The issue of how Chinese medicine attempts to elicit change has been playing across my mind recently and at a time when many of us will soon be thinking of how to recreate themselves anew, so I thought I would consider the facts behind acupuncture, its relationship to Neidan, “internal alchemy”, an ancient art whose aim was transformation of the individual from within. In contrast to waidan, “external alchemy” that aimed to develop medicines which could be swallowed to improve health, neidan aimed to use the capacities of the practitioner to create their own medicine inside themselves. Given the fact that acupuncture does not inject any substances and seems to be based on meridians that were used for meditation it seems more likely that it was attempting this internal change through stimulation and persuasion, rather than forcing one by means of an external agent. I intend to look at what evidence or theoretical foundation there is for such practices using some modern research into the ancient methods. In doing so I hope to make the search for a new you a little clearer and to explain the role acupuncture can have in helping, as well as address some of the myths espoused in the media and even by practitioners.
Before we begin to look at specific methods it is necessary to clarify how change is achieved in the western and eastern medical traditions. In western medicine we generally attempt to achieve changes in function by altering the structure with drugs or surgical procedures, directly changing our physical state. Chinese medicine by contrast, especially the methods of the Neijing where acupuncture is first described, seeks to alter structure by making functional changes, relying on the plasticity of the human organism to adapt as required by the new lifestyle change. Therapy is designed to instigate those changes by giving space to decide on just what changes need to made, initiating the process and then providing support to the person during the adjustment phase until their body changes to accommodate the new lifestyle.
The first method of transformation is to train us to do something new, a technique certainly not unknown in the west, although its incorporation into medicine is generally relegated to complementary areas such as physiotherapy and psychotherapy. In exercise we practice a difficult task until our body and mind adjusts to develop strength, flexibility and coordination to accomplish the task. Education is also based on exploiting this plasticity in the brain, repeating tasks until the neural pathways needed to reproduce those behaviours are reinforced. In most cases a previously unconscious or unknown behaviour is brought into awareness, adjusted and practised until it becomes automatic again.
In acupuncture this would be the activities related to the level of wei qi, the sinew meridians, whose treatment is mainly concerned with exploring wide zones for areas of pain, tension and other unusual signs, bringing them into our awareness and assisting us to release them. In this form acupuncture is fulfilling much the same function as massage and other manual therapies but using a needle instead of pressure. The location of these painful points, along with the movements that aggravate them can then inform the therapist just what exercises need practising at home. Chinese qigong exercise routines are described as “moving meditations”, training strength and flexibility and making us aware of our movements in ways that we were not before. It is through the repeated practise of exercises that changes will happen with treatments aimed at helping aches and pains as the body adjusts and giving information back to the therapist for adjustments in the routine.
Martial and gymnastic training had a complicated relationship with internal alchemical practices which were often meditation based. Moving exercises, called daoyin in early literature, were often criticised in the texts concerned with inner transformation, e.g. Li Daochun (The Way of the Golden Elixir, p.49). We have to remember that in these times Chinese philosophy was not as unified as the “Traditional Chinese Medicine” we see today. This tends to have a finger in all practices and attempts to combine the theories of acupuncture, herbs, taiji and meditation into a single school, some say to the detriment of them all. Rather, the early schools each had their speciality, sometimes with conflicting ideas and each one defended its own practices against the claims of the other. It is then not surprising to see gymnastic practises criticised by meditation schools of which neidan is typically associated. I still think they count as oriental methods of self-transformation and should be embraced by modern practitioners seeking change, especially for relatively external, musculoskeletal concerns, but the true art of alchemy was the creation of a new self from within, a new mind or spirit, so it is to these practices I wish to apply most of my attention.
Meditation and the Brain
The second way we can alter ourselves is through the practice of meditation and mindfulness based stress reduction techniques. In ancient China this was understood to minimize the effects of stressful events on our lifespan and even believed to be transformative in itself. Some modern research is catching up with this idea, confirming that the amygdala, a part of our brain concerned with fight or flight responses, is actually smaller in people who practice mindfulness. They have greater control over the frontal cortex, concerned with higher level cognitive tasks, when in the presence of pain, implying an ability to not read as much into the stimulus, leading to an eventual thickening in density of gray matter in these regions with regular practice. Meditation has also been shown to reduce pro-inflammatory cytokines, such as C-reactive protein and Interleukin-6, and can even help maintain the integrity of DNA damaged by periods of illness.
In terms of neidan these are particularly interesting, not only in that they suggest real transformations can happen through meditation, but also in the methods described to do it. One of these articles found that focused awareness meditation followed by open monitoring was the quickest way of teaching people meditation techniques, enabling pain control after only after only brief training. This is exactly the method taught in neidan where metaphors are used to focus the mind in order to enter a “natural” state where “true breathing” emerges, that is breathing that is not consciously regulated by focused control. The focus initiates the process, after which the practitioner takes a back seat and just observes. The study noting the effects of mindfulness on inflammatory markers in lonely adults also highlights the unique polarity between internal and external practices. Modern medicine, the most advanced external practice to date, has recently observed this connection between inflammation and depression and is now suggesting to use anti-inflammatories to fight depression. Internal practices would suggest improving the state of mind directly though meditation and cognitive restructuring, then hoping to see the physical markers change as a result.
In acupuncture these would be mostly practices that work on the level of ying qi which carries consciousness, thought and emotion and flows through the primary meridians. In these treatments a few points are selected and the patient is left to be present in their body, feeling the sensations from the points. Often they are selected with the intention of bringing a sensation up, down, towards or away from an area, simulating a meditation where these sensations are meant to be felt through focused attention or visualisation, but freeing the mind from the need to concentrate, allowing it to remain in a mindful, “opening monitoring” state. The idea that these treatments are simulated meditations would agree with the exceptionally plain-talking Liu I-Ming‘s notion that the points are not physical locations in the body but in a phenomenological realm, a mental space, and searching for their anatomical position is misguided. This is in stark contrast to a great deal of modern research that has traditionally focused on finding the structures that might explain the effects of acupuncture, often with less than encouraging results, but supports more ancient forms that were often quite vague with their point descriptions and suggested the effects being made through an insubstantial medium that was probably more an understanding of how our mind perceives our body than a physical substance. It also adds an interesting dimension to acupuncture’s ability to produce subjective feelings of well-being, revitalisation or relaxation as more than just a form of pampering but as the mechanism that may produce the most profound transformations over time.
The final way we can cause transformation is through lifestyle change. Western medicine has adopted some of these principles in the prevention and management of complex diseases by encouraging healthy behaviours but it always seems to be struggling against the current of predestination that is embedded in western philosophy. This resurfaces in scientific guise as reductionist theories that imply our fate is not ours to decide but that of our DNA, internal chemistry, psychological conditioning or social position, with the doctor holding a strangely deified position outside of this determinism as the one who can change destiny. In contrast Chinese medicine, while acknowledging the role of constitution in defining our limits, has always given a central role to agency in changing our fate. Without it change would be impossible and any intervention pointless. Even so, it was always important to act early, preferably before symptoms arose, or at the first signs (Su Wen, Ch. 26; Nan Ching, Ch. 77), as the problem would become harder to resolve the deeper entrenched it was until it became able to determine our life.
In both modern and ancient advice on lifestyle change are aimed at prevention rather than cure, and then management and prevention of further problems. This is not surprising since we are, by and large, healthy when we are young and it is the pressures of our lives that lead to preventable dysfunctions: poor diets, smoking, drinking, inactivity, repetitive actions and chronic stress. The aim of most lifestyle change is to find the areas which are causing problems and adjust them in order to give our body the chance it needs to overcome the damage caused to it and return to its prior state. Very often people only come to acupuncture when a problem has already manifested and cannot be reversed, often after all western treatment has been exhausted too, so if prevention is impossible the next target is management, to help them understand their condition and direct the person towards changes that can make life better.
In acupuncture these would mainly fall under the treatments utilising yuan qi, the level most closely associated with our unchangeable constitution, stored in special meridians concerned with major life changes and events called the Extraordinary Vessels. Treatments hope to transform who we are at our core, helping us to live a different life, in tune with our constitution so that we impact it less. As you would expect this is not as simple as practising an exercise or a mindfulness meditation and compliance is only possible if the person is willing to change. We can try to facilitate this with acupuncture by using it to enable a long reflection after a thorough discussion of the issues. Borrowing from systemic therapy, I like to have raised some reflexive questions on which to consider during their time in the session, an approach I feel has an advantage over affirmations in that they are not directive, and also over purely talking based therapies as the treatment time provides a space away from the pressures of daily life to consider the issues, hopefully allowing new perspectives to arise while in deep relaxation.
This non-directive, open-ended question approach to help someone find ways around the obstacles in their life also seems closer to the Taoist principles than a affirmation. It encompasses the principle of wuwei, action without effort, force or control, and has echoes of the ritual of “untying the knots” (jiejie) of regular thought. Although it might seem similar to the mindfulness based treatment, and it certainly includes an element of mindfulness, the points are often in symbolically relevant places to help draw focus to those areas without conscious effort and consider the issues in a detached way. It is not an intellectual exercise but an attempt to make new options arise from wherever creative thinking comes, which in Taoist alchemical literature is the formless state (hundun), from which new options can then be rationally examined and executed. It allows the client to claim full credit for any changes they decide to make in their life, improving self esteem, instead of assuming the therapist is an expert who changed them, leading possibly to passivity or dependency.
There are a few areas where I think the body could be changed positively and directly by lifestyle change. A while ago I was asked if I had heard of the Hypnotic Gastric Band and if there could be an acupuncture equivalent. I have never advertised acupuncture for weight loss since I am unaware of any good evidence or mechanism by which it could work but in theory if you can put someone in a deep trance through acupuncture you can do most things hypnotism can do. So I had a think about how I might go about it and decided that hypnotism probably cannot magic away a ravenous appetite either and started to consider a more practical approach. Recalling a plan that suggested you ate 5 small meals a day instead of 3 main ones, I wondered if this it might cause the stomach to shrink. It makes sense from the view of physiology, as confirmed by at least one study showing that dieting reduces stomach capacity and another on the reverse, that large meals increase capacity. Therefore frequent smaller meals should have a similar effect to a gastric band, reducing appetite without the need for surgery. The frequency should prevent the reduction being such a shock to the body, allowing us to maintain our regular calorie intake and reducing the need for snacks as the next meal is never too far away. Over time a large meal will soon become difficult to manage.
Combined with other Chinese dietary ideas, including ones not just related to what we put in our bodies but also how and when we do it, should all contribute to creating this structural change. How to eat includes principles derived once again from meditation, such as being conscious of eating our food instead of distracted by television or work so that our appreciation of it reaches our mind. This is ultimately what tells us to stop, and if we cloud it with distractions then we will not stop until the signals to stop are so strong they manage to overpower the distraction. We might even eat some better stuff if we have to be aware of it while we do it! When to eat also derives from meditative life including having the largest meal of the day earlier and reducing size as the day goes on so that we burn off the calories instead of sleeping on them. Over time, especially if combined with other lifestyle changes, including exercise, we may create further change in the form of weight loss, providing there is no medical reason in the background that prevents us. This will lead to reduced strain on other areas of the body, preventing harmful changes through stress on other systems. This idea has been explored in Chinese history before, with the Earth School of Li Dong-Yuan (1180 – 1251 C.E.), who saw all disease as stemming from problems in the digestive system, in his time more from compromised nutrition of the poor and conquered peoples, but equally applicable to the excess nutrition of today.
Acupuncture, or hypnotism for that matter, is not really necessary in any of this so far and if you can manage these changes by yourself then I am happy to give you this plan for free, but issues of diet are often complex and bound with social and psychological issues. Acupuncture, especially of the sort to help facilitate problem solving and lifestyle change, can offer something in this aspect. If not explored then the issues that are behind the symptoms will probably exert resistance to progress or create a yo-yo effect. This is probably where hypnotism has its greatest effect too but acupuncture can help on several other levels. As well as a meditation on issues that are blocking progress and stress management through mindfulness training, we can also help to adjust to any new exercise regime through sinew treatments.
Another part of the body that can achieve measurable change is the lungs. Studies of yoga practitioners have found they can expand their chest wall. It seems reasonable to assume qigong, sometimes called “Chinese Yoga”, or the deep abdominal breathing developed through meditation can do the same. As heart and lungs are intricately related, improving our lung capacity may help our heart health. There may be an aspect of meditation involved in this too, as a diver friend was telling me about people who freedive, without breathing apparatus, that a significant part of the practice is mental, controlling the way the body uses oxygen, as much as physical capacity to hold the breath.
This reminds me of another controversial topic which is often requested: acupuncture for smoking cessation. In a similar way to weight issues, we can explore areas of life that cause them to do something they wish to stop, help them identify triggers, improve stress management skills and teach breathing exercises as a part of these meditations but it is not the magic bullet that most people who ask are looking for and I would be pretty sceptical of any practitioner who claims they have a guaranteed method. The evidence for all addiction treatment is pretty poor as the reasons are usually quite complex. I think the best chance is with a psychological approach, unravelling the story behind the addiction and I feel that any treatment style that does not address that complexity is probably missing the point. Unfortunately that is not what people want to hear and every person who has asked me about smoking cessation has subsequently not taken me up on the offer, preferring to find a practitioner who claims to know a point that will stop their cravings or make the cigarettes taste awful. I would like to say they will not find one, but they probably will.
Symbolic Language of Reversal
The language of reversal or inversion is pervasive in alchemical literature. Of the most basic techniques we can see a reversal of the light of consciousness back into the body instead of looking out into the world. Once here a second reversal can take place, projecting our upper dan tian between the eyebrows, containing our spirit-mind (shen) into our centre, where our lungs and stomach produce the qi necessary for survival, and send this breath into our lower dan tian where our deepest essence (jing) is stored. This is done in order to supplement it and prevent its reduction. This is a reversal of the natural process in which zhong qi (central qi) that is generated from breath and food mingles with the yuan qi (original qi) which emanates upwards from the jing in the lower dan tian, gradually depleting it, resulting in a shortening of lifespan. This resulting mixture then enables us to carry out our daily functions in service of the Shen. Therefore by sending the qi down to the lower dan tian they aim to help reduce the natural rate of jing dispersal by supplementing it making this a method of nourishing life. Taken further it was also a means to realise a transformation, represented as creating a embryonic new self in the lower dan tian, where the downward motion is reversed once again as the child grows to ascend into the middle and upper dan tian fields.
A more cryptic expression of this lowering of consciousness is “inverting the fire and water” (I Ching, hexagram 63, Cantong Qi, verses 10 and 11). This means sending the mind-spirit, ethereal like fire and usually in the head or heart, below the kidneys, where water is filtered and the Will (zhi) resides. Some guides add that it should be gently nourished by a slow constant bellowing of air, referring to slow, steady movement of the lungs into the abdomen (Tao Te Ching, verse 5; Liu I-Ming, (trans. Cleary, 1996): Practical Taoism). In some cases it was visualised as a crucible filled with water, heated by a flame that is controlled by a pair of bellows inside the body. This is another description of the creation of a new self from within, arising in the steam created by this gentle infusion of fire and water, spirit with will, mind with determination.
Another way to describe this is by reversing the destructive, controlling Ko cycle of the elements in the opposite direction. Instead of water extinguishing fire and fire melting metal, metal cutting wood and wood growing through earth, the lungs (metal) fan the fire (heart-mind) in order to boil the water (kidneys-will) gently. Through careful attention and nurturing (properties of earth) a mist is formed from which the spiritual body can grow and develop (wood/liver properties, that contain the hun or spiritual aspect of the soul). While this direction is often called the “insulting cycle” in medical practice, for example in instances where stress may lead to a tight diaphragm causing rapid, shallow breathing and anxiety (wood insulting metal, metal insulting fire), when this cycle is initiated in a deliberate way it is a means of breaking free from the natural order of degeneration and transforming the self from within.
If it seems like these cryptic descriptions lean rather heavily towards the meditation aspect of transformation that is because this is where any transformation must begin. The body will strengthen, stretch, adapt and align to the new lifestyle if it is pursued with persistence and determination but without the vision and focus nothing will happen. This is the mysterious realm of the inner world, and if creation of an new life externally is one of the mysteries of life too, then conceiving a new self is truly a mystery of mysteries. Opposing inner forces must be combined and a new identity born within which can be nurtured and allowed to grow. Whichever metaphorical system is used the aim appears to be to reverse the natural progress of years, returning to before conditioning made us who we are, realising the spark of pure spontaneity and plasticity that we were when we were born, or even before, and then cultivating it anew in the image we wish to attain.
Which brings me to the final question that I should address: how long should this process take? It is generally split into three stages consisting of 100 days (about 3 months), 10 lunar months (a little over 9 regular months) and 9 years. Not good news for the quick fix seekers and the idea of having acupuncture for one year is probably quite intimidating financially for most, let alone 9, but the good news is that external aid such as acupuncture is needed regularly only in the first stage which works out at 12 weeks, the same amount of time recommended for Extraordinary Vessel treatments, usually had at 12 weekly intervals. This is considered the laying of the foundations, when the most guidance is needed to work out what to change and how to initiate it. The second stage is the gestation of the new self and the time period more symbolic of embryonic gestation than a literal scheme. It seems roughly realistic though as any change which does not last a year is probably just a fad or trend and will soon reverse itself. To take an example, if you want to become a violin player it is not enough to play one once or even for a few months, but after a year of regular practice you can probably say “I am a violinist”. Treatment during that time should be as and when it is needed to help with adjustment. The final stage most likely means for the rest of your life, or at least into the next phase of life, where you refine the new behaviours and they grow into maturity.
We have looked at how training of different kinds can alter our bodies, including not just our physical strength but our lung capacity, stomach size and brain. In classical acupuncture they say that we need to learn how to breathe, to eat and to sleep in order to have our basic needs met. These were the foundations of a healthy life, which were all developed through meditation to bring them into consciousness and practice to refine them in the belief that real transformations could occur. It seems that modern physiology supports much of this philosophy with real evidence that we can adjust these areas of our body and that they may have additional effects in preventing disease in other systems.
Some may argue that acupuncture has nothing to contribute to this, not being directly responsible for any of these transformations, but it was never claimed to in the classics either. Meditation and lifestyle change was always the goal. Acupuncture was a means to make these meditations more vivid, providing direction and focus for when sitting in a darkened room was not enough. It is no coincidence that the original manual of acupuncture, called the Nei Jing, “Inner Classic”, is included in the Taoist canon and uses the same word as is found in the Neiyeh, “Inner Training”, an early meditation manual and Neidan, “Internal Alchemy”, that aims to seek transformation from within. The common modern translation of Nei Jing as “Classic of Internal Medicine” seem to be adding an inference due to its focus on health but its essential character was that of a meditation on the relationship of man to his environment and to himself, encouraging cultivation of harmony, rather than a technical manual for operations. Applied in this way an acupuncturist is not so much a surgeon but a teacher or a guide, and the treatment should not be a reflection of a syndrome that the needles aim to cure directly, but rather a reflection of the changes that we encourage the patients to make, helping to empower them into taking back controlling their lives.