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
Chinese astrological calendars - get yours today!
Hey everyone,
It’s been a funny beginning of the Autumn season and I’m doing my best to adapt to the shifting energy. Good things are coming to Deepest Health soon, particularly if you’re a student or relatively new to Chinese medicine (you know, like me) but for now I just have a quick suggestion.
Learn more about the energy of your days as described via Chinese astrology! Fortunately, I have a simple and beautiful way for you to do that. My friend and colleague, Brandon Brown, has just created a quite lovely and accurate calendar that contains all the pertinent Chinese astrological data. By using his calendar you not only help support a fine budding scholar of Chinese medicine, but you also get to learn more about this fascinating system for looking at the world.
After you buy and have used it for a while, come back and let us know how it’s going. I find that paying close attention to these things tends to shift my consciousness quite a bit.
Eric
Tags: astrology, autumn, brandon, calendar, chinese-medicine, earthly branches, energy, heavenly stems, Seasons, studentRelated posts
Salt Sensitive Hypertension and Classical Chinese Medicine, Part 3
This is the final post in a three part series by Brandon Brown, blogger and student of Classical Chinese Medicine at NCNM. You can read the first two parts here and here, and can read references for the article by visiting Brandon’s site here.
Salt in the Classics
Salt is mentioned a number of times in the classics. In the Neijing Suwen, salt is considered the flavor of the Kidney. But what does this mean exactly? What follows are the most descriptive and instructive references from the Suwen followed by my translations.
Chapter 67
北方生寒，寒生水，水生鹹，鹹生腎，腎生骨髓，髓生肝。其在天為寒，在地為水，在體為骨，在氣為堅，在藏為腎，其性為凜，其德為寒，其用為，其色為黑，其化為肅，其蟲鱗，其政為靜，其令，其變凝冽，其眚冰雹，其味為鹹，其志為恐。恐傷腎，思勝恐，寒傷血，燥勝寒，鹹傷血，甘勝鹹。
“The north generates cold, cold generates water, water generates salty, salty generates kidneys, kidney generates the marrow, marrow generates the liver. In heaven it is cold, on earth it is water, in the body it is bone, its qi is hard, in the Zang it is the Kidney, its nature is cold(shivering), its virtue is cold, it is “use”, its color is black, it changes into solemn-ness(seriousness), it is worms and fish-scales, its government is stillness(jing), it causes, its pathological change is congealing coldness, its natural disaster is ice hail, its flavor is salty, it is will by fear. Fear impairs the kidney, thought defeats fear, cold damages blood, dryness defeats cold, salty damages blood, sweet defeats salty.”
Chapter 3
味過於鹹，大骨氣勞，短肌，心氣抑。
Excess salty flavor, causes great hardening of bone Qi, shortens the muscles, and restrains heart Qi.
Chapter 5
鹹勝苦。
Salty defeats bitter.
Chapter 10
是故多食鹹則脈凝泣而變色 。
Therefore, much eating of salty makes the pulse concrete and the color changing.
Chapter 22
心欲耎，急食鹹以耎之，用鹹補之，甘寫之。
The Heart desires softness, anxious people eat salty that softens it, use salty to mend it, sweet drains it.
—-
These excerpts from the Suwen indicate the myriad functions of salt. In Chinese Medicine, the Salty flavor is typically used to soften nodules as mentioned in Chapter 22, but we also see in Chapter 3, 10, and 67 that salt can pathologically also create hardness of Bone Qi, restrain Heart Qi, damage blood, and cause the pulse to be very firm. We can read these lines in typical Chinese Medicine fashion: that as a remedy, the salty flavor has a purpose in softening nodules, in moderation salt perhaps allows the Kidney to perform its function of storing, but pathological excess consumption of salt can lead to sclerosis.
In Chinese Medicine, the 5 flavors that go with the 5 organs typically counteract the nature of the targeted organ. For example, the energetic nature of the Liver is up and out whereas the flavor Sour astringes and contracts. The Heart, the fire organ, is up and bitter is down. For the Lung, its nature is contracting down and in, whereas pungent is the opposite: up and out. For the Kidney, as we see in Chapter 67 above, the energetic nature is definitely to store by freezing. Salt, must counteract this freezing nature, as we know that it does from our experience: salt both reduces the freezing point of water and raises the boiling point. The presence of salt liquefies ice, and thus can soften hardness (tumors, goiter, etc.). But because salt has an affinity with the Kidney it counteracts the storing nature of the organ, liquefying the Kidney energy (perhaps Jing) to be used in the body as Qi. Therefore we see again that, salt pushes out from the inside.
In their paper on the Classical Energetics of the Five Flavors (find in references section), Arnaud Versluys and Jessica Atkins describe the therapeutic actions of the five flavors in terms of tonification and purgation. In cases of excess or deficiency, the organs can be respectively purged or tonified with the appropriate flavor as shown in the figure below.
Figure 2: The actions of the 5 flavors
Organ: Excess of, purge with : Deficiency of, tonify with
Fire : Sweet : Salty
Earth : Bitter : Sweet
Metal : Pungent : Sour
Water : Salty : Bitter
Wood : Sour : Pungent
According to their interpretation, the salty flavor purges excess in the Kidneys and tonifies the Heart. In the case of SSH, chronic overexposure to dietary salt may act medicinally and impair or purge the storing function of the Kidney and thus over-tonify the Heart. Because the Kidney is also said to store pre-natal essence if there is no pathological influence to expel in the Kidneys, it is possible that what is purged is actually pre-natal essence (Jing). This essence is circulated throughout the body, transformed to Qi by the Liver function, and transformed and stored as Shen by the Heart. Shen, and thus consciousness, have as a substrate the brain, but Shen is housed in the Heart.
Therefore, the use of salt habitually may increase the Jing-Qi-Shen generation cycle, which makes us sharp and awake, but has the detrimental effect of possibly depleting pre-natal essence if the Kidneys are not constantly tonified. In the Suwen it mentions that at 8 times 7 years (56 years old), the hair (ruled by the Kidney) turns gray and the signs of aging begin to become visible. “The kidneys’ ability to excrete sodium declines gradually with age. If, with age, salt consumption is not reduced, sodium balance is maintained by raising fractional sodium excretion, which requires elevation of BP” (Khalil 2005). The 
accumulation of salt in the ocean over the years has begun to take its toll.
Because purgation of the Kidney in a non-pathological condition also tonifies the Heart, an interesting consequence of excess in the Fire element is that it easily overflows onto its child organ, the Earth. This would lead the Earth to become overwhelmed and thereby inhibiting it to control the Water element, whose function is diminishing due to the natural processes of aging. In CM, we say that the “Earth rules the muscles” and in the SSH case this clearly relates to the smooth muscle of the vasculature losing its ability to contract. Due to an excess in the Heart domain, the smooth muscle becomes dry, stiff, and brittle. The patho-mechanism of this is illustrated below.
The standard American diet is predominantly made of the flavors salty and sweet. The overwhelming absence of bitter (with the exception of Shen disturbing coffee and beer) and the overwhelming abundance of salt and sugar in the standard American diet may explain the danger of increased exposure to dietary salt.
Conclusion
It is not surprising that decreasing daily dietary salt intake will help in treatment SSH. However, what we learn from the classics and the physiology of salt in the body is that Kidney tonification is essential for SSH.
Because the Earth element has become so affected by this chronic exposure to salt, purging the Earth of excess with the bitter flavor will be important. Like a lone neuron in the brain, salt consumption is entangled in the higher social structures that predominate our times: working long hours, using the mind instead of physical labor for generating a living, exposure to a barrage of psycho-sensory information in terms of television, music, and people, along with increasing anxieties about all of it. Seen in this context it really is no wonder why SSH is a modern disease of the “developed” world.
Brandon Brown
Tags: five phases, heart, human physiology, kidney, liver, lung, metal, nature, neijing, salt, student, translationsRelated posts
Deepest Health Chinese Medicine Podcast : Episode 7 : Clinical confidence and memorization
In this episode of the Deepest Health Chinese Medicine podcast, I discuss what it means to have confidence in clinic and why I believe memorization is so important for Chinese medicine practitioners. I do go into a little detail regarding best practices around memorization, and I hope this information will be helpful for everyone.
Look for an interview with Heiner Fruehauf as next week’s podcast, assuming all things go according to plan!
Thank you as always - please do leave comments on this post if you would like to start a discussion about the podcast.
Eric
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Tags: clinic, Learning, memorization, Podcast, student
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20 benefits I have enjoyed since having a blog focused on Chinese Medicine
As a follow-up to my previous popular post about Why all natural health care practitioners should have a blog, I thought I would put forward a list of the benefits I have noticed so far in having my blog about Chinese medicine. I want to create this list because I feel that there could be so much benefit to patients if more health care practitioners would face their fears and put their thoughts out there. This is particularly true in the field of natural medicine, because there is so much low-quality information on the Internet about various natural healing modalities. By flooding the Internet with high-quality personalized content, we can be a force for change in the minds of the world’s citizens. A noble goal! Now, the list.
- Connections with peers : I have a lot of good friends at school and in the Portland acupuncture and herbal medicine community. I wouldn’t trade those connections for anything. However, it’s really wonderful to be able to connect with Chinese medicine students and new practitioners all over the world. Some of those connections seem to be bearing real fruit that will enrich my life for years to come. Lesson - if you want to network within your profession, become a blogger!
- Connections with patients and future patients : In the post I linked to above, there was some discussion about whether blogging is an effective way to bring in patients. I won’t really know until I thoroughly test it, but I have found that my current patients at the clinic enjoy reading my thoughts. At least one patient has rescheduled because she received her email update and it reminded her to reschedule! In the end, though, it’s really about helping to educate patients about the power and promise of Chinese medicine. Lesson - If you’re interested in keeping in touch with your patients, consider blogging and having them sign up for email updates!
- Free critique of my own ideas, refining my thinking about Chinese medicine : Many people are afraid to write about their thoughts concerning Chinese medicine. I’ve never supposed I have all the answers. Sometimes (gasp) I’m even just wrong. But, you really don’t know what you don’t know until you write about it and put it out there. It can be scary, but exhilarating and I truly believe I have grown as a student and scholar by blogging. Lesson - Want to be an expert in your field? Write about it and pay attention to corrections and criticism.
- Writing practice : I guess this is self explanatory, but it’s always easier to learn how to write by … writing. :) Lesson - If “you’re not a writer,” the best way to become one is to start writing. It’s funny like that.
- Crash course in Internet marketing : Because I decided I wanted to grow this blog as large as I could and make some money with it, I had to start learning a lot about Internet marketing. I’ve consumed a whole lot of information on the subject and while I’m no expert, I’m happy to say I get it for the most part. Lesson - Blogging is a multi-skill activity that will expand your knowledge in many different respects.
- Staying abreast of trends in technology : I’m not obsessed with gadgets (really, I’m not!) or even Internet trends. However, in an effort to keep reasonably well updated, I do learn quite a bit about what’s going on and what’s coming up. I like feeling like I know what’s going on and I learn by doing - so running a blog (or three) is an effective way to keep up to date. Lesson - Similar to the one associated with #5.
- Higher standard of personal organization (more projects means more organization) : For some people, more to do means less organized. Naturally, this leads people to believe that they can become more organized if they just simplify their lives and take on fewer projects. For some people, this may be appropriate. In my case, I find that (to a certain limit) the more I take on, the more efficient I become at managing it. When I have relatively little to do, I actually become less likely to fulfill my basic obligations! Many people have asked me how I do what I do - to them I say that the event that most shaped my ability to do a lot was the birth of my daughter. This surely has many dimensions, but one of them was that because of the compression of my available time, I had to become better at managing my time. My schooling, blogging and other activities just add to this. Lesson - You’re capable of more. Maybe much more.
- A higher than average tolerance for thoughtless comments : If blogging doesn’t give you a thick skin, nothing will. I have been blessed to have a lower than average number of “trolls” and my comment spam catching software is quite effective, but I still get a few folks who think it’s fun to be intentionally antagonistic. You learn to ignore them. Lesson - Don’t let a few bad apples spoil the whole crate.
- Less tendency to goof off on the Internet : I know, I know. This sounds crazy. But, because I see being online as part of my job, I really don’t want to use it very much “for fun.” I get off as quickly as I can unless a good friend is online and interested in conversation. My friends who primarily use the Internet for shopping and email seem far more likely to wander the crazytube of the Internet aimlessly. Poor things. Lesson - You can learn to be productive on the Internet. Yes, really.
- Helping others gain study skills : There are lots of ways that I feel that my work on Deepest Health has helped others - and this is truly the greatest benefits I have received by blogging about Chinese Medicine. I’ve listed just three ways I’ve helped here, but there are others. Lesson - If you are a person who likes to help people, blogging is one way you can fulfill that divine desire.
- Helping others understand Chinese medicine concepts : Countless examples abound, from talking to people about the six conformations to talking about the organ clock and so much more. I really enjoy sharing what I’m learning with others. I learn so much in doing so.
- Helping to promote friends’ businesses and hobbies : I’ve promoted others blogs but also businesses like Paul Rosenberg’s Sacred Tea.
- Walking farther along my spiritual path : While I certainly would have made spiritual progress without this blog, the connections I’ve made and conversations I’ve had have really helped me move along. Because I feel empowered to discuss spiritual matters on this blog, it’s been relatively simple to use my blogging as a medium to walk my Path. Lesson - Technology does not negate spirituality.
- Money and other material benefits : Of course it has been nice to get some material benefits from blogging. I’m nowhere near making even a part-time income, but it grows with every lesson from Yaro I am able to implement. I have enjoyed receiving review copies of books and software as well. While I wouldn’t blog ONLY for the material benefits, they are nice. Lesson - Blogging can be profitable in more ways than one.
- Lateral networking : Because of the nature of the Internet, people run across Deepest Health from many different walks of life and professions. While I do come in contact with all sorts of people in the offline world, I generally keep within a certain group of friends and colleagues. The connections I have made with people in very diverse fields has helped me to think differently about Chinese Medicine, and I’m profoundly grateful for that. Lesson - Reaching out on the Internet helps you connect with the whole world.
- Ability to say, in conversation, “I’m a blogger” : A silly one, perhaps. But, it is always interesting to see people’s reactions. More often than not, they try to ignore that I said it. Sometimes, they ask what that means. Sometimes, they launch into a diatribe about Myspace. It’s entertaining. No lesson required.
- A greater appreciation for the immense diversity of our planet : This is connected to some degree with #15 about lateral networking. Again, because of the nature of the Internet, you just end up connecting with a wider variety of people than you would normally when you blog. Particularly when I use various forms of social media, I get a sense for what’s going on in Cairo or Melbourne or anywhere else. I understand the struggles that normal people go through in places different from my own. I also begin to see how similar we all are. Lesson - The world is a vast, fascinating place. You don’t have to pay an arm and a leg to connect with it.
- Better posture : Over time I’ve gone from sitting in a somewhat ergonomically structured plush office chair to a kitchen chair to my current seat - a simple short flat bench. Strange? I find that I am able to keep better posture when I have less support. I don’t know if this makes any biomechanical sense at all. Regardless, I have never paid so much attention to my posture as I have on long days of blogging. Lesson - Just because other people slouch at the computer doesn’t mean you have to.
- A greater than average tolerance for sitting in long, long, long classes and seminars : This one goes with #18 to a certain degree. Instead of making me less tolerant to sitting, blogging has increased my stamina when it comes to sedentary activity. I should note that while I do have long periods of sitting and writing, I do get up to do a couple of minutes of exercise about every 30 minutes. I will sometimes do this in seminars when it is possible (as when I end up in the back of the room and it is not very quiet). I’ll just get up and stretch my legs. But, in general, I find that my ability to sit when necessary is much increased, and this has been tremendously helpful in some circumstances. Lesson - Yeah, sitting all the time is no good, but you have to count your blessings.
- Greater finger strength for needling : I have fingers of POWER from all of this typing, I assure you. Seriously, though, I pay close attention to my finger health, which includes finger exercising. I don’t know if this has actually helped my needling, but let’s just pretend. Lesson - See lesson#19 above.
Thanks for reading,
Eric
Tags: Blogging, Business, fun, internet, Learning, lists, networking, organization, student, Technology, writing
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