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…
The Azure Dragon 