivity and degree of consciousness. If the unconscious in each of us can see a vast amount about what is going on in the environment around us then pursuing disciplines like yoga, meditation or chi kung is a way of organizing and bringing to the conscious mind what is filtered out of our day-to-day conscious experience.
Acupuncture more generally works in the same way organizing observation and encouraging lines of enquiry so that you become more and more aware. The stuff you are taught at college is factually interesting and intellectually provocative but the key point behind it is to start you on the road to looking and looking. I would argue that this society is so stimulating and overwhelming that it has a tendency to render you numb to the small, apparently insignificant, aspects of life, that are actually incredibly important. Far more important than most of the stimulating and overwhelming stuff.
This leads perhaps to the point of writing this besides trying to demystify chinese medicine a bit. The implication of this is that life is more amazing the more alive and aware we become and that human beings are absolutely incredible. I know this is a bit of a truism, but if the novelty of this idea is lost, then it rather misses the point. So to restate this: human beings are absolutely incredible and each holds vast potential. Taoist meditation holds the view that each persons mind is as large as the universe. I believe there is some idea in neuroscience that vaguely supports this notion in terms of potential synaptic connections….whatever. The mind is absolutely huge, vast massive and then some. Each of us has one and it is already doing a huge job that we are mostly completely unaware of, processing huge amounts of information from the world around us. If you develop it, if you learn to observe yourself , you become more aware of this and life becomes a great deal richer. Development of that awareness is a journey into increased experiential sophistication and richness that has no limit, other than time available in this life.
As a culture I think we are tending to lose sight of the wonder of human beings; what they are and what they might be. We’re getting increasingly and unhealthily good at objectifying other people, particularly people who aren’t like us, or who for whatever reason we can’t immediately relate to. In a world of intense stimulation and lost nuance something defined and clear-cut like the I pad three or a new pair of trainers might seem worthy of more of your attention those trying bastards around you. But watch closely and they really, really are.
And so are you.