Necessity is the mother of learning acupuncture points
One of the things I have noticed in my scant 20 or so weeks of hands-on clinical practice is the great difficulty of accurately locating acupuncture points. At times the body seems an intolerably huge landscape - full of unfamiliar landmarks and confounding convolutions. Yes, at other times the complications diminish and it seems as easy as anything. I find the latter times become more frequent as I go along.
Along with a general increase in my confidence and ability comes a deep interest in REALLY learning the points and channels. Before clinic, acupuncture very obviously played second fiddle in my hierarchy of my interests in Chinese medicine. I have always recognized its power, but simply didn’t feel drawn to study or understand it that much. Now, with my struggles in clinic, I find myself fascinated by each point and driven to learn more on multiple levels. I am also developing my non-intellectual skills, my ability to feel Qi, to palpate channels and to connect with the patient. I note this because most often when I relate my problems I have people telling me that I need to get out of my head and just “connect” with the energy of the patient. While I recognize the importance of that, it certainly isn’t the whole answer.
My methods
Before I talk about how I’ve been working with the points, I’d like to make one small note. I’ve divulged various study methods and tips before on Deepest Health. With the exception of a few suggestions, these have all been methods I’ve used. However, they were methods that I learned directly from others or developed after reading ideas in a book or on a blog. This is a great way to pick up new strategies, and I certainly will continue to use it. On the other hand, the methods I list below are different. They emerged organically to solve particular problems. What I mean is that in response to a particular experience, I desired some particular skill or understanding and worked out the best way to obtain it on my own.
This may seem to be a minor point, and I don’t want to hammer away at it. However, it definitely feels different. I feel more committed to consistently using these methods, and they seem to be more effective. Each new thing I learn inflames my desire to learn even more. A similar thing is happening to me regarding formulas, but the effect isn’t so dramatic since I’ve always been interested in understanding them. I expect clinical practice will create some new developments in that arena, however.
In essence, what I’ve been doing is simply making a list of all the points I use in a given week and then reviewing them in great detail. This is the bulk of my “method.” It has several parts, which I will describe in detail below. However, there are more subtle things that I’ve been doing in the treatment room. I don’t know if I’m quite ready to describe those pieces of the puzzle. One recent development was the return of very focused attention on sensing the layers of the body that the needle is passing through. This is something we learned in our first needling class, as one of our points Professors places a high importance on needling and manipulation in the various layers. I think being in clinic and having to manage so many things at once found me being a little neglectful in this realm - I’m glad I’ve remembered it now.
Anatomy : Descriptions, 2D, 3D, palpation and multiple sources
I’ve never been particularly interested in gross anatomy. In fact, this new revolution in my thinking has helped me to understand that I have an odd detachment from the physical nature of the body in general. Working with the anatomy has helped unravel that personal issue, yet another example of the many benefits of dedication to study. Anyway, we did take anatomy during our first year, but given my general reluctance described already and the fact that I was so enthralled with learning the cosmology and symbolism of Chinese medicine, I frankly didn’t pay much attention. I’ve used various sources to help deepen my understanding of anatomy.
Descriptions: Sometimes a word is worth a thousand pictures. While seeing what things look like on the body is very important, often it has been a stray description of a particular bony landmark in relation to a point that has really solidified its location for me. I use Deadman
as a primary source here.
2-D: Again, Deadman’s Manual of Acupuncture
3-D: I have an old version of Qpuncture that has 3D renditions of a needle in various commonly used acupuncture points. While some of the anatomical accuracy has been sacrificed, it is very helpful to see how the needle penetrates with reference to the anatomical markers we cannot see with the eye. I also subject my partner and daughter to infrequent channel palpation and point location (”Is this sensitive? What about this? This?”) which is often very helpful. Of course, while I’m studying the above sources, I palpate my own channels and feel the points on myself.
“Actions”, prescriptions and theory
The point location has been most bothersome for me, mostly because I’m obsessed with being sure that every needle has a real effect. That may seem to be a stupid statement. However, I’ve been needled by many interns and practitioners who don’t seem too interested in actually working with the POINTS - content just to needle anywhere on the body. I gather this from my perception of their lack of intention when needling, the obvious lack of accuracy based on where the needles end up as well as my conversations with them. I do believe that the “points” as they were laid out in ancient times are very special places on the human body that have powerful effects on the human being - I don’t think that “just anywhere” will do.
Despite my obsession with fully knowing where the points are, I haven’t lost sight of the importance of understanding “what they do.” I put “what they do” and “actions” in quotations for a reason. Acupuncture points are not like buttons on a machine. It’s not as if you press the red one and you get a cherry candy, blue one and you get a razzleberry one. It’s not as if some little ghost in the machine stands behind the point ready to report your instructions via the CNS with exactness and machine-like one-to-one correspondence. If a person asks me for “a point for asthma,” I’m reluctant to report the points we all know to be commonly used in prescriptions for that Western defined condition. It isn’t that points don’t “do something” and it isn’t that I’m afraid to talk about certain points as unequivocally treating some particular pathological state, it’s just that the way we try to simplify things for easy consumption result in overly simplistic ideas about how Chinese medicine works.
I think about acupuncture points like areas where one can access a river. They come in big and large sizes, they have varying ranges of ease of access, some put you in at a furious current, others at gentle pools. The direction you’re heading when you put in at any given point makes a difference, as does your intention when you do so - will you paddle upstream or let the current carry you down? Are you fighting the flow or not? Are you dredging the channel a bit to allow greater flow in a given area? Are you moving boulders that have obstructed your path?
The river metaphor breaks down a bit when we drill down a little more. Each point has its particular characteristics based on its location on the channel, its symbolic power given the part of the body and its physical features as well as a whole range of correspondences that fit the channels and points and the human being in with the consistent patterning of the universe. Thus five elements, yin-yang, six divisions and all their permutations and combinations are peppered throughout the system in remarkably predictable and usable ways. When we needle a patient, we are not pushing buttons, but mixing colors and flavors, textures and spirits in alchemically beautiful ways with the purpose of influencing the body in particular ways for the creation of health.
You know, no big deal. :D
All that being said, I’m not just going to abandon myself to studying nature and meditating as a way to understand what KINDS of mixtures are effective in what kinds of situations. I’m not comfortable with that, frankly. Instead, I look to the classics and the theories passed down by the ancients. I use Deadman and some sources given to me by my teachers to understand the Classical point prescriptions. I study closely the theory of the five elements and six conformations as well as point categories to fully comprehend the effect of a given point within a particular clinical context.
All of this is really helping my clinical confidence a great deal and I find that more often than not I am able to recall most of this information when I next encounter a particular point. Sweet! I’ve talked enough about this for now, but I would like to pose a couple of questions. Have you encountered the kinds of troubles I started out this article by describing? If so, how did you get past it? Do any of the methods or ideas above resonate with you? If so, how? If not, why not? I’d really like to hear about others’ experiences. Reply in the comments!
Thanks!
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Tags: Acupuncture, channels, clinic, confidence, focus, Learning, student, study-methods, studyingRelated posts
Herbal quality : the Fuzi (aconite) dilemma
As you all know, herbs are my passion. More accurately, formulas are my passion. Formula science is my passion! :) But, I do have a strong affinity for the herbs as plants and study them as such. Further, I have a real desire to get as close as possible to the original way of prescribing the herbs in formulas, where “original” means Han dynasty or thereabouts. If you read the Shang Han Lun, there are very specific instructions for how herbs are prepared and how they should be processed. Many of these instructions appear to be ignored in contemporary times, and I can only imagine that this is having some effect with regards to our herbal effectiveness.
However, even if we prescribe and prepare the herbs exactly as indicated it means nothing if the quality of the herbs is terrible. Recently, in a class at NCNM, a professor allowed us to taste Fuzi from different sources. We had three samples of bulk Fuzi. One was from a popular herb company, the second was from China, specially prepared in the traditional way at the instruction of Heiner Fruehauf. The third was raw Fuzi - unprepared - from China.
We were asked to observe how the herb tasted, its texture, and how it made us feel. The first batch was - depressing. It was brittle, soft, had almost no flavor and absolutely no bodily sensation resulted from tasting it. This is similar to what is found in many clinics. We tasted the second batch a few minutes later, the differences were striking! There was an almost immediate pungency and quite a bit of numbness on the tongue. This numbness continued for quite a while. We have been told by several professors that we want to find this quality in the Fuzi we prescribe to our patients - it indicates that the living potency of the herb is retained.
The best fun happened when we tasted (just a bit) of fresh Fuzi. Oh boy! My THROAT was numb after that one. You could really feel the medicinal quality - it was incredible. The only thing I could think after this little taste test was, “How can we get more of the good stuff and less of the bad stuff?” The consensus seems to be that the best quality Fuzi is not available in the states or really anywhere in the West. Further, the recent earthquake in China apparently did great damage to the areas where much of the high quality Fuzi is produced - creating even greater shortages.
The quality of the initial herb is only part of the problem - processing is the next piece of the puzzle. Fresh Fuzi is often brined, and then treated in various ways. Reports have indicated that industrial chemicals and harsh processes are used in the preparation of lots of commercial Fuzi. At the very least, you can tell that much of what’s available from the major herb companies is wildly over-brined. The brining process reduces the toxicity of the herb - but we have to remember that the “toxicity” of herbs (usually produced by alkaloid content) is a large part of why it is clinically effective! Skilled herbalists know how to exploit the positive nature of the herb while minimizing the potential for harm from the strong compounds contained within. When we overprocess herbs, we don’t do anyone any favors.
How can we, in the contemporary West, make up for these various deficiencies? How can we prescribe herbs in the way they are meant to be prescribed - full of their vital force and particular benefits? How can we know if an herb has been processed appropriately? These questions can easily be added to the ones I’ve had about using local species and other related conversations on Deepest Health. I’m looking forward to hearing what you think about this important issue. Please voice your thoughts and share your research with us in the comments! No registration is necessary.
Eric
Tags: agriculture, formulas, health, herbs, quality, ScienceRelated posts
Consolidation and the descent into winter
It’s been a very chaotic month. The continuation of my fourth year of schooling in Classical Chinese Medicine has been profoundly destabilizing in a number of ways. I haven’t been able to get my feet under me. This feeling has been further accentuated by the political and social climate, as well as particular personal situations I find myself embroiled in. But, it’s really been the academic side of things that has been the most difficult to take.
The details are largely unimportant. I do think there’s something important in all of it. As a person who is absolutely committed to being a lifelong scholar and practitioner of Classical Chinese Medicine, as a person who has taken the better part of four years to even begin to understand what that means, as a person who has had the unique and wonderful opportunity to work with a variety of folks who have done what I want to do, I have come to seen the difficulty of this task before me.
The difficulty has something to do with the nature of the medicine itself - it is variegated, multi-layered, mysterious, divine. It is the product of thousands of years of histories in more than one country, in more than one political climate, touched and shaped by hundreds of thousands, even millions, of practitioners. The difficulty also has something to do with the particular place and time where I find myself. The way I was raised as a 20th century American kid, the rocky adjustment to the 21st century we’re all making, the political climate of the United States today along with its interpenetration by the world’s political climate, the way that Chinese medicine is practiced in the US… all of this and so much more. The difficulty also, of course, has something to do with just me. Just me as a human being, flawed and persistently stubborn. I imagine I’m not the only person who has had some difficulty figuring out how to be an excellent and integral practitioner of this medicine in the 21st century West.
Over the last four or five weeks, I’ve been challenged on multiple fronts. I’ve had my confidence rocked in clinic. I’ve wondered about my focus. I’ve worried about my ability to integrate all the material before me. I’ve struggled to make things fit, time-wise. I’ve panicked about boards, about business planning and about various administrative problems. I’ve felt thoroughly dispersed.
Then came the steely cold rains of another Pacific Northwest autumn. And with all the agitated heat of late summer, washed away were the bulk of my worries and strivings. Through the clear Fall air I could see my problems perfectly, I could see solutions in the distance against the backdrop of Mount Hood. With each purifying breath, I felt my energy renewed. The gifts of the metal energy of Autumn. I ready myself for intensive consolidation, for the pulling inward of the winter - for warm fires safe under the roof being pounded by rain, for squash soup and roasted potatoes, for Moxa on Zu San Li (Stomach-36) every morning with my tea. Most of all, I welcome the descent into the certainty of my future, for the birth of my scholarhood, for the resting in the calmness of the deep watery ocean of my destiny.
Every year, the five elements and their associations become even more potent as my teachers. I hope to share some of this with my patient readers. As things consolidate enough to be grasped, I will be happy to show you what I’ve found. :)
Eric
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Chinese medicine and the troubled economy
It’s a natural thing for all of us to be thinking about the economy right now. While I think that people often pay too much attention to the news, allowing their Shen to get seriously disturbed, there’s really no question that we’re in a bit of an economic downturn. I have seen that our school clinic seems to be drawing relatively fewer patients, and my practitioner friends have also seen an overall reduction in patient visits. Some students in my class, facing immanent graduation, are getting a little nervous.
Deepest Health reader Jason suggested that I write an article about this topic, which spurred me to action. He writes:
“With the economy in a very precarious situation, what does that mean for practitioners of Chinese medicine, or indeed any CAM therapist? What would be some good strategies for weathering an economic downturn (or heaven forbid, an economic meltdown)? And for people like me, is this even a good time to invest the time and money for an education is Chinese medicine? In my perfect world, I’d do it anyway, and then I would treat anyone regardless of what they can pay. Just can’t ignore the money though, can you?”
Indeed.
There are a number of issues embedded in Jason’s statement. Before I offer my observations, I’d love to pose the two main questions to Deepest Health readers - post your responses in the comments. I look forward to a lively discussion!
1. From a practitioner perspective, what are some good business strategies for weathering an economic downturn?
2. From a student perspective, is this a good time to pursue education in Chinese medicine?
Tags: Business, economy, graduate school, moneyRelated posts
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