Tag Archives: acupuncture

The mysterious dislocation of memory

A tutor of mine who works as an acupuncturist was treating a woman who, years ago, had fallen a long way and broken her ankle badly. Now fully healed, she had come for a treatment for some other condition. The practitioner needled her ankle, and she suddenly experienced a distinct sensation of falling. The tissues had held on to that experience, and when the traumatised area was needled, the associated sensation returned.

It is a well-known phenomenon in the world of internal medicine. The sternocleidomastoid muscle in the neck, for example, is a storehouse of emotion. In Japanese hara diagnosis, treating sympathetic nervous system dominance by needling San Jiao 9 in the forearm can have the miraculous effect of immediately and palpably softening a tight and tense SCM.

Much has been written on this subject of emotional memory being housed in the body, rather than exclusively in the brain, notably by Bessel Van Der Kolk in his excellent book, The Body Keeps the Score. But is this really the whole story? Let’s try a thought experiment…

You used to ski when you were a child. You did so regularly enough to be quite competent. But you haven’t skied for years. Decades, in fact. Now you’re in your sixties. And you’ve travelled to the Alps to visit some friends. They’re taking you out on the slopes for the day. You’re excited, but also nervous. You don’t bounce like you used to.

Tentatively, you clip your boots into the bindings. You wobble. You lurch and sway. You’re cautious, of course, but somehow your body remembers how to do it. After an hour or so on some easy pistes, your confidence has returned, and your movements are relatively efficient. Not as fluid as when you were young, perhaps, but you haven’t forgotten. You can go where you want, at the speed you want. Crucially, you can stop, too!

Somehow, your body remembers how to do it.

Think about that.

Since you last skied, every cell in your body has been replaced several times over. Every cell in your brain has been replaced, too. You don’t even have the same bones.

But your body remembers how to do it.

Where then, is this memory of how to ski located? From where have you accessed it?

If memory is not in our brains, and it is not in our bodies, either, then where precisely is it?

A Body of Space

Is traditional Chinese acupuncture more art than science?

Looking into the body of modern scientific research on acupuncture, there is a plethora of articles out there detailing research projects, many of which come to highly variable or contradictory conclusions regarding its efficacy as a therapy.

With the very real therapeutic effects of placebo treatments, the inherent difficulties involved in successfully administering sham acupuncture (and the question of whether it is in fact inert at all, either when using blunt needles or selecting “non-active” acupoints), the infinite number of variables regarding the pathological presentation of subjects, and the problematic lack of sufficient samples (participants) or doses (number and depth of treatments), it is extremely hard to arrive at any conclusive evidence.

Being a branch of medicine that people tend to resort to for chronic conditions, which are poorly treated by symptomatic medicine, and often in fact merely disguised or controlled by pharmaceuticals and never actually treated in a meaningful way at all, methods of assessing response to treatment leave a lot to be desired.

For example, how does one measure pain? How do you establish a baseline? How do you quantify how it changes? And how do you establish commonality between different individuals? With such a subjective experience as pain, trial designers must often resort to decidedly unscientific techniques such as self-assessment questionnaires. With regard to the relatively small size of acupuncture trials, methods such as this will tend to produce highly skewed results.

And the trouble is, the abstracts (or summaries) of published trials that catch the attention of journalists tend to focus on the headlines and conveniently minimise any issues or flaws admitted (or ignored) by the trial’s designers, which tend to be glossed over and buried towards the back of an article.

Not only are there likely flaws in scientific method, and in the collection and interpretation of data, inevitably there are the personal or institutional motivations, incentives, and natural biases of those running trials, or participating in them, whether that be intellectual or financial, unconscious or otherwise.

You should ask yourself, why and by whom has this trial been funded? Why has it been published? Where has it been published? Science is never pure; it can never absolve itself of the inherently flawed, intentional, and non-objective humans that design its processes. (Until, of course, the machines take over!)

There are issues too with the clinical setting and therapeutic relationship between patient and practitioner. It is especially crucial in the field of acupuncture that there is trust and genuine, open communication on both sides. The patient must be able to relax sufficiently for the parasympathetic nervous response to activate for healing to be possible. In clinical trials that are set up to test a theorem, rather than to facilitate real healing, is that essential therapeutic relationship really present?

Trials are often set up in such a way as to exclude the more subjective or qualitative elements that would ordinarily feed the diagnosis of a traditional acupuncturist. Everything from gait, posture, complexion, body shape, and even a person’s smell, to the nervous disposition, lustre of the eyes, manner and tone of speech, way of moving, and degree of animation, all contribute to the diagnosis, besides any aetiological factors or the actual verbal content of a consultation.

One question that tends to be met by first-time patients with either bemusement or surprise is the practitioner’s interest in the shape, texture, colour, and frequency of their stools; a strange and inexplicable fetish peculiar to the traditional acupuncturist!

Also peculiar to traditional acupuncture is the attention paid to the shape, colour, and coating of the tongue, as pertaining to the patient’s longer-term state of being. The tongue provides an unexpected window on a person’s health. For an accurate viewpoint on the current, moment-to-moment state of being, we use the pulse. By listening through the fingertips to different positions of the radial pulse, we can ascertain the condition of the various energetic networks in the body. It is a live feed to the processes and relative harmony, or disharmony, of the body’s systems.

From my perspective as a second-year BSc student, this is most certainly an opaque and mysterious art, rather than a transparent and graspable science! I have learnt to tune into the more obvious, broad-stroke indications of the pulse, but an experienced practitioner can read an immense amount of detail from the qualities of the different pulse positions and depths. One tutor I have seen monitoring the pulse while she needles the patient, listening for changes and altering her needling technique or even selecting a different point entirely should the desired results not manifest in the pulse. This is a highly subtle (and to me at least still rather mysterious) art that would essentially be impossible to integrate into an ostensibly objective clinical trial.

From my own admittedly limited experience, pulse diagnosis requires a suspension of cognitive function, of the reasoning mind. You have to get out of your own way and simply listen openly to the pulse as it presents itself to you. Search and analysis are unhelpful tools. You must be quiet and present, and as you tune into the sensations beneath your fingertips a picture gradually begins to form. It’s like a blurry image gradually coming into focus, and that focus is achieved through silent, patient, open, wordless inquiry. Through intuition. You have to literally feel your way there. Knowledge underpins the process; it does not rule it.

Instinct plays a big role in pattern diagnosis, too. Chinese medicine practitioners do not arrive at an illness described by a set of symptoms; rather, they diagnose a “pattern”, which is a picture that describes the current presentation of the whole human being. This pattern is, like the rest of the universe, in a constant state of flux.

The various energetic systems of the body as described by Chinese medicine interact with each other and result in a unique pathology, which can be broadly categorised but is in fact a highly individual and ever-changing condition. The same set of symptoms might fit several different patterns, and so the skilled acupuncturist will draw on experience, inquiry and instinct to arrive at their diagnosis.

Because of this holistic understanding of disease, as opposed to the more reductive approach of conventional medicine that sees a group of symptoms, labels them, targets specific and isolated areas, and prescribes a particular medication or surgical procedure, standard protocols of particular acupoint combinations are dubious at best. Unfortunately, especially with the proliferation of Western dry needling techniques, this “one size fits all” approach is becoming increasingly prevalent.

In certain circumstances, such as very specific musculoskeletal injuries, this standardised approach can be effective, particularly with modern practices such as electro acupuncture. But when it is applied to more general conditions, and particularly those that have a more psycho emotional aspect, protocol-based dry needling falls seriously short. The notion that “this point has this effect” is overly simplistic and disregards the rich complexity of traditional acupuncture. This could go a long way towards explaining some of the less favourable or ambiguous results of many acupuncture trials. 

Certainly, a local treatment can be designed based on the anatomical areas that are being affected. But that would be doing a disservice to the wisdom, subtlety, and deep understanding of the entire human being that this ancient art possesses. We can use distal points. We can use the Yin and Yang relationships of the channels. We can use the anterior/posterior relationships of channels paired arm to leg. We can balance left and right, front and back. We can mirror or holographically superimpose the whole body, or parts of it, on to individual areas. We can employ the five-element model. We can use the eight trigrams and sixty-four hexagrams. Eight principles. Six stages. Four levels. Three burners. The heavenly stems. We can work with the twelve primary meridians, or with the eight extraordinary vessels. We can devise treatments based on time of day, or time of year. Certain esoteric methods even make use of the constellations.

We can think of different point categories: five Shu points, source points, connecting points, accumulation and gathering points; back transporting and front collecting, points of the four seas, or the window of heaven points, ghost points, heavenly star points, command points… all these we can combine into a highly effective, bespoke treatment plan that can shift and direct a person’s energetic systems in a precise and specific manner. If we’re any good, that is.

Perhaps those with more conservative (they might say rational) mindsets might scoff at the idea of working out medical treatments according to the lay of the stars. But we ourselves are beings of the cosmos. And, according to Daoist philosophy, in which Chinese medicine is very much based, we are a microcosm of the universe. We are not separate from reality, despite what your innate and individualistic sense of self might tell you. We are not observers; we are right in it. Why shouldn’t we be influenced by the motions of those great entities all around us? We’re certainly changed by those mysterious and alien processes perpetually underway within ourselves.

We are surrounded by mystery, and we enclose it. Our lives are bookended by it. Even our most familiar apparatus, consciousness itself, is apparently intrinsically unfathomable. It used to be the consensus that consciousness was an emergent phenomenon produced by our brain activity. More recently there has been a movement towards the notion that consciousness is a fundamental feature of the cosmos. It is not so much something that we generate, or even access, but something that we are. And not only that: everything is conscious. All the energy and matter (which is just further organised, denser energy) around us and within us is conscious. The whole universe is aware.

This isn’t a new thought. It has been with us through shamanic and animist traditions since prehistory. Rather than a new development, it is more a remembering. Unfortunately, it is largely a recollection born of theory and philosophy, rather than the direct experience, the trance and revelation, of those ancient cultures. Still, it’s a beginning, and to my mind infinitely preferable to the bleak, depressing, “dead matter theory” that has been with us since the Age of Enlightenment.

Chinese medicine supports the concepts of spirit and rebirth. You are not required to sign up to particular religious beliefs in order to practise traditional medicine, but it is fascinating to me that such a sophisticated and integrated system has embedded within it such ideas as the Ethereal Soul, or Hun of the Liver, which yearns for Heaven,  continues after death and wanders the dreamlands of our sleep; and the Corporeal Soul, or Po of the Lungs, which yearns for the Earth and dies with the body.

The Shen, or Mind-Spirit, is housed in the Heart, and is something the acupuncturist will often seek to work with, generally indirectly through the Pericardium, for example, as a crucial part of the patient’s journey towards health and harmony.

Conventional medicine has only recently begun to recognise the importance of a person’s psychological and emotional well-being. For a long time, it has treated the body like a broken car to be fixed, working with the physical structures in isolation and largely ignoring the mind and spirit. Let’s hope that, supported by the approach of complementary therapies, the emerging trend towards an emphasis on mental health and holistic recovery continues to grow.

But I would advocate a circumspect attitude towards the importance of establishing and expanding a scientific evidence base in the established model. In so many ways, a tailored, complex, and refined practice such as traditional acupuncture simply doesn’t fit. It is by its very nature not a standard, repeatable procedure.

The elegant beauty of a minimal and effective treatment relies not on some magic formula, but on the insight, skill and knowledge of the practitioner, on the quality of the therapeutic relationship, and on an understanding of body, mind and spirit that lies within an entirely different paradigm to that of conventional scientific inquiry.

Science, for the time being at least, has no room for Qi. I suspect it will stay that way, for science needs things that can be pinned down and observed. Qi is process. Qi is change itself. While it can be experienced directly, by its very nature it cannot be reduced to a molecular structure or mathematical equation.

Unfortunately, it would appear science is not even prepared to meet the Eastern paradigm halfway. It insists on its own objective parameters, and in large part persists in ignoring even the basic requirements of traditional medicine. I have happened upon research papers in which needles are inserted for only five minutes. There is no mention of needling technique, of manipulation for tonification or draining, or the attaining of De Qi (the dull, grabbing sensation that occurs when a needle engages with the body’s energetic flow).

There is little or no importance placed on the Yi, or practised intention of the acupuncturist, either. This is a shame, for without such fundamental aspects real acupuncture loses its essence and power. Stripped of its blood and vital organs, it is then dismissed by the scientific community as a worthless, empty husk.

I am by no means opposed to evidence-based medicine, and certainly welcome an open-minded investigation of complementary therapies, but with regard to assessing the efficacy of something so tailored and intricate as acupuncture, you have to ask if the very method you are employing to test its effectiveness is itself fundamentally flawed. Where a science lies in the realm of quantification, deduction and induction, art lies in the realm of qualities, subjectivity, and intuition.

Traditional Chinese medicine straddles both these worlds, but in my view it leans heavily towards the side of art. No two practitioners are likely to concoct the same prescription for a given patient, and no one patient should receive the same prescription on successive treatments. Why? Because acupuncture is about dealing with change. It is about tuning into the process of change within a human being, and influencing that process through the intervention of needles, (along with moxibustion, cupping, Tui Na, and so on) and a conducive therapeutic relationship. The pattern is always changing. Everything is in flux.

Science largely requires the world to be static, reproduceable, and predictable. But Nature is none of these things, in truth, particularly when the variables of human mind, emotions and spirit are considered. Yes, certain things obey Newton’s laws, or the laws of relativity. These include human bodies. But these do not include human beings.

Thankfully, there has been some progress. In the UK acupuncture can now be recommended by doctors as an effective treatment for chronic pain. But for those within the field, this small gesture, whilst appreciated, and encouraging to hear, is also kind of laughable. Before the advent of conventional medicine to the East, acupuncture (alongside herbal medicine) was medicine for countless centuries.

Sharpened stones and bone tools thought to be the precursors of acupuncture needles have been found by archaeologists and dated as far back as 6,000 BCE. Who knows how old this ancient art really is? Are we really suggesting that our ancestors remained superstitious idiots for millennia, believing in all this “made-up hocus-pocus”? The arrogance of this belief is quite staggering, and to my mind an unfortunate residue of the new scientific age, which is long overdue a hefty rethink, an adjustment in its own self-belief.

Long before our modern obsession with the nature of matter, our eternal, and perhaps ultimately foolish, rainbow-chasing quest for the most fundamental particles of existence, now swamped in a morass of quantum phenomena, our ancestors had a sophisticated understanding of the body as space. Yes, we were flesh and blood and bones and organs and fascia, but we were also dark, empty caves and interlinking conduits.

They mapped the spaces in our bodies as a network of streams and rivers. They meditated and came to understand in an experiential way the flow of energy through these channels and spaces. They identified the Dan Tian, the Chong Mai, the microcosmic orbit, and the entire energetic body that we in the post-Enlightenment West have largely forgotten or dismissed as nonsense. We have neglected the importance of space. Without space, we have no structure. Without space, we have no room to breathe. No room to grow. No room to flow.

This poses a problem in terms of acupuncture’s acceptance as a valid and effective treatment. For how can science study empty space? It requires “stuff”. For years they searched for these mysterious meridians in the body. They never found them because they were looking for something. The meridians were there all along, there in the spaces that the scientists rigorously ignored.

Tibetan tantric Buddhism knew of the Central Channel and inner winds. Chan, and later Zen, Buddhism knew the importance of emptying the self, and taught of the fundamental emptiness of all things, being so profoundly interdependent and impermanent. Yogic traditions knew of all-permeating prana, the vital breath of the universe. Daoist alchemists knew that Qi had to be built and circulated through the channels, while the mind and body profoundly rested, to attain its optimum state of health. Such concepts pervade spiritual traditions worldwide, from Christian mysticism to Native American animism.

I’m not trying to claim all these ideas of emptiness are the same thing; they are not. But they are expressions of the universal acknowledgment of the fundamentality of space. Astronomers look through its vastness to focus on stars and galaxies. Perhaps we should pay more attention the space itself? To the space within us, as well as without.

Perhaps we should learn to trust our own inner inquiry, instead of relying solely on the external observations of scientific method. To be quiet and still and pay attention to our own inner natures, instead of always looking out at a world whose appearance relies upon the filters of our senses and the presence of our minds.

Or the presence of Mind…

Fettered by the Fuzz: Getting a feel for fascia

You know your own body. Right?

Yeah, of course. Vital organs, flesh, blood, nerves, skeleton… oh, and connective tissues. Most people forget about those. But what exactly are these connective tissues? Tendons, ligaments, cartilage – most of us are aware of these. They consist of elastin, collagen, and chains of polypeptides that keep our sinews fibrous and sinuous. And then there is the complex network of fascia that binds, stabilises and separates our viscera. It encloses and penetrates our muscles, wraps around our organs, and underpins our skin. It prevents us, along with our bones, vessels and skin, from functioning only as amorphous blobs and oozes. But you already knew that… right?

Fascia has largely escaped the notice of the medical world for centuries. It was the annoying stringy membrane that you had to cut through to get to the meat of the operation, so to speak. Modern keyhole surgery, however, makes extensive use of fascia, sliding surgical implements and cameras through the convenient spaces between fascial planes. The human mind tends naturally to focus on “stuff”, on “things”, and to ignore the vital spaces in between, but in recent years the importance of fascia has become increasingly recognised and acknowledged. No longer is it just the good-fer-nuthin’ chewy piece of gristle in your sirloin steak. It keeps us mobile and elastic, contributes significantly to the structural scaffolding of our bodies, and provides us with functional lines of kinetic power and movement.

Increasingly, the fascial network is being offered as an explanation for the efficacy of acupuncture. Whilst I’m not convinced the correlation is so direct and simple as some suggest, there are certainly some convincing parallels with the Sinew Channels and Twelve Primary Meridians. There is, for example, one continuous sheet of fascia that runs from the brow-line, over the scalp and down the back, all the way to the plantar fascia beneath the foot. In traditional Chinese medical theory, the Bladder channel follows the exact same path. Aha! Acupuncturists now have a neat and handy, scientific-sounding explanation for when the sceptical patient asks why a needle in the foot might help alleviate their lumbar pain or stiff neck… without having to resort to nebulous expositions about the mysterious workings of Qi that leave most Westerners flummoxed at best, or derisive at worst.

There is even a suggestion that Qi itself is in fact an electrical flow facilitated by the piezoelectric quality of fascia, and by the conductive properties of the fluids that run along and between it. By manipulating the myofascial web with needles, we can adjust and manipulate the flow. We can release or engage the fascia, and change the manner in which it feeds back to the nervous system. In many cases, chronic pain is not caused by damaged muscle or scarring, but by taut, overstretched, or bound-up fascia. Often, that pain is not felt at the dysfunctional area, but is rather referred along muscle and fascia to knotted Ashi points and trigger points. The fascia is not just inert material; it is a sensitive network running through the entire body and feeding back to the Central Nervous System. Is Qi electricity? Electricity is a kind of Qi, perhaps – but again, I don’t think they are one and the same. I don’t think it’s the whole story.

One of the effective mechanisms common to acupuncture, meditation, yoga, and Qi Gong is that through breathing and an emphasis on an alert but quiet mind-state, the parasympathetic response of the autonomic nervous system can be activated, and this is crucial to dealing with all kinds of pain conditions – not just musculoskeletal ones, but things like Irritable Bowel Syndrome, too. The role of the mind cannot be underestimated here. For tissue to release, the mind and nervous system have first to say, “It’s okay”. Our minds are not separate from our bodies; they are integrated and inseparable systems. Indeed, there has been much written on how negative emotions that are not “worked through” and released can instead become stuck inside the physical tissues.

Certainly, this perspective is one shared with classical Chinese medicine. I have myself witnessed people being needled at particular points, and suddenly becoming overwhelmed with emotion. I’ve seen vasovagal responses, too, in the form of “needle shock”, that have also been closely tied to past trauma, both physical and emotional. Indeed, we easily accept that physical trauma is likely accompanied by emotional trauma; less accepted is the notion that emotional trauma necessarily manifests in the physical body.

Interestingly, one of the Nei Dan, or Daoist internal alchemical, techniques I have learned is an alternating squeezing and releasing of the whole body. This is to encourage full relaxation of the flesh, especially those parts that we unconsciously keep in a state of tension. By squeezing and releasing we can become aware of the degrees of tension we hold within us, and gradually let them go. I believe that this letting-go is not purely physical, but emotional, too. We let go of thoughts, emotions, and physical tension and tightness, and therefore allow the body and mind to enter a state of rest and healing that it cannot attain even in sleep (when the mind is still busy with dreams).

Various Buddhist visualisation techniques also work with imagining the body as space. We know from modern subatomic physics that this is literally true: our bodies are comprised overwhelmingly of empty space, contrary to our sensory experience of ourselves as primarily solid entities. On a more palpable level, the ancient Chinese practice of using suction cups also creates physical space in our bodies, allowing stagnation to move, toxins to drain, and fresh nutrients to replenish. Massage, foam rolling and acupressure work by compressing space in the body. How much time do we spend actually opening it up and increasing internal space?

In Zhan Zhuang standing practices, often associated with martial arts, such as the San Ti Shi posture of Xingyiquan, or with Qi Gong, such as the Wu Ji posture, we work on a process of internal release, through the muscles and connective tissues, but in particular through the spine. As the crown of the head is gently lifted, we relax and allow gravity to pull the pelvis away from the skull, gently stretching the spine and opening up space between the vertebrae. What lies between our vertebrae? Our cushioning intervertebral discs: connective tissue. Through the process of release during standing practice, the overly-curved and compressed lumbar region especially is partially straightened and lengthened as the sacrum drops and the pelvis tilts posteriorly.

This is a perfect antidote to the postural imbalances induced by a lifetime of sitting in chairs, such as Lower Crossed Syndrome, where the glutes and abdominal wall weaken as the thighs and lower back tighten. The whole releasing process, known as Song (approximately pronounced sung) in Qi Gong, Taijiquan, and other Chinese internal martial arts, involves the gradual unbinding of habitually tight fibres in the muscles, and around the bones, so that space can be found in the body and Qi can flow unhindered. Spaciousness and tension within the body are directly paralleled by spaciousness and tension within the mind. Each feeds into the other.

Many Chinese health practices work directly with fascia. Tui Na massage, Gua Sha, and suction cupping therapies certainly do, as do Qi Gong and the internal martial arts. A high level Taijiquan practitioner has a remarkable ability to direct power through the body via lines of connective tissue that are developed through consistent, mindful practice. In Baguazhang, too, there is much emphasis on chain-like, flowing, full-body movement, maintaining a relaxed stretch or torsion of internal fibres. We don’t just move the hand; the whole body moves the hand. We feel how the torso, legs and feet can all become involved in the movement. Nothing is isolated; the whole body is involved in every action. We are an interconnected web, strung together by the cobweb-like filaments of fascia. Where Western medicine dissects, Chinese medicine and martial arts seek to connect, and to work with the whole.

Aside from complex martial and internal practices, simple, natural stretching is crucial to fascial health. Without movement, the fascial membranes that are designed to glide over each other and provide us with an easy, open, and extensive range of movement, instead knit together as strands of sticky, yellowish “fuzz” form between the layers. This fuzz thickens and congeals until our natural elasticity is restricted. We are literally bound up by our own fascia. What should be lubricated and frictionless instead becomes viscous and impaired. And it doesn’t take long. A few hours without motion and the process of knitting together is underway. A few weeks or months go by and whole areas become stuck. By the time we are old we are bent over and drawn in. We can no longer touch our toes. For some people this happens well before they are old. It doesn’t have to be this way.

This is the real, physical benefit of yoga and Qi Gong. A stretched muscle soon returns to its habitual state, but regular movement-based practices such as these inject energy into the body and work these fascial membranes, which might otherwise become irrevocably stuck together. They create internal frictions that gradually free up the body’s restrictions. Not only that, but yoga especially works certain movement patterns that do not form a part of our normal routine, such as lateral stretches, twists, and forward bends. The twists are particularly useful as they work the spiral fascial planes that connect one side of the body to the other, and bear some similarity to the Gall Bladder channel and Dai Mai, or Girdling Vessel.

It is increasingly believed that static stretches are not as effective as dynamic stretches, if indeed they are at all. Dynamic stretching needs to be performed mindfully and cautiously, so as not to overstretch or potentially tear muscles or connective tissue, but quite often a static stretch is simply lengthening areas that are already free to move (and possibly taking them close to their elastic, or even their plastic limit), whilst areas that are bound up simply stay bound up. It might be that it is not even a muscle that is restricted, but rather a nerve or adjacent area of fascia. Perhaps even a distal one. The tightness in your lower back could be rooted in constricted plantar fascia in the foot. When we introduce internal heat and move in various spatial planes, things can slowly begin to unwind internally.

There is an organ in Chinese medicine that is not acknowledged by Western science. Perhaps it should be. It is the “organ with function but without form” – the San Jiao, or Triple Heater. It is an organ of space. Its three spaces separate the respiratory, digesting, and excretory zones of the torso. How are they separated? By fascia. The diaphragm, for example, is a sheet of muscle partitioning thorax and abdomen… and it’s wrapped in fascia, which creates an impregnable wall between the two zones, penetrated only by oesophagus, vena cava, aorta, and vagus nerve. The San Jiao coordinates the cooling and warming functions of the body, transports fluids, and provides for the free passage of Qi. Sound familiar?

Indeed, from an embryological standpoint, the entire foetal development of the body can be seen as an unravelling of distinct, organisational spaces. These begin as the Eight Extraordinary Vessels: the Du Mai, Ren Mai, Chong Mai, Dai Mai, Yin and Yang Qiao Mai (“stepping” vessels), and Yin and Yang Wei Mai (“linking” vessels). Only after parturition do the Twelve Primary Channels of the Zang Fu take over as we enter the Xian Tian, or “Post-Heaven” phase of our lives. The way in which the embryo divides and organises itself can be equated uncannily closely with the partitioning lines of these Extraordinary Vessels.

Fascia, whilst criminally overlooked, is crucial to us as living organisms. Without it we would literally be a real mess, like blobby amoebae. Fascia is instrumental in the smooth functioning of our organs, and of our muscular, nervous, lymphatic, respiratory, digestive, vascular, immune and endocrine systems. Everything, basically. It holds us in space, and lends us structure, spaciousness, and freedom of movement. Its health reflects our emotional and physical state. Keep it moving, and it lubricates our entire existence in integrated, joyful motion. But let it grow stagnant, and it will bind us, constrict us, and fetter us to a lifetime of stiffness, pain, and decline.

See those elderly people still practising the slow, fluid movements of Taijiquan in the parks of China in their seventies and eighties? Those are people who have not only looked after their organs, their breathing, their minds, muscles, and bones; they’ve looked after their fascia, too. Pulling and twisting, stretching and relaxing their way to a graceful old age.

It’s time to get connected.

Recommended reading and viewing…

Bessel Van Der Kolk: The Body Keeps the Score (Penguin Books, 2015)

Dolma Johanison: The Beginner’s Guide to the Eight Extraordinary Vessels (Singing Dragon, 2022)

Dr Daniel Keown: The Spark in the Machine (Singing Dragon, 2014)

Gil Hedley: Fascia & Stretching – The Fuzz Speech [https://youtu.be/_FtSP-tkSug]

Thomas Myers: Anatomy Trains (4th Edition, Elsevier, 2021)

University of California Television (UCTV): The Role of Fascia in Movement and Function [https://youtu.be/raCBeQ-gXfs]

Running Piglets and Intestinal Wind: The Poetry of Chinese Medicine

Aikido is a wonderful martial art. The peaceful philosophy of Morihei Ueshiba, the emphasis on mindful perfection of technique, the trance-like state of mental calm, the easeful grace and flow of the circular movements…

But its terminology lacks a little in poetry. To the English-speaking mind terms like Irimi Nage and Nikyo sound exotic and tantalising; it’s a bit of a let-down to discover they mean Entering Throw and Second Teaching respectively. Tenchi Nage is an improvement: Heaven and Earth throw. But on the whole, it’s all rather matter of fact. Efficient, instructive, and direct – yes. And there’s nothing intrinsically wrong with that. But it is a bit dull.

One of the things I love about the Chinese martial arts is the rich use of vivid metaphor. And it’s not just that it’s aesthetically pleasing; the vivid titles of forms and techniques make them easier to learn and remember. When we apply imagination and associative techniques to our learning, our powers of recall improve astronomically.

I’ve been using these kinds of techniques to help memorise acupuncture points. Kidney 1, Liver 5, Heart 7, and Stomach 35 don’t exactly fire the imagination. Bubbling Spring, Woodworm Enters the Groove, Spirit Gate, and Calf’s Nose, however, all draw memorable imagery that also poetically describes the primary function of the point.

Various gong fu styles are famous for their imitation of animal movement. In Xingyiquan we have the Twelve Animal Forms, including some rather unexpected ones such as Chicken and Swallow. In circular Baguazhang we have snake, dragon, tiger, and the same darting, overturning swallow. The linear forms, whilst more literal in general (“adhere”, “fold”, “pierce”, “encircle”), contain some descriptive gems too: Two Immortals Point the Way, Phoenix Robs the Nest, Flower Hidden Under Leaf Palm…

More widely known are the Taijiquan forms: Part the Horse’s Mane, White Snake Creeps Down, White Crane Spreads its Wings, Embrace Tiger Return to Mountain, Buddha’s Warrior Pounds the Mortar…

And then there is Qi Gong. In the Eight Silk Brocades we have Open the Golden Bow and Wise Owl Turns its Head; in the Eighteen Taiji set we have Hawk Flies to the Forest and Scoop Up the Sea, Gaze at the Sky. Even the very notion of “reeling silk” visually and tactilely conveys a sense of continuous, flowing movement, of tensile strength and suppleness, of simultaneous softness and relentlessness.

Such descriptive names suggest not only what the movements are, but also how to perform them and why. All this lends wonderful flavour and imagery to these arts, as well as giving practical hints on their execution, intention, and the quality or “feel” of the movement, and of course serving as a mnemonic aid.

As I learn more about Chinese Medicine, I’m discovering more and more fantastically vivid and unusual terminology, some of it amusing, some profound. What follows is just a small selection…

Running Piglets (Ben Tun Qi)

A form of “rebellious Qi”, or energy moving in the wrong direction, that arises in the abdomen and rises through the torso to disturb the chest and heart with palpitations and a swelling sense of panic. It occurs due to an imbalance between the crucial Fire–Water relationship in the body between the Heart and the Kidneys. Either the Kidneys are overflowing, or the Heart Fire has faded or weakened, and Qi rushes upwards. Today we might simply call it a “panic attack”, but the imagery of a squealing stampede of spooked piglets is so much more compelling.

Running Piglet Syndrome is distinct from Li Ji, another form of rebellious Qi that also manifests as tightness in the abdomen and rises to lodge in the throat. But Li Ji refers to a more vague, internal anxiety or restlessness originating in the Chong Mai (Penetrating Vessel) and is often associated with emotional stress or the menopause.

There is also Plum Pit Qi; a constant feeling of having a lump in the throat, despite a lack of any physical obstruction, which is caused by chronic worry, stagnation, and Phlegm.

Wind, Damp and Phlegm

Wind, Damp and Phlegm are pathogenic factors in Chinese Medicine that can, with the exception of Phlegm, be either external or internal. Wind conditions tend to be sudden and upward-moving in nature, and can either invade the body’s Wei Qi (defensive surface energy) from the exterior, or develop internally from a “vacuum” created by rising Fire or Liver Yang energies.

If you get diagnosed with a case of Intestinal Wind, I’m afraid it’s not just the unfortunate effects of last night’s broad bean curry; it’s early onset haemorrhoids.

Damp is the opposite of Wind: a slow, heavy, sinking, lingering stickiness. Phlegm is similar, except that it is always internal in its aetiology, and is more congealed and condensed than Damp. In its extreme expression it can “mist the mind”, or unbalance the Heart and Spirit, causing psychosis.

A Thousand Coins in the Belly

A feeling of abdominal distension or fullness that occurs when the Dai Mai (Girdling Vessel) is too tight, as though carrying a heavy weight of coins in the belly.

Legs in Cold Water

Persistent cold in the legs and feet, as though you’d been dangling them in a cold lake. Contrary to the previous condition, this is due to a slackness of the Dai Mai, leading to potential prolapse or sciatica. It can result from a weakened core due to Lower Crossed Syndrome, which is often caused by an overly sedentary lifestyle (or the habitual wearing of high heels). The erector spinae group and rectus femoris tighten, while the glutes and rectus abdominus muscles grow weak and soggy. The humble chair has to be one of humankind’s worst inventions…

The Sea of Marrow

The Four Seas within the body are the Sea of Grain, the Sea of Qi, the Sea of Blood, and the Sea of Marrow, into which the twelve primary channels, or “rivers”, flow. The Sea of Grain relates to the Stomach channel, the Sea of Qi to the Lungs, and the Sea of Blood to the Chong Mai.

The Sea of Marrow is associated with the Brain, which is demoted to an “Extraordinary Fu” by Chinese Medicine, and regarded, rather insultingly, as a hollow vessel that stores Yin essence. This Sea also comprises the bone marrow itself, and the entire spinal column and central nervous system. Signs of deficiency of the Sea of Marrow are akin to Kidney deficiency and include such symptoms as a weak lower back and knees, dizziness, blurred vision, and low-pitched, constant tinnitus.

The whole notion of the body as a complex network of streams, rivers and seas is a great metaphor to emphasise the Daoists’ understanding of life as flow and process, rather than as matter and function. Even within the channels themselves we have well points, spring points, stream points, river points, and sea points, reflecting how the Qi gathers, flows, and changes from babbling brook to vast ocean as it moves through the body.

The Gates of Life and Mystery

Many people who know a little about Chinese Medicine or Qi Gong are familiar with the Fire of Ming Men, the Gate of Life. This is the vital energy associated with the Seas of Blood and Marrow, with the Jing (Essence) that sustains life, and with the Original (Yuan) Qi that animates our bodily processes.

The Ming Men Fire is contained by the Kidneys, or sometimes correlated to the right kidney specifically, and therefore to Kidney Yang energy. The Yi Jing trigram for water (the Kidney element) is a Yang line contained within two Yin lines, which represents not only the power hidden within the apparent softness of water, but also the Fire that warms the “cauldron” of the Kidneys and creates the “steam” of Kidney Qi.

Lesser known is the concept of the Xuan Men, or Mystery Gate. This is the “Gate of Darkness” and could perhaps be compared in some respects with the Cloud of Unknowing of Christian mystic literature. In Daoist alchemical practice it refers to the state of mind beyond thought, where the body and mind have entered a profound rest.

Once the more intentional, conscious alchemical techniques have been performed, the experienced meditator can let go and enter a deep, self-maintaining meditation. In this deeply restful state, the nervous system is subdued, the thoughts are quieted, the breath forgotten, and the body completely stilled, so that the internal systems and organs can repair and restore to their optimal functionality. Essentially it is a gateway to greater health and harmony, but also a paradoxically dark window upon higher realisations of spirit and self-nature.

Hun and Po

Each Zang organ has its spiritual aspect in Chinese Medicine. The Heart is the seat of the Shen, or Spirit-Mind; the Spleen houses the Yi, or Intention/Intellect; the Kidneys contain the Zhi, or Willpower; the Lungs house the Po, and the Liver houses the Hun.

The Po is the Corporeal Spirit. It is the Yin, bodily aspect of the soul which forms at conception along with the Jing, or Essence. It is the breath of life, and it dies when the body dies. Disfunction of the Lungs can lead to excessive grief or melancholy that cannot be let go of, and at its extreme this can develop into suicidal ideation and depression of this physical spirit.

At the opposite pole is the Hun – the Ethereal Spirit. It is the Yang, spiritual aspect of the soul, which is eternal; it enters the body after birth and survives it after death. The Hun gives us direction, ambition, imagination, vision, creativity, and inspiration, and its nightly wanderings give us our dreams.

We need both these aspects of spirit, the Yin and the Yang. The image of the Po, pulling us into our bodies and back into the earth, and the Hun pulling us out of our bodies into the world of spirit and subtle energy, is a powerful metaphor that provides for a deep understanding of our inner experience.

Eight Extraordinary Vessels

The Chong Mai, Du Mai (Governing Vessel), Ren Mai (Conception Vessel), Dai Mai, and Yin and Yang linking and stepping vessels, form a network of eight channels that act as reservoirs connecting with the Kidneys, integrate the Extraordinary Fu and Zang Fu, circulate Wei Qi, and regulate the developmental life cycle. They are thought to be the first of the channels that form in utero, and some theories* correlate them directly with the process of embryonic division and development.

The twelve channels pertaining to the Zang Fu (Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, Triple Heater, Gall Bladder and Liver) take supremacy over the Eight Extraordinary Vessels as the infant takes its first breath after birth. Thus, the twelve primary channels are linked to Post-Heaven (Hou Tian) Qi, whilst the eight vessels are associated with Pre-Heaven (Xian Tian) Qi.

The unfolding of these sustaining channels within the developing body is yet another arresting image that not only provides a useful working model for Chinese medical theory but is increasingly supported by the scientific evidence base within modern embryology.

Qi

One of the most mysterious and unique concepts in Chinese Medicine, and martial arts, is Qi. I don’t want to disappear down convoluted theoretical rabbit holes here, but it’s interesting that in Daoist philosophy everything is regarded as a form of Qi.

Everything.

Material form is simply a heavy, embodied form of Qi, whereas spirit and mind are refined forms of Qi. One of the purposes of alchemical practice is to engage in this process of refinement, by turning Jing to Qi to Shen, and thus to raise the body’s energies to a higher vibration.

Indeed, all is process. In the patterns of the universe, from the constellations in the heavens to the gnarled bark of a tree, the unfolding nature of the cosmos is imprinted. Indeed, to some extent Qi could be defined as “process”, although that doesn’t quite capture its essence in full. It is more than that; a palpable, moving energy, an animating force, and the mysterious, fundamental substance of all apparent existence.

There have been many parallels drawn with current ideas in subatomic physics about the fluctuating, “quantum soup” out of which things emerge on mixing with consciousness, but again, I’m not sure it equates perfectly.

One thing that draws me to Daoist thought is that it accepts mystery and is happy to live with it. I certainly don’t reject science’s urge to explore and explain, but mystery is an essential and enriching aspect of life, from which imagination, poetry, and creativity can spring.

We need some mystery in our lives. Perhaps science is the Po to Daoism’s Hun? Perhaps we need them both – Yin and Yang together, locked in their eternal dance. Unshackled from bodily existence, we would be free, but unrooted, wandering in interminable bardos of the spiritual realm. Unshackled from spiritual existence, we would be like rocks – present in our bodies, but mindless, devoid of all the richness of human existence.

Best, then, that Qi remains undefined, untranslated, that its edges stay blurred, that its true nature slips into shadowed corners every time we peer too closely. What use is knowledge at the expense of poetry and mystery?

* For more on this fascinating theory, see The Spark in the Machine, by Dr Daniel Keown (Singing Dragon, 2014).

It’s been clinical

The best aspect of my degree course in Chinese Medicine so far has been working in the student clinic. Dealing with real patients with real problems, every day has been crammed full of learning and insights. And because it is a fully lived experience, rather than simply reading theory in a textbook, everything that has arisen has stuck vividly and intractably in my memory. I find the theoretical and philosophical aspects of Chinese Medicine fascinating too, but my time in the college clinic has been by far the most enlightening.

All our supervisors have been extremely knowledgeable, patient, supportive, generous, and good-humoured. The atmosphere has always been positive, professional, open, encouraging, and respectful, and the whole experience has made me even more enthusiastic about forging my own path in this wonderful, profound, and intriguing field. There are lots of different kinds of acupuncturists, with different expertise and different approaches to healing, and that’s important to me – to be able to practise in a way that suits me, rather than having to fit a certain mould.

Unfortunately, many vocations have gone in that direction; overly managed, prescribed, and structured, with unending and largely fruitless meetings, patronising supervisions, and arbitrary, unproductive targets. Opportunities for self-expression, experimentation, and spontaneity are suppressed and stifled in favour of paper trails, conformity, justification, and accountability. Largely, it seems to be down to a breakdown of trust.

I’m lucky – my previous roles as a ski instructor and special needs outreach activity worker have afforded me a lot of freedom. As I move on to create my own space in the world of acupuncture, I hope to continue that streak. While it’s good in many ways that acupuncture is becoming more and more recognised as a valid treatment by established healthcare institutions and governing bodies, becoming more accessible and reputable, and more complementary than alternative, it does worry me that acupuncture might become homogenised and standardised in the process. It is crucial that the practitioner is able to work with an open mind and respond to their intuitions. A series of textbook protocols of needle combinations is just not real internal medicine. Every treatment must be tailored for the individual patient.

This is one of the things I have learnt in clinic, that even those patients who return week after week with the same fundamental problem receive a different treatment each time. The pattern has always shifted. The pulse has changed, the symptoms have altered, the psycho-emotional state is different, even if only subtly so. Accordingly, the combination of points we decide upon is different, too. Different channels are targeted, or the points are clustered more locally, or more distally for a more moving treatment. The needles are manipulated differently, or points are selected to affect the body in a different way. It’s as much an art as a science, and a utilitarian, homogenous approach would kill Chinese medicine dead. At the very least, it would be marginalised as a neuron-stimulating, fascia-releasing chronic pain therapy. All the beauty, depth and subtlety would be lost.

What else have I learnt? The importance of a good therapeutic relationship, for one thing. Trust is key. That, and basic, human connection. Maintaining professionalism, but also being able to connect with the patient on a person-to-person level. Two humans in a mutually respectful dialogue, rather than one, better human fixing a broken one. Eye contact. Smiling. Showing you understand. Showing you’re listening, and not judging. Giving the person your full attention. These are crucial to a successful relationship, and, I would argue, crucial to the healing process also.

Having the courage and honesty to acknowledge your own shortcomings and fallibility as a practitioner is essential, too. I can’t be an expert on every ailment and condition, nor should I pretend to be. My speciality is Chinese Medicine strategies and techniques (at least it’s a work in progress!), and whilst a good grasp of Western biomedicine is very desirable, I am unlikely to intimately know every obscure syndrome that presents itself. Certainly, a person who is suffering from a chronic illness is likely to have carried out a lot of research on their own condition before coming to see me. But they probably haven’t considered it through the lens of Chinese Medicine. Or if they have, they will probably have been wearing amateur spectacles.

Even then, I fully acknowledge that I shall only be a fledgling practitioner when I graduate in eighteen months or so. I have merely chipped a few slivers from the vast edifice of Chinese Medicine. Humility and forgiveness will be prominent qualities for the foreseeable future, and so they should remain throughout my career. Shunryu Suzuki wrote profoundly on maintaining a “beginner’s mind”. I will certainly have one of those for a long time to come!

Of course, an acupuncture treatment goes beyond the consultation. There’s the sticking-the-needles-in part, as well. And that is so much more than a purely mechanical process. It’s not just sticking them in! You make contact with the patient. Physical, caring, reassuring contact. Perhaps you warm the area to be needled with a bit of massage – begin to stir and bring the Qi, both through the generation of heat and flow in the channel, but also through drawing the patient’s attention to the area. Then, on inserting the needle you maintain connection with the patient. Maintain communication. And extend your own intention through the needle. Connect with the patient’s Qi. Feel it. Act with purpose.

The shamans of the Amazon basin told the plants they picked why they were picking them. They believed that without this basic communication with the plant, no healing could be achieved. Intention and attention are so fundamental to traditional medicines. It is something largely lost in modern, pharmacological practice. Aspects of mind and spirit are largely disregarded in favour of a purely mechanical model of biology, of existence. I think that is beginning to change. I hope it is.

The mind-states of both practitioner and patient are vital to the efficacy of treatment. We want to activate the parasympathetic nervous response in the patient. We want them to feel calm and safe. A heightened nervous state is not conducive to healing. Similarly, the mind of the acupuncturist must be quiet. They must have Ting – an open, quiet, sensitivity; a focused concentration; a diffuse awareness; a mind that listens. Whether during the consultation, observing and gathering information, or during palpation, or during needle insertion, and extraction in fact, too, there must be a quality of Ting.

For me, one of the marvels of acupuncture, and other somatic therapies like massage and medical Qi Gong, is that pathogens can be released from the body through a wordless process of letting go. Harmful emotions stuck in the tissues or organs can be unblocked and dissipated. The patient doesn’t need psychoanalysis; they don’t need to dwell on their fears, anxieties, disturbing, dislocating memories, or self-deluding narratives – they simply relax and let go, prompted and guided by the touch of a hand, or the motion of a needle. It’s elegant beyond words.

Of course, we should not shut patients down, either. If they have something they need to express verbally, we need to give them space and permission to do so. We need to show empathy and compassion. People’s lives are often seriously impacted by health issues. Physical problems feed emotional problems; emotional trauma feeds physical discomfort. Being fully attentive and open-hearted is fundamental. But we also need to steer them back on course, and move them towards a place of healing, towards a place of harmony and balance.

On the level of practical skills, the student clinic has been invaluable. It is one thing to practice a technique in a classroom environment with fellow students; it’s quite another to work with a real patient. And so much more rewarding. I’ve been fortunate to experience a wide range of procedures. Aside from needling, I’ve been able to practise or observe cupping, auricular acupuncture, acupressure, moxibustion, postural, tongue and pulse diagnosis, ear seeds, Ashi and trigger point location, and electro-acupuncture. The last is of course a relatively modern invention, and I know some more traditionalist practitioners are sceptical of it, but I have seen it produce some incredible results with musculoskeletal complaints.

It’s also been really helpful to practise on certain areas of the body that I didn’t feel confident working with. With the risk of pneumothorax, I was concerned about needling the back and shoulders, but with the guidance of our experienced tutors my mind is easing, if not yet completely at ease. And that’s okay – uncertainty and caution are definitely preferable to reckless incompetence! The scalp was a concern, too, largely because of the lack of soft tissue and my own relative lack of experience and dexterity with needles.

And then there are the simple things. Acquiring good habits for health and hygiene. Operating the couch. Remembering to give the patient an alarm before leaving them to relax with needles in. Being comfortable with the basics lends a certain flow to things, and puts the patient at ease, too.

There are a few specific experiences that have really impressed and inspired me. Seeing some of the supervisors’ skill at diagnosis through palpation of the channels is one. Their sensitivity to what is going on energetically is astounding. I know it will take many years for me to build up that kind of skill. The same applies to pulse diagnosis. They are feeling all kinds of subtle qualities that my own fingertips are currently completely blind to, and of course then they also have the requisite knowledge to be able to insightfully interpret their sensations. Even as the needles are inserted, some keep feeling the pulse and noticing changes needle by needle, observing the effectiveness of the treatment as it happens. It really is an art.

I have also been impressed by the emphasis on selecting an elegant and minimal set of points to needle. Cutting out any overkill. Choosing one point over another because of some secondary effect or utility of its location that should enhance results. Having a nice spread of points throughout the whole body. Working with mind, emotions and spirit as much as with the body and with physical manifestations of illness. Manipulating the Qi like a musician, not just a doctor. Like I say, it really is an art.

Acupressure, too. I think it is a little neglected in favour of needles. I suppose as a working practitioner it makes more practical sense to insert the needles and go off to prepare for the next patient, and of course you only have two hands, and many needles. But for me that was my first real, visceral sensation of another person’s Qi. It took a long time for it to arrive at my fingertip, but when it did it was unmistakable. And the patient feels it, too. A vibration, a pulsing, a throbbing, a dull ache, a feeling of heat, of electric charge. Its expressions are varied, but it certainly isn’t some imagined fiction. It’s palpable.

One final observation. Simply how varied are human bodies. On some people, the spine is pronounced, like a stegosaurus. On others, it’s difficult to distinguish the vertebrae. There is the inelastic squishiness of the flesh in the Spleen Xu (deficient) individual, and the tautness of the pulse in the wiry person with stagnating Liver Qi. There is the drawn body, the varicose, the flabby, the inflated, the brittle, the jumpy, the numb, the tense, the inflamed… and then of course there are all the qualities of character, of emotion, of spirit – it still amazes me that, in spite of its sophistication and complexity on one level, Chinese Medicine manages to account for all the infinite variability of the human condition with a simple overarching framework that has not changed in more than two millennia.

A simple turn of the wheel. Yin to Yang to Yin to Yang to Yin to…

This is going to hurt: Pain, Acupuncture, Meditation, and Qigong

We get many people coming to our student acupuncture clinic with chronic pain. Some are looking for a solution that avoids surgery, or reduces the need for painkillers; others have tried everything and acupuncture is their final, desperate recourse! (Charming!)

Chronic pain is a strange phenomenon. In many cases of musculoskeletal injury, the actual tissue has long repaired itself, but still the pain lingers, as though the brain is stuck in a habitual and unhelpful loop. There is no longer any need for pain signals to tell us to protect the area, yet still the nervous system persists.

Not only can our nervous response to pain be baffling, but so can our psycho-emotional response. People tend to mentally separate pain out from themselves. They take ownership of it (“My bad leg…”). They even, as with one patient we had recently, actually personify their pain and give it agency: “My bad back doesn’t like it when I move like this.”

Is this healthy? On one level, it is an instinctive coping mechanism. Like anything else for which we feel aversion, we naturally want to push it away, remove it from our experience. So this mental trick of objectifying pain is our mind’s way of reducing it. The trouble is, it just doesn’t work. In fact, by solidifying it as a definable “thing”, we’re probably making it worse. We’re probably embedding it deeper, entrenching it into our daily experience. This mental response could even be the very thing that is blocking our ability to heal.

I discovered a wonderful little book recently, called “Pain is Really Strange”, by Steve Haines, and illustrated by Sophie Standing. Laid out in comic strip format, it makes for a short but entertaining and enlightening read. The main thrust of it is that pain is not the simple, mechanical response to injury or dangerous stimuli that most of us imagine it to be. It’s much more complicated than that. And thoroughly subjective, too.

Haines gives various examples: there is one person who felt agony at the merest touch of a feather, and another individual who ran a race with a broken leg. Surgeries to remove nerve endings around painful cancers only result in the pain returning later, and more severely. I’ll refrain from summarising the whole text, but it suffices to say that pain is… er… well, it’s really, really strange.

But it is an entirely malleable phenomenon, and chronic pain can be reduced – even cured. Even understanding our pain better can help to reduce our experience of it.

Acupuncture can certainly work, too. In Chinese Medicine, pain is viewed as a stagnation of Qi and Blood. By needling appropriately, we can instruct the central nervous system to move energy in the relevant channel and shift the area of stagnation. Unblock the dammed river and get things flowing again.

In fact, in many cases, working to retrain the brain is a far better strategy than painkillers or surgery. Haines suggests a few techniques, including the visualisation of joyful and free movement, and also changing our linguistic relationship with pain.

Often, the problem is compounded by the language and metaphors we use. We talk about “combatting” pain, and view it as our enemy – something outside of ourselves. Perhaps this dissociative relationship is only further embedding our experience of pain? Perhaps it would be far better to feel and accept the sensations we experience, and refrain from labelling it as “pain”, or even something “bad”, at all?

This is easier said than done, of course, and I certainly don’t mean to belittle people’s experience of chronic pain, but there is much evidence in mindfulness research that the meditative technique of refraining from overlaying judgements on our direct experience is in fact an extremely healthy approach. As a way of dealing with chronic pain, which seems to be as much a habit of the mind as anything else, this attitude of detachment and acceptance, this method of direct perception without subsequent labelling, could be a crucial part of the healing process.

Then, of course, there’s the obvious response to a state of stagnancy… move! Literally, physically move. Move the body, move the blood, move the lymph, move the Qi. Move in small ways. Move in new ways. We all intuitively know that if we sit still for prolonged periods, our bodies get clunky; we get aches and twinges, we lose our flexibility and our connection to our physical selves. Muscles shorten. Joints stiffen. I have definitely seen a huge increase in suppleness and fluidity of movement since I started practising yoga, Qigong, Taijiquan, and Baguazhang. Better posture. Better connectedness. More relaxation. Less stiffness. Less pain.

By viscerally connecting, immersing, your mind into your body, yoking your breath, and switching off your headphones, you can reach unimagined levels of inner awareness.

Which brings me to the solution to pain that Haines seems to emphasise most: we should seek to increase our skills at proprioception and interoception. In simple words, we should learn to look inside. By increasing our awareness of our own bodies, we can reduce our experience of pain. The parallels here to Daoist meditation techniques are uncanny and undeniable. Neidan (internal alchemy) methods incorporate looking at and listening to the internal body with a great deal of sensitivity and detail, employing contrasting methods of both stillness and movement. Neidan teaches us to explore our thoughts and our breath, and to fully inhabit the physical body, by feeling the internal organs, paying attention to inner spaces and structures, feeling sensations, and becoming aware of inner processes, all with a mindset of calm, detached curiosity…

… It would appear that modern pain research may have just “discovered” the benefits of Daoist meditation and Qigong in the same way progenitors of western dry needling techniques “discovered” the efficacy of acupuncture!

Oh well, we may be a few thousand years behind the Chinese, but we get there in the end…!

Haines’ book is excellent, and I highly recommend it, but it is particularly interesting when viewed through the lens of traditional Chinese health practices. It turns out that our best recourses to reducing pain are a combination of Daoist meditation and mindful movement, such as Qigong, yoga, or martial arts. Or dance. Or swimming. Or running. Or walking. Anything, really, as long as it is done with our fullest attention and awareness.

What’s more, establishing a meditation and mindful movement practice won’t just help you to deal with pain; it will help you to relax and let go of all sorts of anxieties, ruminative thinking patterns, stuck and attritional emotions, self-doubt and negative thoughts, lack of confidence and motivation, emotional trauma, unhealthy cognitive loops, habitual responses, unconscious and automatic behaviours… the list goes on!

Haines reassures us that pain is plastic, and we can change it in a similar way to learning to write with our weak hand. It requires small steps, gentle persistence, and a creative approach to retraining our own minds. Pain is a subjective phenomenon, and as such it is within our capacity to change it. We all know experientially that if we tell ourselves something is going to hurt, then it probably will.

Needling thoughts

Peacefulness. Listening. Communication. Consideration. These are the more abstract and innate elements of medical practice that don’t necessarily emerge from text books and lectures.

I’ve been observing a few acupuncture treatments in clinic recently, and there were a number of interesting details that cropped up, and which should hopefully guide my own practice in the future.

One was the personal interaction between practitioner and client. It struck me as quite a fine balance between professionalism and friendliness. Not that these two are necessarily opposites that must be balanced against each other. But an over-familiarity would harm the interaction, I think, and therefore consequently the treatment.

Conversely, too much playing a role would put up a barrier that might hinder a genuine exchange and understanding. There was a palpable and genuine sense of warmth and caring from the acupuncturist in clinic that I think unfortunately is all too rare amongst Western GPs.

To be clear, I’m not saying I think GPs are cold and heartless – far from it; I just think there’s a level of detached professionalism in their approach (speaking very generally, of course) that probably arises partly from time and performance pressures, partly from their training, and partly from the Western method of dealing with the symptoms or disease rather than the whole person.

In the acupuncture clinic there is a luxury of not running against the clock so much, and also of the necessity of a thorough conversation with the patient to arrive at a penetrating diagnosis.

There’s also a need to be quiet, focused and methodical when inserting the needles. A rushed treatment is liable to be ineffective. There’s a requisite that the acupuncturist find a connection between themselves and the client – a focused Yi and perhaps even an exchange of Qi through the needle. And that takes a good degree of peacefulness and attention.

A sense of spaciousness and calm permeated the whole consultation and treatment process, as well as an emphasis on the patient as participant. They weren’t there to have a treatment “done” to them. The needles work by stimulating the body to heal itself.

The 20 minutes or so just sitting quietly by themselves with the needles in is an essential element of the treatment. Time for the body to receive and respond to the instructions of the needles. Time to be quiet and pay attention inwardly. And with busy modern lives, how many of the patients, unless they are meditators, really give themselves opportunity to sit silently and rest the mind?

Patients were asked what it was they wanted from the treatment. Did they want balancing? Energising? Calming? Which symptoms would they prioritise? Not that the acupuncturist was there to simply pander to the client’s wishes, either. There was an exchange here. The patient offered the practitioner their trust and respect, and allowed them to plan a treatment that was appropriate and went to the root of the patient’s condition.

Likewise, the practitioner paid attention to what motivated the client. They weren’t just a thing to be dealt with, a set of symptoms to be gotten rid of. No judgment, only kindness. The patient was a rounded individual whose poor physical or emotional health was impacting upon their daily lives and ability to function in relation to their families, friends and colleagues. And on their relationship with themselves. The practitioner approached the patient as a learned friend, with an attitude of informed inquiry, and real interest, rather than a slightly ambivalent or disinterested mechanic who could categorise the issue, give them a label, and then “fix” them. There’s a big distinction there between the Western and Eastern methods. Western medicine fixes a problem. Eastern medicine restores balance and harmony.

Sometimes, of course, the former approach is necessary. Acute conditions often need surgical or pharmaceutical solutions. But so much can be addressed by holistic treatments. Especially with regard to things like chronic pain, anxiety and depression, digestive disorders, and the like; Chinese Medicine offers a far more elegant solution.

Anyway, I did feel that, while there was a professionalism maintained throughout the treatments, partly due to the automatic subconsciously ingrained respect, subservience even, to the “white coat”, the acupuncturist managed to convey a genuine sense of compassion and empathy for the client – a compassion that’s perhaps sometimes lacking in other fields that are more pressured and that hone in on the dysfunction or pathogen rather than observing the whole. It was shown in the warmth of the eyes and smile, in the reassuring touch that accompanied and completed the pulse taking, and in the needling itself.

Any massage that was conducted was gentle, or at least started gentle and never became aggressive. I could tell that the patients felt looked after, cared for and safe. There was no brutal spine-cracking Thai massage here. I think making the client feel like they’re in a safe space is a really crucial aspect of treatment. It allows the mind and body to relax and be receptive. It takes people out of the flight or fight mode that so many are permanently locked into to some degree.

The acupuncturist was constantly checking in with the client, partly to make sure they were comfortable, but mainly to check that there was some communication there between body and needle. The acupuncturist is looking for some sensation. No sensation means, in all likelihood, an ineffective treatment (unless the patient is Qi deficient, that is, or has some nerve damage). Pain is undesirable, and most probably indicates that the acupoint has been missed, but a dull ache or throb is a good sign that the body is responding. The practitioner would stand back sometimes to “zoom out” of their intense focus, to look at the overall picture of the needles and make sure they were properly following the channels.

There is feedback from the needle, too. The acupuncturist, as well as the patient, can feel the flesh “grab” the needle. It’s crucial that the practitioner be tuned into their tools. And it’s likely there will be some sensation of resistance and redness on the skin around the insertion, too. All good signs.

By asking the patient how they’re feeling, the acupuncturist can both reassure and get a measure of whether the needle needs “working” a bit to induce a response, either by turning it or moving it up and down in the flesh. It also ensures that the patient’s awareness is focused on the needle, which also increases the likelihood of efficacy.

At one point, Baihui (Du 20 – the 100 meetings) was being needled at the top of the head. The needle was placed at an angle to direct the Qi downwards, back down the Du channel, as the patient had too much rising energy and was suffering with headaches and other signs of excessive Yang. The practitioner, having placed some needles in the head and upper body, then massaged Yongquan (Kid 1 – Bubbling Well) in order to help ground the patient and bring things down further. There was real purpose behind that touch – it wasn’t just an idle gesture, but an integral part of the procedure.

The order of inserting needles was important too – working from top down to help descend the Qi. And, in another case, ensuring there was a stabilising, balancing needle around the level of the Lower Dan Tian along the Ren channel before other points were needled. Or, in the case of radiating pain, the needles were sequenced in the same direction as the flow of sensation, so as to draw it along and disperse it rather than creating a conflict or barrier that might cause further stagnation.

The acupuncturist’s phrasing was attended to, as well. Patients with deficient patterns were talked to in terms of “building resilience” through the treatment, rather than saying it was going to be a “powerful” treatment that might sound like too much and block the parasympathetic response. They tended to be given less needles too, so as not to overwhelm the body.

Taking needles out was given equal importance to insertion. The sequence of removal was considered, as well as the quality of the action – by which I mean, they weren’t just “yanked out” but removed carefully, with as much attention and intention as they were inserted. If pathogens needed to be released, there was no pressure applied to the area. But if the treatment was tonifying, the practitioner would keep some pressure on with the cotton bud so that nothing “leaked”.

There were a few other new things for me. I’d never seen threading before, or even some supplementary treatments such as ear seeds. But it was the quality of the approach that absorbed me most. And the honesty and communication with the client, too. For example, when a patient was treated for stagnation they were warned that the release of pressure could send things upwards and cause headaches. They weren’t just sent out the door with no concept of possible emergent effects.

There were no miracle cures promised, either – patients with chronic or severe symptoms knew that several sessions would be needed and often could expect only temporary relief rather than a complete and permanent cure. Nothing was ruled out. Hopes weren’t callously dashed, but false hopes weren’t fed, either.

And the patients were really listened to. There was an open, welcoming space that invited the patients to open up and made them feel looked after. They were encouraged to express themselves and vent their inner experiences. From their point of view, here was someone who actually cared about what they were going through and genuinely wanted to help.

I think they were reassured by the obvious skill of the practitioner, too. Palpating along the channels, the acupuncturist could feel what was going on with the body. They were tuned in, sensitive and… well, frankly borderline psychic in some cases. If you feel stagnation at a point you know is associated with unexpressed grief or frustration, and ask the client if that’s something they can relate to, you begin to enter the realm of the uncanny…

The pulse-taking is a seemingly rather mystical art, too. I think it will take a long time to reach any degree of skill at reading pulses. I could see an almost sedative effect on the patient, too, as everything went quiet while the practitioner just touched and listened to their body. It was like a few minutes of meditation in the middle of the consultation and felt quite powerful. In fact, everything about the sessions was calm, unhurried, precise, and deeply considered.

So, these are just a few impressions. You can read all the books and learn all the theory, but it’s these details of actual practice, along with experience of course, and a comprehensive grasp of point actions and the complexity of each client’s pattern, that turn you from a competent practitioner to one with real skill, awareness, and understanding for the patient.

It might sound a little trite, but above all you have to be human. Not a doctor. Not a specialist. Not a professional or a sage. But one human being engaging openly and deeply with another.