Transcript
Reflection Two: The Spirit Uprooted—Classical Chinese Medicine Loses its Humanity The Problem:
shenming or spirit clarity (spirit light): “If the xueqi, the heart and the lungs are functioning well, and all the meridians and the zangfu are in harmony with this functioning, there is a kind of concentration of xueqi at this place, and there is a good impregnation of the layers of the skin. The eyes and vision are good, and the brain is alert. The bones are solid. All that is called shenming (ibid, p. 118).”
As Part II will reveal, not only have the Ordinary Skills of Classical jing-luo Acupuncture suffered at the hands of this radical reshaping of Classical Chinese Medicine (in its new, communist, TCM version, taught in a simplified language with simplified theory accessible to new students at TCM Colleges with no grounding in the Classical concepts).
Larre and de la Vallee paraphrase the oftquoted concept that the practitioner of ordinary skills observes the body, while the practitioner of high skills observes the spirits: “This means that he observes the blood and qi of man, tonifying or dispersing, following excess or deficiency (ibid, p. 120).” This decidedly physical depiction of spirit is echoed in Maciocia’s study on the subject.
In addition, Confucian and Daoist foundational knowledge, which informed mainland Chinese concepts of humanity, was stripped from Chinese medical texts as religious and feudal remnants of a past to be outlawed, forgotten and left behind, along with life nourishing and self-cultivation practices (Dao-Yin, Qi Gong) thought to be essential, in the Classics and up until the late 1950’s in the PRC, in order to aspire to become a practitioner of High Skills.
Whereas the Western view of body and spirit depicts the spirit as that which animates the body, according to Maciocia, the spirit and body in Chinese medicine “are nothing but two different states of condensation and aggregation of Qi […] with the Qi being the most rarified form (The Psyche in Chinese Medicine, Churchill Livingston, 2009, pp.45).” He goes on to paraphrase the ancient concept that the body is able to stand erect due to the spirit within, and that the spirit requires the body for its existence and dies with the body (ibid). He translates from chapter 66 of the SuWen in a similar, and again decidedly embodied way, thus: “What is called shen? Qi and Blood are harmonious; Nutritive and Defense Qi circulate freely; the 5 Yin organs have been formed; the mind resides in the heart; the ethereal and corporeal souls have been formed. Where there is no shen, there is death. Where there is shen, there is life (ibid, p. 9).”
Rooted in Spirit: shen and xueqi Sinologists Claude Larre and Elizabeth Rochat de la Vallee stress the near identical nature between the spirits (wushen), and blood (xue) and qi. “Blood and qi are one of the best ways through which the spirits express themselves in a perceptible way. It is perceptible because it is always through the balance of xueqi that we have the indication for treatment. You know that there is excess or deficiency, so you tonify or disperse […] The blood and qi are the spirits of man, one cannot but pay great attention to their maintenance (Essence, Spirit, Blood and Qi, Monkey Press, London, 1999, pp. 121-123). This equation between xueqi-blood and qi--, and shen-spirit taken as a whole, also define
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Elisa Rossi comes to the same conclusion in her study of the classical and modern Chinese medical concept of Shen. In her text, Shen: Psycho-Emotional Aspects of Chinese Medicine, she stresses from the outset that the classics of Chinese medicine view the emotions, which can lead to a disturbance of shen when overly strong or in a person of weak constitution, as physiological events, a response of the Shen to stimuli of the outside world (p. 23).”
of constraint and heat; fullness; and emptiness in Rossi; Lilium syndrome depression; emotional stagnation; plum-stone syndrome; visceral agitation; and excess and deficiency variants of palpitation and anxiety syndromes in Maciocia). The focus of each author, and Larre and de la Vallee is clear: a practitioner who aspires to practicing High Skills must learn to recognize, and regulate, excess, deficiency and stagnation of Qi and Blood, to treat the shen level with needles and moxa.
She goes on to clarify that mind and body in Chinese medicine are perceived as an indivisible and dynamic unit: “Emotions can give rise to somatic disorders as well as psychic illnesses; organic illness can, in turn give rise to emotional alterations and psychic pathologies […] This implies that psychic disorders should be treated starting from the energetic system of channels and organs, utilizing the usual diagnostic process, the same principles, and the same therapeutic tools (ibid, p.24).”
The first chapter of the Ling Shu goes on for a few pages detailing the methods, ‘slow, then quick’ for tonification, and ‘quick, then slow’ for dispersion. As the text clarifies, this “is the manipulation and the way of the needles. Firmness is precious. The primary fingers make a vertical insertion; do not needle to the left or right. The spirit seems to be at the tip of the needle. Focus awareness on the patient. Investigate the blood pulses and the needle will not be dangerous. When inserting the needle, it is necessary to harmonize the yang and control both the yin and the yang. The spirit will follow. Do not go away […] The blood pulses are widely distributed at the shu points. They are clear to see and strong to touch (ibid, p. 2).”
She stresses that emotions, when excessive or in a susceptible individual, alter the movement of Qi, leading to stagnation of Qi and functional disturbances of the viscera. If prolonged, this can lead to actual organ disorders and even death, as underscored in the oft-quoted Chapter 8 of the Lingshu: Benshen, often translated as “rooted in spirit”. In such serious disorders rooted in the spirit from emotional stagnation, as this chapter outlines, death will come in the season that dominates the organ in question: in Spring, for the Spleen for example (ibid, pp 26-27).
In this description, which I will return to in a later Reflection on Needling Technique, the Ling Shu stresses that only “when the qi is reached, will acupuncture be effective. This effect, it is said, is as if the winds blow away the clouds and clear the azure sky. These are all the Dao of acupuncture (ibid, p. 3).”
She concludes in like fashion to Larre and de la Vallee, that to recognize and treat disorders rooted in spirit, one must recognize the disorders of qi that have arisen, and treat them with regular meridian strategies of point combinations and needling techniques to tonify or disperse.
So how does a practitioner know if the Qi (and hence the shen) has been reached? The Ling Shu provides a clear method of inspection of the patient’s ‘vital signs’ near the end of the first scroll thus: “Look at the patient’s color. Observe the eyes. Know how the qi disperses and returns. Each has its own form. Listen to the patient’s movement or stillness. Know his imbalance and his balance (ibid, p. 4).”
Rossi and Maciocia each lay out classical and modern categories of shen disorders (patterns
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Thus far, the Classical Chinese notion of shen or spirit sounds very embodied, and Wang Ju-Yi would seem to concur in his modern interpretation: “Remember that, to me, the character shen (character included in the original text) refers to the intelligence of existence. It is an innate intelligence that, when the heart is healthy, any person or animal might have. This intelligence is also present in the world at large ( Applied Channel Theory in Chinese Medicine, Wang Ju-Yi and Jason D. Robertson, Eastland Press, Seattle, 2008, p. 148).” He is speaking here, of course, of the shen of the Heart-Mind.
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In the Chart on the next page, I will list the main signs and symptoms of disordered shen in the five Zang as depicted in Rossi, pp. 2627 as suggested by Bruce Park, a former Korean Buddhist monk and now teacher of Buddhism, during his presentation of a class on Chapter 8 of the Ling Shu known as BenShen (Roots of Spirit). I feel that Rossi gives a good feel for the effect of the emotions without getting overly bogged down in details of the five spirits which have little to do with Western patients and their emotional stresses.
These various definitions of spirit are in keeping with Wiseman and Ye’s definition of shen in their text, A Practical Dictionary of CHINESE MEDICINE (second edition, Paradigm Publications, Brookline, MA, 2008, pp 550-551): “ 1. (In the narrow sense, that which is said to be stored by the heart […] 2. (In a wider sense) that which is said to present in individuals with healthy complexion, bright eyes, erect bearing, physical agility, and clear and coherent speech. It is said, ‘If the patient is spirited, he is fundamentally healthy; if he is spiritless, he is doomed.’ Thus, the spirit sheds useful light on the severity of a given complaint (ibid).” The authors of this dictionary go on to elaborate that there are three fundamental “conditions of the spirit”: •
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inquiry (ibid).” These signs indicate a relatively serious condition where extreme caution is necessary; False Spiritedness: The most classic sign is that of a fatally ill patient, who suddenly and briefly exhibits a rosy complexion, talkativeness, and an animated spirit not in keeping with the seriousness of the patient’s condition. “It is a sign that the patient’s condition will soon deteriorate…(ibid).”
Spiritedness: If the patient exhibits signs of being spirited as above, indicating that the complaint is relatively minor, and that although “certain aspects of the patient’s health may be seriously affected, swift improvement may be expected (ibid, p. 551);” Spiritlessness: Lack of mental energy, abnormal breathing, apathy, “torpid expression, dark complexion and dull eyes, low voice, slow, halting speech, and incoherent response to
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ZANG /Spirit
EMOTION
S&S
DEFICIENCY
EXCESS
Fear, terror, lost control, the muscles are consumed
Sadness
Heart/shen
Anxiety, worry, thoughts and apprehension injure shen
Uncontrollable laughter
Spleen/yi
Oppression and anguish that do not dissolve injure yi
Restlessness and disorder, the four limbs do not lift up
The four limbs do not function, the five organs are not in harmony
Abdomen swollen, difficult menstruation and urination
Mania and oblivion, abnormal behavior, genitals retract, muscles contract, ribs do not lift up
Fear
Anger
Nose obstructed, passage of air difficult, breath short
Laboured and hoarse breathing, Fullness in the chest, lifts the head to breath
Reversal-jue
Swelling, the five zang are not calm
Liver/hun
Sadness and sorrow convulse the center and injure hun
Lung/po
Euphoria and joy without limits injure po
Mania, the mind does not see others, the skin dries out
Intense and incessant anger injure zhi
Forgetfulness, flanks and spinal column painful, Cannot bend forward or backward
Kidney zhi Kidney jing
Fear and apprehension injure jing
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(Tu Wei-ming, Humanity and Self-Cultivation: Essays on Confucian Thought, Cheng & Tsui Co., Boston, 1978, pp 6-7).
The Spirit by Any Other Name In a discussion on Shen in Chinese medicine with senior interns at the college, I was at first struck by the fact that each person who spoke up seemed to have a different take on what spirit meant in the practice of acupuncture. Reflecting back, I realized two things: the college had not done a sufficient job in explaining what shen and spirit mean in classical Chinese medicine; North American students are not a homogeneous cohort, with the same moral and ethicoreligious codes, such as would have existed in mainland China in Confucian, and perhaps even Daoist forms, until the PRC communist regime’s ruthless annihilation of the Chinese people’s philosophical and even religious heritage which endured for 4,500 years.
This issue of self-cultivation will be returned to in a later reflection on reflective practice. As a ‘religiophilosophy’, which is the way Confucian scholar Tu Wei-ming frames his argument, Confucianism seeks to “establish the ultimacy of man” and to study his unique “morality, sociality and religiosity” (ibid, pp 84-85). The focus here is on becoming the most authentic man or sage possible, which in Chinese Medicine would entail one who practices High Skills, the Superior Physician. Sagehood, in this Confucian sense, “rests on the belief that man is perfectible through his own effort. To know oneself as a form of selfcultivation is therefore deemed simultaneously an act of internal selftransformation (ibid, p. 85).”
In the Confucian and Neo-Confucian traditions, the latter incorporating elements of Buddhism and Daoism, the mainland Chinese people had a philosophical and even religious tradition, depending on the interpretation, that laid out basic codes of conduct and upright bearing that were especially applicable to doctors who sought to practice High Skills.
Leaving aside the questions raised by some scholars of Chinese thought regarding the legitimacy of claims by the Neo-Confucian masters to be “in the mainstream of Confucian thinking”, which revolve around the Neo-Confucian appropriation of many Daoist and Buddhist beliefs and values, Tu Wei-ming nonetheless concludes that, “despite its efforts to absorb inspiration from other spiritual systems, Neo-Confucianism is a creative adaptation of classical Confucian insights, rather than a syncretic culmination of the ‘Three Teachings’ (ibid)” that spanned the 11th to the 17th centuries.
In these traditions, which Confucian scholar Tu Wei-ming refers to as “humanity and selfcultivation” in a text by the same name, the relationship and tension between jen (goodness, humanity) and li (propriety) bespeak a creative tension between an internal focus on “self-cultivation” and an external focus on realizing ones self in society, for the common good.
In his detailed study of the Neo-Confucian Master Wang-Yang-ming (1472-1529), TuWei-ming focuses on the development of the innate knowledge of the sage, only possible through a committed and never-ending effort of will entailing “a hundred deaths and a thousand hardships (ibid, p. 105)”, as a selfeffort and a teaching which must be “embodied”—a “learning of the body and the
A man, in our case a physician, who achieves the highest “human achievement ever reached through moral self-cultivation”, is a chun-zhu or gentleman, a superior person, a superior physician of high skills
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mind”, to “think with ones whole being”. This is portrayed, relative to Yang-ming’s teachings, as an active and ongoing “decision to focus on the problem of how rather than the cognitive issues of what and why”, thereby refraining “from converting issues of profound human existence into mere issues of speculation.” This is a way of understanding experientially, “as if one has ‘encountered’ or ‘met’ […] that which is to be understood by “deepening ones selfknowledge (ibid).”
shown great reluctance to submit her teachings based on the sum total of her inner experience to rigid formulas. As Wang Yangming puts it, “I strongly fear that the student might easily grasp [this simple formulation of] it, treat it as a circumstantial notion, and play with it, without solidly dwelling in it and strenuously working at it (ibid p. 105).” After reviving myself from the exhaustive study of Maciocia’s The Psyche in Chinese Medicine, whose voluminous nature reproduces hundreds of pages from his ‘Foundations’ and ‘Practice of Chinese Medicine’ texts, and critically reflecting on his attempt to share his knowledge of the role of shen in Chinese Medicine in the way that he did, I realized I was distrustful of such a wordy, intellectual and academic discourse on a subject that is so foreign to his, and my, Western experiences of the psyche and the body process.
I have learned, from my long-time colleague Master Kiiko Matsumoto, how the question “why” during Grand Rounds where we each treat community patients in a clinical theater classroom setting, is inappropriate, jarring to the teaching-learning experience, and irrelevant. I once watched and listened as Sensei Matsumoto responded to a student’s question about why she just did what she did to the patient thus: “can you not see well, come up here in the front so you see better”. A little later in the same Grand Rounds day, another student asked what the diagnosis was for the treatment Sensei just completed and Sensei responded: “When she comes back next week, if she is better, the diagnosis is what I did today!”
Having struggled 28 years ago with the incongruity of Western notions of the inner Self and the issue of the Western Body-Mind split, as compared to the Chinese classical notion of self, I already came to the decision that I could not apply Chinese spiritual, philosophical or medical concepts to my Western patients’ experiences of illness, especially where matters of the spirit and the emotions are concerned. While I was able to liberate myself, in writing this book, from an infatuation with (often quite brilliant) Western psycho-somatic concepts, as derivative of the Body-Mind split of Western psychology, in order to attempt to practice acupuncture as a bodymind practice like EastAsian martial arts, or meditation, or Sumi-E Japanese brush painting, it was through a constant struggle that I changed my own teachings at the college.
What I took to be a decidedly Japanese way of teaching in such clinical environments appears to have been quite consistent with this Neo-Confucian teaching which “points to a kind of ‘confirmation’ in which the truthfulness of an idea cannot be demonstrated by logical argument but must be lived by concrete experience” and whose “meaning can be readily acknowledged only by those who have tuned their minds and bodies to appreciate it (ibid, p. 104).” And like Wang Yang-ming, who stated that his process of ‘digging’ and ‘drilling’ as a “way of examining, tasting, comprehending, understanding, confirming, and verifying the quality of [his] life” made such knowing an “experienced reality”, Master Matsumoto has
In year-end faculty meetings, we often return to the fact that students are getting better and better at practicing what they are taught, but are still not necessarily able to clearly articulate what it is they are seeing, hearing,
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feeling and doing when they practice in clinic. And I inevitably come down on the side of better practice.
It is with that sense that I was struck by Tu Wei-ming’s elucidation of the view that “to ‘conquer oneself and return to propriety is humanity.’ Indeed, the ego has to be transcended and sometimes even denied for the sake of realizing the genuine self. For selfcontrol, overcoming the ego, is the authentic way to gain inner experience. This path is universally open to every human being, but it ought to be traveled concretely by each person (ibid, pp 106-7).” This sort of process does not alienate one from society, Tu Weiming clarifies, but rather “impels one to enter into what may be called ‘the community of the like-minded’ or even ‘ the community of selfhood.’ In such a community one not only befriends one’s contemporaries, but one also establishes an immediate relationship with the ancients (ibid, p. 107).”
Having taught Judo as a teenager, for the children’s class while Sensei Takahiko Ishikawa, an 8th degree black belt and the most advanced practitioner of Judo on the East coast, and twice world champion (sent from Tokyo by the Kodokan to bring judo to this part of the country) played GO (in which he was a highly ranked international expert), I was always in awe of this powerful man, whose ability to concentrate on GO and then move fluidly across the dojo as he taught us the way of judo, and totally appreciated the strict discipline he instilled by his example, and not by words. One could ask how he just did something, and he would pain-stakingly take you up and demonstrate the move on you. But if you asked ‘why’ he did something the way he did, you would be sent hurling through the air without knowing what hit you. Experience with your whole being, I realized, was the message here, and do not ask questions which takes you into a cognitive realm.
I believe that this is how I come to “know” what Nigel Dawes, or David Kailen were saying in their Blog responses last month, or how I know what Kiiko Matsumoto means when I see, hear, watch and sense what she is doing. We have all been doing this acupuncture thing for three decades, and when things ring true, very few words of explanation are necessary.
For some reason, this way of learning was a relief from overly heady French intellectual studies I was pursuing. And it came naturally, as did the practice of acupuncture as I shared in the first month’s Blog. I realized when I started treating patients in the South Bronx with acupuncture that this was a similar way of knowing/learning, and that to teach this would be a great struggle.
This way of knowing and achieving professional know-how through the doing of it is referred to by Polanyi as “the tacit dimension” which I will explore in my Blog next week. This feeling of community is exactly what I am seeking with this OTHER ACUPUNCTURE project, which has already led to connections with colleagues in such a way as to foster communication about each of our inner experiences with the classics and with our practice, in the form of Nigel Dawes’ and David Kailen’s responses to my Blog last month, and when I had a sit-down discussion with Linda Barnes, who steered me to Tu-Wei-ming ( her former Religious
I have come to finally appreciate looking at the classic texts, even though I recognize the impossibility of knowing the reliability of their translation, while in fact sharing a deep affinity with many things I am reading, based on a whole bodymind felt-sense or tacit knowledge of how what I am reading resonates with my own inner experiences and tacit knowing of acupuncture, akin to the process elaborated by Tu-Wei-ming’s study of Neo-Confucian self-cultivation and learning.
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Studies PhD mentor at Harvard) and his work.
Complete Translation of the Yellow Emperor’s Classics of Internal Medicine and the Difficult Classic(Nei-Jing and Nan-Jing, International College of Traditional Chinese Medicine, Vancouver, 2004, p. 65).
What we can learn from Rossi and Maciocia is that we should not inject our Western notions of self, the sacred, and spirituality into the Chinese medical concepts, but rather attempt to understand these Classical Chinese concepts on their own terms. But we must struggle with these notions each in our own way, and especially when we take responsibility for teaching others.
After over a year interning with the celebrated late Chinese Doctor John Shen in Manhattan’s Chinatown, most Sundays, it became evident that this was a living example of the Superior physician of High Skills. Over two thirds of his patients, who came for his unique herbal remedies, would be denied the “poison of medicines” as the Ling Shu advises, because their problem, as he told each one in turn, was no problem, their disease was no disease; their problem was their Life.
Life Nourishing Practices Texts examining the main forms of daoyin and yangsheng as the proper way to live, to nourish life, existed at the same time as, or even before the Su Wen, according to Rossi and Lu. It is for this reason that the first scroll of the Su Wen already refers to the ways the people in olden times conducted themselves in order to live out their proper life span of 120 years. The patients in those days were at the center of their own life nourishing and Daoyin self-development, on the basis of which the Chinese doctor would address issues of disordered emotions and the Five Shen.
He would then proceed to tell them to regulate their eating times, the time they went to bed and arose, and to simplify their life to reduce stressors. He would tell them to get Chinese rice wine, and Chinese celery on the way to the subway from his office, and infuse the celery in the wine, drinking this at night to help with sleep. He would inevitably conclude with a new patient suffering such issues of lifestyle and stress: You take care of your car better than you take care of yourself.
The patient, previously to the Su Wen, was, to sound very modern, an active participant in his own care where spiritual health and the moderation of emotions and lifestyle were concerned:
He would then give them a simple acupuncture treatment to calm the nervous system, and not suggest a return. He would not give herbal medicine because he did not consider them to have a disease, but rather a stress disorder that they could and should learn to manage on their own.
1. “One should take an easy-going attitude toward life and have few desires; 2. One should form good eating habits; 3. One should lead a regular living pattern; 4. One should work adequately and avoid excessive fatigue; 5. One should control sexual desires; 6. One should live in harmony with the climate of the four seasons ( Su Wen, Chapter 1, in Henry C. Lu, A
In his later years, he would have tui na practitioners recently over from PRC, who became licensed in acupuncture, treat such patients with massage and acupuncture and again never prescribe herbal remedies. When I asked him if I would have to learn how to master the pulse and tongue as he did, he stated that since it was clear I wanted to specialize in acupuncture, there was no need
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to master these skills, which he relegated to the treatment of serious internal diseases with Chinese medicinals. This clarification between what acupuncture could best treat (the two thirds of what he saw where he did not prescribe herbal remedies)—chronic pain, stress disorders, functional disorders of the various organ systems without signs of disease-- are what I have come to specialize in, and it is here that mainstream medicine holds out the most hope for complementary and alternative medicine and healthcare. In such chronic musculoskeletal and internal functional and stress disorders, I have found acupuncture to be extremely beneficial with very few treatments at a time. In these disorders, the shen is always at issue, and when there is a central adrenal syndrome at the heart of what I term four patters of visceral agitation/fatigue, I resort to the extraordinary vessels as outlined in chapters VII and VIII of Acupuncture Physical Medicine. These four templates serve as exemplars for any stress disorders of the Zang organs. Where a central internal functional disorder, or emotionally driven disorder has no involvement of the adrenals, I simply use the normal treatment strategies of the regular meridian circuits, adding the outside line of the Bladder meridian for the shen aspect of the Zang involved as well as reactive chong mai points on the front (Kid 11-27; St 30-13) to regulate prenatal and postnatal qi, thereby restoring more normal function of the organs and the channels, and Qi and Blood. It is in this way that I address shen disorders when there is no actual, or serious, mental illness. I will present the chart for these four patterns in chart form on the next page:
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APM Acupuncture – 4 patterns of fatigue/stress Spinal Irritation __________________ Du Mai Excess Kidney Yang/Heart Protector Dysfunction Water/Fire Imbalance Precipitating factors may be trauma of a physical or emotional nature (car accident, attack by dog, abuse)
Signs & Symptoms
Point strategies
AOM Lifestyle Coaching ________________ ________________ _______________ running on empty, type-A, adrenal exhaustion (drops-dead in bed at night)
YinYang Regulation
works and plays hard, lives world muscularly, reacts to world somatically very productive, very active at work, sports, socially Ever-Ready Bunny Superman, Superwoman, Supermom or Dad
Patient Complaints:
o
o o
Ying: Kid 2(Fire) and 3(source)/ying and shu; Bl 58 (luo); BL 23 (tonify or disperse carefully if lower back muscles are rigid) on right especially, and BL 14-43 on left (Kidney Yang/Heart Protector dysfunction
Neck & back pain in stress muscles Lowback syndrome with adrenal exhaustionback goes out under stress Fibromyalgia Insomnia and agitated sleep
To above add BL 18, 20/triple heater regulatory; SP 6 and Ht 7 for insomnia; Local multifidi if spine is irritated from stress Can turn over at end and do yintang for 10 more minutes. Wei level shallow oblique needling to most tender points in fibromyalgia or highly sensitive or reactive patients, leave needles only 5 minutes Release most symptomatic TrPs per patient’s de Qi tolerance in stress muscles (traps, paraspinals, gluteals, piriformis)
Take hot bath with sleep inducing bath salts, sleepy time tea or other soporific while meditating or listening to soothing music last hour before bedtime Stress importance of solid sleep to restore adrenals
Patient Complaint
End result—Adrenal collapse and CFS
o
Jing: SI3/BL 62 for du and yangwei Mai
Counsel patient to start stress reduction/relaxation response activity for overall agitation
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Engage in physical activities that distress muscles per exercise tolerance level (do not exercise at night if suffering from insomnia) Do stretching for tight neck, back, lumbosacral muscles Get pillow-top mattress or egg-crate mattress cover; side lying pillow, or cervical pillow if sleeping face up Suggest hypnotherapy, EMDR, psychotherapy to deal with behavioral and post-traumatic issues
Diaphragmatic Constriction/ GI Distress/ chong mai middle heater dysfunction
Signs & Symptoms
AOM Lifestyle Coaching ________________ ________________ _______________
___________________ Constrained Liver Qi Up-regulated SNS overacts on PNS Taiyin/YAngming Circuit dysfunction Liver/Spleen dysfunction Spinal Irritation and up-regulated SNS may be precipitating factors for this pattern of visceral agitation
Point strategies
YinYang Regulation tight rectus & oblique muscles- viscerosomatic tight chest (pectoralis level with ST 18-Liv 14) Tight SCM (plum pit Qi)
Patient Complaints: o
o o
IBS, bloating, undigested food, diarrhea and/or constipation, abdominal pain, gas Reflux or GERD Relief in Crohn’s Disease or colitis
Jing: SP 4(R)/Per 6(L) for chong and yinwei mai Ying: LI 4/Liv 3 Liv 14 (and GB 22 or Per 1), SP 6 Patient Complaint ST 36-39 & ST 25; CV 10, 12, 13; ST 24-18 on left ST 25 (Bil) all where tight and constricted (dispersal, not TrP needling) For Xu-Li, add CV 12, ST 14-16(left), ST 18 (L); ST 44-43 where tender either or both sides For heartburn to chest, add CV 18to 17 and lateral Kid points; or Kid 22 and Per I if left sided heartburn
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Counsel patients that “their problem is their Life” Dr. Shen advice- eat regularly 3 x day, never late at night, never while working at desk or standing, slowly, quietly Do not indulge in fatty foods or alcohol Check out if they are wheat, lactose, or corn intolerant or have celiac disease Do not drink ice-cold drinks In reflux and GERD, raise back of bed 6” to prevent acid reflux Above all, teach abdominal breathing as AM and PM stress reduction activity before arising and falling asleep, while in bed face up with knees bolstered with pillows, or whenever hyperventilating (5 minutes)
Pelvic collapse/ chong, dai, ren dysfunction Lower heater dysfunction
__________________ Spleen Qi Sinking with or without Constrained Liver Qi in Middle heater as possible precipitating factors for this pattern of visceral agitation
Signs & Symptoms
Point strategies
________________
________________
Flaccidity in middle heater abdominal muscles, tightness and constriction below navel, pressure and pain at Kid 15.5 to Kid 11 and ST 26-30, and CV 7-2 (chong mai lower heater branch), tight lower external obliques (dai mai); tight linea alba (ren mai)
YinYang Regulation
Patient Complaints: o
o
o
o
Prolapsed organs: postbirthing; uterus, bladder, right kidney, hemorrhoids, hernias (Shan) PMS, amenorrhea, disrupted menses, infertility and impotence prostatitis, vaginitis, cystitis, pelvic floor syndrome; sexual dysfunctions such as erectile dysfunction or frigidity
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Jing: Chong-Dai Infinity Treatment: SP 4(R)/Per 6(L) for chong mai; GB 41(L)/TH 5 (R) for dai mai Ying: Three leg yin source points SP 3, Kid 3, Liv 3; Sp 6 and 9; Liv 9 for constrained Liver Qi in lower heater; Patient Complaint Local chong, dai and ren mai points in lower heater; local Liv, Sp, Kid meridian points in lower heater; local points over visceral irritation (ST 30 for ovaries, CV 4-6 for uterus etcetera); CV 2 down, to right and left to propagate Qi for lower heater-it is.
AOM Lifestyle Coaching _______________ Coach patients to develop core strengthening routine for middle heater; stretches for lumbar region; Yoga or Qi gong for lower heater strengthening counseling/therapy for sexual dysfunction counsel women with vulvadynea to seek PT specializing in manual therapy who specialize in this
Cardiac Alarm/ UpperLower heater dysfunction
__________________ Kidney Yang/Heart Protector Dysfunction Kidney/Lung Qi Dysfunction
Pelvic collapse and/or diaphragmatic constriction may be precipitating factors for this pattern of visceral agitation
Signs & Symptoms
Point strategies
________________
________________
Free-floating anxiety, dread, fear of impending doom
YinYang Regulation
Shallow breathing, hyperventilation, heart palpitations induced by stress
Chong-Dai Treatment: SP 4(R)/Per 6(L) for panic attack, anxiety, palpitations in patients with Kidney Yang & Heart Protector dysfunction
Suggest stress reduction or relaxation response programs for coping with stress
Ren & Yinchiao mai: Lu 7/Kid 6 for shallow breathing and hyperventilation syndrome in patients with Kid/Lu Qi dysfunction
Suggest mindfulness training for practicing anytime/ anywhere
Non-cardiac chest tightness and discomfort from diaphragm to under armpits and sternum (3 yin muscle channel referral patterns) with tightness in rhomboids and paraspinals in upper back
Jing:
Ying/Patient Complaint:
Patient Complaints:
o Anxiety, panic
Kid 15.5 for adrenals;
o
Per 4 &5 with CV 18-17 for chest constriction
o
attack, heart palpitations; cardiac neurosis; costrochondritis
Kid 22 and Per 1(L) for chest pain on left (cardiac neurosis) Xu-Li treatment for chest pain from reflux or GERD (see second pattern of fatigue above) SP 20 & LU 1, Kid 27, BL 13 and 42 for hyperventilation syndrome
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AOM Lifestyle Coaching _______________ Coach patients to do abdominal breathing as above
Suggest meditation, yoga, Qi gong
Suggest biofeedback, hypnotherapy, EMDR, Psychotherapy for behavioral and posttraumatic issues
medicine, but more specific, perhaps, to the diverse needs of the North American student or patient of Acupuncture & Oriental Medicine (Institute for Functional Medicine, WA, 2006, pp. 669-685).
The Western Spirit Recovered What I have realized in researching this topic and in reflecting at length on my senior students’ various approaches to and interpretations of spirit, is that unlike the Confucian Chinese, who had a centuries-old set of beliefs and practices based on an ideal social person who possessed the 5 virtues -benevolence (ren), propriety (li), integrity (xin), decisiveness (zhi), and right action (yi), our North American students come from varied cultural backgrounds that might derive from Judeo-Christian, Moslem, and African roots to name but a few. It is therefore unrealistic to assume that North American students, or patients, of AOM would share the same notions of the self, the sacred, and what spirit means in their lives.
In this 21st century approach to care, the relevance to the healthcare practitioner of Mind and Spirit, and the impact of a patient’s “spirituality” (“search for the sacred, the sense of being connected to something greater than self”) and/or organized or institutionalized religious beliefs, is pivotal. Evidence on the beneficial effects to health of a patient’s spirituality and/or religion was gathered in a systematic review of the literature over the entire 20th century (Koenig HG. Religion and medicine IV: religion, physical health, and clinical implications. Int J Psychiatry Med. 2001; 31(3): 321-336): “While more research and better designed studies are needed, the vast majority of research completed to date indicates that religious beliefs and practices are associated with better mental and physical health (Textbook of FUNCTIONAL MEDICINE, p. 677).
The notions of the self, the sacred, spirituality and the relationship between humans and nature were heavily influenced by East-Asian traditions and practices at the height of the New Age Movement, which gave way to holistic medicine, and then to complementary and alternative medicine, and now integrative or functional medicine. These decidedly North American traditions yielded a rich array of approaches to the sacred and spirituality and went on to greatly influence the way mind-body medicine approached the role of the spirit in health and disease.
In another review of the evidence which looked at the religious/spiritual as compared to meditation/relaxation practices, Seeman et al concluded that: “1. Meditation/relaxation is associated with better health outcomes in clinical patient populations (…); 2. Meditation/relaxation is associated with lower blood pressure (…); 3. Religion/spirituality is associated with lower blood pressure, less hypertension, better immune function (…); 4. Meditation/relaxation is associated with lower cholesterol, lower stress hormone levels, and differential patterns of brain activity (…); 5. Meditation is associated with less oxidative stress, and less blood pressure and stress hormone reactivity under challenge (…)
21st Century North American Search for the Sacred In their primer, Textbook of FUNCTIONAL MEDICINE, the Institute of Functional Medicine lays out its approach to the relevance of the role and impact of spirituality and the “search for the sacred, the sense of being connected to something greater than self” on healthcare practitioners that is consistent with classical Chinese
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(ibid).” Other studies cited find that regular church attendance in healthy individuals reduces mortality by some 25%, and that regular church attendance can reduce cardiovascular disease, which may be related to the “healthier lifestyles adopted by churchgoers (ibid, p. 678).”
Alternative Medicine show that an enormous number of people avail themselves of these practices for their health, wellness and disease prevention, which I will return to in a later reflection. Such practices are consistent with, and complementary to Acupuncture and Oriental Medicine life nourishing practices, and AOM practitioners trained in such approaches will be in a better position to engage in wellness and health prevention lifestyle counseling with their patients in a way that is best suited to their patients needs. Such a combination of East Asian and Western approaches might well become a more and more practical way of bringing life-nurturing practices back into a Chinese medicine that would restore the soul and spirit of Western AOM practitioners and their patients, through creative conjunctions and collaborations for best care.
Citing the conclusions of a study by Hawks et al on three peer-reviewed spiritually based health intervention programs (Stress Reduction Clinic of Jon Kabat-Zinn at the University of Massachusetts Medical Center, The Lifestyle Heart Trial, and the Stamford University School of Medicine complex psycho-social intervention with metastatic breast cancer patients) the effects of “improved spiritual health may be associated with improved behavioral and emotional health in such areas as diet, activity levels, communication skills, treatment compliance, reduced anxiety and depression, and improved mood states. These positive behavioral and emotional improvements in turn may be associated with heart disease reversal, reduced cancer mortality, enhanced immune function, and reductions in pain and other medical symptoms (ibid, p. 680).” While it is possible for North American AOM practitioners to develop Lifestyle and Life Nurturing programs for their patients, including Dao-Yin, Qi Gong and herbal practices, it may be more pragmatic and appealing to their Western patients to refer them to neighborhood programs in mindbody and spiritual practice, tailored to their desires and needs, as well as specialists in the psyche (psychotherapy, cognitive-behavioral therapy, body-centered psychotherapy) and the body (physical and occupational therapy, athletic training, Rolfing, massage, Feldenkrais Method, the Alexander Technique, Gyrotonics, Pilates) and programs in mind-body health (Yoga, Qi Gong, T’ai-Qi, Meditation etcetera). Recent studies on the use of mind-body practices as one form of Complementary and
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