Teaching Neijing Acupuncture

Nearly six years ago, I was ask to develop a short series of seminars to introduce the five systems of channels and vessels of acupuncture. I tried in good faith to organize such a series, and the plan ended up including eighteen weekends, most of which were conceived as three day meetings. My continuing education contact at Golden Flower, John, chuckled and noted that I wasn’t known well enough to attract people for such a long series. He concluded, “I wasn’t looking for the ‘master series,’ I just want an introduction.”

I looked back with a firm gaze and said, “Eighteen weekends IS the Introduction; you must want the Cliff’s Notes for the Introduction.”

John’s smile faded to reveal determination, “we can package and enroll a few weekends; just keep it down to a few.”

So, I set about writing a SHORT series to organize and convey the fundamental theory and some key clinical practices for using the five systems of channels and vessels. The result was a four weekend series, which eventually grew to five. I taught that series three times (2010-12), and prepared handouts that grew to nearly two hundred pages. I shared a huge amount of information, including instruction and guidance on using it. It was a massive undertaking, and it turned out to be far too much. By the end of my third time through the series (2012 in Santa Cruz), my participation in the usual information-based approach to teaching acupuncture felt a bit like putting a fire hose into the mouths of participants and turning it on, while inviting them to drink. Although I had tried to fulfill what I’d been asked to do, I finally realized there was a fundamental flaw; I’d allowed the direction of my teaching to be focused by the wrong question. I needed to find the right question(s).

Had I been among a select group of literate Chinese doctors more than thousand years ago facing such a challenge, I would simply have turned to Nèijīng for inspiration. While the texts of Nèijīng are now readily available for purchase, they are certainly not easy to study. My path has necessarily included study of classical Chinese, which is difficult, even for native speakers of the modern language, which I am not. Yet, I’ve worked with experts in classical Chinese who have helped me explore the language of these challenging texts, which were originally conceived only as companions to the oral transmission of teachings. How can one hope to understand them without receiving such practical teachings?

This apparently separate stream of work delving into Nèijīng during the past few years coincided with this quest for clarity around my teaching. I’ve been eyeball deep in various chapters from Nèijīng, both Língshū (which was long known as “Acupuncture Classic”) and Sùwèn, including its classical language and writing style. I’ve considered layers of connotation implied in Nèijīng, reflected on my experience, and frequently recalled seemingly random comments from a couple hundred weekends of classes with Jeffrey Yuen, during more than twenty years. In my search for the right question(s) about acupuncture, and I’ve been particularly inspired by ‘unpacking’ the first chapter of Língshū.

My confluence of many years of experience using lineage-based acupuncture teachings with study of the texts has begun to bear fruit. My experience with methods like the 鑱 (chán, chisel) needle technique from my lineage allows me to understand the frequently vague and suggestive language of the Classic differently from sinologists, even though I depend on them to help me understand the meanings of the characters, grammar and syntax. I believe my sensibilities as a practitioner will allow me to share topics from the classical language of Nèijīng particularly well for practitioners. This seminar grounds study of Nèijīng in experience, by sharing the chán needling technique, which simulates the first needle of Nèijīng, at the beginning of the weekend. We will learn about at least two implied hierarchies of needling, when the ‘small needles’ are introduced in the first chapter of Língshū. Do they remain important: why or why not?

Practicing the chán needling method is a wonderful clinical exercise, which is fundamental to studying Nèijīng acupuncture. The chán is the first of the nine ‘small needles’ introduced in Nèijīng, so it is naturally the first to master. The first chapter of Língshū clearly suggests mastering the chán needle to communicate with the channels and vessels, before moving on to more sophisticated applications, such as attuning points to various functions, as we see taught in acupuncture texts throughout the past five hundred years. Yet, practitioners who begin with the chán needle can deepen their relationships with the entire art of acupuncture.

After participants have learned and experienced this exercise, we will see that much of the beginning of the first chapter of Língshū is a shockingly literal and accurate description of its key principles. Yet, this seminal chapter is not a clinical textbook; while it share standards and values, it does not provide a description of how to practice needling this way. Such instruction was considered the exclusive purview of personal transmission from a teacher. Instead, after a few brief remarks to inspire practitioners to greatness at the beginning of this chapter, its theory and thinking process grows complex. This immediate shift indicates we must be ready to pay careful attention and work diligently to uncover the many layers of meaning in Nèijīng.

While I recognize the value of reading Língshū 1 from the beginning, I don’t want to get bogged down with those complexities from the outset. So, we’ll just skip over a few lines this time, and come back to study Língshū 1 from beginning to end, after we’ve ‘unpacked’ the peculiar ideas and worldview of the Classic. This seemingly arbitrary choice to skip those lines is supported by a phrase in the first line of this chapter, which we will discuss during this initial weekend seminar. That phrase can be construed to tell us the key topics of the lines we’ll skip are beyond the beginner. My pedagogical choice appears to align with the texts’ own suggestion for study. The sequence of each day of the seminar is fundamental to the teaching strategy:

Reflect on the Art (術, shù) of Acupuncture, by asking some penetrating questions about our work as practitioners
Learn and experience a new way to do, and thus to understand, acupuncture
Discuss some carefully selected passages from Nèijīng, which are both accessible and clinically relevant

On Saturday afternoon of this seminar, we will see how the needling exercise we learned and practiced during the morning is described quite precisely in selected lines from the first half of Língshū 1. Sunday morning, we will palpate for temperature changes in the skin, and learn a needling technique from Língshū to release superficial cold. The clinical skills we will explore during this initial weekend seminar all focus on identifying and releasing blocks in wèi . Sunday afternoon we will look at some passages from Sùwèn 13 and Língshū 47, which relate to the morning’s clinical exercises and build upon the material we studied from Língshū 1 the prior afternoon.

We will see that the còulǐ (anatomically, the skin) is an amazingly rich terrain for acupuncture. It is MUCH more than just the initial painful stage of insertion, which we learned to penetrate as quickly and painlessly as possible. Indeed, many practitioners choose to avoid it almost entirely, by using insertion tubes with very fine needles. Might we instead learn something important about acupuncture and human life, by learning to work with wèi qì in the còulǐ?

Yet, I don’t blame members of our profession AT ALL for using insertion tubes. I understand the impulse to decrease the pain of needle insertion. We are not taught to work with wèi qì, and especially the còulǐ, when we learn to needle in acupuncture school. What other choice does a compassionate practitioner have, especially when many experience thin Japanese needles inserted with tubes working as well as the contemporary Chinese needling methods we learn? Typical contemporary needling practices, either with or without insertion tubes, skip the concentration of wèi qì at the còulǐ. This oversight is particularly tragic, because it is exactly where the first chapter of Língshū tells us to start!

Might some practitioners and students of acupuncture wish to begin cultivating the art of acupuncture as Língshū suggests? Does such focus generate a substantially different service from the modern Chinese acupuncture we have learned? In a very practical sense, learning to free up wèi qì can allow practitioners to make many of their treatments effective, without having to draw on yuán qì through deep needling with long retention.

I believe we will advance the profession, by going past single-minded focus on finding effective treatments to explore how they work. If a patient’s condition dictates that we elicit yuán qì to make his or her treatments work, doing so well is a wonderful gift. On the other hand, if we can learn to use wèi qì effectively, so we draw on yuán qì only when truly necessary, we will preserve that precious resource. The first chapter of Língshū (line 11.7, included among the handouts for this first seminar) instructs that our treatments will weaken the patient, if we needle very deeply before releasing blockages of wèi qì (with perverse ) to the outside.

Língshū clearly suggests a hierarchy for engaging a patient’s , and it starts with wèi. Alas, the commonly taught modern Chinese needling practice for needle insertion and 得氣 (déqì, achieving the ) fails to recognize the profound nature of this ‘layer’ of an individual’s life. This seminar might be understood simply as a remediation, which introduces this critical first stage of acupuncture. I believe this seminar represents a step forward for our profession, by seeking wisdom from its classical roots.

Rather than trying to organize and convey a lot of theory, most of which is rather different from what we learned in acupuncture school, we start this seminar exploring the practice itself. We will discuss fundamental topics, and then launch directly into the first clinical workshop:

What is acupuncture? What are we doing with needles?
What is 得氣 (déqì), and why is it important? Who feels it? How does it feel?

During this first weekend seminar, I will share about fifteen (15) pages of my renditions from Nèijīng, and we will discuss both the language and clinical application of the text. Most of the theory I’ve tried to teach in the past, derives from working with my lineage’s transmission of Nèijīng, and I now realize one must develop a relationship with it over time. I still use all of it, I’ve simply realized that I can’t lead with that STUFF. If I want to share my understanding of acupuncture, I need to start from the beginning — as a healing art, based on ‘playing with’ the  and eliciting its response.

Two Kinds of Scholarship

One challenge modern people face in studying classical Chinese medicine is recognizing, appreciating, and eventually participating in the peculiar nature of classical Chinese scholarship. While modern scholarship has contributed substantially to our understanding of Neijing (Inner Classic) by establishing the ‘provenance’ of the received texts, its value wanes substantially beyond that. Literary reading of classic texts like Neijing can only recognize a portion of their teachings, because they were designed as contemplation companions rather than textbooks.

The texts of NeijingSuwen (Simple Questions) and Lingshu (The Soul’s Pivot) were recorded approximately a thousand years before the advent of mechanical printing. When those texts were conceived and initially codified, a student could not simply buy them. They were only available to individuals who found a teacher that would convey their teachings and allow the seeker to copy the written texts by hand. They are not textbooks; rather, they are poetry intended to stimulate contemplation and creative problem solving. Specifically, nearly all chapters of Neijing are snippets of dialogue, which together present a conceptual tapestry of an approach to classical Chinese medicine.

The Written Texts of Classical Chinese Medicine are NOT their Entire Teachings!

As a student or practitioner contemplates his or her experience, he or she can find more meaning in the classical texts of Suwen and Lingshu. Of course, this is true for any profound text, either ancient or modern. However, in addition to finding multiple ‘levels’ of meaning in this relatively common way, the texts of Neijing have another process of encoding ‘secret teachings’ into their text through ambiguities and alternate reading of various passages. The language of these texts is subtle and beautiful, and most importantly poetic. The text invites contemplative reverie in one’s experience, both as an embodied spirit and as a practitioner who considers the trial and tribulations of many embodied spirits. The words can be translated, and one can tell a few stories to share A BIT of one’s experience, but the breadth of one’s experience cannot be shared in words. Each individual student of Neijing must grasp for oneself the ability to identify and work through its conundrums. Learning classical Chinese medicine is so much more than simply learning to differentiate the expression of distress into diagnostic categories.

Perhaps the greatest confusions concerning the meaning and import of classical Chinese medical texts arise from modern scholarship, which organizes and categorizes the information conveyed in the language of the texts. This ‘HAVING’ (in Chinese, 有 [yǒu]) of information gives the impression that one knows Chinese medicine, but it is divorced from practical knowledge of the material, so it fails to truly understand the texts. The texts of Neijing invite practitioners to cultivate a dynamic and responsive ‘NOT HAVING’ (無 [wú]) approach to practicing Chinese medicine. What the heck is that?

‘HAVING’ (有, Yǒu) and ‘NOT HAVING’ (無, ) in Chinese Medicine

Clinical doctrines of Chinese medicine contain bits of discrete information. We learn associations for a fairly large number of symptoms and diagnostic signs. Then, we learn that when a patient presents with a few of the key symptoms and signs of various “imbalances,” that person HAS that syndrome. Most often patients are identified with a few syndromes, and then a treatment strategy is determined. It is relatively easy to project the clinical associations of a clinical doctrine of Chinese medicine onto a patient, and that is only the first step of diagnosis. It is a 有 (yǒu, ‘having’) approach to medicine, and thus represents only the grossest of beginnings.

Classical Chinese thought, especially inspired by Daoist perspectives, was focused on 無 (, ‘not having’). Relative to medicine, that means keeping all the theory and information one knows IN THE BACK GROUND, while one is simply present with the patient — following the flow of life. The ‘goal’ of this process is NOT to attribute the patient to a group of symptom-sign complexes, but to identify his or her blocks in life. While that may just seem like ‘just language,’ these are profoundly different activities. 有 (yǒu, ‘having’) knowledge projects it onto phenomena which are then differentiated according to the categories of one’s knowledge. On the other hand, 無 (, ‘not having’) knowledge allows the symbolic imagery of Chinese medicine to be elicited by what one sees and feels in examining a patient, so one can make key differentiations to discern the flux of the individual patient’s life.

Clinical doctrines that differentiate the symptoms and signs of disease into diagnostic categories exhibit a 有 (yǒu, ‘having’) approach to Chinese medicine, which can only be partially correct. Well, that’s quite a claim! There are at least two good reasons for that claim:

  1. By nature, pathologies progress. While that MAY be simply a matter of accumulating more of some pathogenic factor that directly stagnates the intrinsic flow of , most often the embodied spirit reacts to change pathogenic factors in some way. The expression of most pathologies evolve, so how they present is often not their original nature.
  2. Symptoms and signs ARE NOT the direct expression of pathology; rather, they reflect the embodied spirit’s reaction to pathogenic factors the individual has failed to resolve. Manifest ‘imbalances’ arise from both the ‘underlying’ pathogenic factors, and how 衛氣 (wèi qì) has activating to defend the individual. Thus, treatments that manage manifest imbalances suppress the individual’s 衛氣 (wèi qì), while they try to resolve pathogenic factors.

When practitioners 有 (yǒu, ‘have’) a clinical doctrine to project onto their patients, they gain a sense of security and empowerment. Yet, they limit their inquiries into their patients’ suffering to how that doctrine understands various diseases. Differential diagnosis from the perspective of 有 (yǒu, ‘having’) a clinical doctrine generally assigns patients to various diagnostic categories, rather than identifying specific individual blocks leading to their manifest imbalances.

On the other hand, as they continue to study Chinese medicine, practitioners who are willing to 無 (, ‘not have’) their knowledge can begin to use their experience creatively to discern each individual patient’s blocks. What the heck does that mean?

A Prolegomena to ‘Not Knowing’ Chinese Medicine

All perceptions are accompanied by questions, and every conclusion inspires several more questions than it answers. One’s ‘knowledge’ does not grow from a secure basis; rather, it is an ongoing inquiry:

  • From where do these symptoms and signs (as the expression of distress) arise?
  • What is the dynamic process of the pathology, rather than simply ‘what is the nature of its expression’?
  • How can I ‘sort out’ the pathogenic factors from the embodied spirit’s reactions to them?
  • How can I stimulate and facilitate the embodied spirit’s intrinsic response to pathogenic stagnation, rather than suppressing or ‘harmonizing’ its expression?

Seek the ‘subtle,’ (hidden) dynamic within any expression, rather than simply describing its manifest nature. This is the way of 無 (, ‘not having’)-type Chinese Medicine, which probes into the magical possibilities for profound healing of the embodied spirit.



Picking Fights with Luminaries?

A few weeks ago, a friend wrote an email to me after reading my initial posting on studying Neijing in Chinese. He was concerned that I might undermine my attempt to educate our profession by ‘picking fights with luminaries,’ before I was ready to make my case. I assured him that I’ve done my ‘homework,’ and am ready to share and defend (if necessary) my beliefs about Chinese medicine. While it’s true that I haven’t translated the entire Neijing, I’ve done some of it carefully enough to clearly identify how those two classic texts of Chinese medicine ‘encode’ their most profound teachings. Some teachings are clearly available for anyone to read, while others are ‘hidden in plain sight’ by means of some ambiguity or alternate reading. These obscure ‘hidden teachings’ can be found by readers who had already received practical instruction in the teachings represented by the text, but are generally glossed over by other literate readers. While this suggestion may shock our modern egalitarian sensibilities, and challenge our understanding of scholarship, it is also consistent with academic work on the transmission of classical medical teachings.

Yet, I wonder if he’s right that many readers may perceive my points as ‘personal’ attacks, rather than well reasoned scholarly arguments. I’ve discussed two fine examples of this ‘encoding’ process in some detail in my blog — one in that first long essay, and the other in a shorter essay on the challenges of studying Neijing about a week later. I believe those two examples alone suggest our profession look more carefully at Neijing. Might there be more to the classics than most contemporary practitioners realize? Might the classics suggest a very different approach to Chinese medicine than our contemporary clinical doctrine based on differentiating patients into symptom-sign complexes of the 藏府 (zàngfǔ)? How might our sense of Chinese medicine grow and even transform through studying Neijing?

And, I wonder…who are these ‘luminaries,’ and why would their followers be polarized by my comments and questions? I don’t believe I’ve attacked anyone, though I’m aware others — with different points of view — may see it differently. I don’t believe I’m ‘attacking’ anything that illuminates, but rather clarifying confusions and misunderstandings. Since most practitioner’s don’t study classical Chinese sufficiently well to study Neijing themselves, they must use the work of others. Whose reading of the classics does one trust, and what characteristics does one look for in a translation?

Regarding the ‘luminaries’ my friend was so concerned I had attacked, I mentioned the work of only two individuals in that essay. However, I’ve also been reminded recently that many teachers of Chinese medicine, especially ones trained in China, are rather touchy about having their approach to Chinese medicine characterized as “the modern clinical doctrine,” rather their preferred name of “Traditional Chinese Medicine.” There is an unspoken assumption among many contemporary practitioners that understanding of Chinese medicine has improved over time, and that we should trust the Chinese to provide us the theory and practice of Chinese medicine. Most practitioners simply trust the translators of historical material who step forward, because doing this work themselves would require they master another substantial specialty in the language. There has generally been an emphasis on ‘practical’ information, which accentuates the huge volume of works generated since the advent of mechanical printing, and virtually no discussion of philosophical exploration of the classics of Chinese medicine. Aside from practical their interest, relatively modern texts are much easier to translate than the classics, especially Neijing.

On Paul Unschuld’s translations and scholarship on the Chinese medicine classics:

The most highly respected translations of two of the three primary classic texts of Chinese medicine (Suwen and Nanjing) were done by the academic specialist Paul Unschuld, who considers the aspiration to practice ‘classical Chinese medicine’ foolish. While he can read the texts, he considers them only historical artifacts, rather than inspiration for a living inquiry. He doesn’t understand the medicine, and failed to mention there is clear historical evidence that classical Chinese medical texts were intended only for students who were also receiving their practical teachings. While Unschuld’s translations certainly help me with some of the difficult grammar and usage, I think he gets some passages very wrong, and his lack of interest in the use of the material in the classics prevents him from accurately understanding their content.

Suwen and Lingshu are primarily brief snippets of dialogue intended to stimulate thought, rather than complete discussions of theory. They stimulate practitioners to deepen their understanding of Chinese medicine by fermenting their practical teachings and experience, rather than describing the theoretical framework or thinking process. While they contain much important information, they generally fail to describe how to integrate it into one’s thinking process and practical work. That was left to the practical instruction one received from a lineage, so why would one trust the conclusions of someone who has only a literary relationship with the texts?

Unschuld’s work on these classics should certainly be consulted, but it should not be trusted uncritically, especially by practitioners seeking inspiration from the classics. Learn from his superior understanding of the language, but leave conclusions about the content and import of the classics to people who know them through use. Neijing is unlike more modern texts, and especially ‘western’ texts and references. While it contains much information, its purpose is not primarily to organize a body of doctrine. Rather, it is philosophical poetry intended to stimulate thought, especially contemplation on one’s experience. In that regard, it is much like Dao De Jing or Yi Jing; while these slightly older classics consists of brief poems, the medical classic consists primarily of short exchanges of dialogue.

On Ed Neal’s work with Neijing:

Dr. Neal is a medical doctor, who became interested in acupuncture more than twenty years ago. He studied with an Italian doctor, who had trained with a Chinese doctor that practiced a ‘pre-TCM’ version of Chinese medicine. The Chinese doctor frequently referred to Neijing, and Dr. Neal’s mentor consequently did so as well. While Dr. Neal refers to his ‘Italian lineage,’ those references primarily recall the leisurely and congenial lifestyle he experienced during visits with his teacher. He declares quite clearly that his methodology for studying the text is based solely on reading, compiling, and organizing the information, then experimenting with applying what it seems to instruct. As he reads the text, he recognizes there are many questions that will require further research and experimentation, and he shared the results of one example of that experimentation. Dr. Neal proudly characterizes his work to restore interest in Neijing starts by reading the classic from scratch to start using its teachings.

To his credit, Dr. Neal clearly taught that acupuncture based on Neijing is much more about needling the proper channel(s), rather than needling points according to functions and indications that were articulated much later in Chinese medical history. Unfortunately, his knowledge of classical Chinese falls short of a well-trained academic, and his reading of the classic includes some fundamental errors. Two of these ‘fundamental errors’ involve his translation of the names of two ‘secondary vessels’ in chapters 10 and 11 of Lingshu. Those mistakes are ‘fundamental,’ because they lead to secondary errors in attributing information about these ‘secondary vessels’ from many other chapters. While Dr. Neal claims his unique names for those systems of channels and vessels are evidence of his rediscovering the classic, they are errors that introduce pervasive confusions into his teachings.

I agree that ‘modern’ Chinese medicine, since at least the Song Dynasty (960-1279), has moved a long way from its classical roots. We certainly have a lot of work to do in ‘rediscovering’ classical medicine, and I believe Dr. Neal’s methodology is fatally flawed. Beyond much of it being difficult to decipher, when Neijing was recorded the written text was understood to be a only companion for students who were receiving practical instruction in medicine. It provided ongoing stimulation and inspiration, by challenging the reader with many cognitive puzzles, which I’ve called ‘conundrums’ in other essays. Before the advent of mechanical printing, which allowed relatively broad distribution, the written texts were the source of ongoing inspiration that the student copied by hand and took with him (or her), after completing initial training with a teacher.

On other ‘luminaries’ of Chinese medicine:

I certainly don’t blame any particular individual for the sad state of contemporary acupuncture theory. The recent history of Chinese medicine has been tumultuous, and it has been profoundly impacted by modern ‘scientific’ thinking and worldview. I’m sure most acupuncture teachers are doing their best in this difficult situation; many seek out and find wonderful empirical acupuncture teachings such as those of many Japanese teachers or for instance Susan Johnson’s work with Master Tung’s lineage. None the less, I believe contemporary acupuncture education has severe systemic shortcomings, including its ‘professional’ focus with a strong emphasis on standardized and consistent information (that can be tested on licensing exams), rather than ‘academic’ focus that emphasizes students developing their critical thinking. Rich understanding of clinical Chinese medical relies on study of both Chinese ‘philosophy’ and the history of Chinese medicine, and especially through contemplating the meanings of various groups of symbolic images. It cannot be divined solely from organizing information in contemporary textbooks.

Yet, regardless of how wonderful or lacking one’s initial training may be, the depth of each individual’s understanding of Chinese medicine depends on both conceptual training and practical experience. Ideally, these two components ferment each other to deepen one’s relationship with Chinese medicine, and one learns throughout one’s entire career. The most important opportunity for profound learning occurs after a practitioner has five or ten, or even twenty or more years of experience — after one has a clear understanding of both the strengths and weakness of ‘textbook’ Chinese medicine. Yet, one of the key standards of our required continuing education is that the participant can apply what one learn over the weekend in the clinic on Monday. How can one hope to probe the depths of Chinese medicine, while fulfilling that standard?

Might it be time for a next generation of acupuncture education, based in study of Neijing and focused on stimulating participants to develop their Chinese medical thinking and problem solving?

Martial Arts Training with a Master

Sometimes it’s hard to keep your feet firmly on the ground, especially when you’re  a student approaching a Master, and think you know your stuff. Certainly, that is true for the ‘physical’ martial arts. It is no less true for martial art of the spirit.

What is “martial arts of the spirit?”

Martial artists of the spirit, like their physical martial arts ‘cousins,’ train their awareness to be awake and alert. Further, both types of martial arts use their awareness to grow strong and secure in their own ground. Yet, while a usual martial artist directs that awareness to some physical acts, the martial artist of the spirit devotes his or her awareness specifically toward rooting out unconscious identification with his or her own projections of static point of view. Wow that’s a mouthful! I’ve written at some length about the process of transcending one’s ‘usual’ perception through symbolic thinking; that is a long journey, which requires considerable attention. Yet, only liberation from one’s automatically projected interpretations allows one to begin perceiving phenomena as they are, and thereby begin to discern the subtle dynamics of Dao.

In our initial training, all acupuncturists learn to categorize a patient’s overt expressions of distress into zàngfǔ syndromes, which differentiate excesses and deficiencies of various humors (blood, , fluids, and eventually yīn and yáng). While this is a start, it is far from the perfect differentiation for most patients. Let us say, for instance, that a person has many signs of dampness with overt stagnation in the abdomen, such as fatigue, a sense of heaviness, bloating after eating, digestive irregularities, etc. Does that necessarily mean this patient has spleen  deficiency with  stagnation of the middle jiāo leading to dampness (possibly secondary to food stagnation, so ask about the patient’s eating habits)? Well, it might mean that, though there are myriad other causes for blockage of an individual’s fluid system, which can then ‘back up’ into the spleen and stomach — the individual’s ongoing source of fluids through the ingestion and digestion of water and foods. One might primarily have:

  • a lung  deficiency, which inadequately disseminates  and fluids, and might specifically
    • descend inadequate fluids to the kidney and urinary bladder to differentiate and eventually eliminate waste
  • a blockage of wèi qì in:
    • the còulǐ — I’ve found this is VERY common among contemporary people, probably secondary to our local climate control and sedentary lifestyles
    • the sinews  — of course this is also fairly common, and it’s not always easy to differentiate whether the sinew blockage is primary or secondary to some internal imbalance
  • a blockage of the urinary bladder by damp-heat or cold, or
    • other blockages of the lower jiāo, such as the liver by cold

And, this is only a partial list!

But, wouldn’t these other causes overtly express themselves? They certainly might, though the expression of those ‘primary causes’ may not be any more clear than the symptoms mentioned above. In that case, the clinical doctrine of modern Chinese medicine teaches us to simply add suitable ‘imbalances’ of physiological distress registering in manifest symptoms or signs to the diagnosis. Of course, those added syndromes may or may not capture the dynamics that create that patient’s clinical expression.

But, why doesn’t the primary cause show the strongest? There are many reasons for that peculiarity, though perhaps the primary one is that the ‘primary cause’ has been (or may still be) relatively well maintained. What the heck does that mean?

Let us say, for instance, that our patient is a middle aged woman, who had a history of several urinary tract infections during her teens. She took anti-biotics for those infections, and each promptly went away. She learned to drink a lot of water, and she drinks tea, but not many other drinks. Whenever she feels mild symptoms in her lower abdomen near her urinary bladder, she drinks cranberry juice and an herbal product originally give by a practitioner whom she consulted ten years ago when she had a rare infection. Now, she doesn’t get urinary tract infections, perhaps mostly due to her care in preventing them — drinking lots of water generally helps people with a tendency toward urinary tract infections, and tea is somewhat diuretic, so at the very least drinking it helps her manage a slight excess of fluids. One may or may not believe the other remedies allow her to treat incipient infections; it doesn’t really matter, because patients who have learned to manage their ‘primary’ pathological processes abound, and this woman’s mild fluid excess was apparently managed until:

  • it has simply overwhelmed the spleen and stomach, or
  • some other factor, such as a blockage in the còulǐ, precipitates the eventual manifest stagnation

There is almost always a process, and I believe our job is to clarify it. When a practitioner can identify a patient’s specific block(s) clearly enough, then he or she can develop a treatment strategy according to the principle of ‘moving a thousand pounds with four ounces of force’ to stimulate profound transformation of the patient’s physiological process. Thereby, one can stimulate the resolution of pathology, rather than simply learning to classify the expression of distress, and working to find ways to control it. While one may find effective management for a chronic pathology, we limit our potential to participate in the profound healing of our patients when we conflate effective management with ‘cure.’ True cure entails resolution.

How do practitioners learn to discern key blocks, so they can develop strategies to stimulate their patients to resolve their diseases rather than maintaining them?

It’s a process, though it begins by setting aside the projections we all learned from the contemporary clinical doctrine of Chinese medicine. Those ideas aren’t ‘wrong,’ though the diagnostic process of differentiating the (already) manifest expression of distress is inherently limited. Pathologies grow and develop; the first thing to remember is that each human life is tasked with survival, and they find many different ways to fulfill that imperative. Each individual compensates and adapts to various challenges, adjusting to circumstances and events to secure the basic requirements of life. While a person with the manifest symptoms listed above appears to have a spleen  deficiency with  stagnation in the middle jiāo, that is only where their distress manifests. Although it is certainly overwhelmed, the spleen may not even be deficient; when the ‘core’ block is cleared, the spleen’s adequate function may be restored without any further attention.

If the manifesting channel (or zàngfǔ) is not the source of one’s pathology, as for the spleen in this example, treating it will become an ongoing process of management. Sometimes, such strategies don’t work at all, and at best they provide temporary relief, until they stop working. This is the most common scenario when one treats the manifesting expression of an individual’s pathology, rather than identifying and addressing its roots (etiology) and pathological process.

So, this process of differentiating an individual’s dynamics comes down to letting go of projections, and that brings us back to ‘martial arts of the spirit.’ When one brings fixed projections, based in modern TCM, any other Chinese medical doctrine, or most especially modern ‘scientific worldview’ to the study of Neijing, one either:

  • misses many of the classic’s most subtle and profound teachings, or
  • simply gets confused — tumbled and disoriented, like being thrown for a triple somersault with two twists.

Most often, people experience a combination of both, when confronted with the ‘jumble’ of ideas and concepts in Neijing. As the clinical science of Chinese medicine grew and developed, there was a massive proliferation of information, but the breadth and depth of its classical source faded. Each school of thought chose to emphasize those portions of doctrine from “the classic” that support their approach, regardless of the context of those ideas. Thus, Neijing became the source of many contrary doctrines, and its deeper stream of coherent inquiry was largely lost in the confusion.

How might we ‘reclaim’ the classic texts of Neijing? Well, that process certainly starts with considerable study. Neijing study presents many challenges, because their tapestries of chapters were sacred texts rather than textbooks. They were intended as poetic inspiration for those who had already received teachings through personal instruction; the texts by themselves were never meant to provide systematic instruction. Perhaps seeking lineage instruction could help one decipher the texts of Neijing, and thereby uncover more of their practical application.

But, how can we evaluate the legitimacy of a purported ‘lineage’? This is a BIG challenge, though there may be several clues:

  • cogency and philosophical depth, especially concerning the nature of life in health and disease, which may be challenging to find due to:
  • an element of ‘martial arts of the spirit’ to stimulate one to transform one’s point of view, rather than just adding new doctrine
  • clinical efficacy
  • finding one’s teachings in the texts, especially being able to identify some of the many ‘conundrums’ in Neijing

Unfortunately, one cannot evaluate a purported lineage based on doctrine alone, as the classic includes so many contrary ideas. Very different schools of thought could develop with different emphasis, yet still both be based on Neijing. However, one distinctive feature of Neijing-style Chinese medicine is the use of the entire channel complexes, beyond the primary channels as conduits to the zàngfǔ. Perhaps the best measure of a lineage is to work diligently with its teachings, and then study Neijing. If one’s experience informs and elucidates the texts in ways that provide practical value for practitioners, then at least that individual has found value in his or her lineage.

A Key Question: Why aren’t there more people at Jeffrey Yuen’s classes?

Lilly Moon, M.D. posed that question, when I met her a few weeks ago at Jeffrey Yuen’s class in the Bay Area. She has been his student for a few years, is very stimulated by his teachings, and seems to wonder why they haven’t taken over the entire profession. While Jeffrey is well known and widely respected, he doesn’t draw large crowds like some teachers, especially ones who give very specific instructions on how to treat, either for specific conditions or more general instruction that is easy to apply clinically. So, it might be that other teachers just make their instruction easier to apply, so they attract more participants, but I think it’s more than that.

Jeffrey Yuen teaches Chinese medicine as martial arts of the spirit, and he does it so smoothly that many participants aren’t completely aware they’ve been sent reeling many times during a lecture, until they emerge feeling somewhat overwhelmed and confused. Everyone responds differently to his classes. Some participants are very stimulated, follow him avidly, and each receives surprisingly individual teachings within the context of his seminars. Jeffrey teaches broad principles of many historical ideas and approaches to Chinese medicine, and generally doesn’t explain how it all fits together. He teaches how to develop strategies for treating patients, based on identifying their personal blocks, rather than protocols for treating patients with particularly disease expressions. While this may seem a subtle difference, his classes leave his students A LOT of work learning to apply them clinically. Doing that work to integrate and apply the teachings is how to make them one’s own.

A few practitioners become agitated and upset by Jeffrey Yuen’s teachings, and many of these question the legitimacy of his lineage and teachings. After all there is now such a vast literature of Chinese medicine to study, including both exhaustive textbooks and myriad case studies to illustrate various theories and key differentiations. Why should we even consider a lineage important? Some people, imbued with our contemporary egalitarian standards, demean the idea of personal transmission of lineage teachings in learning Chinese medicine; instead, they seem to believe all teachings are available simply by buying and studying books (or even watching DVDs). Many others come to a few of his classes, and seem to feel overwhelmed by the enormity of the teachings; they simply don’t choose to devote the time and energy to work with them.

So Lilly, I guess that after finishing professional school and passing licensing exams, most practitioners just want to practice. They want specific tools that will help them practice more effectively, rather than a life long journey of martial arts of the spirit. I suppose most practitioners are satisfied with the modern clinical doctrine, based on differentiating syndromes of the zàngfǔ and then treating them with the primary channels. Why not? It’s what we’ve all been taught.

Whatever Happened to Neijing?

There are MANY ways to study Chinese medicine. The practical desire to assure adequate training in China early in the Song (960-279) led to the standardization of the basic modern clinical doctrine. Many clinical differentiations had already been ‘worked out’ by that time, and they were organized into the familiar syndromes of the 藏府 (zàngfǔ). This process of standardization certainly accelerated with the advent of mechanical printing about a thousand years ago, which allowed relatively wide distribution of the vast textbooks of the Ming (1368-1644) and even simpler handbooks of the Qing (1644-1911). We now have SO MUCH information to learn, and students of Chinese medicine are generally expected to memorize many disparate ‘facts.’ There is little appreciation for clinical thinking to discern the dynamic responsive nature of an individual’s pathology, because there is so much emphasis on accurately classifying its manifestations.

While the most recent round of modernization during the second half of the 20th century stressed consistent and coherent theory, it did not completely eliminate the inherently heterogeneous nature of Chinese medical theory. We all learn differential diagnosis, according to the zàngfǔ, which has been standard for the past thousand years, yet many individuals continue to supplement that basic theory with other systems such as the ‘six stages’ of Shanghanlun. Indeed, throughout the history of Chinese medicine there have been MANY schools of thought that have accentuated various aspects of Chinese medical theory. While we have seen the effort to integrate ‘the best’ of many disparate historical ideas into the contemporary clinical doctrine (‘TCM’), that process has neither completely integrated those historical ideas nor always preserved them with perfect fidelity.

The process of modernization and standardization began MANY centuries before Chinese medicine was imported to the West, so a very large portion of ‘historical texts’ implement that program. Certainly, these included the The Best of Acupuncture and Moxibustion, by Gao Wu (1523) The Great Accomplishments of Acupuncture and Moxibustion, by Yang Jizhou (1601), many other texts of the Ming and Qing Dynasties (1368-1911), and the more recent Chinese Acupuncture, by George Soulie de Morant (translated into English by Grinnell, et. al.). Many scholarly practitioners dive into this nearly limitless sea of information, seeking specific options for treating patients who have not responded well to their initial treatments. While this is laudable research, as many historical texts provide more detailed information than the standard texts of “TCM,” these texts do not substantially broaden the modern doctrine’s clinical theory. Emphasis on information, including specific differentiations and treatment strategies, brings most focus to clearly discerning the expression of distress, rather than the complex process of ‘sorting out’ the individual’s dynamic process.

In response to being overwhelmed by information, many acupuncturists choose to learn ’empirical’ systems of evaluation and treatment, ranging from a wide variety of Japanese approaches to the lineage of Master Tung. While learning the craft of acupuncture can certainly make one a more effective practitioner, these teachings generally work around TCM acupuncture, rather than helping one understand how to resolve the contemporary doctrine’s shortcomings. Virtually all of the empirical teachings highlighted by various teachers have their theoretical foundations in Neijing, though this broader theory is not clearly elucidated — neither in the texts of the classics themselves, nor by the teachers. Empirical schools are generally much more about ‘how to do it,’ rather than ‘how to think about it.’

All students and practitioners of acupuncture and Chinese herbal medicine learn these are ancient arts/sciences, based on a pair of fundamental classic texts — Suwen (Simple Questions) and Lingshu (The Spiritual Pivot), which together are called Neijing (The Inner Classic [of Medicine]). This invocation is repeated so often; it has become a mantra and an article of faith. Often, it is one of the main reasons people — both within and outside the profession — are inclined to believe in our work. And, it is only partially true!

So, what is true about the relationship between modern TCM and Neijing? Well, most of the basic theory of contemporary Chinese medicine can be found in specific chapters of Neijing. For instance:

  • Many of the Five Phase associations we all learn are delineated in Suwen, chapter 5
  • Much of the basic theory of zàngfǔ (sometimes translated as “viscera and bowels”) comes from Suwen, chapter 8
  • The idea that we can treat a primary channel to effect the zàng or  for which it is named is implied by from Lingshu, chapter 2

Isn’t that enough? The ‘TCM’ we learn in acupuncture school comes from Neijing. Well…it’s not that simple. Each of the two texts of Neijing consists of eighty-one (81) chapters, and almost all of them are relatively short snippets of dialogue between the Yellow Emperor and one of his advisers (medicine teachers). Each of these short dialogues centers around a few themes; the entire texts of Suwen and Lingshu are each like tapestries of these dialogues. Each text exhibits MANY themes, and their information is NOT logically consistent. Indeed, they are both are riddled with discrepancies and apparent contradictions, and that creates their beauty and depth.

Suwen and Lingshu are NOT textbooks or handbooks!

The classic texts of Neijing are filled with a wide variety of thought provoking conundrums. They are designed to stimulate inquiry — into the nature of life in general, and the subtle dynamics of each individual’s struggles with it. They focus a reader’s attention on many aspects of life,  some being rather obvious, and they lead to some startling conclusions, especially for people trained in the modern clinical doctrine of Chinese medicine. The suggest a profound transformation in our perception of life, including a framework for understanding the nature of transformational healing for people with chronic degenerative diseases.

How does one resolve the apparent contradictions and mysteries in the texts? Working with patients allows practitioners to delve into the subtle and responsive dynamics of the individually embodied spirit. Contemplation on one’s experience as a practitioner is the ultimate teacher, as it informs one’s ability to probe the depths of the text.

Why were the classics written in conundrums? Seems like a great topic for another blog posting


Challenges of Studying Neijing

The classical language of Neijing presents many complications. I wrote a blog piece recently about the challenge of determining if a particular phrase refers to the macrocosm or microcosm. Another ubiquitous challenge is that classical Chinese has no punctuation — that’s a big one, and I’ll write about it more in the future. Yet, in addition to these challenges peculiar to the difficult and foreign language of the text, Neijing includes common ambiguity in the attribution of pronouns. In some passages, simple vagueness introduces diverging meanings, including multiple streams of interpretation. These “Type 3” conundrums each have an obvious reading, but those interpretations express only a superficial layer of meaning. What else might there be?

The deepest meanings of Neijing are available only to those who know how and where to look for them, and how to recognize the classic’s theory in its sometimes ambiguous language. How would one know to recognize such layers of meaning in the text’s strings of characters? I suggest the written text, which until the tenth or eleventh centuries a student had to copy by hand from his teacher’s copy, was originally intended as ongoing inspiration for those who had already been initiated into its subtle and dynamic worldview. Thus, the written text is only a portion of the teaching; the more important portion of the teaching is a schema for interpreting and applying its language, built on practical knowledge based in experience working with the dynamics of the Dao within the microcosm of individual life.

Some of the classic’s most profound conundrums were styled with very simple language like “其 (),” which is just a pronoun that means “its” or “their.” Chapter 52 of Lingshu provides a good example. It begins (my translation, implied punctuation added by sinologists):


The Yellow Emperor said:
The five zàng are where the embodied spirit and hún-pò are treasured.
The six are where water and grains are received, and consequently substances are moved and transformed.
Their [moves toward] the inside into the five zàng, and outside it connects with the limbs and joints.
Their surface , which does not follow the channels, it constitutes wèi qì.
Their refined , which moves into the channels, it constitutes yíng qì.

Notice the character “其 ()” begins each of the last three lines quoted above. So, what is its reference? By far the most common “literary reading” of these lines interprets it as “the person’s…” or “the body’s…” This interpretation is very common throughout Neijing, it makes good sense here, and it reinforces very basic theory — concerning the locations of the five zàng and the limbs and joints, and the locations and nature of wèi qì and yíng qì. There’s no problem with any of those meanings, and indeed Sabine suggested one of those wordings to me as a more clear translation for this passage. However, perhaps the three uses of 其 () in this  chapter were purposely ambiguous; I chose to preserve that ambiguity to suggest the possibility of multiple streams of meaning. In this case, I believe the ‘deeper meaning’ of 其 () refers back to the six .

This ‘alternate’ interpretation of these last three lines places the six between the five zàng and the outside structures of the limbs and joints, which is slightly more detailed than the other interpretation. However, it is not particularly new or inspiring. However, the next two lines suggest that the surface of the six is the wèi qì, and that their refined (or essence) is the yíng qì. That is far more interesting! The fifth line relates the six with the internal sinews, which communicate with the external sinews. The sixth line recognizes that the six are responsible for refining the water and grains they receive into the  that flows inside the channels — the yíng qì, which is clearly characterized as the refined product of what the individual ingests. Combined with the third line (above), which says the six are responsible for transforming the water and grains they receive, this is a substantial divergence from modern TCM theory, where this function is attributed to the spleen’s .

Okay, so this passage may introduce some new theory. Is that important? Does it introduce anything other than confusion? The relationship between the six and the sinews in the fifth line is very important clinically, as it highlights how closely related are the flows of the internal and external sinews. This line can fundamentally deepens one’s understanding of wèi qì. The sixth line enriches the theory of Chinese medicine, by differentiating more clearly than modern TCM between the functions of the six and five zàng. And, all of this rich theory is hidden in plain sight — available only to someone initiated into the teachings!


Working with Sabine to Decipher Neijing

Classical Chinese is a difficult language, and I’ve been lucky enough to find the perfect person to help me undertake direct study of Neijing (The Inner Classic [of Medicine]) with all its beauty and challenges in classical Chinese. I wrote a little about Sabine and her background in a previous posting, but that brief review focused primarily on her external qualifications. Far more important than her literacy in classical Chinese, and even the specific usages of classical medical writings, Sabine has been willing to support me in finding my own reading of the text. While her reading of chapters of Neijing is informed by her long term work with classical Chinese medical writings, she is not a practitioner. While she shares the benefits of her  ‘literary’ reading, she does not impose it onto my process. Instead, Sabine challenges me to clarify my reading as a practitioner.

When I started working with Sabine last summer, I was nearly illiterate. Oh, I had been using a wonderful software Chinese dictionary for well more than a year, including to re-translate about eighty pages of excerpts from Neijing that Ed Neal had given as handouts for his series on “Neijing Acupuncture.” Although I had reworked his translations to correct many mistakes and misconceptions, and had grown familiar with a much larger vocabulary of Chinese characters, my knowledge of classical grammar remained rudimentary. None the less, that early work with the Chinese text convinced me to focus on translating whole chapters of Neijing, which allows any statements drawn from the classic to be understood in context. Almost ANY idea, including some very bizarre ones, can be supported by pulling specific lines out of context. It’s a bad idea, and fraught with dangers! I will only do so AFTER translating the entire chapter, which at this point includes going over it with Sabine (at least for me). Sometimes, scholarly discourse requires discussion of specific passages, such as comparing and contrasting different readings of a passage, as I’ve done below with Paul Unschuld’s translation of a short passage. However, I believe study of the text should focus on entire chapters, and consider the placement and role of each chapter within the text as a whole.

Most chapters of both Suwen (Simple Questions) and Lingshu (The Spiritual Axis) are snippets of dialogue, generally between the legendary Yellow Emperor and one (or in a few instances more) of his advisers. Context is everything! Yet, translating and studying whole chapters requires much more focus and intention than pulling out short excerpts to translate, and then using them as the basis for study. Working with entire chapters seemed to me the only responsible course, so while taking a year long series of seminars from Elisabeth Rochat, I started with a couple dozen of them. Elisabeth graciously spent a whole afternoon with me near the end of that series, as a sort of classical Chinese ‘boot camp,’ which convinced me that I needed to learn A LOT more classical Chinese syntax and semantics in order to do a credible translation of Neijing. I bought a couple books at her suggestion, and that recognition also led me to Sabine (who also encouraged me to expand my library).

Many chapters of Neijing (especially Suwen) are VERY challenging, even for someone well trained in classical Chinese language. A couple months ago, Sabine wrote back to me with some exasperation after working for an entire day on one short chapter I’d sent to her; she declared that I must be interested in only the hardest chapters! Well, I admit I’m particularly interested in the myriad conundrums presented by the classic texts, though only one type exhibits language that is particularly difficult for Sabine.

The three types of ‘conundrum’ one faces in studying Neijing:

  1. the grammar and/or usage is very obscure or complex; these passages are easily misunderstood, even for readers with good classical Chinese language skills
  2. the language seems fairly clear, but its ‘literary’ meaning makes little or no sense; a practitioner must find meaning based in his or her experience and understanding of the medical theory
  3. the language seems straight-forward, but the ‘obvious’ interpretation (of a literate reader) is limited or even misleading

The first of these requires someone with A LOT of experience with classical Chinese. Sabine has led me through several of these, and gradually I’m learning some of the many ‘quirks’ found in the classical language of Neijing. However, I can’t simply hire Sabine or any other academic sinologist to translate these texts. No matter how open they may be toward Chinese medicine, the last two types of conundrum are far too common. A practitioner’s reading, when informed by classical Chinese literacy, is qualitatively different from an academic’s reading.

While Sabine is highly skilled in reading classical Chinese, she is also refreshingly humble about Chinese medicine. Unlike some other sinologists who concentrate on historical Chinese medical texts, she recognizes that literary reading of Neijing by itself is incomplete. When she comes across a passage she doesn’t understand clearly, she simply says so. On a few occasions she has said, “the language of this passage literally means…; you’re going to have to use your clinical experience to understand what it signifies.” One of these in Lingshu 1, which I had not gotten by myself, astounded me — it was so specific and clear. I’d not realized the classic’s discussion of the theory of wei qi was SO explicit. As soon as Sabine gave me a clear literal rendition, I recognized the meaning of the statement in my clinical understanding, but without that experience the statement had little meaning.

I’ve found the third type of ‘conundrum’ even more interesting, and have already found a couple dozen of them. They are particularly interesting because they provide a wonderful way to obscure profound Chinese medical theory ‘in plain sight’ in the text. That is, ideas discussed this way are available to those who already understand them to some extent — at least well enough to look for them effectively, but are glossed over by most readers. Wow! Can this be real? Why would the authors do such a thing? Well, the ancient Chinese had already discussed the issue of transmitting medical teachings, which highlighted the central role of experience rooted in direct study with a teacher, who understands how to apply the subtle complexities of the texts, as the foundation for understanding.

The Benefits of Illiteracy

So, how does this third type of conundrum obscure the deeper meanings within the texts? While each case is individual, most have a rather obvious literary reading for those who is literate, which also misses some important piece of Chinese medical theory. One good example, which occurs many times in Suwen, involves the expression 時之序 (shí zhī xù). This is a VERY common expression used in a wide range of Chinese writings, where it refers to the intrinsic ordering or rhythm () of the timing (shí) of the four seasons — the 四時. This is the ‘literary’ reading of this phrase, which is generally understood ONLY in the macrocosm. The potential meaning of this expression within the microcosm are particularly interesting to the practitioner, who is constantly focused on the nature of life process within individuals — the Dao in microcosm. We are studying, after all, the Neijing — the Inner Classic. Might one consider (even give priority to) other internal aspects of studying Neijing?

My work with the text is very different from that of a literate reader. I’ve been working with interpreting and applying ideas from the classic for twenty years, yet am only now learning the language well enough to study the text. My limited literacy has forced me to devote a couple hundred hours to each short chapter I’ve studied carefully, so I’ve grown very familiar with their language and content. I’ve begun to discern an ‘inner’ network among chapters, where one chapter comments on another, sometimes where a chapter in Lingshu expands on an idea first mentioned in Suwen.

While I ponder the meaning of any passage, I think about my understanding of the medicine as well as the language. While 時之序 (shí zhī xù) SOMETIMES refers to the usual ‘sequence of the seasons’ in the “Inner Classic” (Neijing), it frequently refers to the “the rhythm of the timing [of wei qi ].” This ‘alternate interpretation’ considers 時之序 (shí zhī xù) within the microcosm of an individual’s life, rather than the literary interpretation in the macrocosm. The text gives only subtle clues of this ‘inner’ interpretation, including a few lines later in the chapter of Suwen discussed below, but it does not clearly indicate when to choose between these two fundamental interpretations.

Perhaps the best clue that one should consider this ‘inner’ interpretation is that the usual ‘outer’ one doesn’t make much sense. One example can be found in Suwen 3, lines 2.1 and 2.2 (of my translation):


Professor Unschuld’s translation (volume 1, p. 60-1; his rendering devotes a new line at each comma, and places the first comma after 氣 rather than two characters later as in the text above):

The qi of the hoary heaven,
it is clear and pure, and as a result the mind is in order.
If one lives in accordance with it, then the yang qi is strong.
Even if there is a robber wind,
it cannot bring any harm.
This [is so because one] follows the sequence of the seasons.

My translation:

When the qì of deep dark Heaven is clear and clean, then the purposeful intent governs [well]; when one aligns with it, then yáng qì consolidates.
Although one is exposed to the thieving wind, it cannot harm, due to the rhythm of the timing [of wèiqì].

While this short passage demonstrates a few divergences in our translations, I’ll focus here on the meaning (in context) of the last three characters “時之序.” While Professor Unschuld and I render the first line somewhat differently, we agree that is describes the conditions that make a person’s yáng qì consolidated or strong (則陽氣固). Then, he renders the text to claim that when there is a robber wind, that is doesn’t harm such a person because he or she follows the sequence of the seasons. Really? That’s utter nonsense! There is no reason to switch scale in this passage from the microcosm to the macrocosm, and that change suggested by the ‘literary reading’ of this phrase simply introduces confusion and makes the classic appear incoherent. This is clearly an instance where 時之序 (shí zhī xù) should be interpreted within the microcosm of individual life as the “rhythm of the timing [of wèiqì].”

[Note: My translation of this short passage differs from Professor Unschuld’s in several other ways. One concerns the meaning and significance of 志意 (zhìyì). My translation of Lingshu 47 discusses the meaning 志意 (zhìyì), which I translated here as “purposeful intent,” with 魂魄 (hún-pò) and 精神 (jīngshén). These are the three complexes of 神 (shén-spirits) that animate the Three Qi.]

While Unschuld is a famous sinologist with unquestioned literacy in classical Chinese, he failed to recognize this ‘inner’ interpretation, and consequently his rendition of this passage is quite limited. By making the classic appear only oriented to the environment, rather than discussing the individual’s responsiveness to the environment, he missed important theory and a deeper stream of meaning. Alas, I’ve found too many such misunderstandings among the chapters of Suwen I’ve studied carefully, and I have A LOT more work to do with both that text and Lingshu. Collected together, professor Unschuld’s interpretations produce a literary translation that misses much of the incisive power of Neijing. While he and his team have done Herculean work in producing his two volume translation of Suwen, many of the historical comments he included were written by editors who were not primarily practitioners. Thus, their comments were limited to their own ‘literary reading,’ which didn’t substantially challenge or deepen the translator’s own reading.

On the first page of his Prolegomena, Professor Unschuld noted, “this translation was not prepared primarily with an eye on the contemporary clinical applicability of its physiological and pathological views, as well as the text’s therapeutic advice, provided by the authors of the Suwen…” Well, he got that right! Unfortunately, Professor Unschuld’s translation conveys his misconceptions concerning the content and meaning of the classic, misses its deeper logic, and consequently leaves the reader little opportunity to find its clinical value. Of course, that doesn’t matter to him. I understand Professor Unschuld considers the very concept, that we may diligently study today to practice ‘classical Chinese medicine,’ absurd. Might his translations not be our best possible resource for the Chinese medicine classics, especially when we are seeking clinical insight and inspiration?

Professor Unschuld also noted in his Prolegomena that Neijing is heterogeneous, while Nanjing is homogeneous. I agree completely, though he misinterprets the significance of that perception. He considers the tangled collection of contrary information in Neijing a sign it was still immature and confused, and that the later Nanjing clarifies Chinese medical theory and makes in coherent. On the other hand, I consider Neijing a complex tapestry of ideas and perspectives, which weave together into a profound investigation of life in health and disease. It is far more subtle and complex than the author(s) of the received version of Nanjing recognized. Unschuld believes Nanjing completes the evolution of Chinese medicine as a ‘medicine of correspondences;’ instead, perhaps it merely simplifies Neijing into a medicine of correspondences. He assumes the ‘progress of history’ brought clarification; I understand Neijing is much more subtle and profound than Nanjing, which exhibits only one approach in conceptualizing classical Chinese medicine.

While Nanjing presents one relatively accessible conceptual model for understanding and practicing Chinese medicine, doctors throughout history have returned to Neijing, for its ‘heterogeneous’ theory, when seeking clinical inspiration. In many circles of Chinese medical practice in the contemporary world, there is an emphasis on detailed discussions of theory and practice from the (relatively) modern Qing and Ming Dynasties (1368-1911). While those authors provide some detailed guidance, they lack the breadth and depth of insight available through studying Neijing.

The pervasive influence of Unschuld’s misunderstandings on the professional practice of Chinese medicine arise from our weakness, rather than his mistaken assertions, no matter how egregious. Can’t someone produce a careful translation of the Neijing based in practical understanding of the practice of Chinese medicine? [Everyone takes three steps backwards.] While academics scoff at Wu Jing-nuan’s translation of Lingshu, I used it for many years, and now that I’m working on chapters myself find that it portrays the meaning and import of the text with more fidelity than Unschuld’s translation of Suwen, which was produced according to his academic ‘rigorous philological principles.’ Yet, Wu’s work certainly lacks notes to help the reader explore the text’s textured meanings, he inserts some of his own interpretations into his translation, and it misses some subtle points; so, his work needs careful updating.

Maoshing Ni’s rendition of Suwen was published nearly twenty years ago. It seamlessly includes his interpretations and clarifications of the often challenging text. While it has made the classic much more accessible to an entire generation of practitioners and students, it has done so only through his interpretations, which were not clearly differentiated from the text itself. This is light reading.

The Yellow Emperor’s Canon of Internal Medicine, translated by Wu Liansheng and Wu Qi, benefits through including the Chinese text with the English translation. However, their English is poor, which severely limits their ability to convey the subtle meanings woven into the text. They insert their own interpretations fairly liberally, which limits the value of their translation, even if one wishes to weed through their obvious problems with English.

I look around, and it seems everyone has withdrawn from my imploring request for a ‘clean’ translation of Neijing that arises from a practitioner’s sensibilities, which thereby can convey the beauty and power of classical Chinese medical thinking. I seem to be standing by myself. Uhm…Oh my! I seem to have volunteered. Oops! How did that happen? What the…

Well, working with Sabine is a great help! I couldn’t do this without her support. She is stringent with me and insists on clarity and accuracy, yet she also supports my efforts to find wisdom for myself in the texts of Neijing, based in my experience and/or lineage training. As I struggle to understand the text’s syntax and semantics, I’m contemplating my nearly twenty years experience working with my lineage’s interpretations, and several years teaching the content and dynamic thinking process of our approach. Sometimes, I believe a certain passage in Neijing has multiple readings, where one is the ‘literary’ (or obvious) reading, and others share deeper ‘coded’ ideas or theory. I consider these ‘alternate’ readings little messages to the initiated — those who  understand medicine well enough to find and understand them. I’m discussing the ‘messages’ I find in my commentaries for the chapters I’m translating. It’s a BIG project.

Stay tuned for more news concerning my work on “An Acupuncturist’s Neijing.”

I’m already working on a posting focused on another ‘type 3 conundrum’ from the opening lines of Lingshu 52. The literary reading of that one is SO obvious it even ‘took me in’ for almost two weeks early last month. Shocking! Well, I hope I don’t grow too literate.


Scholar’s Retreat a Huge Success (for me)!

During the past few months, I’ve grown increasingly involved with the International Society for the Study of Classical Acupuncture (ISSCA); we’ve recently had our second annual “Scholar’s Retreat” in Trout Lake, WA (near Portland, OR). It was a relatively small conference, as such gathers go, yet we had some fine presentations; and the four day gathering within the inspirational environment of Trout Lake Abbey was filled with opportunities for informal discussion and learning. I presented a paper just after lunch of the first day on the transmission of classical medical teachings, based on the biographical sketch of Chunyu Yi from the Western (Early) Han Dynasty. Then, late in the afternoon of the fourth day, I did a clinical demonstration with a patient of one of the young practitioners attending the retreat, who lives and works near Trout Lake. That was an interesting experience, in part because I decided that “when in Rome” (in this case, among Neijing practitioners), I would do “as the Romans do” — us larger diameter needles. In short, I’d learned that what I’d learned to do with mostly 36 and 34 gauge needles is MUCH more powerful with 28-32 gauge needles (as the number gets lower, the diameter is bigger).

ISSCA originally grew from a group of Dr. Ed Neal’s students in Portland, OR. He is a medical doctor who grew interested in acupuncture many years ago, and went to Italy to study with an Italian doctor who had learned from a pre-TCM acupuncturist who often referred to Neijing. During the early nineties, Ed had some health challenges that prevented him from doing very much other than working on translating the texts of Neijing. Dr. Neal has been working with direct translation of Neijing for approximately the same amount of time I’ve been studying with Jeffrey. While he has learned some interesting things from those efforts, he espouses many ideas than need careful review. I’ve taken his introductory series on “Neijing Acupuncture,” which explores some of the classic’s key language and concepts. His work inspired me to begin my studies of classical Chinese, so I could better understand the linguistic and  conceptual foundation for Jeffrey Yuen’s teachings.

The entire retreat was a wonderful experience, and next week I’ll be meeting with several ISSCA members in Portland, OR to discuss plans for my series on the channel systems to start there during the coming months. My early experience indicates that ISSCA is fertile ground for cross-fertilization, at least for me. I believe we can all learn a lot from each other — me from their scholarship of the texts of Neijing, and Dr. Neal and his students from my work learning ‘my’ oral lineage. While it has taken Dr. Neal a little time to accept the value of my work with my/Jeffrey’s lineage, my presentation at the 2nd annual ISSCA conference last month seems to have won him over. He was the first to ‘sign up’ for my series in Portland, when I saw him briefly a week after our retreat. I was in Portland to pick up my car, after flying back from being co-Keynote Speaker at the 37th Annual Conference of the International Veterinary Acupuncture Society (IVAS), but that’s another story. Stay tuned!

Update: I’m sorry to say that my associate with ISSCA has come to naught. I guess that either they decided by lineage wasn’t important after all, or that I wasn’t an adequate representative for their “scholarly” group. C’est la vie!