Its been a while since my last post and I have been developing in many directions. I was planning to make my next post about the similarities and differences between systemic therapy and Chinese medicine since I have been doing a lot of reading around that over the past year and felt it might be good to collect my thoughts into an orderly fashion and write about it but that may be a project for next month. I wanted to do it properly with references to any texts I could find and that means it requires a bit more planning. So today’s post is going to be about something else that should bridge that post and the last, regarding acupuncture as a system of stimulation, manipulating the conscious experience of our body to encourage self-regulation. By thinking along those lines we can start to be creative with treatment plans and think critically about ancient protocols using them as inspiration based on how they would feel rather than accepting their explanations dogmatically.
The unique aspect of this approach is that it does not need to take the language of Chinese medicine literally and in fact does not even need to come from an oriental perspective but instead attempts to develop treatments based on the principle that they should manipulate our conscious perception of our bodies by stimulating the somatosensory system to make it feel like change is happening. This manages to find a middle ground between traditional systems which insist on specific protocols for reasons that often lack any empirical basis and modern theories that suggest the particulars of treatment are of minimal importance. In this view the person being treated is central to the efficacy and what the practitioner attempts to do is an art, creating an experience that resonates with them and encourages them to change. There may be many ways to accomplish this based on the patient and their values but certain trends in principle and technique can be identified and evaluated while allowing considerable scope in adopting ideas from different schools to develop a personal style that suits your audience.
Constructed “Bodies” of Knowledge
Social Constructionism is interested in the ways people participate in constructing their social realities. It argues that all forms of knowledge are the results of ongoing, dynamic processes that must be continually reproduced in order to persist. It does not necessarily deny the existance of an objective world but argues that knowledge of this world is only possible through our senses and that the constructs these hold are the result of dialogues about the interpretations of these phenomena. This process is also at work about our bodies and there are multiple interpretations that we use to understand the sensations it gives us. The dominant model, the modern medical model, being solely focused on empirically verifiable phenomena, is often at odds with how we feel our bodies work. It is not uncommon that we may return positive from a test but feel quite well, or feel quite ill and have no causes found. This does not deny the veracity of their findings but it stands in stark contrast to traditional medical models, where lacking the ability to discover many of these hidden signs they were largely dependent on phenomena that could be directly sensed or described: gross signs and subjective symptoms. Through generations of refinement these bodies of knowledge came to be the best fit for experienced phenomena and are still undergoing the processes of transformation as different interpretations are debated in the social sphere.
Acupuncture, seen as a system of stimulation, provides a method that is designed to manipulate these intrinsic bodies of knowledge into providing relief. This indicates that acupuncture is neither a uniquely Asian phenomenon with many pre-modern western forms of medicine relying on similar principles, nor should it remain so since, as the ideas of Chinese medicine permeate western culture, they will enter the power dialectic and start to evolve into a form adapted to their new western context. There is clearly room for a practice such as this within western culture or it would not have already carved out the corner for itself that it already has but its progress could be hampered if concepts that are in direct conflict with popular western understandings are adopted uncritically. This should encourage western practitioners of traditional acupuncture to take a creative approach to applying traditional Chinese forms of knowlege, adapting their practices to fit with their patients’ current interpretations of their body obtained through questioning and palpation allowing new forms of practice to arise that are perhaps closer to an art than science. If the artist is attempting to create a image that will arouse a response in the viewer, so too is an acupuncturist attempting to arouse a response in their patient through the stimulation of the nervous system. What produces the best response will naturally not be the same for everyone and will have considerable variation according to the cultural heritage and forms of education they have been exposed to. The great advantage of acupuncture’s traditional origins is that it allows such questions to be asked from a neutral position in the form of a statement that traditionally such practices and beliefs were held and gauging the response. Some may only be open to things that can be supported by a modern physiological model, others may be prepared to accept a practice may work for unknown reasons while still others actively believe and support beliefs that may be outside of the conventional spectrum, be they traditional Chinese, pagan, new age, pscyhological theories or a relativist perspective.
Language and Theory of Traditional Medical Systems
I, like most pracititioners of Chinese medicine, have many books in my collection about traditional medical ideas and practices but most of my clients do not see the world that way and would recoil in horror if they thought I might be attempting to exorcise ghosts, alter the balance of their humours, chase out the wind in their sinews and so on. For many even the thought that I am manipulating energy flows seems absurd and quite rightly so since no real evidence for ‘qi’ as an objective substance exists (that qi was never intended as an objective substance is a matter for another piece). In a lot of cases I struggle to believe traditional theories literally myself because my knowledge of modern physiology knows better and my reading of anthropology tells me that many other people had different explanations for a similar practice and they cannot all be right. The similarities in general principle seem to outweigh many of the specific differences which leads to consider that they must have some common source which is unsurprising since we all share a common anatomy and are likely to experience simliar nervous stimuli such as heat, cold, pain, weakness, numbness, interpreted through a socially constructed reality.
This has led me to notice some considerable overlaps with the language that is used around the world. The basic categories are:
- invasion by external forces (“catching a cold”, “not feeling myself”, external pathogens of TCM, possession)
- corresponding internal forces with the same natural metaphors (Avicienna’s “hot”, “cold”, “wet” and “dry” homours, TCMs internally arising “wind”, “damp”, “heat”, “cold” and “dryness”)
- an essential duality (Yin/Yang, Matter and Spirit)
- a trinity of volatile energetics, fluidity/change and fixed solids (3 Treasures of TCM, the 3 principles of Paracelsus and western medical alchemy)
- notions of the emotions being carried in the blood and originating from or affecting particular organs (“full of bile”, “my heart sank”, “butterflies in my tummy”, the Hippocratic humours, the 7 emotions of TCM)
These terms seems to permeate traditional healing language in both Europe, Asia and the Americas (see Wind in the Blood by Garcia et al, 1999, on Mayan medical language) and whose descriptive qualities have left their traces in colloquial speech even in the west today. In some cases these may approximate the modern physiological understanding, such as bruising being a pooling or stagnation of Blood in an area. In others the observation may fit the visible facts but not the physiological ones, such as the idea that the Spleen makes the Blood, which would seem to be the case when observing that dietary insufficiencies may produce anemia which could be remedied with dietary correction but physiologically we know blood is generated by bone marrow. Some others may indicate phenomena that are outside the bounds of physiology, often touching more on psychology, philosophy or even theology but explain the way we feel such as the notions relating to the movement of the Spirit, locations for aspects of the Soul, and concepts such as Will and destiny. My suggestion for this is because that is how our minds perceive our bodies and the ailments that afflict them and that bodywork practices like acupuncture were a method of stimulating this symbolic representation of our body in a way that encourages our potential for change. In a sense, the art of maximising the placebo effect.
The Channel System and the Body as a Symbol
Our bodies are our ultimate symbol of ourselves and contain many metaphors of our struggle through life. It bears the scars of traumatic events in both a physical, literal and psychological, symbolic sense and expresses our view of the world in its very structure. We can often detect psychological issues through observation, palpation and description of symptoms. Take the tense shoulders of someone under a lot of pressure, the hunched posture of a person who lacks confidence or the loss of appetite of a person who is extremely worried about something for a few examples. These can often be located through palpation of the primary and sinew channels where we can detect points that demonstrate how the body is expressing its issues. Finding the areas that have emerged as hypersensitive can help someone to reconnect their problems to their body and then by helping resolve those physical issues help them feel that they are no longer in a body that is as constrained by their situation as before.
This operates not only on the level creating conscious links to points that have become subconsciously sensitised but the layout of the channel system provides us with a simple bodily metaphor: the yang channels covering our back representing our ability to stand tall and extend ourselves into the world while the yin channels cover our inner aspects representing our more inner experiences. The single exception to this is the stomach channel, a solitary yang channel on the very front of our body encircling our face, symbolising our ability to project ourselves forward and digest new experiences in both a literal and metaphorical sense. It does not take a lot of understanding of Chinese philosophy to grasp these metaphors and it is quite possible to explain them to people who have come for psychological issues why you would select these channels. I suspect the European picture of Zodiac Man who has his body divided into twelve zones relating to the symbols of the zodiac was an attempt to do the same within a European context and it could be an equal way of selecting points according to these zones if one so wished and was familiar with medieval European philosophy. I have even seen very similiar pictures of modern psychosomatic zones which seem to be saying the same thing with the astrological symbols removed, such as tension in the shoulders representing a feeling that one is carrying too much weight, which happens to be the zone of Taurus, the bull, a beast of burden, and a tight, constricted chest being a sign of emotional hurt, which relates to the zone of Cancer, one of the more emotional signs.
The Collateral Vessels: Disease as an Expression of Inner Conflicts
Another set of channels notable for their symbolic locations are the extraordinary vessels. The existence of these ‘collateral’ channel pathways demonstrate how even within Chinese medicine there was always the understanding that the same point could change its meaning depending on the context. These channels are activated with a particular point, called a confluent point and then other points, usually from a variety of primary meridians, are selected in order to treat deep-seated emotional and spiritual issues which generate a set of symptoms that mirror this state of mind. The sort of disorders implied by the extraordinary vessels include:
- Signs of the body rebelling against itself, such as in autoimmune or allergic responses, and also the natural channel flow turning counter to itself, or involuntary movements, in a person who pursues activism and rebellion in an attempt change the world, usually as the result of a deep dissatisfaction turned outward (Yang Qiao Mai). Turned inward this produces a lack of movement, excessive introspection, lethargy and sleepiness, accompanied by physical signs of a Yin nature, especially Damp and Cold signs such as weight gain, oedema, growths and atrophy (Yin Qiao Mai).
- Chest pains born from longing, especially longing for the past and acceptance leading to attempts to maintain an unrealistic body image (Yin Wei Mai), or conversely, an obsession with the future, always making plans that they cannot complete until they end up worn out and chronically fatigued (Yang Wei Mai).
- A timid disposition resulting in curvature of the spine from not standing straight (Du Mai), or complaints involving reproductive organs, the chest or throat and mouth, on the front of the body due to a failure to bond (Ren Mai).
- Easing the pain of accumulated experiences we cannot let go of by compulsive eating leading to accumulation of weight (Dai Mai), or inability to accept our inherited nature leading to blood related symptoms as we are uncomfortable with our ‘bloodline’ (Chong Mai).
The points along these channels are also symbolic in their selection, for example: the Yang Qiao Mai, symbolising our approach to the world starting on the heels, covering the major articulations and ending in the eyes. This is taking “approach” literally and metaphorically as our ability to move and our viewpoint, although which term is the literal and which is the metaphor depends on whether we are referring to the cause or the manifestation. The other extraordinary pathways also have similar symbolic pathways which would take longer than the scope of this post to discuss.
The collaterals known as the Divergent channels also carry interesting psychological connotations. These channels are indicated in chronic diseases with intermittent phases of relapse and remission. The suggestion here is that a pathogen can be too strong to expel but may instead be held in latency and when the body is weak it will resurface and attempt to resume its attack. One of the main methods for utilising the divergent channels is in putting the disease back into latency allowing the person to rebuild their resources to fight again another day. A lot of chronic diseases will follow this pattern, remaining quiet until someone is worn down, weakened or under stress and then reappear. In this sense the cycles of relapse and remission can be seen as representative of psychological conflicts and acupuncture may be an effective strategy to help combat the stress levels, aid recuperation of psychological resources and push the disease back into remission. The method of selecting which divergent to place the pathogen into involves an assessment of the patient’s resources which includes physical and psychological factors. These divergent channels were seen as being one level above the ‘extraordinary vessels’ as the diseases they treat are pathologies contracted from our environment and activities while the extraordinary vessels are spiritual in scope where disease is the result of a fundamental imbalance in our views of the world. If the divergents cannot contain a disease though, it may overflow into the extraordinaries creating a imbalance on the deeper level.
Blood and Emotion
Pulse taking is an integral part of Chinese medicine and one that has often come under criticism of Western sources. While it is doubtless possible to detect certain pathologies from taking the pulse such as skipped or irregular beats present in heart conditions, it is widely considered impossible to detect changes in the other organs as Chinese medical practitioners do. However, the strength and rhythm of the pulse do vary quite considerably between individuals and even within one individuals spectrum depending on their state of mind. The heart is affected quite considerably by adrenaline in stressful situations which makes the heart beat faster and harder and it will slow and soften when at peace. My suggestion is that pulse taking is not so much a way to directly ascertain the state of the organs but a way to assess them via the medium of the mind. Each organ in Chinese medicine contains an aspect of mind determined by the effect of that aspect on our bodily sensations. Since every state of mind affects the beating of the heart the heart is said to house the spirit (Shen) of which the parts housed in others are a fragment of extensino of. Therefore it becomes possible to evaluate ones state of mind through the pulse, also indicating why pulses to even out during treatment as the patient calms, relaxes and feels invigorated. Of course this also means the pulses are quite easily tricked if the patient walked to the clinic or drank coffee just before arriving. For this reason the Ling Shu advises people to rest for an hour before pulse taking, not very realistic in most clinic settings today, but a sensible precaution if we want to get a real impression of someone’s inner emotional state through their pulses.
A group of channels that have particular symbolic relevance in relation to blood and emotion are the Luo vessels. Traditionally they represented visible blood vessels and were pricked to allow both external and emotional pathogens which had been diverted into them to drain out before they overflowed and could progress to harm the organs. In modern practice this is rarely done but they are often indicated for releasing emotional accumulation. I find this emotional use of the Luo interesting due to the similarity reported by individuals who self-harm. They often claim that they do so because once they see the blood flow it makes them feel like they have released something. The conventional model claims that cutting releases endorphins which gives a sense of euphoria but I would suggest that this is focusing too much on the biochemistry and ignoring the possible symbolic associations of emotions with the blood that still exist in our language (“my blood boiled with rage”, “I almost burst a blood vessel”, “cold blooded”, etc.). The fact that this language remains is reason enough to suggest a connection in our consciousness probably still exists for many people who experience emotion as a blood based phenomenon and there is a good chance the language evolved because we actually feel emotions this way. It may be more of a magical act, resolving a conflict on a symbolic level which cannot be resolved in any other way, but this makes it a potential for consideration by an acupuncturist to reconstruct a similar experience, working with this metaphorical system.
The Chinese system of bleeding is already quite far along this path as they limit the blood loss to a few drops, usually from the Jing Well points at the tip of the finger, or the Luo and occasionally from other points. This limitation to a few drops makes it more of a symbolic act than an attempt to cause a physiologically significant loss. Even so, while a few accidental drops of blood may be expected during an acupuncture session in order to secure a bleed most books recommend special procedures such as larger guage lancets and precautions to deal with the possibility of us getting more than we tried for. As an alternative, when employing a classical Luo protocol I have begun to use standard large gauge needles with cups placed over Luo points: the needle creating the hole necessary for the symbolic escape route and the suction of the cup creating the feeling of drawing the pathogenic emotion out. The advantage of this is that the sensation of pulling is strong under a cup and it often stimulates the needle too generating deqi sometimes lasting a considerable time after the treatment has ended. It still involves the blood metaphors, as seen in the well known cupping rings but the needle stops it escaping although usually, once the needle removed a cupped point will release a couple of drops allowing to qualify for a classical Luo treatment. Jing Well points cannot be cupped but it is usually quite easy to make these bleed if you so wish.
Possession and Invasion
Another challenging aspect of classical practice which has clear parallels in the way some people experience themselves is the use of Sun Si-Miao‘s 13 ghost points. These are indicated for people who seem to have been overtaken by an outside force. Hollywood has made us think of possession as something that must involve levitation, speaking in tongues and extraordinary contortions of the body but to many ancient peoples it was something far more mundane. It was believed that it could certainly progress to those stages and forms of epilepsy and psychotic breaks would certainly have been included under the term ‘possession’ but it also applied to other feelings when we are literally ‘not ourselves’. This could mean bouts of depression, addictions and many other conditions where we act in a way that we do not identify as being us. This is another protocol that traditionally involved a certain amount of bleeding to expel the ghost but Jeffrey Yuen also says that moxa is appropriate to all points too, using heat to counteract the essentially yin nature of ghosts and the withdrawn nature of the symptoms. The points used are in trinities that become gradually deeper towards to the core of the person as the influence takes greater hold. When working it is customary to work backwards from the level where the influence resides and outwards to the peripheral points creating a feeling of pushing something to the surface and out.
Needling Techniques and Propagation of Deqi Sensations
There are plenty more examples of practices in classical acupuncture that seem to be more symbolic than working on a physical level including a lot of needling techniques whose movements often indicate a sense of pushing or turning in to nourish and drawing out to drain or clear. In some cases it is hard to know how this is going to be effective unless the client feels the pushing or pulling of the point too and this is where my thinking of traditional practices is currently taking me. It does not actually matter that much whether we turn the needle clockwise or anticlockwise or whether we emphasize the push or the pull motion of the needle. What is important is whether we can manage to get the person we are treating to feel as if an area they need to concentrate on is being manipulated in the fashion that we intend. Simply grasping the qi at a point that represents their current problem is probably enough, especially in points where the sensations propagates strongly in a particular direction, but if you can make the area of excess feel as though it is being drained, loosened and made less painful or the area of deficiency feel fuller, stronger and more nourished then this somatosensory change may be accompanied by equivalent changes in the body underneath.
One way this could be done is to manipulate the needle until the skin grasps it and then perform a pushing, pulling, rotating or shaking motion to signify the intention. This is actually what the traditional Chinese texts encourage: grasp the qi and then perform the manipulation. Chinese texts also suggest that it is the practitioner who should “feel the qi being grasped” instead of the patient and at least with ‘lifting and thrusting’ style manipulations you can see this clearly as the skin either ‘tents’ up as we withdraw the needle or presses inwards and we push it down. Other manipulations may revolve a more subtle sense of feeling or visualising what we know we can transmit through experience of doing it many times. The mechanism I suggest for this working is that skin is loaded with sensory nerves and so when the needle is grasped the movement of the needle will translate through to the skin that will generate the feeling of this intention being transmitted. A lot of papers on acupuncture have emphasized the importance of intention but few have developed a method that explains how this can be achieved and often leave me with the sense that simply holding the needle and willing something to happen is enough. Maybe if intention is strong enough that can be achieved but for those of us who need a mechanical or neurological model with which to develop a skill with this seems to be a move in the right direction.
Esoterics and the Power of the Unknown
Often when explaining symbolic systems it seems as if they might only work if the person receiving the treatment understands the message being conveyed. This is misleading for in many instances rituals derive their power precisely because the exact meaning is unknown. Trust that the practitioner or the system they are employing are guardians of a special wisdom can give the power to make changes even without understanding why. This is evident in harmful ways within the medical profession when a set of symptoms is made into an official diagnosis by the authority of a doctor, causing the patient to start exhibiting additional patterns believed to be part of the diagnosis that were not there previously. The patient does not have to understand the processes behind their disease and in many cases the actual pathophysiology may be unknown and the objective existance of the disease debatable, especially in psychiatric conditions where only behavioural patterns may be present. Faith in the medical model can be enough to make someone read about their condition and start to subconsciously reproduce it. This process is known as reification, the act of making something real, or labelling. An authority on a different body of medical wisdom approaching from a different perspective can help to counter this by questioning if a person has to conform to the standard set of signs and symptoms. By breaking away from their expected behaviour patterns a person can gain considerably greater control of their life.
The benevolent side of reification can be seen in placebo trials too where belief in the practitioner and their authority can considerably affect the outcome and cause an inert medication to show real effects. In many cases this does not have to be dependent on the person believing that their placebo is real. It seems that simply taking the steps to develop a ritual that attempts to take control of a condition can help it improve. In the same respect not all aspect of the practitioner’s actions need to be understood. In ritualised healing contexts the ambiguity of meaning allows multiple interpretations to exist in the same community making the same act affect different people in different ways, depending on what meaning is most poignant to them personally. This has been written about regarding religious healing rites where only the priests may understand the official meaning of the props, prayers and actions but the effect is on a lay person who does not. These two processes, of trust that the practitioner is privvy to a body of knowledge that is unknown to the patient but which they believe is working for their benefit, combined with a possibility for multiple meanings of their actions means that they are likely to find a helpful interpretation of what has happened without the pratitioner necessarily having to explain why each action was chosen.
Even the practitioner does have to know all the meanings behind their actions as we often hear people saying that they trust the ancients’ prescriptions for reasons that have been lost to time. The belief that ancient people had a great wisdom is widespread and even mentioned in the first chapters of the great classic of Chinese medicine, the Huangdi Neijing and is evident in the strength that “traditions” can hold over people. Making a call to the past and a claim that it has always been done that way can make a modern invention into a powerful myth dictating human behaviour and psychology on the deepest level. Since all of our reality occurs in our mind, imagination, or the ability to fill in the gaps and provide the raw sensory information we receive with meaning, is possibly the greatest, oldest and most mysterious healing tool we possess.
This view of acupuncture working on the conscious body explains how so many different methods can achieve the same results without completely denying any efficacy to any particular school. They can be deconstructed into terms of what sensation they are attempting to transmit and evaluated in terms of how successfully they achieve this and how well it converts into personal change for the patient. Practitioners can begin to learn how to induce particular sensations with certain techniques leaving considerable room for experimentation and developing a personal style that can draw from but does not have to be overly reliant on esoteric principles. It does not negate the possiblity that acupuncture works on physiological mechanisms such as the endorphin network or trigger point activation for which there is considerable evidence, nor deny that certain points may have intrinsic psychological association if it can be proven, but it adds an additional level of artistry on top of that explaining how personal change on a deep psychological level may be achieved in many ways. This is not contradicting the classical texts whose authors wrote under the taoist belief that a disordered body was the result of a disordered mind and aimed to restore balance at a spiritual level to see this mirrored on the body before imbalance reached a level of no return. It could also provide the potential for inclusion into experimental research of gauges which measure how effective the treatment is thought or felt to be, or how the treatment seems to symbolically address the complaint, compared with changes or improvements in objective signs and measurements. I feel these would be more useful measures than trials testing strict point prescriptions that are bound to have a variable degree of influence if the practitioners have varying success in transmitting their intention or the patients have varying degrees of importance attached to those points. It is similar to a drug trial where the active group have an unknown but varying doseage and wondering why the results are unclear. Finally I think this model of acupuncture helps us to advance towards a truly integrated practice that is comprehensible from both a western and eastern point of view, by enabling us to analyze traditional protocols from a symbolic perspective and appraise them based on their manipulation of sensations and semantics. We can then employ the creative skills of western minds to develop new protocols, inspired but not constrained by ancient ones, that will speak better to western notions of the body as it is experienced in the mind.