Guess who got a Kindle over Christmas? And that means that all the articles I had saved and wanted to read but either did not want to waste the paper printing them or endure the headache of reading them off a laptop screen are now in a portable, readable format. I have gotten around reading some of them already, in particular the writings of Lorimer Moseley, a neuroscientist and physiotherapist in South Australia whose theories of how our perception of our body does not always accurately reflect the reality have sparked some interesting thoughts in my head, so I thought I would inflict them on my blog this month. Much of this goes back to my original undergraduate project for acupuncture, where I studied phantom limb syndrome and postulated that further research might help us understand the concept of Qi better. From what I am seeing I have not been proven wrong, with ideas that areas can become smaller, larger, become displaced or disappear altogether in the presence of pathology.
Qi in Classical Literature
In classical literature Qi is often introduced with little or no formal definition and has to be inferred from its context. One exception to this is the Neiyeh, one of the oldest writings on Taoist meditation techniques from the mid-4th century BC, that describes Qi, albeit poetically, in the context of the three treasures: Jing, Qi and Shen. The text has been translated by Harold Roth (2004), in which the term Vital Energy or Vital Breath is used, and places it as the the intermediary between the Vital Essence (Jing) of things that “brings them to life” in the first chapter and the mind (Shen), which through “calmness… attains repose”. Qi “Cannot be halted by force, Yet can be secured by inner power [Te]”. Te is also translated in “Virtue” in other contexts and is closely bound with the Taoist ideal of maintaining an unfettered flow to produce an effect without effort (Wuwei).
The impression this gives me is of a description of consciousness. Jing is not the “thing-in-itself” to borrow a Kantian expression, but the essence of the thing as it is represented to us. In bodily terms it is our connection to our existence, described in the Su Wen as something which when exhausted, we die. While closest to the material object itself it does not make sense to equate it directly with the body as some authors, both ancient and modern, have done with DNA or seminal fluids, since the body continues to exist after death, at least until decomposition takes it. The idea that it is spent during sexual activity is perhaps similar of the notion of “la petite mort” of French philosophy, where our sense of self becomes briefly annihilated during orgasm, with the suggestion that if done carelessly and frequently it may erode the connection to our sensual self until we become insensitive and apathetic (De Beauvoir and Deleuze have written essays that examine similar themes from a western perspective in relation to Sade). The Shen is the spirit that thinks, perceives sensation and reflects upon things, including itself. It is aware of its own existence and perturbations in its well-being and also considered to be the part that contains elements which can survive death, to be reborn or reunited with the Tao, depending on the tradition. Together these form the Jingshen which is a common term for consciousness and parallels modern ideas in philosophy that the mind cannot exist in isolation but requires a world to shape it, as it shapes the world.
Qi forms this bridge between them, enabling the mind to engage with the phenomena we experience, as well as enabling the phenomena of this world to affect us. It is “energy” only in the classical sense of the Greek energeia, “activity, action, operation”, or as the “light” of consciousness that enables objects to be apprehended by the self, but not in the physical scientific definition in use today. Without it our minds would be disconnected from the phenomena we experience, not only making us locked up boxes and unable to interact with the world but actually not existing at all since, in parallel to modern theories of mind, consciousness is a process formed by interaction with the world and could not come into exist in a void (e.g. Maturana and Varela, 1992; Dennett, 1993; Hofstadter, 2008; Thompson, 2014).
The ability of Te, Virtue or Inner Power, to “secure” Qi, when “it cannot be halted by force”, suggests something quite different to physical energy, since expenditure of energy, force, is ineffective. If it was a physical force then twice the expenditure should produce twice the result but instead we tend to see excess of Qi as simply producing stagnation, generating extra resistance and reducing efficiency as much as a deficiency can. This is more like water than energy, where too little will dry up the river and too much will burst the banks, a metaphor often applied to consciousness, described as a stream by William James in 1890 and the Buddhist Abhidharma philosophers a thousand years before (Thompson, 2014: 34-5). Te is therefore the ability of practice and cultivation to harmonise our connection between the perception we have of our actions and the real actions we are doing, minimising the amount of energy we expend to achieve a result, instead of increasing the amount we can give. Qi is the consciousness whose flow Te can shape to run smoothly ensuring the efficiency of those actions. The tai chi exercise of pushing hands is a great example of this where we learn to generate force without effort, using training, focus and correct technique to replace muscular exertion. No amount of force can make us better able to execute a skill, hitting a bullseye with an arrow for example, but repeated practice produces a closer matching up of where we believe our arrow will land and where it actually lands. This effortless result is the inner power the Neiye speaks of.
When Zhang Zai stated that the entire universe is made of Qi, I think he was referring to this concept of interaction and that nothing would exist if everything was static. Jung-Yeup Kim’s (2015) analysis of Zhang Zai’s philosophy supports this view with Qi being viewed as a force of creativity that enables mutual communication and transformation between interdependent opposites, a dynamic organic pluralism, and not as a transcendent substance that underlies all physical reality, which he terms ‘substance monism’. Zhang Zai also said that “every birth is a condensation and every death a dispersal of Qi” (Eisen & Chen, 2011), indicating their ability to interact brings them into being and makes us alive, while death is the ultimate dispersal of this ability, including the ability of our organs to interact with each other and provide the mutual support they need to exist. Consciousness is the ability to interact while we are living and so the expression of Qi in living things. In physiology it is often defined as the breath, the operation of which starts our life independent from our mother, ceases at death and affects everything about the interaction of our mental state and bodily functioning during life, raising when we are exhausted or frightened, and able to calm us by slowing it down to bring us back from a panicked state or help us enter into a meditative trance.
This can of course lead us along a path to animism or panpsychism, assuming the entire world is conscious, or a completely phenomenal universe that requires an observer to exist, although I would suggest it can also call into question exactly what we mean by consciousness. These forms of Qi that exist in the early days of the universe and before our births are given a special status, referred to as Yuan Qi, Original or Source Qi and imply something more subtle than our thoughts and feelings. When applied to the individual they often mean our constitutional self that lies underneath our thoughts, the processes we cannot alter or change easily if at all. In the universe the creation myth in the Huainanzi 3.1, elaborating on Tao Te Ching Ch. 42, says that “the universe produced original Qi” which is then divided to form the “myriad things”, including ourselves. This indicates that the interactions between things are going on before our birth and after our death, our existence never disconnected from or dissociated from the processes around it and that even simple biological processes contain the potential for consciousness if organised in the right way. This can be seen in numerous examples in nature where life forms respond to their environment in varying levels of complexity. This view of consciousness has parallels in Maturana and Varela’s (1992) and Hofstadter’s (2008) notion of the mind being like a colony of interacting neurons, interacting with each other and our sense organs, which in turn interact with the world around us, enabling consciousness to emerge from simple biological principles organised in a complex way. Interaction becomes not just the basic building block for life but the same principle on a complex level gives rise to our brain functions which lead to the creation of the mind.
Introduction of Meridian Theory
Meridians in classical acupuncture texts represent philosophical principles or roadmaps of life (Yuen, 2003: Pp. 2-8) and their mapping on the body represented how our affairs could impact us physically. The organ names which we commonly use today are simply the manifestation of that principle on the internal anatomy and are used relatively infrequently in the Nei jing when talking about meridians. Instead a scale of greater to lesser Yin and Yang are more commonly used, depending on the concept the meridian represents. So, for example the ability to absorb and digest is represented by the Stomach and Spleen but also covers the ability of the body to stop and take in an experience, so the Stomach meridian, the more Yang and so more concerned with movement, runs along the front of the legs, covering the muscles which help us to stop moving forward, and up to the head and eyes where we absorb experiences through our senses. In psychology these meridians cover the principle of attentive thought, Yi, that enables us to remain focused and learn. The Spleen, as the more Yin (internal and nourishing) of this pair, is more representative of this aspect, weakness of which may lead to foggy and confused thinking, seen quite often in any student who has not eaten well and finds it hard to concentrate, or had too much and feels lethargic. Treating the Stomach or Spleen meridians therefore means to treat the principle of being able absorb. Correcting a physical symptom such as poor digestion is just the physical extension of correcting the principle.
A whole essay can be written on this alone, which I have done in relation to the Luo and emotions so I will settle with just pointing out some general trends. The leg meridians represent our ability to move through life, the Yang in a physical way and the Yin in a more spiritual sense of having the vision, focus and determination to go where we want in life. The arm meridians represent our ability to interact with the world, the Yin to connect with life and others, literally to touch and be touched, the Yang our ability to create and determine ourselves through our actions. Suffice to say the notion of finding an actual physical energy running through an anatomical structure on the body seem as likely to the classical authors as finding the contour lines on a map etched into a mountain. This sentiment is echoed much later when 18th century Taoist Liu I-Ming warned that the points mentioned in meditation texts could not be found on the body, nor inside the body, and the mistake of many practitioners was to believe this could be done.
The idea behind acupuncture was that the body mirrored the person’s situation in life. Those who used a certain meridian regularly would become stronger in those areas, if physically then with additional muscle, if mentally with a stronger faculty in that aspect, while one that did not exercise that concept would become weaker in that area. Excessive or insufficient attention or an external stressor applied to any particular area of life would cause stagnation, deficiency or invasion in the corresponding meridian and its physical, mental or internal aspect. Therefore where problems arose they could be traced back to a principle cause and their life examined to discover the solution. Since every person’s situation is different it was best to use this system of abstract principles to draw attention to the area of the body where pathology was manifesting and help them discover what meaning was behind their symptom. In this way it could be a complete system of medicine and philosophy, helping to resolve the causation behind disease and learn to accept and adjust to transitions in life without needing to be didactic or become outdated as conditions changed. Needles were an extension of meditative practice, placing them at symbolic points to induce a state where problems could be examined from a relaxed but focused position, while helping with some symptoms to facilitate any necessary action too.
Qi in TCM
Since the 1950s when Chairman Mao decided to restore traditional Chinese arts in a cultural revolution the concept of Qi has been standardised, reduced, anatomised and stripped of its religious overtones to fit in with the communist atheist stance. It is from here we get the notions of a life force energy that flows through the body in a literal fashion and can be intercepted at various points along it path, causing disease when blocked and resolving it when cleared. One important demonstration of this in the modern world of acupuncture and Tai chi is the notion of sensations arising from needle manipulation or exercise. When an acupuncturist inserts a needle and manipulates it, sensations of tingling, heaviness, aching, distension or numbness are said to herald “Deqi” or “the arrival of Qi“. Similar sensations are often felt while doing Tai chi or Qigong exercises and are considered to be signs that the meridians are opening and the Qi flowing through. Meditation can also produce similar sensations which are considered very important in Taoist practice.
Although popular imagination likes to adopt the view of an energy flowing through channels, it is more likely the product of 19th century vitalist, positivist and essentialist views from western sciences influencing the reconstruction of Chinese medicine in the 1950s. Both communism and capitalism, appealing to science, reason and industry to justify their policies, have driven the metaphysical to the peripheries of modern life. When it does appear it often seems forced to appear in the form of religion and a polarised opinion on whether to believe or not believe literally in a concept that lacks any factual evidence. Even with this simplified materialist perspective acupuncture has fared surprisingly well in clinical trials, leading to the discovery of endorphins to explain its mechanism of pain control, and the observation of changes in brain activity during the experience of Deqi. Even so, it seems most likely that these sensations are generated by the brain trying to make sense of some usual neurological input and not due to an unblocking of any peripheral energetic structures, correcting the body from the mind outwards, as is suggested in the Neiye (Ch. 3 & 14) and Neijing (Ch. 1).
If we were to view Qi in the more abstract sense portrayed in classical philosophy outlined above, these unusual sensations could be said to mean the arrival of an interaction between our body and our mind, or the practitioner with the patient. The latter seems most likely as classical sources seem to emphasize the practitioner feeling something responding in the patient than asking for a verbal response. The two do seem to coincide however, as when the needle grasps and the practitioner feels it, that is usually the time when the patient feels the Deqi arrive too. The impression I am always left with is of a form of dialogue taking place on the level of touch and sensation, where you are attempting to persuade the body to change in a particular way.
Not all sensations of Qi are positive though. Pain is generally considered to be a stagnation of Qi, stagnation because we cannot shift our attention from a particular location. Many psychological distresses can seen as the same inability to allow our focus to move on, often with physical correlations on the body. Other forms of pernicious Qi can cause sensations named after environmental factors which they feel like and may be caused by. They may be sensations on their own or accompanied by physical signs of that nature too. Heat presents with feeling of burning and possibly redness. Cold causes contraction and tightness, leading to cramps and sharp focused points of pain. If the area is cold to the touch it may indicate Cold too as contraction of blood vessels have reduced flow in the area. Damp slows movement, like wading through water, leading to feelings of heaviness or a dullness of sensation, as if the body is waterlogged, foggy or pushing through a swamp. Physically there may be swelling and water retention. Wind is ephemeral and transitory, invisible in itself but making other things move, creating spontaneous twitches and pains that shift quickly and cannot be pinpointed. In extreme cases Wind can be strong enough to cause something to break, blocking a vessel off like a storm causing a tree to fall across a road leading to the opposite response: paralysis, immobility and complete numbness.
These elemental forms of Qi have existed since antiquity and remain in popular use today for their practicality. They describe bodily sensations in terms of the phenomena we are able to perceive: heat, cold, heaviness, stiffness, twitches, numbness and pain, and suggest a treatment method for each one by reversing the sensation. Like many references to Qi it is possible to view this in a physical sense, as the literal penetration of environmental factors into our bodies, as has been common in the materialistic interpretations of the modern era, or as the way our body has responded to an interaction with that element, which seem more sensible and in greater alignment with the classical views on Qi that I have read.
Early Modern Research into Body Sense and Bodily Illusions
Besides an attractive metaphor there are now the beginnings of scientific investigation in the way our body image becomes distorted under certain disease states. This work builds upon the model of the cortical homunculus presented by Wilder Penfield in the 1930s and more recent work by V.S. Ramachandran using the integration of multisensory phenomena to create illusions that help us understand that mysterious neurological conditions are not just issues of touch or pain, but that visual feedback and senses such as proprioception (relative position of body parts, our inner sense of movement) are important for our sense of connection to our own body too. It seems as if we do not have one single representation of our body inside our brain but several and our final decision about what our body is feeling or doing is based on all of them communicating with each other.
One of the most famous of demonstrations of this is the Rubber Hand Illusion where a fake hand is placed in view and the real hand hidden. Both are stroked with a brush simultaneously and after a time the person begins to experience the fake hand as their own. In a variation that reveals the multisensory nature of pain, a painful stimulus is suddenly applied to the fake hand, usually a blow with a hidden hammer, and people will often recoil in an attempt to defend a hand they know to be fake and may even feel real pain. This has led to a direction in research that suggests a lot of pain is a multisensory phenomena that may originate more in the brain as a means to make us to avoid movements that we perceive as dangerous, to avoid causing or aggravating an injury, than an input from damaged tissues. Many of the most frustrating types of muskuloskeletal pain are quite poorly correlated with actual degeneration as detected by scans and investigations which suggests that this same process of neuroplasticity that enables us to feel a pain in a fake hand is sometimes at work in our own bodies, generating pain from a distorted sense of what our bodies are actually doing.
Common Body Distortions in Disease States
The most pronounced disorder in which the image of our body becomes distorted to produce pathological signs and symptoms is in amputees who continue to feel phantom limb pains and distortions of a body part that is no longer there. It has been observed that areas of the brain which correlate with the missing part can shift and the parts which are no longer receiving any sensory input may be encroached by other neighbouring areas (Ramachandran & Blakeslee, 1999, Lotze & Moseley, 2007). This fascinated me when I studied it in my college days since one of the most reported forms this takes is for the area which represents the cheek to move into the area where a missing hand used to be. In acupuncture all three of the arm Yang meridians travel onto the side of the face, two of them crossing the cheek specifically. Often the points on one end of a meridian are suggested to affect the opposite end making the suggestion that phantom itching in the hand can be treated with scratching the cheek (Ramachandran & Blakeslee, 1999) seem almost like supporting evidence of acupuncture theory. Multisensory modes of treatment such as treating the opposite, present limb and using a mirror to fool our visual sense into thinking the missing limb was being treated was also suggested, which bears a similarity to the acupuncture practice of treating the opposing side to the one affected in some cases, albeit without the mirror. I find that a difficult treatment to give to many people in the west who insist on me doing something to ‘fix’ the painful area and have figured any effect it gives to be a generic effect of acupuncture rather than anything specific but I would be keen to try a simultaneous manipulation of needles on both sides or with a mirror to see if we could get stimulation in an area of total numbness.
In Complex Regional Pain Syndrome, where chronic pain is combined with sensory, motor and autonomic dysfunctions, a similar pattern of cortical reorganisation occurs (Moseley et al, 2011). Some interesting features of this disorder relate to our perception of left and right. Sufferers take longer to identify a picture of a limb as left or right when compared to healthy controls when it is the same side as their affected limb. This indicates some kind of disconnection to their affected part. In an even more curious twist, when applying stimulation to both sides of the body it is found that they have to stimulate the affected side first and then the unaffected side in order to make them feel simultaneous, but if they cross their limbs over then the opposite is true. The same is observed in body temperature, that the affected side displays measurable differences in temperature to the unaffected limb, but if they cross them over then it is reversed. This has been used to suggest a possible reason for the beneficial effects of cross body movement in exercises like Tai chi but another observation also seems to shed light on the nature of Qi as an interaction between body and mind. This same cooling affect is demonstrated in the Rubber Hand Illusion mentioned above: the temperature of the ‘replaced’ hand appears to drop while the rest of the body stays the same. A cold feeling is often said to indicate a lack of Qi and conversely warm hands are sign of Qi flowing into them. This can be a subjective sensation or physically as the Qi moves the Blood. It would seem from these experiments that our ability to identify with our bodies is connected with the ability to make them warm, presumably through circulation.
Another condition where distorted body image has been observed is in lower back pain. This is perhaps more relevant to a practitioner of acupuncture than the others since it is such a prevalent condition in our society which people seek manual therapies for more than anything else. Moseley (2008) wrote in the Journal of Pain that our body image becomes disrupted and tactile acuity is decreased in sufferers of lower back pain. The diagrams his subjects drew of how their back felt and the descriptions they gave seemed to indicate that in the locations of pain their trunk felt distorted, areas seemed to have shrunk or even disappeared altogether causing them to miss out some of the vertebrae on their diagram at the levels where the pain was experienced. In addition their ability to detect two separate points being stimulated on their body was significantly reduced at the painful areas. Since then Moseley has contributed to a larger experiment with Bowering et al, 2014 which found that people who were experiencing back pain, or had a chronic history of back pain, found it harder to determine whether a model was flexed or rotated when compared to healthy controls. The group which found the task hardest of all were those with a chronic history and currently presenting symptoms.
Some similar observations have been made in other painful conditions and I wonder if there are many more disease states which have not been studied or whose inability to describe may make them more difficult to record and analyze. In people with osteoarthritis of the hand, those affected appeared to have a smaller perceived hand size than healthy controls (Gilpin et al, 2014). They also found that optical illusions which stretched the hand size worked for both groups but ones which shrunk the hand only worked on the controls. The implication is that those with arthritis already had a body image shrunk as much as is possible and an illusion could shrink it no further. An opposite observation was made by Moseley, 2005 where people with Complex Regional Pain Syndrome (discussed above) Type 1 of the hand found their hands often felt larger than healthy controls. Some therapeutic approaches based on this have been developed too such as optical illusions which restore perceived size to normal and tactile stimulation combined with focused attention to identify which area was being stimulated (Lotze & Moseley, 2007).
Getting people to look at images and make evaluations based on their comparison to their own perception and measuring the distance people can succeed at two point differentiation can all be recorded and analyzed statistically but what about a sensation like weight? I would wager that there are many disorders, such as depression and chronic fatigue syndrome that cause the body to feel heavier and harder to move than it really is. I suspect it will take some more creativity to develop a system of measurement for symptoms like this but it could be done. The recent renewed recognition of Chronic Fatigue Syndrome as a real disease, complete with the new name Systemic Exertion Intolerance Disease (SEID), implies we might be developing some tools to measure difficulty in exertion that go beyond simple what our muscles are physically capable of doing. We are all aware of certain states when our body feels different to how it is, whether the throbbing after we hurt ourselves (a pulsing expanding feeling), the lightness when we carry a weight for a long time and put it down or the heaviness of a lack of motivation. These studies represent a step forward in trying to learn how we experience ourselves and how this changes during disease states.
Implications for Chinese Medicine
What I find most interesting from the perspective of a practitioner and analyst of traditional manual therapies is the way this correlates with the patients I see who insist that their “back is out”. The spine rarely dislocates and when it does it is a surgical emergency and not something to be manipulated back into place but it is interesting to see some studies showing that this is how people with back pain feel themselves to be. I imagine a lot of chiropractic and osteopathic manipulations are really manipulations of this body sense, moving someone in a way that helps to reset their body image and perhaps stretch out some muscles in spasm rather than actually adjusting the spine. Acupuncture with its strange sensations of distortion may do the same as well as many massage techniques that stretch the skin or make people focus on areas of their body and match up their perception with the reality. One of my favourite Tui na techniques resembles the two point differentiation tests combined with a feeling of stretching by placing one hand still and performing a Tui fa (effleurage for the Swedish trained) away from it with the other. An fa (straight pressing on points) is also similar to the tactile stimulation with focused attention described by Lotze & Moseley (2007), especially if done with a command to try and relax or “breathe through” the area, which is also quite common in deeper massage therapies. The fact that it is not unusual that people get off the couch feeling taller, looser or even stretched out suggests we are altering their body image, even though I may have not been applying any traction based techniques at all.
From the point of view of traditional diagnoses it is interesting to consider how the most common pathogen to cause lower back pain is probably Cold, which is said to cause contraction, and should therefore pull the body to one side and reduce two point differentiation of stimuli in the way Moseley describes. In addition this is supposed to cause Qi to be stagnated causing pain in one area and is accompanied by an implication that beyond the blockage there will be a deficiency, causing areas of numbness or absence of awareness, which Moseley’s (2008) study also suggested is happening.
Finally, I think that studies like these could take research into manual therapies of all kinds in different directions but none more so that acupuncture. Instead of attempting to test TCM prescriptions of points against non-points or sham needles and trying to search for non-existent anatomical structures and energy signs, we can see if any particular techniques or groups of points and combinations have the effect of inducing particular sensations of Deqi more reliably and then work out which of those sensations have a positive effect on the various kinds of body image distortion and how to diagnose them. It seems already that we are finding some similar categories of body image distortions, including enlarged and swollen (Heat), contracted and cramped (Cold), dull and heavy (Damp) and movements not under our control (Wind) along with pain (stagnation) and numbness (deficiency). It seems almost certain that Deqi is a kind of distortion of the body image, so the question is which ones help what? Do distending sensations help to ‘reset’ the body image? Does a heavy feeling have a similar effect to wearing weights and when it passes leave a feeling of relative lightness? Does a burning feeling help expand a contracted area of body image?
I would guess that some of the classic groupings might contain the best areas to test already. The elemental groups seem to contain the principle of what they should treat within their grouping already. The Jing Well points, which are Wood or Metal, principles of expansion and contraction in classical philosophy, seem well suited as a group for generally restoring sensation in that limb and are often shocking enough to give the person a jolt, maybe normalising their conscious perceptions of their body. Their classical action is to “restore consciousness” and “expel pathogenic factors” generally which might be read as restoring our conscious connection to our body rather than the usual implied notion of waking someone up. The Ying Spring points are Fire and Water and traditionally indicated for Heat conditions, so we could see if they are more likely to reduce feelings of burning or throbbing. He Sea points which are either Water or Earth, both heavy elements, should be best at inducing a feeling of heaviness. The other Five Phase points seem have less obvious elemental pairs and in the case of the Yin Shu Stream points, they share their location with the Yuan Source point which is for reaching the deeper levels and so is probably indicated for inducing deep relaxation closest to meditation trances, but these are all just possible combinations to test and experiment with. In terms of combinations it has certainly been my experience that needling two points on one channel, preferably quite far apart and stimulated strongly (electro or manual that leaves a sensation afterwards), is the best way to induce a feeling of a limb getting longer or shorter, expanding and shrinking.
What I hope to get out of the writings and studies of Moseley and other neuroscientists is threefold. First I hope to be able to use their findings to help me understand what traditional medical systems, especially those of bodywork, but quite possibly those of herbalism and ritual systems, are actually doing to their patients, how they might be helping to alleviate symptoms and even triggering real changes over time. Second, I hope to inform my own practice, to place the acupuncture and tui na services I offer to make a better context that includes modern scientific developments while remaining true to at least the principles of eastern thought. Finally, I hope that these developments will find a greater acceptance in the acupuncture community enabling the discipline to continue to evolve, researching which methods of stimulation are best to induce a particular sensation and then testing whether inducing that sensation helps to realign a particular body image distortion.
With the current work that is being developed in neuroscience, acupuncturists have the opportunity to be at the frontier of finding clinical applications for these theories without abandoning their historical principles. Bridges are being built between science and eastern philosophy as we use modern technology to unlock the mysteries of the mind. Books like Evan Thompson’s (2014) Waking, Dreaming, Being have tried to do this and I have tried to show here that Moseley’s research is doing much the same by providing a framework within which we can understand how traditional diagnoses and treatments are working. Perhaps the pinnacle of this cross fertilisation can be seen in the attendance of both the Dalai Lama and top neuroscientists such as Norman Doidge at the “Neuroplasticity and Healing” symposium in Birmingham, Alabama.
Some compromise will always be necessary, which may include abandoning the essentialist ideas of energy flows and returning to a more classical approach of viewing Qi as a philosophical concept that constructs the narratives of our lives and bodies, but I think this is hardly even a compromise and more a hard line stance to insist on core philosophical standards in our industry. If medicine is the application of philosophy on the body, utilising what we understand life to be in order to attain what we believe it to be for, then we have to wonder what is happening if oriental philosophy is inspiring neuroscience but acupuncture is not inspiring clinical practice. Somewhere a gulf must have opened up between them and needs to be closed. I would rather resolve problems through the principles of neuroplasticity combined with Taoist and Buddhist practices than be some sort of New Age plumber with a sharp set of plungers. The question of whether Qi has a future depends on its ability to conform to the principles of the Tao in remaining formless and adaptable. If it does not, it will become stagnant and die, an ironic fate that I suspect will be lost on a lot of acupuncturists.
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