Acupuncture Today Column

April ’06: In Defense of Case Studies

Case studies have a long and distinguished history in Chinese medicine. In 90 B.C.E., the Imperial historian, Sima Qian, recorded a case that had been orally transmitted for several hundred years. It reported the illness of the crown prince of Guo, and his cure after treatment by Bian Que, who has been linked by some later historians with authorship of the Nanjing (The Classic of Difficulties). Following that precedent, innovative physicians through the ages have used cases, besides broader discourses on theory, to demonstrate important clinical differentiations. The importance of cases was also reflected in the classical method of training through apprenticeship, which was based on gaining the experience of watching the master work with thousands of them, as well as receiving and memorizing various texts.

In Defense of Case Studies (PDF – 68kb)

June ’06: Is this Deficiency or Excess

Experience with cases can teach the subtle art of classical Chinese medicine. Each individual has a story, which presents a unique collection of challenges to his or her embodiment. Reviewing how treatments work, and sometimes what is even more importantly how they don’t, brings new interpretations and insights. Interesting and difficult cases become emblematic of concepts or aspects of theory that they demonstrate.

Is this Deficiency or Excess (PDF – 76kb)

August ’06: Treating Patients with Chronic Disease

Many people seek relief from the suffering of progressive degenerative disease. Yet, that impulse leaves an important question: What does one mean by “relief” from such chronic conditions? Focus on the physical manifestations of disease leads many modern practitioners to search for the perfect protocol – the “magic bullet.” Most patients and many practitioners identify the supposed “magic bullet” with a cure for disease. They accept temporary control of disease expression, and fail to realize that focus obstructs the search for a true cure, which entails a reversal of the physiological process creating the disease process.

Treating Patients with Chronic Disease (PDF – 64kb)

October ’06: Discovering the Alchemy of Healing

Many people used to call vascular disease “the silent killer,” because individuals had no knowledge of its accumulation, until the fatal event occurred. We now have much broader dissemination of knowledge and equipment to allow many more people to survive their acute crises, yet the insidious accumulations that create them remain. Pathological stagnations accumulate and become substantial without individuals being aware of that process.

This model of pathogenic factors accumulating in “dormancy” occurs in many diseases from osteo-arthritis to cancer. While the symptomatic expressions of many diseases appear suddenly, the pathological processes that create them accumulate over a period of many years. Yet, the individual does not experience any physical distress, so they are not affecting the primary channels, which are responsible for the individual’s moment-to-moment physiological and experiential process.

Discovering the Alchemy of Healing (PDF – 52kb)

December ’06: The Spirit of Inquiry

Acupuncturists and herbalists face a daunting task in learning our healing arts. The history of Chinese medicine is vast; its conceptual frameworks varied, and richly textured. The poetic and evocative language of Chinese medicine has inspired penetrating and profound inquiry into the nature of life in health and disease for more than twenty centuries. Yet, among our contemporary teachers, we have surprisingly narrow guides for uncovering its riches.

The Spirit of Inquiry (PDF – 72kb)

February ’07: Understanding the Channels through Experience

Chinese exercises appeal to many beyond our profession. Their wide variety can attract people with many different interests. Young people appreciate the physical discipline of learning a martial art, and the self-esteem one gains in strengthening and training the body. These benefits certainly extend to adults, and as people mature some are drawn to the more sublime pleasures and benefits of internal martial arts such as taijiquan, and the wide variety of qigong exercises.

Understanding the Channels through Experience (PDF – 52kb)

April ’07: The Tragic (Second) Modernization of Chinese Medicine

Chinese medicine arose, developed, and flourished in a pre-modern society, with decidedly pre-modern ideas and concepts. Early beliefs regarding pathogenesis focused on ghosts, and other spiritual entities. The recording of Neijing was a pivotal step in the first modernization of Chinese medicine. The classic texts of Neijing (Suwen and Lingshu) focused primarily on natural factors, such as wind and cold, and specific emotions such as anger, as the causes of disease. They also introduced the idea that diseases evolve naturally, rather than arising and developing randomly.

The Tragic (Second) Modernization of Chinese Medicine (PDF – 56kb)

June ’07: Sorting Out Symptoms

More than twenty-one hundred years ago a devoted student and practitioner of medicine named Chun-yu I delineated four stages in the transmission of Chinese medical texts. These four stages provide valuable insight into the process of mastering the teachings based on the oldest medical classics. The first two stages, receiving and reading, can be attained through good luck in finding a competent teacher, and diligent work in study. The third and fourth stages require the creative inspiration of the student in learning to apply the theoretical principles to diagnose and treat specific individuals.

Sorting Out Symptoms (PDF – 64kb)

August ’07: Beyond Substance to Process

Chinese medicine is more (and less!) than the symptom-sign complexes used to identify imbalances of the zangfu (vital and hollow organs). Current clinical doctrines arise from several themes of modernization that cloud the eyes of most contemporary people to the magical possibilities for healing discussed during the history of Chinese medicine. The modern world is so penetrated by wondrous external technologies that many fail to appreciate the equally amazing internal technology presented in the classic texts of Huangdi Neijing (The Yellow Emperor’s Classic of Internal [Medicine]).

Beyond Substance to Process (PDF – 68kb)

October ’07: The Challenge of Aging

One of the great challenges of aging is that ailments frequently descend on individuals for no apparent reason. People who have been generally “healthy” and fit suddenly find themselves confronted by pains and other limitations. Sometimes, serious illnesses arise without discernable precipitating factors. Many people are left with the awful questions: “Why me?” and “Why now?”

Most often patients simply complain that they’ve now unable to do certain things that they’ve “always done.” Many “retired” people note that they’ve decreased their external stressors, and hence believe their sources of distress have been resolved. They wonder how emotional and spiritual factors can contribute to their current ailments. The conceptual and emotional challenge faced by patients and practitioners alike is that most people think they experience life in the present.

The Challenge of Aging (PDF -48kb)

December ’07: Facing the Challenges of “Aging”

Individuals fall out of the Amniotic Sea, and emerge into this world of duality. We transform from being physically connected to the source and exchanging processed nutrients to a state where each individual must commit to processing his or her own interactions with the world. Yet, if the fetus passes urine or stools into the Sea, it faces a dangerous challenge. Physical connection to the source through the umbilical cord obviates the need and the opportunity to maintain the internal environment to support growth. The mother’s organs do that work; she gives her essence so the fetus can grow in oneness with her life.

Facing the Challenges of “Aging” (PDF – 60kb)

February ’08: The Peculiar Power of Chinese Medicine

Modern Chinese medicine follows western medicine in defining its specialties according to a patient’s manifest pathology. This “common sense” approach classifies, for instance, a post-menopausal woman with heavy vaginal bleeding as a gynecology case and a patient with chief complaints of abdominal bloating and irregular bowel movements a case for the digestive specialty. While categorizing the physical expression of pathogenic process is familiar, it misses the peculiar power of classical and historical Chinese medicine.

The Peculiar Power of Chinese Medicine (PDF – 64kb)

April ’08: The Fine Art of Subtle Manipulation

Acupuncture stimulates the embodied spirit to change life process (qi). Manipulating needles conducts movement to unblock vital flow, or attract it to emptiness. Acupuncture focuses movement and responsiveness to enhance the potency of specific vital functions. This art stimulates the emergence of healing as a natural expression of the embodied spirit, rather than attempting to control the symptoms or signs that communicate distress.

Of course, individuals want to diminish the intensity and severity of unpleasant symptoms. Many patients seek treatments with proven benefits, often through controlling the expression of pathology, even if the relief they seek is fleeting. Unfortunately, attempts to control pathological expression simply displace the embodied spirit’s struggle, rather than resolving it. They elicit rebellion from the embodied spirit, which renews the very symptoms or signs one had tried to control. This cycle of short term control and rebellion reinforces the original pathology by training the embodied spirit to recreate it.

The Fine Art of Subtle Manipulation (PDF – 52kb)

June ’08: History Written into the Body

Taking patient histories is an art. We ask questions. Their personalities respond, and we must sort through their moods and projections to form clear pictures of both current manifestations and the sequence of developments leading to them. Memory is subject to revision as the individual’s personality rationalizes its experience. Even accurate information is limited by the patient’s inability to identify causal relationships.

Somatic and spiritual reactions to various stimuli are not always obvious. Despite the challenge of relating cause and effect, patient histories remain among the most important information practitioners use to discriminate the dynamics of each individual’s struggles. Some clinical traditions focus on individuals’ constitutional tendencies toward certain dysfunctions, and identify “elemental” patterns in their patients’ responses to various questions. While this approach enhances modern TCM, which classifies only the manifesting symptoms and signs, it remains only a partial solution to its deficiencies caused by focusing solely on presentations.

History Written into the Body (PDF – 52kb)

August ’08: The Dynamics of Yin-Yang

This essay is being re-written. Thank you for your patience.

October ’08: Specialties in Chinese Medicine

In the June ’08 issue of Acupuncture Today, Leon Hammer wrote an impassioned essay decrying our profession’s current fascination with specialization. While he shed welcome light on the professional insecurity that motivates some to adopt modern specialties, Dr. Hammer didn’t focus on the enduring value of historical specialties, which differ from their modern counterparts. Rather than categorizing patients simplistically according to the expression of their pathologies as Dr. Hammer rightly criticized, historical specialties differentiate patients by the source of their ailments.

Specialties in Chinese Medicine (PDF – 64kb)

December ’08: Wherefore Humanity

October 10, 2008 in the Sierra Nevada foothills: I walked out the front door of my house this morning, and saw a doe with her young fawn grazing for pine nuts and other tasty morsels in my yard. The sun was warm this morning, with a hint of the impending chill of autumn in the air. It’s a great time to be a human being, even though it’s been a REALY LOUSY month to be an economic being.

A close friend who owns a small business shared with me his profound sense of impending doom. While his investments to transform production methods during the past year have diminished his payroll, thus making his business more resilient to a downturn, this week he reported feeling “like he’s going to die.” His identity and self worth have been so entangled with his business accomplishments that he “can’t see beyond” the current crisis to a time when life will again be “normal.”

Wherefore Humanity (PDF – 60kb)

February ’09: Managing the Internal Economy

Life is based on transactions. Embodied spirits live by exchanging both physical and experiential influences with the environment. Individuals ingest food and drink as physical inputs and sense data as experiential inputs, which are both grasped internally to digest them. This is the process that generates post-natal qi, allowing the embodied spirit to survive as an individual. Indeed, the core physical functions of the zangfu associated with the first three primary channels (sequence following Lingshu, chap. 10) clearly demonstrate that embodied spirits live through transacting with the environment:

Managing the Internal Economy (PDF – 76kb)

April ’09: The Myth of Deficiency

This was my last column printed by Acupuncture Today. Actually, the version they printed was substantially different. I disavow their version, which was entitled “More is Better.” Yes, they even changed the title, without consulting me, and that wasn’t the only damage they did to my essay. Read the original — here for the first time.

If some is good, more is better. Bigger, Faster, Newer, Stronger. America has a voracious appetite for goods and services, and modern economic activity produces a vast array of them to give our personalities a constant flow of stimulating experiences. Both physical and experiential interactions with the outside world generate internal transactions. These transactions then yield influences that are:

  • Integrated into postnatal qi – qi and blood, which are the ability to interact with the environment and the capacity to experience that process
  • Released or expelled – back to the environment
  • Unresolved and suspended – within the being

The Myth of Deficiency (PDF – 88kb)