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“When a falcon strike breaks the body of its prey, it is because of timing. When torrential water tosses boulders, it is because of momentum.”
Timing
In the current culture of TCM, the evidence-based protocol is king. A hypothetical example: “On 6-14/09 Patient K. was diagnosed with asthma. UB-13, UB-23, Ding Chuan, and Lu-9 were needled with reinforcing method for 30 minutes. Treatment was repeated daily for 7 days. Upon re-evaluation patient’s spirometer performance increased 15%. Therefore, this protocol is useful in treating asthma. ” This is how case studies are presented to us in our primary textbooks. This is also the primary research method in Chinese TCM hospitals presently, thus making it the perceived superior method of research and treatment amongst the standardized professional Chinese medicine community in the West.
However, this method has an ocean of problems, chiefly that it doesn’t work very well when replicated in clinic. Leaving alone for now the problem of misunderstanding what particular points/methods/herbs/formulas really do, it also neglects the necessity of meeting the patient exactly where they are at that very moment. This is what I mean by timing.
No matter how effective a formula or protocol has been in the past, if applied to the wrong situation it will not only not be effective, it may actually make the situation worse.
The importance of accurate diagnosis cannot be overstated. As a clinician, it’s the heart of your job to figure exactly what is going on with the patient in front of you at that moment, work out specifically what needs to be done, and apply it correctly. It’s no good giving a patient Gui Zhi Tang because they have a “Wind-Cold Invasion” when in fact the disease has moved on to a deeper level and the patient now needs Xiao Chai Hu Tang. You may have been needling St-36 and Sp-3 for the past three visits and seeing improvement in the patient’s digestive condition, but continuing to needle it would be a huge mistake if this week they’re having back spasms and can’t walk.
Timing in Acupuncture
The image of a falcon crashing into its prey from a steep dive at a hundred miles per hour is an accurate description of how effective doing the exact right thing at the exact right time is. However if we imagine the situation from the reverse angle, we can imagine the falcon arriving at the wrong time and completely missing its intended target. As the Lingshu says: “At the moment the energy arrives, [the physician] does not stray even by a hair; and if he is unaware of it, no results are produced. Therefore it is necessary to discern the arriving and departing movements of energy in order to intervene in time. The mediocre physician ignores this rule; the skilled physician respects it.”
This is a good time to clear up a common misconception among acupuncturists about this “arrival of energy”, usually referred to as De Qi. The commonly held belief is that De Qi is when the patient experiences a jolt or shocking sensation. This is held to be the sign that things are working and that now the patient should be left to relax with needles in for twenty minutes or so in order to allow the Ying Qi to make a full circuit through the body.
What the text is actually referring to when it talks about the arrival of Qi is the moment of regulation, the specific and clearly perceivable moment when the channel imbalance has been corrected. The higher level of perceiving this moment of regulation relies upon the acupuncturists ability to experience the unseen energy of the patient, a subject I don’t feel currently qualified to address. However the lower method (one that can be used by everyone fairly easily) is to monitor the state of channel balance via the Renying-Cunkuo pulse method where the very moment of balance can be felt by comparing the strength of the pulse at Renying St-9 and Cunkuo Lu-9 while needling the affected channels. The timing for this is so delicate and vital that the Lingshu says: “When needling, if the energy does not arrive, the number of needles is insignificant. If the energy arrives, stop needling.”
This timing is important not only for good results, but also for avoiding bad ones. You can imagine the falcon missing its target so badly that it crashes into the ground face-first. This is a very real possibility in everything we do. Contrary to popular belief, the Lingshu makes very clear many times throughout its text that the patient can be significantly harmed by incorrect acupuncture technique. To wit:
“Needling presents two risks:
- Not removing the needle once it has reached the affected zone, which may cause the loss of Jing
- Removing the needle as soon as it reaches the affected zone, which may cause the Xie Qi to return.
The loss of Jing exacerbates the illness with nervous exhaustion, and the return of Xie Qi is the origin of abscesses and ulcerations.”
Our primary concerns for harming the patient in our schooling are things like puncturing the pleura, the peritoneum, or an organ. However, the Lingshu rarely talks about physical damage due to incorrect needling and instead frequently cites examples of energetically-caused damage from doing the wrong thing at the wrong time, including different forms of insanity and even death. Clearly, the acupuncture needle is a powerful tool, one that must be treated with the same respect as a sharp knife or sword.
My point here isn’t to scare people, but rather to insist that if we are going to use any tool in the pursuit of altering the health of another person for a fee it’s our responsibility to be very very good at what we do and to not mistakenly believe that we can get away with following a protocol cookbook. Our practice of a natural and holistic medicine in no way lessens our responsibility to practice safely and effectively to the utmost of our abilities and the ability of our medicine. Acupuncture is capable of a lot, and the Neijing repeatedly talks about it in the context of treating very serious illness. However, it only works when you do it correctly.
Next week in this column we’ll discuss timing in herbology. If you want to talk more, please leave a comment or drop by the Deepest Health Community Forum.
See you Wednesday.
I really appreciate this article and am looking forward to the follow-ups. I’m in my first year of school and still limited in experience and knowledge, but getting this type of insight is really helpful.
Just yesterday in my Introduction to Clinical Techniques class we finished discussing the dangers/contraindications of acupuncture and energetic harm wasn’t mentioned once. I also came out of the class feeling a bit off (after we gave each other cookbook treatments). We are students and do have to to practice on each other to gain experience, but it’s interesting that it isn’t addressed.
*totally* happy you mentioned this about the Qi coming to the point. I think that is a common misconception in school that the patient has to feel some sensation and that must be the DeQi. A lot of my classmates used to aggressively twist and turn the needles until the patient would say “yes! I feel the Qi!” mainly because the needle was twisting the muscle fibers and they wanted the sensation to stop.. lol
The way I look at it, is that the patient is not trained in being able to feel Qi, but WE are, that is my job, to know when the Qi has come to the point, the patient doesn’t need to feel anything, except perhaps a greater sense of wellbeing, a calm and relaxed, but heightened state of being in the moment.
Once I feel the Qi come I will go back and check the pulses as well to make sure it has had the effect I want. That way if something didn’t change how I want it, I can adjust things then and there.
Thanks for the comments guys. Let’s take ‘em one at a time.
Noah: Yes, that is something I have never heard anyone address in a school setting. Maybe NCNM covers it, I don’t know. I found out about it the hard way before I ran into my mentor when I was having students treat me on a regular basis, doing what the clinic supervisors told them to. Despite having a barely detectable pulse I was regularly getting “Shen treatments” that involved a ton of e-stim for long periods of time. I remember once having really intense e-stim done on several of my back shu points and afterwards feeling pretty sure I was going to die. When I found out later that the Lingshu says, essentially, “yeah…back shus…you should moxa those” I realized that no one really had any clue what they were doing. So that’s my major argument and what I want people to fix: either a) no one knows what they’re doing or b) they know what they’re doing according to a flawed model that either doesn’t work or makes the problem worse.
Kristy: Yes, that was something of a revelation for me too when I learned what was actually being talked about. Unfortunately at this juncture I have’t learned to detect De Qi apart from the pulse, but hopefully that will happen sooner rather than later.
Michael:
The best way to learn this (imo) is to have a colleague feel the pulses at the same time as you needle. Find the point with your left index finger, grasp the Qi of the channel by bringing your thumb towards your index finger (just pretend at the start til you get the hang of it, and eventually you will be able to feel the Qi – like grasping the ribbon of Qi along the meridian) Then, bring the needle down into the point you have found, if you’re using tubes, you can insert the tube right between the fingers of the left hand and then tap it in. Pull off the tube, and you can adjust the needle with the right hand while you have your left hand around the point still, you don’t have to touch the needle shaft or anything to feel the Qi, just see if you notice anything. After a while you’ll start to notice “something” .. apparently some people feel it in different ways, like a warm sensation like a smile in their stomach or other various ways. I feel it in my left hand like tingling and a slight motion. Anyways, if you have someone feeling the pulse at the same time, they can report back and you will start to be able to recognize when a sensation you feel makes a change, and then focus in on more of that sensation.
This is a lot harder to type than it is to show, and I’m not the worlds best writer, but I hope you get the gist
It’s actually mega fun to practice this way, and very exciting! This is the way I learned from my teachers. There are probably all sorts of other ways and methods of learning this and I’d love to hear if others have different experiences or tips because I’m always looking to refine my technique.
Now that sounds like an excellent idea. Thank you very much, Kristy.
Thanks Michael for this great series of articles, and thanks Kristy for the insightful comments.
When I was in school, my teachers insisted on the importance of accurate diagnosis. Without a proper diagnosis (in Chinese medicine terms, not modern medicine), you can’t have an effective treatment. Without a destination in mind, you’re just wandering aimlessly. Circumstances might force you to make some detour, but you should always keep your destination in mind and keep going in that direction.
I too deplore the state of TCM (though I’m a TCM trained acupuncturist) nowadays. An old Chinese Chengyu goes : Han Dan Xue Bu (Imitating Another without Success and Losing What Used to Be One’s Own Ability). Unfortunately it seems to be what TCM is doing now.