Acupuncture is more than just needles
I consider myself an herbs man, primarily. During my first year in school, I decided that I was going to try to focus as quickly as possible. Now, granted, I need to learn as much as possible about the medicine as a whole. I need to know points, channel theory, point combinations, herbs, formulas, modifications, general theory and all its subdivisions, patient-doctor communication, business management and all the rest. I need to know where to access resources when I need them and I need to be a competent overall practitioner. However, this medicine is so vast that it is extremely dangerous for a person as enamored with it as I am to operate without a particular focus. Having focus will allow me to increase my abilities in my chosen field while helping me to avoid overwhelm and avoiding becoming a jack-of-all-trades. It will also help me choose a thesis topic, mentor and help me to know who to work with in clinic. Not everyone takes this view, and I realize that.
Regardless - I love my herbs and I love formulas and I feel uncommonly blessed to be at NCNM - home of so many incredible scholars of Classical Chinese herbalism. However, this term I am learning a deep love and respect for acupuncture as well. Although some have argued that NCNM does not have a Classical acupuncture program, I beg to differ. We do learn points as other schools do - memorizing them and learning what sorts of standard actions are commonly ascribed to them by the profession at large. However, this teaching is mediated by a much broader and more Classically based view of channel theory and, most importantly, techniques. Currently in our classes with Dr. Youping Qin we are learning the principles of Shen management as well as a host of Classically based needle manipulation techniques. It’s freaking AWESOME.
I’m especially interested in the Shen management portions of lecture and it has done a lot to change the way I needle. These are the five things I’ve taken from those lectures. I’d be delighted to hear your thoughts in the comments.
1. You must needle without distraction.
The most important point I’ve taken away from the lectures so far is the vital importance of focus. This is, at least in part, the process of focusing your Shen completely on the needling. The idea is to focus everything on the tip of the needle, sensing the tissues and energies around it. When you get this kind of focus, you can drive the Qi, you can sense whether you are dealing with evil or even Qi and your treatments will be more effective overall. When I started marshalling all of my resources and not thinking about irrelevant things or even thinking about my performance, I found my insertions improved greatly and I grabbed the Qi much more quickly.
2. You must self-cultivate.
This partly follows from the last point. Focus doesn’t always come easily. You have to be able to step outside your problems or at least let them live somewhere else for a while. You have to be able to be totally present for the patient. Even some of my most beloved doctors have trouble with this, but I do think it is very important. Being needled by a doctor who is wholly focused on the treatment and not on talking to me about the latest football game score seems far more effective on the whole. Self cultivation will also enhance your ability to correctly access and interpret Qi, and probably increases the efficacy of your manipulation. That’s on top of all the other benefits.
3. You must have good contact with the patient and maintain that throughout the visit.
In more than one class we have talked about the fact that the treatment actually begins with your very first contact with the patient. Even the most practical of doctors have to admit that the conversation between the doctor and the patient - including your body language and speech quality - have a sometimes huge influence on the treatment effectiveness. Given that eyes are the windows of the Shen, having good eye contact is quite important in the Shen management part of any given treatment. I have to admit I am a little confused about this part - the pragmatist in me wants to reduce it down to easily analyzable behavioral actions and reactions. But somehow I know that it’s more than that.
4. You must study technique as well as point location.
As usual, I take from my studies a strong urging to study. The greatest needle manipulation techniques in the world aren’t going to matter much if you don’t hit the point. Regardless of recent studies that indicate that “sham” acupuncture is as effective as “real” acupuncture - good location and excellent understanding of channel theory are a huge part of great treatments. I can’t even imagine how you would go about challenging this - one simply needs to get a few treatments from someone only recently trained, or hastily trained and then turn to someone who has been practicing and improving the health of patients for 30 years… you’ll see the difference. However, beyond knowing points and channels it is also vital to learn techniques for manipulating the Qi and actually USE them. We have learned reduction and tonification techniques, and this week began to learn “joined needling” and “joint needling.” I needled through my partner’s ankle! It was awesome! The more I learn about techniques and apply them in my limited experiences the more I see their power.
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Tags: Acupuncture, channels, chinese-herb, Learning, Personal Development, study, theory-to-practice
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There is no divide between pragmatism and what you describe here. It is simply enlarging one’s sense of what is pragmatic by enhancing awareness. Shen management? I find that ridiculous. I don’t manage Shen I engage with an individual. You can do that with: needles, moxa, talking, feeling the pulse, a look. I seek the greatest effect with the smallest stimulus. But your points are all valid.
Seems like a problem with language, mostly. Management is certainly not the best word - we actually discussed the problem with that translation. It’s an engagement, and mostly you’re “managing” your own Shen and through your interaction with the patient, through that linkage, guidance is offered and -hopefully- received. Then the healing begins.
Thanks for your comments as always.
Eric
Well put. Thanks. As always, I am impressed by your acumen, and the rigor of your language.
With only a shiatsu background it is interesting to read about needling technique. It is something to grasp the idea of working with Qi when you are touching the patient but I have often wondered how an acupuncturist can act beyond the mechanical aspect of inserting a needle.
I guess from what you are write that you use the needle as an extension of your own self. That your cultivation and improving technique allows you to deliver an intention through that needle as I would hope to using a thumb or finger?
Tony,
That’s very much the idea - well said. Interesting to know that shiatsu uses a similar idea, only through the hands. It’s funny because I think some acupuncturists wonder how the energy/intention can be delivered without puncturing the skin! Truth is - both are effective and intention is key.
Thanks for your comment, as always.
Eric
Hi Eric,
First of all let me just say that I find your blog to be a great place to read and go back in time. I am a practitioner from Tel Aviv, Israel, my name is Yael (female), and I enjoy your blog so much that I included it in my “8 blogs you need to visit” list on my latest post on my own blog. It is all Hebrew, if you know the language I will send you a link…. :)
You listed many things on your “to do” list and you must remember that you really don’t need to finish that whole list on your first basic 4 years. I finished my basic 4 years on 2002, and I still have SO MUCH to learn, not because I don’t know enough to start working, but because we deal with health and you need to learn more and more about your chosen field and try and know more about people and what troubles them.
So you can focus on one thing, but what I would suggest is to give everything equal time, and after the first 4 years are finally over, then it will be the time for you to focus, and be able to stay in shape with the other techniques you chose to keep on hold for the time being.
Keep up the good work,
Yael
Yael,
Thank you so much for your wise comment. It is greatly appreciated. Only now I have to learn Hebrew, too! Another thing on my to-do list. :)
I appreciate your words and it’s funny but I think you haven’t read my very latest post (just sent it out) that expresses some of what you’ve offered.
It’s hard to come to terms with the fact that I probably won’t absorb EVERYTHING thrown at me in these four years, but I know I have a lifetime to continue my education.
Several of my fellow students have gone to a more expanded program (5-6 years) because they fear they are not absorbing everything they are supposed to be learning. What I always say to these folks, though, is that so much learning occurs in clinic and in further study…
But everyone does it their own way, I suppose. :)
Thanks again,
Eric
Glad to hear you have a focus - this makes it much easier to learn (it even makes it easier to learn the things you are not focussing on).
I’m pretty sure you could be an excellent herbalist without ever touching a pin but this creates admin problems for colleges so they usually don’t do it. But my focus is acupuncture rather than herbs so I don’t really know.
I’d like to know what you make of the simplified (”modular”) approach to herbs in Between Heaven and Earth. It appealed to me but I’d like to know what someone into herbs makes of it.
As to methods for meeting someone. The focus is on learning to not-do. You can practise this by focussing on one area and then going back to the whole. You may look at how they walk in, then their voice, then the more traditional diagnosis, the see how these fit together. Then check in with your responses to them. Then go back to the whole picture you have of them. You tell them what you think and ask if this matches what they think. Then go back to the whole picture etc In this way you gradually expand the picture you have of them. By practising this you will gradually come to the point where you get the whole picture more and more quickly.
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What similarities does acupressure have with accupuncture? I always thought acupressure has the same results with the latter, albeit to a lesser extent. Is it because it only uses pressure from fingers and not needles?
As far as I use the terms the only difference between acupressure and acupuncture is the treatment - needles vs pressure.
Why one works better than the other I don’t understand.
Ernesto and Evan,
To my understanding, working with needles requires you to be on the point exactly, not around it, not next to it- but right on it.
That’s what happens with acupuncture, and the stimulation is more delicate but more effective. Sort of like the thought behind one needle instead of 10.
Acupressure is good, but just isn’t the same, at least to my modest opinion. I think that the results of acupuncture are much better for the reasons I mentioned above.
Hi Yael,
I’m not sure. Does this mean that pressure around the point detracts from acupressure’s effectiveness - would it be possible for acupressure to be as precise? If the pressure hits the right spot does it matter that there is other pressure around the point?
I find the difference very puzzling.
I may be misunderstanding this conversation, if so - please forgive me.
I’m confused whether we have decided that “pressure” is the mechanism of acupuncture’s effectiveness. There are certainly worlds of difference between the way that acupressure and acupuncture work - one uses needles that puncture the skin and underlying tissues, one simply presses on the region around the point. That critical feature - breaking of the skin - surely is behind most of the difference in effectiveness.
The skin is the body’s largest immune organ from a Western perspective, and the skin contains many active components. From a Chinese perspective, the skin is intimately connected with organs and functions of the whole organism. The penetration of that barrier and the active working of energy from the surface to the interior has a lot to do with what acupuncture is doing.
Precision of application of force may also be part of it. I think what Yael said is essentially correct. There’s a huge difference when you apply force to a single point as opposed to applying that same force over a broader area. The result is far more focused, with more energy being transferred to that single area. I reckon this also has something to do with the stronger effects of acupuncture.
I would expect the conducting nature of the metal needles to have some impact as well. We don’t use needles of other materials anymore, but I assume there was some difference in effectiveness between metal and, say, bone. Metal conducts energy to a greater degree than compressed tissue (the result of acupressure) - at least I would expect this is the case.
Interesting discussion, folks, thanks for keeping it going!
Eric
I’m confused too.
I’d like to know more about the effects of other pins than metal - but guess this would be hard to find out.
If puncturing is how acupuncture works and pressure is how acupuncture works, why do they both work? And why does pressure work less? Is it because it affects a larger area? If so why does putting pressure around the point diminish the effect of pressing on the precise point?
I wish I had some answers. I find this intriguing but I don’t have any ideas really.
I do think we need to know LOTS more about HOW acupuncture and acupressure work. Maybe when we do this will help us solve this.
Interesting. . .
Thought I would leave a couple of comments…
First. . .
Classical, anyone can say they are classical. I read a lingshu, thus I’m classical. What makes it “classical” or “traditional” is a debat. What you must do is understand the how and why.
And for me, that isn’t in any of the classical texts of Chinese Medicine. Why do I say this? Well, I’m not the only one. Dr. Van Nghi also said that the Nei Jing is incomprehensible without commentary. Now, he believes the commentary to be acurate. The only way to know if it is or not is to put it to the test. And there’s the rub.
Acupuncture can be put to the test, every time and all the time and it ought to be.
The pulses will tell you if you hit a point and so will the sensation of the person being needles, and NO this is not a heavy, or tingly sensation at all. It is a clear and very strong sensation at another acupuncture point up stream or down stream from the point being needled, or it may be a point that responds with that point, e.g. LI-5 and Bl-40.
However, the key is in the pulses.
I did the whole, I lover herbs, TCM is great, oh Porkert is the man, Classical “ling shu” acupuncture is where it’s at….etc….
The only thing I’ve found truly “classical” in understanding is the work of George Soulie de Morant.
Most can’t handle his book. Too hard to understand, too hard to find the point–only 1-2mm and off by 2mm = nill effect.
However, I’ve found his work to be 100% accurate.
He understood what was hidden in the classical texts that the masters didn’t want the average acupuncturist to know.
Though you may agree or disagree with another person’s view of acupuncture, you cannot argue with the proof when you see it in the pulses–not a little change in quality, either. A drastic change in every aspect of the pulse from a single needle. And guess what? I don’t need to focus anything. I simply need to be acurate! If acupuncture is dependent on my “mind” then it is nothing more than placebo and I might as well high a homeopathic and be done with it.
True Acupuncture does work and amazingly well without any “techniques” other than hittig the point dead and tonigy or sedate–best done with gold or silver platted needles….
Don’t believe me….put in the work and find one point dead on. The easiest is LI-4, which is nowhere near TCM LI-4. It is at the base of the thumb’s metacarbal bone. . . yeah, 1 cun proximal from tcm LI-4 ;).
ok…enough of me…..
Hey Classical,
It appears we have very different understandings of this medicine. Wonderful! I disagree strongly that the Ling Shu or any other classical work is “incomprehensible” without commentary. Certainly I have been shaped by the commentary and teaching I have encountered, but even with my limited experience I find tremendous benefit in working through my own translation of the Classical texts. Every reading reveals something new that is immediately clinically relevant and effective.
I am interested in your description of what De Qi must feel like. I have seen dramatic results and experienced them myself with a varying degree of sensations. I think I would have to disagree that the only acceptable sensation is the experience of something something along the channel being stimulated or some other point related to it. Different people will, by nature, have different experiences. The key is results - in the pulse and in the symptoms. If you get great results with your method, fantastic.
I do agree that the true tale lies in the pulse. I have seen unbelievably dramatic transformation of all the pulse positions in a variety of contexts, however.
Thanks a lot for your comment!
Eric
Classical, Eric and Friends,
Good medicine and Classical medicine don’t have to be the same, but it is important to carefully define “Classical medicine.”
Finding a teacher who is effective and following him or her can be an excellent way to learn very good medicine, but that is the folk style of medicine. Finding those who can comment on the classics and who can give a useful interpretation is nice, as well as finding someone who can really transmit a direct teaching of their own style or lineage. But this also is not classical. Though a classical approach will inevitably rely on teachers and lineages. It is important to see what is unique about a classical appoach though.
There is nothing inherently wrong with any of these, for what works, what brings about healing, is what matters.
Classical medicine needs to be defined though so that we know what we are refering to and so that we know how it is different from folk medicine and from various schools of thought.
Look at the style of education called “Perenialist Education” in the West. This is classical. It is based on the Socratic notion that original sources speak a fundamental truth, and when one engages this orginal work, without the influence of commentators, one finds what is true because one is directly engaging oneself and an original source. To engage in commentary is to engage in the other “selves” and their experience with the orginal source, so that would lead to us connecting to the precepts and concepts of that commentator, not the text itself.
A true classical approach relies on scholarship, it relies on engaging original sources, understanding them both outside of their circumstances, as they stand alone, and within their cultural and historical context. A true classical approach is distinct from folk medicine in that it is based on a systematic philosophical basis. Folk medicine is based on what works. What you describe sounds to me like folk acupuncture, though don’t get me wrong, I’m not saying one is better than the other, I’m just trying to define them so we can talk about them.
The reason it sounds to me like folk acupuncture is because it is based on emperical evidence and is an offshoot of classical as well as traditional medicine. For instance, in the Lingshu the defined location for “LI 4″ He Gu (”Joining Valley” or “Enclosed Valley” or United Valley”) is pretty clear, and it is not defined right up against the bone. Finding the point and a Qi response that is slightly different from what also is described in the Lingshu (though certainly within the possible descriptions)shows innovation, empirical application and something outside of the classical system.
Lingshu Ch8 most specifically states that “All of acupuncture’s laws first must be rooted in spirit (ben shen).” [not my translation, but certainly a valid one]. If we disregard this first law, we should just call it something else.
Classical Chinese medicine does not exist in 99.9% of what is being practiced right now. It cannot be found within the confines of TCM; it is something very different, yet does not always look like it, for TCM has it’s history in the classics (whereas, the acupuncture you are describing is outside of the classics).
The classical Chinese medicine Eric is presenting is very rare, a gem indeed, and so we should carefully inspect is distinctness and value!
Thanks for reading,
Michael
I’ve studied the Indian and Chinese systems before, and they are all mostly the same, in spite of this “thing” never actually being seen by human eyes. You’ll notice the point areas are mostly similar, which is amazing.
A bit of personal experience. I have actually undergone acupuncture treatment some years back, and what I can say is, it feels good for a while after the session, but this soon fades away.
I’d be interesting in some references to help me understand the similarities between the “Indian and Chinese systems.” Intriguing!
Regarding the “fading” of the acupuncture treatment effects - there are a number of explanations for this effect. Simplest of all to understand - acupuncture makes adjustments to the body’s energy flow and sometimes it is best to make these adjustments small and fluid as opposed to large and jarring. As such, it can take several appointments for the full adjustment to take place and “set.” I recommend people to come in for treatment at least 2 times a week for the first couple of weeks, at least 1 time a week for several weeks after, then to every 2-3 weeks, finally 3-4 weeks and quarterly “adjustments” thereafter. This will ensure that the treatment is fully incorporated and settled, and that minor variations from the norm are continually accounted for so that optimal health is maintained.
The treatments could have also been done by someone who was not right for you, or not as well trained as some other CM practitioners. As in every field, we have our shining stars, our “barely made-its” and everything in between. I urge you to seek out treatment again when you need it, trying someone new and taking time to let the treatment fully settle into your body.
Good luck and thanks for the comment,
eric