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.

Share

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):

黃帝曰:
五藏者,所以藏精神魂魄者也。
六府者,所以受水穀而行化物者也。
其氣內于五藏,而外絡肢節。
其浮氣之不循經者,為衛氣。
其精氣之行于經者,為營氣。

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!

 

Share

It’s Great Having Acupuncture Students in the Series

… because students are SO studious, and want to be clear on the info. I think it was Sesame who showed me an illustration of the L.I. sinew channel that connected all the way to the upper thoracic spine. My comment at the time was that I use it all the way to the medial margin of the scapula, but was not really connecting it to the spine. A more complete answer is that it flows over the areas that either activate or restrict the yangming movement of the arm —  medial flexion over the chest with the arm extended. I’m now seeing that it can go further medial, but it does not connect directly to Dumai.

We plan and the Supreme Being Laughs

I realized shortly after the sinew release demo that I have to keep my hands on the demo model, just as I would with a patient. That’s what I get for using my hands to gesture when I present ideas. And, I’m not even Italian! Well, even my Jewish heritage has a fair amount of talking with one’s hands, so I guess I come by it honestly, so I’ll have to pay particular attention during clinical demos. It may work during the lecture, but definitely doesn’t while demonstrating those releases. Yet, it appeared that most of you were able to successfully use those sinew releases.

Some people (possibly including Desiree) will need channel divergence treatment rather than sinew treatments. Work with the sinews for now — both with the releases and needling approach we discussed, and see what you can do with them. That will prepare you well for the class on channel divergences in just less than three months!

I’m also glad Justin and Carrie encouraged me to do an actual demonstration of “chiseling” needle technique, rather than just explaining it and modeling the movement. I’d been a little concerned in the environment of the class it might be hard for demo models to feel the propagation of wei qi. So much for my thoughts… Practice that needling technique, and we’ll get into others in coming weekends. However, I must warn you. I’m not particularly focused on needling techniques — part of any technique is for the physical sensation in the patient, and part of their value is in focusing the practitioner’s intention. I’ll talk more about that during the second weekend.

I’m ready to discuss — to help you work with the sinews. Who wants to start?

Share

San Diego Channel Series Begins

Wow!

Thank you all for coming, and contributing to the start of what I hope will be a great series! Enjoy working with the ideas we discussed, and post questions and comments relative to the Sunday seminar — the first day on the primary channels — after this posting. I’ll respond to some of them online through this blog, and others I’ll address next time we meet. We still have another day on the primary channels. Can you believe it? I’m hoping to learn some more names, so we’ll be able to have more “connected” communications in this forum.

I’m particularly interested in hearing ideas on how you believe this series will work best for you. I have a lot of ideas to discuss during the second day on the primary channels, and can certainly make some room for responding to your questions. Have a good time experimenting with “pulse feedback,” and using that process to better understand how to read the specific struggles of the embodied spirit.

Grace: I’m sorry I wasn’t able to complete the communication with you after reading your pulse. Staying completely present with that during breaks is a little challenging, as I have other things on your mind. I do have some thoughts (which I won’t share in this forum — probably with just the class, but not on the internet), and you may end up as a workshop “demonstration model” for the second weekend.

Desiree: It’s entirely possible that you could be a demo case for the third weekend.

I’m open to discussing. Who wants to start?

Share