APM Acupuncture in Clinical

Practice
Classical Approaches for the 21st Century

Mark D. Seem, PhD, LAc

© APM Acupuncture, P.C. and Mark D. Seem July 2012

TSCA students, faculty and alumni are free to scan or otherwise incorporate any parts of
this book into any of their clinical devices/resources by simply citing this source. All others
must obtain permission directly from the author at: mark.seem@tsca.edu.
TABLE OF CONTENTS

Dedication 3
Prologue 5
APM Acupuncture Jingluo Charts 9
 Master Systems Chart 14
 Regular Meridian/Circuit
Chart 20
 Four Patterns Chart 37
APM and APM
Acupuncture Defined 46
Introduction 52
PART ONE:
PROFESSIONAL DIMENSION 54
Chapters:
1. APM Clinical Training 54
2. Human Centerdness 58
3. History of TCM Compromise 60
4. APM Big Picture 64
5. APM Charting 68
6. APM Learning Objectives 70
7. Human Dimension 72
8. APM Needling Techniques 73
9. Classical Chinese Acupuncture 78
PART II:
PHILOSOPHICAL FOUNDATIONS 79
10. Beginning with the Ling Shu 79
11. Ordinary Skills 90
12. Yang Tends Toward Excess:
Thorns, Stains, Knots, Obstructions 120
13. Acupuncture as Physical
Medicine/ the Role of Location 140
14. The Spirit Uprooted 162
15. The Sages of Antiquity 188
16. Self Cultivation East and West 198

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PART III:
APM ACUPUNCTURE PRAGMATICS 213
17. APM Case in Point 213
18. Acupuncture Needling and Tacit
Knowing 238
CONCLUSION AND BEGINNING 266
a. Key APM Concepts 266
b. APM Clinical Katas 269
c. APM Clinical Readiness 304
APPENDICES
1. Etiology and Pathology in APM 308
2. APM Physical Assessment 318

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DEDICATION--ACUPUNCTURE IMAGING IN CHART
FORM

The unusual prologue below to a new book, by way of revised APM Acupuncture charts, is
dedicated to Bruce Park, MS/Ac, a serious and dedicated student of mine and now a
graduate of the Tri-State College of Acupuncture.

Bruce challenged me to clarify APM Acupuncture in book and chart form and introduced
me, and others at the college, who were studying the Ling Shu together, to the Learning of
the Mind-and-Heart through the Scroll known as ‘rooted in spirit’.

This way of beginning to come to the present has the distinct advantage of putting the
conclusion, the outcome first, showing what APM Acupuncture is as it has emerged until
now.

I did not always receive these challenges well, as I was deeply agitated at times by what I
found to be wanting in my own APM Acupuncture teaching in particular, and in acupuncture
practice in North American as a whole. I lashed out once in anger at Bruce in class, who had
shown me various APM charts and forms of his own design over time, which he felt might
be beneficial to all students. I realize now that this was because I did not feel like my own
APM chart that figures in the back of Acupuncture Physical Medicine was correct and if I
could not pinpoint what was wrong with this picture how could anyone else?

I now know that Bruce’s efforts to clarify APM in chart form, and with class notes that he
shared generously with other students, was done not out of disrespect for me and my
teaching efforts, but out of reverence for what he found to be a style of practice that
resonated deeply for him. He displayed that same reverence for deep, embodied learning in
the Ling Shu class and it was infectious, and caused me for one to research and then dig
deeply into the Neo-Confucian Learning of the Mind-and-Heart which is at the root of such
embodied study and practice.

The third step in this Neo-Confucian learning, derived from the Confucian classic The Great
Learning, is to make the will sincere, to commit to this learning as a search for li, the
principle or coherence in all things, which leads to a seriousness and a reverence for what
one is studying which keeps one engaged in the Dao of human becoming (ren). In this way
one learns the deep logic or coherence in what one is studying, and learns how to become
a more authentic human being at the same time.

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After serious and reverent reflection I realize what Bruce was really challenging me to do
was to transform the APM Acupuncture learning at the college to become more. I have
come to realize that the only way to do that is to remove myself from the position of a
‘sage on the stage’ as is common to say in academe these days, to become at most a ‘guide
on the side’ and mostly a serious student and practitioner myself, abiding in reverence for
this amazing practice which has been a way of life for me for three decades.

Bruce Park showed me reverence and I did not know how to receive it. That is the most
valuable lesson I have ever learned in my AOM career, and perhaps in my life. I shall take
that lesson to heart, literally, for the rest of my days. I will gladly
consider myself a fellow traveler with Bruce, if he permits, whose serious Buddhist training
has allowed him to walk much further along the way, and who will assuredly have much to
share with us all about abiding in reverence for this wonderful practice.

To Bruce Park,

With Love and Gratitude,

Mark Seem

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PROLOGUE

DECLARATION OF INDEPENDENCE

This is July 4th, 2012.

Close to Thanksgiving 2010 my search for the PRC Chinese-language original

version of a text prepared by leading academies of Chinese Medicine to serve as a
core textbook for the new TCM colleges bore fruit, and it became clear that the
Zhongyi Xuegailun of 1958 was the textbook translated in Hanoi in the 60s, which
Dr. Nguyen Van Nghi translated into French in 1971, and which I translated into
English (from the 1977 third edition) for the Quebec Institute of Acupuncture in
1979. I found this reference in Felix Mann’s Meridians of Acupuncture first written in
the early 60’s, as presented in Mann’s complete work, Handbook of Acupuncture
where he clarified that in studying this and other Chinese medicine academy texts
during his research in PRC, that were being prepared for the same purpose, he was
struck by differences between these PRC texts and the work of George Soulie de
Morant whom he had relied heavily upon in his early writings on the meridians, as
did most European acupuncturists in those early days.

In my new book, APM Acupuncture in Clinical Practice I do my best to correct for

errors in Van Nghi’s work, I place this early pre-TCM text in perspective as one that
could have been adopted by the new TCM colleges, but was not, and show how the
original teachings on ‘merdian acupuncture’ as it was often termed in those days, by
Felix Mann, and taken up by Yitian Ni who cites him, who uses his way of
differentiating the various meridian systems in terms of and based on the 12
meridians and their circuits, is critical for a clear understanding of Classical Chinese
Acupuncture jingluo pattern differentiation and treatment.

In writing this book, I am especially interested in correcting for errors which have
crept into the training I have overseen at the Tri-State College of Acupuncture for
the past 33 years, and which has in turn created confusion and obfuscation about

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meridian acupuncture, as I was fond of calling it for at least 2 decades, in other
AOM colleges in the Tri-State region.

I am referring specifically to the meridian teachings of Jeffrey Yuen, a former

student who never graduated from the Tri-State College of Acupuncture when it
was in Stamford, Connecticut twenty years ago, who went on to develop a teaching
of allegedly secret Daoist lineage trainings that were, at least twenty years ago
when he began this venture, derived from the Van Nghi text I was using when I
taught in Stamford, and which I translated into English for the Quebec Institute of
Acupuncture to assist non-French speaking students. The errors he inherited from
this training in Van Nghi’s approach at the college I founded, based on this teaching
as endorsed by the Montreal school, have followed him, as they have me, as he
founded a curriculum at the now defunct Swedish Institute of Massage
Acupuncture program, which he apparently transferred to the NYC branch of
Pacific College of Oriental Medicine where what is referred to as a ‘Classical
Chinese Acupuncture’ style overseen by some very senior faculty formerly from
the Swedish institute who were trained at our college or other branches of the
Montreal school, or who were subsequently taught by these senior faculty, a few of
whom have been practicing for three decades.

In making these points it is not my interest to criticize anyone. We all have done the
best we could using sources in translation that have often gone out of print (the
Chinese text, and Van Nghi’s translation of the Vietnamese version of it, and Felix
Mann’s texts have all gone out of print).

I am doing this because my introduction to Van Nghi’s work starting in 1978 to non-
French speaking students, faculty and practitioners not only in the Tri-State region,
but throughout North America, Canada, England and Holland, where I taught
extensively for many years, has served as a foundation for a significant number of
AOM practitioners who treat from a ‘meridian acupuncture’ perspective.

If this book helps correct for errors they have undoubtedly come across in many
cases themselves if they have been at it for more than a decade, or if it helps re-
ignite interest in jingluo practice inspired by the classics which they may, like so
many, have abandoned as TCM became the dominant form of acupuncture
practice in English-speaking countries I will be very content.

  7  
And in the meantime, this text shall serve as my declaration of independence from
French-Vietnamese sources that were academically fascinating but clinically
deficient because they were based on translations twice removed (Van Nghi’s
Translation of the Vietnamese Trung Y Hoc, itself a translation of the 1958 PRC
ZhongYi Xuegailun all of which are now out of print), but more importantly because
they failed to clarify that this training was rooted in 1958, and never bore fruit in the
new TCM colleges. Van Nghi suffered greatly from the cold shoulder the TCM
college world showed to him when he petitioned to be recognized as a pioneer of
European acupuncture and TCM. This was denied time and time again as the late
Oscar Wexu, President of the Quebec Institute of Acupuncture shared with me
then. They doubtless knew full well that his life’s work consisted merely in
translating books from Hanoi, which were translations of books from China that the
TCM academic world passed over in favor of ones that portrayed a ZangFu
orientation.

I have come to believe, and have based the training in Classical Chinese
Acupuncture and APM at the college on the premise that acupuncture is a highly
personal affair, and requires tacit and tactile understanding that can be called upon
in an instant when treating because it has been internalized through deep learning
and practice.

This way of embodied learning is something that struck me when I trained with 8th
degree Japanese world champion Takahiko Ishikawa in judo in Philadelphia from
1965-1970, where he allowed me to assist in children’s classes. Here was a master
of his art, who also had a PhD in religion and was a top ranking GO champion as
well and it is only now that I appreciate the extent to which his martial arts training
paralleled his training in GO and was also founded on training and study of East
Asian religio-philosophy.

It is to that ancient and classical Chinese literature and practice that I directed my
attention this past year, as I realized that the French, following the Vietnamese and
the PRC Chinese, in fact left out major aspects of what makes Classical Chinese
Acupuncture and Medicine classical in the first place, and so powerful. These
reflections are included for those who are interested in how physical self-
cultivation, and spiritual cultivation of the mind-and-heart went hand in hand in the

  8  
several hundred years leading up to the development of Acupuncture and Chinese
Medicine as passed on in the early written texts, something the Su Wen bemoans in
Scroll one as a lost tradition.

The process that I have endured in digging deep into the issues and problems
raised during and by this inquiry has been long and hard and has taken a certain toll.

It has made me realize that while I was cast as an expert in French meridian
acupuncture, too young and too early in my career, what that was was not clear
then, or now. Furthermore, it has made me realize that the best I can offer is to
keep looking for the li (principle, coherence) underneath jingluo acupuncture,
which is still my passion.

This task will be much less daunting now that several of us at the college and
especially those on the APM Team will be studying with Andrew Nugent-Head,
MSOM, who has spent 25 years in PRC learning Classical Chinese Medicine from
the Yin Style Ba Gua tradition, which is founded on physical (Daoyin, martial arts)
and mental (Daoism, Confucianism) approaches to self-cultivation, with a
dedication to cultivating ones medical arts as a lifelong learning process.

In the process of doing the research and reflection that lead to this book, I realized
what is not included in Travell, perhaps because she struggled so vigorously to free
physical medicine, as she was coming to see it, from its moorings in psychosomatic
medicine and plant it squarely on the side of the soma, was the interplay
nonetheless between ‘the psyche and the body process’ as Dr. Flanders Dunbar
from Columbia University called it in her groundbreaking Emotions and Bodily
Changes.

APM Acupuncture corrects for this lack.

This rigid demarcation of a somatic territory where myofascial pain and

dysfunction would play out free from emotional turmoil, trauma and stress is as
lopsided as the over-emphasis on the side of the psyche Travell fought against,
where patients with chronic pain would be seen to suffer from a psychosomatic
disorder best treated in psychotherapy.

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It is my experience in the vast majority of cases of chronic pain that I treat, where
the patients are also being treated by other physical medicine practitioners
(orthopedists, neuroloigists, osteopaths, physical and occupational therapists and
massage therapists) that the side of the psyche is being totally overlooked in favor
of a narrow physical medical perspective.

There is no reason why any acupuncturist woud make this mistake, if they adhere
to the classical Chinese acupuncture teachings that the main cause of internal
dysfunction and disease are the 7 emotions when they become inhibited or
expressed excessively. Unfortunately, too many North American TCM practitioners
ignore the side of the psyche as well, framing the patient’s problem from a much
more materialist perspective that is dominant in PRC that is aligned with modern
scientific medicine and so looks askance, in fact, at classical theory and practice,
paying it lip service only in this regard.

And unfortunately, too many North American TCM practitioners, especially if they
ractice herbal medicine, see their terrain as ‘internal medicine’ and look down on
any physical medicine approach to acupuncture and Chinese medicine as
tantamount to tuina which they disdain or consider a lowly step-child of TCM.

It is a frequent occurrence for APM practitioners trained at the Tri-State College of

Acupuncture to see patients for chronic pain and dysfunction who were treated by
TCM practitiners to no avail, who clearly had no phsyiocal medicine perspective or
skills.

APM practitioners, on the other hand, who ignore or even disdain getting involved
on the side of the psyche without a network of some mindbody and bodymind
practitioners are selling their patients short on the benefits they couod derive from
a more comprehensive approach.

And so after 25 years of developing an approach to acupuncture as physical

medicine, which it was and always should have remained as Andrew Nugent-Head
shows in his powerfuil ‘tangible Qi’ video and teachings, and knowing that the
physical medicine training at the college is probably the strongest in North America
and will only get that much more powerful and clinically effective under his ifluence
and training, I am ready to return full force to the bodymind energetic approach I

  10  
laid out in Bodymind Energetics in 1987, to bring back acupuncture as a powerful
psychosomatic therapy that, by dint of being a physical medicine, can gain deep
access to the inner reaches of the Mind-and-Heart and prod the bodymind to
actualize its potential by restoring the equilibrium before the feelings are aroused
as Confucius advocated.

Acupuncture Physical Medicine (APM), as I have forged it over the past 20 years
under the influence of Dr. Janet Travell and her amazing work, is now solidly
grounded at the college and the APM faculty is strong, and in many cases quite
young and so this training will survive well withioutn the need for me to watch over
it. It is the foundational training at the college, built upon a Classical Chinese
Acupuncture foundation in Year One that serves to support training in KM and TCM
styes as well, and so I will stay a part of this training, but know whatever my
involvement, I leave it in very capable hands.

My work for the last phase of my life will be to develop APM Acupuncture, with the
Learning of the Mind-and-Heart as central, from the same bodymind position I
occupied in 1987, but with a little more know-how hopefully.

I happily leave the “sage on the stage” position where I was thrust and latched on
too early and too fast, to become a student again, now, and forever. I feel as if I am
now re-entering the territory I confronted in my initial days in the South Bronx with
sufficient experience and skills and life behind me to engage the bodymind fully
with APM Acupuncture. This return will necessitate study with other bodymind and
mindbody practitioners and students courageous enough to experiment and
explore new ways, in North America for those who live here, of doing acupuncture
as an alternative and compliment not only to physical medicine, but to the entire
field of psychology and psychotherapy originally referred to as psychosomatic
medicine, and now stress or mind-body medicine. Feeling this lack, psychology has
spawned two new ‘fields’, somatic psychology and positive psychology which could
be a good thing, or a sign of panic or decay.

APM Acupuncture has the philosophical sophistication to add much to these new
fields, if we have the stomach for new movements. In the meantime, APM
Acupuncture and Neo-Confucian Learning of the Mind-and-Heart, which combine
almost effortlessly, can serve as a powerful parallel practice for keeping the

  11  
body(mind) and its capacity for life affirmation and self-actualization in the center
of the therapeutic process.

What has endured for me is the same passion I felt when I first encountered this
strange practice from a foreign land which I was learning in the South Bronx with
people very far removed from this exotic space. It was their passion, and ability to
connect in a direct bodily-felt way when experiencing the changes from the
needling that helped me free myself from overly intellectual and medicalized
French approaches, and at the same time steer clear of anything that attempted to
divorce this practice from the Earth where it is solidly rooted.

Paraphrasing Confucius, if I were asked how to reach the deep level where the
mind-and-heart obtain, I would say behold, it is all around: it is impossible to treat
any patient without the mind-and-heart of practitioner and patient being engaged,
and the calmer and more focused the xin, the mind-and-heart, the deeper and more
relaxed the breathing and heartbeat, the more firmy rooted the body on the Earth,
the more powerful this work can be. And that is something worth dedicating the
rest of ones life to.

  12  
APM Acupuncture JingLuo System Treatment &
Charts

Philosophical Prologue:

1. Thorns, Stains, Knots & Obstructions-Tough Love

The LingShu ends Scroll One stating that it is said that acupuncture cannot treat
chronic conditions, leading one to realize the bulk of Scroll One is about treating
the “source or root’ instead.

Once this has been achieved, the Ling Shu addresses how to address the more
surface structure, the Small Body as Neo-Confucians would term it, which is
comprised of signs and symptoms that can be detected with ones eyes, ears, and
touch, and which reveal complex contortions of the bodymind which appear like
banners waving in the wind to announce their presence (one of the primary
meanings of biao) as painful ‘thorns’, which need to be pulled out, ‘stains’ which
need to be flushed with blood and fluids to course freely, ‘knots’, which need to be
untied to ease constriction in the channels and collaterals so as to connect freely
with the interior, and ‘obstruction’ which must be broken through to allow free-flow.

  13  
While one can affect immediate change in the deep structure with a few distal
needles stimulated properly and the inner being/becoming, this will not clear away
chronic or complex structures which require more specific, often local attention
and physical release. One cannot affect a person’s surface structure, small body,
physical nature without attention at the surface were these stubborn holding
patterns take hold. Such work, while less critical, takes longer than the ‘deep’
treatment, and take great skill: in this realm of relieving chronic, complex patient
complaints, the more tools, and the better skills one possesses, the better for the
patient and her pain and suffering.

As a former YMCA camp director and father of two now adult children, I know
what ‘tough love’ is required in handling situations requiring immediate action—
pulling out hundreds of thorns from running hands down a rough wooden railing to
see how it feels or pulling off a Bandaid that has gotten stuck to a wound that
needs the dressing changed; scrubbing dirt and gravel out of a bad scrape; untying
chewing gum from the hair; breaking through a sailboat lead line that had suddenly
tightened on a leg and cut through the skin to the bone as it broke free of the dock.
Such situations need action without hesitation, a firm but compassionate hand that
says this is going to hurt, and an iron will. The most compassionate and effective
action in such cases is swift, no talking, and without hesitation.

2. Authentic Human Becoming-Compassion, Abiding in Reverence,

Making the Will Sincere

Given that the LingShu ends Scroll One stating that it is said that acupuncture
cannot treat chronic conditions, this would lead one to conclude that the rest of
Chapter One up until then, on promoting circulation of Qi and Blood by tonfying,
dispersing and dredging stasis, on needle techniques to perform these three
actions, on the use of source and some other distal points to connect with the Qi,
and how to read changes in the patient, are about making immediate changes and
handling acute situations. It is known owing to Dr. Catherine Hui’s research at
Harvard on fMRI brain scans during acupuncture stimulation that once de qi is
obtained at a few distal points on hands and legs, the deepest most primitive
regions of the brain, pertaining to homeostasis, especially when the bodymind is
suddenly challenged, floods with Blood and Qi from an AOM perspective). If this is

  14  
true, then obtaining Qi, as Scroll One tells us, guarantees that acupuncture will be
effective, and the bodymind of the patient will immediately start to shows signs of
this auto(yinyang) regulation in the complexion and countenance, breathing, and
other vital signs. This is the immediate effect of acupuncture and the bodymind
starts to reorient itself, shift more toward balance. The skills of tonifying, dispersing
and dredging stasis with needles, in order to achieve this auto-regulation, is the
primary effect of acupuncture, and all acupuncturists mist possess these Ordinary
Skills and achieve these ordinary changes. If the problem is new, or minor, then it
may resolve with just a few distal needles thus stimulated in a heart-beat. This
treatment is achieved quite quickly, is quite basic and yet affects the DEEP
STRUCTURE of the bodymind, what Neo-Confucians refer to as the Big Body,
man’s human nature which connects with and is infused by the Heavenly principle
and the coherence of human becoming, at one with the coherence in Nature, in the
cosmos. It is ironically quick and relatively straight-forward to touch this deep
structure of the mind-and-heart with needling.

At this deepest human level, needling is quite routine and relatively easy, yet one
must treat, we are reminded over and over, with a ‘calm heart and mind’ which
refers back to ancient religio-philosophical approaches to Learning of the Heart and
Mind which I shall explore in this book. It is here that discussion and practical
instructions for how to attend to ones feelings and emotions when agitated or
aroused is presented, and seen as a lifelong practice as this ‘physical nature’ of
human beings, the ‘small body’, which connects humans to all other animals under
heaven, is full of powerful vital forces and one must be able to remain focused and
calm like ‘holding a tiger by the tail over a great abyss’ when this animal energy is
stirred. To work on this level of high Skills, it is not enough to be a skillful
acupuncturist. One must also be engaged in daily cultivation of self on the physical
and spiritual/moral levels, and ideally the patient too has seriously committed to
such self-cultivation.

And even here, Neo-Confucians stress, it is not a question of ‘soft talking, slow
walking, silent sitting’ as many Chan Buddhists maintained, but rather of being
capable of acting without hesitation as the situation dictates, with passion and the
full force of ones feelings and emotions engaged appropriately (Cf. Tu Wei-ming’s
discussion in his Humanity and Self-Cultivation of Yen Yuan’s approach to learning
what is useful and can be out into action, pp. 198-202).

  15  
3. Heaven, Earth and Humanity: Three Levels of Intervention: Regular
Meridians, Secondary Vessels, Extraordinary Vessels /Three Circuits/
Three Zones/ Three Heaters
Faced with a person’s manifestations (biao-as-symptoms of pain, discomfort,
distress, complaint, condition and reason for seeking our care) or what we see,
hear, feel, sense from our system(biao-as-signs) a classicaly informed acupuncturist
will navigate the channels in jingluo pattern differentiation starting with the regular
meridian(s), their pairings and circuits to detect where in the jingluo system things
are obstructed and have gone awry to locate where we will begin to palpate as
assessment, and then where we will treat, and then differentiate/locate the thorns,
stains, knots and obstructions in the regular meridians, the secondary vessels and/or
the extraordinary vessels:

As an example, if a person comes complaining of tightness in the chest, some

difficulty breathing and slight panic that something serious might have been amiss,
but who was reassured by the cardiologist-internist who treats his mild asthma with
inhalers only as needed that this is not a serious internal medical condition and who
said the patient could most certainly do massage and acupuncture for this, our task
in our jingluo pattern process, is to first locate it within:
• The regular taiyin-yangming circuit where the tightness in the chest is found
on palpation to be worst at LU 1-2 to SP 20(Taiyin Meeting), and where,
when asked to say where the panic and difficulty breathing resides, the
patient points to ST 13-15 on both sides of the chest and also says he has a
nervous stomach and holds all his stress there;
• The yangming muscle channel near ST 13-18, when palpation reveals
exquisitely tender ashi/trigger points in the pectoralis minor recreating pain
in the nipple, and pectoralis major recreating diffuse chest pain from the
area of Per 1 to ST 18 to CV 17 brought on by vigorous rowing in a row
boat against a strong wind;
• The yangming zone/Yangming-Taiyin Circuit in a patient exhibiting chronic
protective constriction in the yangming zone and pectoral muscles, which
she says comes from her readiness to protect the chest which started after
a bad accident when she was 22 when a car literally ran over her chest; while
she is aware of this, she feels she is unable to break this myofascial guarding

  16  
 reaction and that even Rolfing did not help and it is now affecting her lower
rectus abdominus and rectus femoris;
• The middle heater aspect of Chongmai, with constraint of the diaphragm
and abdomen with symptoms of GERD, IBS and bad acid reflux causing
chest and abdominal pain, where the referring acupuncturist suggests it may
be a ‘chongmai’ problem .

All of these patients might have similar chest pain and abdominal discomfort, similar
symptoms of pain and distress, but can be addressed from an APM Acupuncture
approach with four different treatment options depending on which aspect of the
Taiyin-Yangming System writ-large is affected: regular meridian-circuit; tendino-
muscular meridian; zone; upregulated extraordinary vessel systems of the back, and
the front--middle, lower and upper heaters.

The APM ACUPUNCTURE JUNGLUO SYSTEM CHART below is meant to capture in

one chart form all of these options, with reference to the other APM Treatment
Strategy Charts (Regular Meridians/Circuits, pp. 58-76; Four Patterns of
Fatigue/Stress/Visceral Agitation, pp. 133-142) which follow behind it, and can be
reinforced by reference to Dr. Ni’s clinical manual, Navigating the Channels.

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ONE
APM ACUPUNCTURE JINGLUO SYSTEM CHART
© APM Acupuncture PC

I. TAIYIN-YANGMING SYSTEM

TAIYIN-YANGMING YANG MING YANG MING

LEVEL CIRCUIT VENTRAL ZONE LOCAL VENTRAL ZONE DISTAL
‘BEN’ ‘BIAO’ ‘BIAO’
LOCAL LOCAL DISTAL

N/A TrPs and Ashi Points in:

 Masseter  LI 4 and 10 and 11
 Platysma
DISTAL  SCM
a. 4 Gates-LIV 3/LI 4; jing-well;  Subclavius  Per 4-5 ashi
luo and tender ashi in Tendino-  Pectoralis (sternal and
Muscular Meridian Treatment; clavicular divisions)

WEI  Rectus abdominis  ST 13 and 30; and ST

OR
b. Other distal command
points per other styles for
integrated approach
 Quadriceps 37-39
 Tibialis anterior  SP 4 (luo) for
 Extensor digitorum abdominal
longus manifestations
 Biceps
 Brachialis
 Brachioradialis
 Index extensor
 1st dorsal interroseus
 Other per Travell

  18  
 LOCAL N/A N/A
“Ends” and “Beginnings” of
the meridians. Local Lung and
Spleen and Large intestine and
YING Stomach Meridian Points in
affected areas for relief of
manifestations (patient
complaints) such as:
 LU 1/SP 20-taiyin
meeting/respiratory
distress
 CV 12, 17, ST 18-19
and ST 13-16, ST
Fire, Xu-li
 ST 13-16-mental
agitation, mania,
depression
 LI 20, ST 2-3-nasal
congestion
 SP 1 and CV 12-root
and node

DISTAL

 SP 3 and 2/ LU 9 and
10;
 ST 40 (source luo);
 ST 40-mania
 ST 42-43, ST Fire,
xu-li)

 SEE CIRCUIT CHART

for more options;
and TCM and Five
Phase Lung and
Spleen and Large
Intestine and
Stomach point

  19  
 combinations

LOCAL N/A N/A

• KID 11-27/ST 30-13

chongmai

DISTAL
JING
• SP 4/Per 6 as
chongmai- yinweimai
opening points; can
add GB 41/TH 5 for
infinity treatment

OR

• LU 7/KID 6 for
renmai-yinqiaomai
for “cardiac
alarm”/with SI 3/BL
62 for dumai-
yangchiaomai

(See 4 patterns chart for more

local and distal options and
details at jing level)

II. SHAOYIN-TAIYANG
SHAOYIN-TAIYANG TAIYANG TAIYANG
LEVEL CIRCUIT DORSAL ZONE LOCAL DORSAL ZONE DISTAL
‘BEN’ ‘BIAO’ ‘BIAO’

  20  
 LOCAL • frontalis • Bl 59
• occipitalis
N/A • upper, middle, lower
trapezius
• latissimus dorsi • SI 8.5
DISTAL horizontal aspect

WEI a. 4 Gates-LIV 3/LI 4; jing-well; • levator scapula

luo and tender ashi in Tendino-
Muscular Meridian Treatment;
OR
b. Other distal command
points per other styles for
integrated approach
LOCAL
“Ends” and “Beginnings” of
the meridians. Local Heart and
Kidney and Small Intestine and
Bladder Regular Meridian
Points in affected areas for
• infraspinatus
• supraspinatus
• teres major and minor
• rhomboids • BL 58.5
• paraspinals
• guadratus lumborum
• gluteals
• piriformis
• hamstrings
• gastrocnemius
• arm and leg taiyang
muscle channel Ashi
• SI and Bl muscle
channel TrPs per
Travell
N/A N/A

YING relief of manifestations

(patient complaints) such as:
• HT 1-KID 27-shaoyin
Meeting
• BL 23-52/BL 14-43-
kidney yang/heart
protector
• BL 2 and SI 18
(taiyang meeting) for
facial pain and
sinuses
• KID 1 and CV 23-root
and node

DISTAL

• KID 3 and 2/ HT 7 and

8;
• BL 58 (source luo);

• SEE CIRCUIT CHART

  21  
 for more options;
and TCM and Five
Phase Heart, Small
Intestine and Kidney,
Bladder point
combinations

LOCAL N/A N/A

• Du mai and HJJ and
Bladder meridian

DISTAL
JING • SI 3 and BL 62 for
dumai-yangchiaomai
(can add Lu 7 and Kid
6 for renmai-
yangchiaomai)
(See 4 patterns chart for more
local and distal options and
details at jing level)

III. JUEYIN-SHAOYANG

  22
 
 JUEYIN-SHAOYANG
LEVEL CIRCUIT
‘BEN’
LOCAL
N/A
DISTAL
a. 4 Gates-LIV 3/LI 4; jing-well;
luo and tender ashi in Tendino-
WEI Muscular Meridian Treatment;
OR
b. Other distal command
points per other styles for
integrated approach
LOCAL
“Ends” and “Beginnings” of
the meridians. Local PER and
LIV and TH and GB Regular
Meridian Points in affected
areas for relief of
SHAOYANG SHAOYANG
LATERAL ZONE LOCAL LATERAL ZONE DISTAL
‘BIAO’ ‘BIAO’
• temporalis • “TI” 10 and TH 3
• upper trapezius
anterior to GB 21
• latissimus dorsi • GB 41, 39, 38, 37
longitudinal aspect
• serratus anterior
• upper and lower
external obliques
• iliopsoas
• tensor fascia latae
• anterior gluteus • GB 34
minimus
• iliotibial band
• vastus lateralis
• peroneals
• ring finger extensor • TH 1, 3; GB 44, 43
• other arm and leg
shaoyang muscle
channel ashi and TrPs
per Travell
N/A N/A

YING manifestations (patient

complaints) such as:
• LIV 14 and PER 1-
jueyin meeting
• CV 17-constrained Qi
in chest
• CV 10-13-constrained
Qi in abdomen
• CV 2-3-constrtained
Qi in pelvis
• PER 1-2-chest pain,
emotional distress
• TH 22-23 and GB 1-2-
shaoyang meeting for
temple pain,
migraines, TMJ-like
symptoms
• CV 18 and LIV 1-root
and node

DISTAL

  23  
 • LIV 3 and 2/ PER 7
and 8;
• GB 37 (source luo)

• SEE CIRCUIT CHART

for more options;
and TCM and Five
Phase Pericardium
and Triple Heater and
Liver and Gallbladder
point combinations

LOCAL N/A N/A

• GB 26-28
• GB 24

JING
DISTAL
• GB 41 and TH 5 (can
add SP 4 and Per 6
for infinity
treatment)

(See 4 patterns chart for more

local and distal options and
details at jing level)

TWO
REGULAR MERIDIAN/CIRCUIT PATTERN
DIFFERENTIATION CHARTS

  24  
© APM Acupuncture PC

1. TAIYIN/YANGMING CIRCUIT – Regular Meridian (Jing

Mai) Pattern Differentiation© APM Acupuncture PC

Hand Taiyin/ Hand Foot Yangming/ Foot

Body Area Lung Yangming/ Stomach Taiyin/Spleen
Signs & Large
Symptoms Intestine

Face, Flushing Toothache, Facial pain, Root of

swollen ashen tongue rigid,
Head, cheeks, complexion, hot jaundice
yellow eyes, face, nose bleed,
Neck dry mouth, nasal
nosebleed, congestion,
Throat Dry throat swollen cervical neck
throat/thirst pain, skin rashes Vertigo
around mouth,
swollen painful
throat,
submandibular
pain
Perspires easily,
Yawning, Violent warm diseases, Whole body
General sweating & shivering whole body heavy
pain from from cold, chilled as if
wind-cold inability to doused by
warm up water, frequent
stretching and
yawning
Cardio- Shortness of No organ S&S Breast pain, Chest
Respiratory, breath, heart pain (ST irritability
Chest/Upper irritable 18-15), flank pain
Back breathing, (SP 21), front of

  25  
 cough, body hot
wheezing,
fullness of
chest, hugs
oneself while
shivering,

Gastro- Borborygmus, Nausea from

intestinal, Gastric pain No Organ edema/distention eating,
S&S due to cold, stomach pain,
Abdomen Abdominal belching,
discomfort, passing gas
constant hunger, and
ascites, area hot defecating
or cold, pain in brings great
intestines relief,
diarrhea with
mucous and
blood
Genito-urinary,
Gynecological, Frequent No Organ Yellow urine, Scanty urine
Reproductive, urination S&S pain in lower
Lower Back abdomen (ST 26-
30)
Lower
abdomen and
channels Heat in the Pain along extremities
palms, pain Heat, swelling channel (ST 32- heavy, medial
along and pain LI 43), rigidity of thigh and
channels, esp. 12-15; index knee, middle toe knew swollen,
LU 3-10 finger dysfunction chilling and
dysfunction numbness
along SP
channel of
calf, big toe

  26  
 dysfunction

Mental Signs & Obsessions Mental Aversion to Mental

Symptoms * that are confusion, people and fire, sluggishness,
future defective rapid heart beat, melancholia,
directed, elimination of shuts oneself in obsessive
feels ideas, when frightened, thoughts of
vulnerable stubbornness, prone to mania, the past, fixed
complacency singing, and rigid
in being disrobing and ideas,
wrong, rigid running about, sleepwalking,
thinking, depression, agitated
distressed by death wishes, sleep,
cold mentally nightmares
overwrought,
mentally slow
LU 7-luo LI 2 –dispersal ST 44-43 ashi for SP 3- source
Point Palette LU 9 source LI 4-source heat/Xu Li SP 2-
LU 6 – cleft LI 6-luo for ST 36, 37, 39- tonification
LU 5-dispersal Toothache lower Sea points SP 2&3-ying
Lu 3-4 ST 40-luo and shu
window to SP 4- luo
sky ST 25-LI/ST SP 5-dispersal
Lu 1-2/SP 20- union SP 6- three
Taiyin union ST 18/xu li heart leg Yin
pain/heart burn, SP 8-cleft
Stomach Fire SP 9-Sea
SP 10-Blood
SP 21-Great
Luo
Associated Local for S&S Local for S&S SP 20/Lu 1-
channel points Local for S&S Ashi for pain Ashi for pain Taiyin union
Ashi for pain Local for S&S
Points from Points from LI, Ashi for pain

  27  
 Points from ST, LU, SP SP, LU for circuit
LI, ST, SP channels for Points from
channels for circuit ST, LI, LU for
circuit circuit

(* Cf. Seem, citing Faubert, Acupuncture Imaging pages 27-28. These charts are derived from Shudo
Denmei, with information from Ni, Seem, Faubert.)

Regular Meridian Treatment

In the Ling Shu Chapter 9, treatment of the regular meridians is presented thus:

1] If Spleen is deficient, Stomach is excess

(carotid pulse four times stronger than radial pulse): tonify Spleen with one needle;
disperse ST with 2 needles. If carotid pulse is “restless”, disperse Large Intestine
(for circuit).

While the actual points are not indicated in this chapter, chapter One stresses
needling the source point for yin meridians, and a later chapter suggests needling
the ying (spring) and shu (stream) points for disorders of yin of yin. Dispersal points
for Yang meridians could be dispersal points themselves, luo points, jing-well points,
he-sea points, xi-cleft points for acute disorders, or fire points. So one could tonify
Sp 2 or 3, or both, and disperse ST 40 and ST 36 for example, and disperse LI 2 and
LI 5.

If the reverse is true, with radial pulses stronger than carotid, this is Yin
meridian/organ excess:

2] If Spleen is excess (radial four times stronger than carotid): disperse Spleen with
one needle (Sp 5 for example); tonify Stomach with 2 needles (ST 38
Fire/Tonification Pt and ST 36). If radial pulse is “restless”, disperse Lung meridian
(Lu 10 or Lu 5 for example for the circuit as above).

We used to see the late Dr. Ki Min Kim, a master Korean constitutional acupuncture
practitioner after whom the Tri-State College of Acupuncture Library is named, do
this carotid/radial diagnosis, and root treatment based on this chapter of the classic

  28  
text, using the Five Phase “4 needle technique” strategies as the base, followed by
careful dispersal of local excess, constrained and stagnant points/pathways.

Regular Meridian Disorders for this Circuit from Dr. Ni

Note:
Any point on a regular meridian may be used as a local point for signs and
symptoms in that area on that meridian.

A] Hand Taiyin Lung meridian

Exterior syndromes, the cold or flu; allergies with sneezing and itchy eyes and nose;
immuno-deficiency/frequent colds, low energy, cold hands and feet, CFIDS, chronic
diseases; respiratory disorders with cough, asthma, breathing difficulties; nose and
throat disorders, rhinitis, sinusitis, pharyngitis, laryngitis, tonsillitis; edema, enuresis,
retention of urine or urinary difficulty; diarrhea, constipation, hemorrhoids; GERD;
sinus(ST 2-3), temporal (ST 7-8), Occipital headaches (all treated by LU 7); sighing,
mental distress, weeping, grief; Bi syndrome along muscle channel.

B] Hand Yangming Large Intestine meridian:

Toothache; Yangming headache; facial paralysis, trigeminal neuralgia and TMJ (ST
5-8); rhinitis, sinusitis (LI 20-ST 2); Nosebleed; sore throat and vocal cord disorders,
thyroid disorders; diarrhea, facial edema, sweating/ dry mouth, throat, stool,
concentrated urine, dry skin); yang ming febrile disorders; rashes, eczema, boils,
psoriasis; abdominal pain, epigastric pain, nausea, vomiting, belching, cough,
asthma, chest pain; lassitude, spontaneous sweating, low immunity; Bi syndrome
along muscle channel.

C] Foot Yangming Stomach meridian:

Excess and deficient digestive disorders with excess hunger or poor appetite,
burning sensation or cold sensation in the stomach, and in either case epigastric

  29  
pain, abdominal fullness, distention, diarrhea constipation; yangming headache,
sinusitis, rhinitis, stuffy nose, nose bleeds; sore, swollen throat, gums, toothache;
facial paralysis, trigeminal neuralgia, TMJ; yangming febrile syndrome; general
lassitude, sallow complexion, spontaneous sweating, palpitations; stomach fire;
violent or withdrawn behavior (mania or depression); swollen, painful, cystic
breasts; Bi syndrome along channel el; wei syndrome with whole body weakness
and atrophy of the muscles.

D] Foot Taiyin Spleen meridian:

Deficiency or excess digestive disorders as for stomach; edema, heavy sensation

of face, head, whole body; post-prandial fatigue; dampness disorders and s&s; high
cholesterol; obesity; atherosclerosis; masses and nodules; Qi & Blood deficiency;
Spleen Qi sinking with prolapses, dizziness, vertigo, lightheadedness; constant
worry, low spirits, difficulty concentrating, poor memory, depression, palpitations;
Bi syndrome along channel; wei syndrome with whole body atrophy and flaccidity,
especially of lower body and extremities.

Personality Patterns

For a detailed summary of J.R. Worsley’s depiction of the 5 Element personality

types, and Dr. Yves Requena’s 8 Temperaments, see my Bodymind Energetics,
pages 85-107. While character typing is described in the classic texts, I caution
against taking such depictions of complex human beings too literally. With that
caution, and with the realization that a person may exhibit characteristics from
more then one temperament or type, such information is useful in providing
practitioners with another lens through which to view the people who seek their
help. One can also juxtapose the emotional (shen) signs and symptoms presented in
chart form from chapter 8 of the Ling Shu from last month’s Reflection to further
narrow down the specific meridian-organ system or systems involved within a
circuit. This applies to the next two circuits as well.

  30  
2. SHAOYIN/TAIYANG CIRCUIT – Regular Meridian (Jing
Mai) Pattern Differentiation

Hand Shaoyin/ Hand Taiyang/ Foot Taiyang/ Foot

Body Area Heart Small Intestine Bladder Shaoyin/Kidney
Signs &
Symptoms

Face, Yellow eyes, Yellow eyes, Yellow eyes, Yellow eyes,

hearing loss, eyes tearing, dizziness,
Head, swollen eye pain as if blurred vision,
cheeks, popping out, jaundice,
Neck submandibular vertex flushed face,
swelling, neck headache, dark
Throat Dry throat pain, sore occipital comlexion, dry
throat headache, tongue, hot
nape of neck mouth, dry and
pain, nose sore throat,
bleed hoarseness,
Alternating appears as if
No desire to chills and about to be
General drink fever, captured
epilepsy,
derangement,
Cardio- Heart pain Intense Thoracic back Wheezing,
Respiratory, posterior pain cough,
Chest/Upper shoulder and coughing up
Back, arm pain (SI 8- blood, heart
14) as if pain, irritability
broken,
inability to
turn neck
(stiffness at
SI-14-17)

  31  
Hand Arm pain Arm and hand
channels (heart 3-7), pain (SI 8-4)
heat in palms

Gastro-
intestinal, Hypochondriac Mid back pain Hunger but no
region pain desire to eat,
Abdomen watery
diarrhea

Genito-urinary,
Gynecological, Hemorrhoids,
Reproductive, Lumbar pain,
Lower Back, gluteal area
pain
Foot channels
Tight Lumbar spine
popliteal pain, inner
fossa, hip thigh pain, Pain
joint pain and and cold along
inability to leg channel
bend, pain in (Kid 9-11, pain
calves as if and heat in the
torn, little toe soles
dysfunction
Mental Signs & All shen Poor mental Changeable Anxiety, pain in
Symptoms * disturbances, assimilation, moods, over- the pit of the
insomnia, insecurity, enthusiasm, stomach,
anxiety suspicion, sadness,

  32  
 jealousy, lack physical and
of mental fatigue,
confidence, antisocial
lassitude tendencies,
laziness

Point Palette HT 8- fire SI 2-water Bl 67- Kid 3-source

HT 7-source SI 3- tonification Kid 2-fire
HT 7&8-ying tonfication BL 65- Kid 2&3-ying
and shu SI 4 –source dispersal and shu
HT 5-luo SI 5-wrist BL 64-source Kid 4-luo
HT 6-cleft SI 6-cleft BL 58-luo Kid 1-dispersal
HT 3 (Sea) SI 7-luo BL 40-Sea Kid 7-tonify
SI 8 –Sea Back Shu Kid 10-Sea
HT 1 and 2 SI 9-14-ashi Points Kid 15.5-
adrenals
Local for S&S Local for S&S
Associated Ashi for pain Local for S&S Ashi for pain
channel points Ashi for pain Local for S&S
From SI, Kid, Ashi for pain From Bl, Ht, SI
Bl for circuit From HT, BL, For circuit
Kid for circuit From Kid, SI,
HT for circuit

Treatment of Regular Meridians

In Chapter 9 of Ling Shu:

1] If Kidney is deficient, Bladder is excess (carotid pulse three times stronger than
radial pulse): tonify Kidney with one needle (Kid 7 for example); disperse BL with 2
needles (Bl 58 and BL 65 for example). If carotid pulse is “restless”, disperse Small
Intestine (SI 1 and SI 6 for example) for the circuit.

2] If Kidney is excess, Bladder is deficient (radial pulse is three times stronger than
carotid): disperse Kidney (Kid 1 for example) with one needle; tonify BL with 2

  33  
needles (Bl 67 and 60 for example). If radial pulse is “restless”, disperse Heart (Ht 9
and 8 for example) for the circuit.

Regular Meridian Disorders for this Circuit from Dr. Ni

Note:
Any point on a regular meridian may be used as a local point for signs and
symptoms on that meridian.

A] Hand Shaoyin Heart meridian:

Heart and Lung disorders like cardiac pain and palpitations, arrhythmia, shortness of
breath, cold extremities, sweating, red, purple or pale complexion; heat syndromes
with whole body hot, dry mouth, red face, hot flashes, tongue ulcers, boils; red,
painful, swollen eyes; mania, depression, fainting, schizophrenia, anxiety, hysteria,
mood swings, laughing or crying without apparent reason, nervousness,
restlessness, insomnia, scattered thinking; severe pain or spasm of internal organs,
post-traumatic or post-surgical pain, cancer pain; skin rashes, itching, pain; pain
along channel (Ht 1-8) and costochondritis/non-cardiac chest and upper back
muscle pain.

B] Hand Taiyang Small Intestine meridian:

Occipital headache, deafness, earache, tinnitus; red, swollen, painful inner and outer
canthi of eyes, blurry vision, excessive tearing, yellow sclera; mouth and tongue
sores and ulcers, toothache; swelling and pain of cheeks, lymph glands, parotid
glands, TMJ syndrome; cold and flu, allergies; febrile diseases with yellow urine and
night sweats; edema, retention of urine, painful and yellow urination; diarrhea,
indigestion, stomach pain, abdominal pain and distention, constipation; pain of lower
lateral abdomen referring to back and testicles, as with inguinal hernia, epididymitis,
urethral stones, ovarian cysts; Bi syndrome, pain along muscle channel (scapula &
posterior shoulder from SI 14-9, elbow near SI 8, forearm near SI 7-6, wrist near SI
5-4 and little finger dysfunction.

  34  
 C] Foot Taiyang Bladder meridian:

Cold, flu, allergies; occipital headache; eye disorders with tearing and pain; rhinitis,
sinusitis, nose bleed; urogenital, gynecological and male reproductive disorders;
disorders of any ZangFu especially when chronic or deficient treated via the Back-
Shu points (combined with Front-Mu points); mania, depression, epilepsy,
schizophrenia; emotional disorders of any organ, treated with second line of
Bladder meridian; Bi syndrome and pain affecting muscles, tendons, ligaments and
joints throughout nape of neck, upper, middle, lower back, sacrum and hips,
hamstrings, posterior calves and heels, little toe dysfunction; acute or traumatic in
jury to neck, back, lumbar region, spine, lower extremities

D] Foot Shaoyin Kidney meridian:

Kidney deficiency with fatigue, low back pain, pain along spinal column, muscular
atrophy; deafness, tinnitus, chronic tooth, gum and throat disorders; poor memory,
forgetfulness; hair loss; deficient yin and yang signs and symptoms; Kidney and
Bladder disorders with edema, facial puffiness, impotence, infertility; treated for
chronic disorders of the other ZangFu; channel deficiency and Bi syndrome with
pain and weakness of the lower back, hip and knee, spinal column, degenerative
disorders of bones and joints; wei syndrome with cold, pain or heat in the soles.

Personality Patterns

See discussion under the first circuit above.

  35  
3.JUEYIN/SHAOYANG CIRCUIT – Regular Meridian (Jing
Mai) Pattern Differentiation

Hand Jueyin/ Hand Foot Foot Jueyin/

Body Area Pericardium Shaoyang/ Shaoyang/ Liver
Signs & Triple Heater Gallbladder
Symptoms

Face, Yellow eyes, Hearing loss, Dull, lusterless Dull, lusterless

red retro- complexion, complexion,
Head, complexion auricular pain, headache, dry throat
outer canthus outer canthus
Neck and cheek pain, bitter
pain, tinnitus, taste,
Throat swollen sore submandibular
throat pain,
supraclavicuar
pain (GB 21)

Constant Sweating Excessive

General laughing sweating, chills
and shivering,
repeated
sighing
Cardio- Heart pain, Posterior Maxillary pain, Distention in
Respiratory, severe shoulder pain chest pain, chest and
Chest/Upper palpitations, (TH 15) breast pain, hypochondriac
Back, distention of hypochondriac region
chest, axillary region pain
swelling (GB 22-24),
difficulty
moving torso
(GB24-Liv 14
stiffness)
Contraction Posterior

  36  
Hand and pain in arm, elbow,
channels elbow and wrist, hand
forearm (Per pain (TH 14-
3-6), heat in 3), ring finger
palms dysfunction
Gastro-
intestinal, Distended Vomiting
sub costal
Abdomen region

Genitor-
urinary, Diarrhea with
Gynecological, undigested
Reproductive, food, inguinal
Lower Back, hernia, scanty
or dribbling
Foot channels Hip, lateral urine, swollen
thigh, knee, scrotum,
ankle, and foot “Shan”, pelvic
pain (GB 30- pain, lower
40), heat in back pain,
ankles and inability to
feet, aversion bend forwards
th
of foot, 4 toe or backwards,
dysfunction Liv 5-6
nodules
Mental Signs & Depression, Emotional Bitterness, Irritability,
Symptoms * sexual upset at lack of control, anger,
perversion, family/friend irritability, difficulty
aversions, breakups, unfaithfulness, developing
phobias depression, lack of ideas,
suspicion, courage, depression,
anxiety, poor timidity, lack of energy
elimination of hypochondria

  37  
 harmful
thoughts

Per 8-fire TH 3- GB 41-dai mai Liv 3-source

Point Palette Per 7-source tonification GB 40-source Liv 2-
Per 7&8-ying TH 4-source GB 38- fire/dispersal
and shu TH 5-luo fire/dispersal Liv 2&3-ying
Per 6-luo TH 7-cleft GB 34- and shu
Per 4-cleft TH 10- Sea/tonification Liv 5-luo
Per 3-Sea dispersal GB 36-cleft Liv 6-cleft
Per 1-2-heart GB 26-daimai Liv 8-he-sea/
and breast TH 17, 21-23- GB 24-mu tonification
pain ears/tinnitus
Local for S&S Local for S&S
Local for S&S Local for S&S Ashi for pain Ashi for pain
Associated Ashi for pain Ashi for pain
channel points From Liv, TH, From GB, Per,
From TH, Liv, From Per, GB, Per for circuit TH for circuit
GB for circuit Liv for circuit

  38  
Treatment of Regular Meridians

In Chapter 9 of the Ling Shu:

1] If Liver is deficient, Gallbladder is excess (carotid pulse twice as strong as radial

pulse): tonify Liver with one needle (Liv 3 or Liv 8 for example) disperse GB with 2
needles (GB 38 and GB 34 for example). If the carotid pulse is also “restless”,
disperse Triple heater (TH 1 and TH 10 for example) for the circuit.

2] If Liver is excess, Gallbladder is deficient (radial twice as strong as carotid):

disperse Liver with one needle (Liv 2 for example); tonify Gallbladder with 2
needles (GB 43 and 40 for example). If radial pulse is “restless”, disperse
Pericardium meridian (Per 8 and 9 for example) for the circuit.

Regular Meridian Disorders for this Circuit from Dr. Ni

Note:
Any point on a regular meridian may be used as a local point for signs and
symptoms on that meridian.

A] Hand Jueyin Pericardium meridian:

Heart and blood vessel disorders with palpitations, cardiac pain, restlessness, high
lipid levels; mental and emotional disorders, delirium, fainting, incessant laughter,
depression, mania, anxiety; chest and lung disorders with stuffiness and restrictions
in the chest, cough, restricted breathing, asthma; stomach disorders, stomach pain,
epigastric distention, hiccups, nausea, vomiting, food poisoning; channel disorders
with pain and swelling of the armpit, upper arm, elbow, forearm (Per 2-6), hot
palms and hand and foot spasms; stiffness of the nape of the neck, chest and
hypochondriac regions.
B] Hand Shaoyang Triple Heater meridian:

Fluid disorders, edema, puffiness, enuresis, retention of urine, frequent urination;

upper heater disorders like chest pain, palpitations, cough; middle heater disorders
like epigastric pain, nausea and vomiting; lower heater disorders like lower
abdominal distention, fullness, diarrhea, constipation; endocrine and lymphatic
disorders like hypo or hyperthyroidism, diabetes, swollen glands; high lipid levels,
fibroids, masses, tumors; channel disorders including shaoyang syndrome with
chills and fever; channel disorders affecting the sense organs like migraine
headache, ear pain, deafness, blocked feeling in ears, tinnitus, cheek and face pain
along course of channel including TMJ syndrome and toothache, swollen glands,
sore throat, pain in the mandible and around the ears, purely channel Bi syndrome
pain with difficulty laterally flexing the neck and pain down medial deltoid, upper
arm, elbow and forearm to top of hand, ring finger dysfunction.

C] Foot Shaoyang Gallbladder meridian:

Gallbladder and Liver disorders with bitter taste in the mouth, belching, nausea,
vomiting, poor appetite, abnormal bowel movements, dark lusterless complexion,
abnormal bowel movements, hypochondriac pain; Urogenital disorders with
swelling and pain and itching of scrotum, external genitalia, inguinal hernia,
leucorrhea, difficulty urinating; emotional disorders with depression, deep signing,
poor judgment, indecision, mood swings, frequent anger, insomnia; shaoyang
channel syndrome with alternating chills and fever; channel disorders affecting the
sense organs with temporal headache, eye pain, pain in the cheek, swollen glands,
swelling and pain in the neck, mandible, deafnesss, tinnitus; Bi syndrome affecting
the lateral side of the body from lateral ribcage to lateral hip, ITB, peroneal
distribution of lateral knee, lower legs and lateral ankle and foot with 4th toe
dysfunction (GB 22, 29-30, 31, 34, 37-39, 40-44).

D] Foot Jueyin Liver meridian:

Liver Qi and yang disorders with fullness, distention, pain of hypochondriac region,
dizziness, blurred vision, tinnitus, dry mouth with bitter taste, flushed face, jaundice;
emotional disorders with depression, mood swings, nervousness, frequent anger,

  40  
frustration, plum pit Qi in throat; stomach and spleen disorders with epigastric pain,
distention, flatulence, belching, eating disorders, vomiting, diarrhea; lung and heart
disorders with stuffiness of chest, cough, shallow breathing, deep sighing,
palpitations, dream disturbed sleep; abnormal growth including cysts, nodules,
masses; channel disorders with spasms of feet and hands, headache, low back and
lumbar pain extending to scrotum, hernia pain, pain and swelling of lateral lower
abdomen (dai mai), spasm and tightness of joints and muscles and pain along
course of channel.

Personality Patterns

See discussion under the first circuit above.

  41  
3.FOUR PATTERNS OF FATIGUE/STRESS/VISCERAL
AGITATION
© APM Acupuncture. PC

  42  
Spinal Irritation Signs & Point strategies AOM Lifestyle
Symptoms Coaching

________________ ______________ _______________ ______________

running on empty, YinYang Regulation Counsel patient to

Du Mai Excess type-A, adrenal start stress
exhaustion (drops- Jing: SI3/BL 62 for reduction/relaxation
Kidney Yang/Heart dead in bed at night) du and yangwei Mai response activity for
Protector overall agitation
Dysfunction works and plays
hard, lives world Ying: Kid 2(Fire) and Take hot bath with
Water/Fire Imbalance muscularly, reacts to 3(source)/ying and sleep inducing bath
world somatically shu; salts, sleepy time tea
Precipitating factors Bl 58 (luo); BL 23 or other soporific
may be trauma of a very productive, (tonify or disperse while meditating or
physical or very active at work, carefully if lower listening to soothing
emotional nature sports, socially back muscles are music last hour
(car accident, attack rigid) on right before bedtime
by dog, abuse) Ever-Ready Bunny especially, and BL
14-43 on left (Kidney Stress importance of
Superman, Yang/Heart Protector solid sleep to restore
Superwoman, dysfunction adrenals
Supermom or Dad
Patient Complaint
End result—Adrenal Engage in physical
collapse and CFS To above add BL 18, activities that distress
20/triple heater muscles per exercise
regulatory; SP 6 and tolerance level (do
Patient Complaints: Ht 7 for insomnia; not exercise at night
Local multifidi if if suffering from
o Neck & back spine is irritated insomnia)
pain in stress from stress
muscles Do stretching for
o Lowback Can turn over at end tight neck, back,
syndrome and do yintang for lumbosacral
with adrenal 10 more minutes. muscles
exhaustion-
back goes Wei level shallow Get pillow-top

  43  
 out under oblique needling to mattress or egg-
stress most tender points in crate mattress
o Fibromyalgia fibromyalgia or cover; side lying
o Insomnia and highly sensitive or pillow, or cervical
agitated reactive patients, pillow if sleeping
sleep leave needles only 5 face up
minutes
Suggest
Release most hypnotherapy,
symptomatic TrPs EMDR,
per patient’s de Qi psychotherapy to
tolerance in stress deal with behavioral
muscles (traps, and post-traumatic
paraspinals, gluteals, issues
piriformis)

  44  
Diaphragmatic Signs & Point strategies AOM Lifestyle
Constriction/ Symptoms Coaching
GI Distress/
chong mai middle
heater dysfunction
_______________ _______________ ______________
_______________

YinYang Regulation
Constrained Counsel patients that
tight rectus &
Liver Qi “their problem is
oblique muscles- Jing:
their Life”
viscerosomatic
Up-regulated
SP 4(R)/Per 6(L) for
SNS overacts on PNS Dr. Shen advice- eat
tight chest chong and yinwei
mai regularly 3 x day,
(pectoralis level with
Taiyin/YAngming never late at night,
ST 18-Liv 14)
Circuit dysfunction never while working
Ying:
at desk or standing,
Tight SCM (plum pit
Liver/Spleen slowly, quietly
Qi) LI 4/Liv 3
dysfunction
Liv 14 (and GB 22 or
Do not indulge in
Per 1), SP 6
Spinal Irritation and fatty foods or
Patient Complaints:
up-regulated SNS alcohol
may be precipitating Patient Complaint
o IBS, bloating,
factors for this Check out if they are
undigested ST 36-39 &
pattern of visceral wheat, lactose, or
food, ST 25; CV 10, 12, 13;
agitation corn intolerant or
diarrhea ST 24-18 on left
have celiac disease
and/or ST 25 (Bil) all where
constipation, tight and constricted
Do not drink ice-cold
abdominal (dispersal, not TrP
drinks
pain, gas needling)
o Reflux or
In reflux and GERD,
GERD For Xu-Li, add CV 12,
raise back of bed 6”
o Relief in ST 14-16(left), ST 18
to prevent acid
Crohn’s (L); ST 44-43 where
reflux
Disease or tender either or both
colitis sides
Above all, teach
abdominal breathing
For heartburn to
as AM and PM stress
chest, add CV 18to
reduction activity

  45  
 17 and lateral Kid before arising and
points; or Kid 22 and falling asleep, while
Per I if left sided in bed face up with
heartburn knees bolstered with
pillows, or whenever
hyperventilating (5
minutes)

  46  
Pelvic collapse Signs & Point strategies AOM Lifestyle
chong, dai, ren Symptoms Coaching
dysfunction
Lower heater
______________ _______________ ______________
dysfunction
________________
Flaccidity in middle YinYang Regulation Coach patients to
heater abdominal develop core
Spleen Qi Sinking with
muscles, tightness Jing: strengthening
or without
and constriction routine for middle
Constrained Liver Qi
below navel, Chong-Dai Infinity heater; stretches for
in Middle heater as
pressure and pain at Treatment: SP lumbar region;
possible precipitating
Kid 15.5 to Kid 11 4(R)/Per 6(L) for
factors for this
and ST 26-30, and chong mai; GB Yoga or Qi gong for
pattern of visceral
CV 7-2 (chong mai 41(L)/TH 5 (R) for lower heater
agitation
lower heater dai mai strengthening
branch), tight lower
external obliques
(dai mai); tight linea Ying: counseling/therapy
alba (ren mai) for sexual
Three leg yin source dysfunction
points SP 3, Kid 3,
Liv 3; Sp 6 and 9; Liv counsel women with
Patient 9 for constrained vulvadynea to seek
Complaints: Liver Qi in lower PT specializing in
heater; manual therapy who
o Prolapsed specialize in this
organs:
Patient Complaint
post-
birthing;
uterus,
Local chong, dai and
bladder,
ren mai points in
right kidney,
lower heater; local
hemorrhoids
Liv, Sp, Kid meridian
, hernias
points in lower
(Shan)
heater; local points
o PMS,
over visceral
amenorrhea,
irritation (ST 30 for
disrupted
ovaries, CV 4-6 for
menses,

  47  
 infertility uterus etcetera);
and CV 2 down, to right
impotence and left to propagate
o prostatitis, Qi for lower heater-it
vaginitis, is.
cystitis,
pelvic floor
syndrome;
o sexual
dysfunctions
such as
erectile
dysfunction
or frigidity

  48  
Cardiac Alarm Signs & Point strategies AOM Lifestyle
Upper-Lower heater Symptoms Coaching
dysfunction

_______________
______________ _______________ _______________

Kidney Yang/Heart
Free-floating
Protector Dysfunction
anxiety, dread, fear
of impending doom
YinYang Regulation Coach patients to do
abdominal breathing
Jing: as above

Kidney/Lung Qi
Shallow breathing, Chong-Dai Suggest stress
Dysfunction
hyperventilation, Treatment: SP reduction or
heart palpitations 4(R)/Per 6(L) for relaxation response
induced by stress panic attack, anxiety, programs for coping
palpitations in with stress
Pelvic collapse and/or
Non-cardiac chest patients with Kidney
diaphragmatic
tightness and Yang & Heart Suggest meditation,
constriction may be
discomfort from Protector yoga, Qi gong
precipitating factors
diaphragm to under dysfunction
for this pattern of
armpits and sternum Suggest mindfulness
visceral agitation
(3 yin muscle Ren & Yinchiao mai: training for
channel referral Lu 7/Kid 6 for practicing anytime/
patterns) with shallow breathing anywhere
tightness in and hyperventilation
rhomboids and syndrome in patients Suggest
paraspinals in upper with Kid/Lu Qi biofeedback,
back dysfunction hypnotherapy,
EMDR,
Psychotherapy for
Patient Ying/Patient behavioral and post-
Complaints: Complaint: traumatic issues

o Anxiety, Kid 15.5 for

panic attack, adrenals;
heart
palpitations; Per 4 &5 with CV 18-
o cardiac 17 for chest
neurosis; constriction

  49  
 o costro-
chondritis 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

  50  
Definitions
Acupuncture Physical Medicine (APM) is a North American approach to
Acupuncture that stems from the program at the Quebec Institute of Acupuncture
in Montreal founded by Dr. Oscar Wexu. Trained in acupuncture in Paris, Dr. Wexu
maintained ties after moving his family to Montreal to French physician
acupuncturists Drs. Nguyen Van Nghi and Jean Schatz and with sinologist
colleagues of Dr. Schatz, Father Claude Larre and his protégé, Elizabeth Rochat de
la Vallee from the Ricci Institute in Paris, who were experts in classical medical and
philosophical Chinese translation. This French tradition of acupuncture informed the
training at the European School of Acupuncture in Paris and was rooted in the
classics of Chinese acupuncture and medicine.

As founder of the Tri-State College of Acupuncture, I translated French materials

for the Quebec Institute and its satellite Program, Lincoln Detox School of
Acupuncture in the South Bronx run by Mutulu Shakur, Walter Bosque, Richard
Delaney and Wafiya, who all graduated from the Montreal Program and which was
originally established with the help of Mario Wexu, son of Oscar and director of
education of the Quebec Institute who moved to New York City for a year to
accomplish this. In lieu of a doctoral level thesis, I translated Van Nghi’s seminal
work, Pathogenesis and Pathology in Traditional Chinese Medicine for the Montreal
school so that students whose native language was English would have better
access to these foundations.

When Lincoln Detox School of Acupuncture was forced to leave the hospital space
two divisions of the program emerged, and the Tri-State College of Acupuncture
grew out of one of these groups as explained in more detail in a later chapter of
this book.

APM starts with the classical approach to meridian—jingluo—acupuncture treatment

as espoused in the earliest classical Chinese acupuncture text, the Ling Shu. This
approach is fortified by modern practical interpretations and applications of
jingluo/meridian acupuncture based on the works of Felix Mann, now out of print,
and the late Dr. Yitian Ni, whose clinical treasure house, Navigating the Channels
forms an integral part of APM teaching and practice.

  51  
APM is also unique in integrating Travell and Simons myofascial release of trigger
points into classical Chinese tendino-muscular meridian treatment, thereby
expanding greatly upon students’ knowledge and treatment of the muscles and
tendon attachments in chronic as well as acute neuromusculoskeletal pain
syndromes whether perpetuated by repetitive strain or stress overload. This is
parallel to the later integration of trigger points into the French Association of
Acupuncture training, but at the Tri-State College of Acupuncture this integration is
far more comprehensive and leads to an approach that is consistent with classical
Chinese medicine, rather than being reduced to trigger point dry-needling.

APM also draws heavily from the original traditions that lead to bodymind
integrative therapies and somatic psychology in North America in the 60s and 70s.
The 19th century work of Friedrich Nietzsche on the body, Wilhelm Reich on
character armor, Georg Groddeck on the “It” and the meaning of illness, and the
modern North American work of Stanley Keleman on emotional anatomy and
insults to form, Thomas Hanna on the body in revolt, David Lewin on recollection
and the felt-sense, Eugene Gendlin on the bodily felt-sense, Milton Erickson on
reframing and Arthur Kleinman on the experience of illness, which stem from the
mind side of the Bodymind Continuum, but in a decidedly embodied way, are as
pivotal to Acupuncture Physical Medicine in its approach to acupuncture treatment
and the authentic doctor-patient relationship, as is Travell’s osteopathically derived
focus on somato-visceral and viscero-somatic reflexes so close to the acupuncture
and Chinese medicine interplay between the jingluo and the zangfu.

Armed with this decidedly Western approach to psychosomatics and the bodymind,
I suggested in Bodymind Energetics in 1987 that acupuncture and Chinese
medicine were emerging as a part of the new integrative medicine known first as
New Age Medicine, then Holistic Medicine, then Complementary and Alternative
Medicine and its most recent iterations. From that perspective, which I still believe
to be valid, Acupuncture and Oriental Medicine (AOM) is the most comprehensive
and powerful member of Complementary and Alternative Medicine in North
America. APM was developed, through integration of this classic Western
psychosomatic foundational knowledge and core working principles, and through
integration of modern North American work on Myofascial holding patterns, to
bring classical acupuncture into the mainstream with a language that would

  52  
facilitate communication, cooperation and collaboration with mainstream and
integrative medical physicians and other health care providers of all persuasions.

In this vein, APM has demonstrated over the past three decades the power of
acupuncture as a stand-alone practice that equals those of classical osteopathy,
chiropractic, physical and occupational therapy. Just as these other physical, hands-
on medicines focus on treating somatic constrictions, blockages and weaknesses,
even in the treatment of patients who also have visceral complaints, APM
Acupuncture uses a decidedly hands-on physical medicine approach not only to
neuro-musculoskeletal disorders, but also to visceral complaints, stress and fatigue,
as well as emotional disorders.

Over the past year and a half I have been correcting for an error in modern
acupuncture and Oriental Medicine training in North America and at the college that
failed to recognize that when the Su Wen or the Ling Shu or later classical Chinese
texts refer to treating with a ‘calm heart and mind’, this was a reference to the
Learning of the Mind-and-Heart in the Confucian tradition, and specifically to the 8
steps of self-cultivation stemming from The Great Learning which Neo-Confucians
believe was lost after the death of Mencius around 290 BCE, and was not
resurrected as the “Learning of the Way” until 1000 CE by Neo-Confucians who
made this there starting point for self-actualization and moral development for the
common good. That is to say that this Way was lost, as stated in Scroll One of the
Su Wen, for well over a thousand years and classical texts of Chinese acupuncture
and medicine suffer from this loss, which was dealt a final death blow by the
Nationalists and the Communists in mainland China in the 20th century.

APM Acupuncture, as compared to Acupuncture Phsyical Medicine (APM) as

described above, seeks to revive this Neo-Confucian Way, and is best practiced by
those, I believe, who have a regular physical practice to regulate the bodymind
from the side of the soma (East Asian Daoyin or Yoga practices for example), as
well as a daily practice from the side of the psyche to calm the Mind-and-Heart
which might entail sitting or moving meditation, chanting, breathwork, prayer,
keeping a diary of ones interactions with Self and Others, sharing ones personal
work at engaging, especially in ones AOM teaching and practice, with like-minded

  53  
colleagues, close friends or a mentor, aimed at authentic human relatedness in all
of ones encounters with self and other: the Dao of the Sage.

I originally practiced Judo, then T’ai-Qi, then Qi Gong, from the physical side, and
worked out at the gym, and ran and jumped horses until injuries made that
impossible, and now swim daily while meditating or chanting/praying. My daily
Daoyin practices originally learned from Tom Bisio and Marshall Wood are now
informed by the 8 Healing Sounds and Storing Qi and Developing Sensitivity
Practices that Andrew Nugent-Head, MSOM, has brought to the college recently
and these practices have become much more tangible for me as a result of this
happy encounter. As several APM faculty and I will be studying with Andrew in his
Acupuncture in Orthopedics and Rehabilitation Program starting in July, 2012, this
will allow APM training at the college to become that much more embodied and
grounded in Daoyin physical self-cultivation with more tangible results.

In my work as Director of Education at the college, I am working with focus groups

of students and faculty to build back in the bodymind energetic approach that
served as APM’s precursor, into a revived APM Acupuncture teaching and practice,
with an Acupuncture Clinical Topic as an elective where students who are new to
the bodily-felt sense will have discussions I initiate, followed up with several
monthly bodymind therapy breathwork sessions with Jesse Torgerson, a highly
experienced and gifted bodymind therapist, along with facilitated discussion groups
lead by senior students or graduates who have worked with her, and with other
bodymind integrative practices in a rigorous way.

As part of the 4th year of the eventual First professional Doctorate, finally, senior
doctorally prepared faculty (Linda Barnes, PhD, David Kailen, PhD, Mark Seem,
PhD) will be running seminars on Eastern and Western approaches to “the life of the
spirit” from interdisciplinary perspectives, and some of these will be piloted as early
as the 2012-13 academic year.

It is my goal as director of education, through the APM Acupuncture approach

which will now be expanded to include the approaches from Yin Style Ba Gua that
Andrew Nugent-Head will be training faculty in, and through the Neo-Confucian
approach to Self-Cultivation, to establish the possibility for a classically inspired
advanced training in Acupuncture, AOM bodywork and their adjunctive therapies

  54  
worthy of the First Professional Doctorate, as a powerful partner in 21st century
physical medicine writ-large. This training will require that participants engage in
daily Daoyin, Yoga or parallel physical practices, as well as Mind-and-Heart
cultivation practices as discussed above.

And in all of this APM Acupuncture study, and in fact in all training at the college in
the current Master’s Degree Program in Acupuncture and in Oriental Medicine,
students will continue to be trained in critical and reflective practice, informed by
the late Donald Schon’s work on Reflective Practice, with weekly, preferably daily
self-reflection on Self and Others, derived from the innovative training at the
former College for Human Services established by the late Audrey Cohen in the
70s, where I was on faculty.

This was formally built into the masters entry-level training at the college in 2004,
and is parallel in many respects to the Neo-Confucian Learning of the Mind-and-
Heart as I will discuss in this book, which will continue to serve as an inspiration for
APM Acupuncture training and practice.

In brief, Acupuncture Physical Medicine (APM) is a decidedly Western, specifically

North American approach to bodymind integration, that is heavily influenced by
Classical Chinese Acupuncture theory and practice, especially as presented in the
“Spiritual Pivot”(Ling Shu) and was developed so that all MS degree students at the
college could practice it competently and confidently to good effect.

APM Acupuncture©, on the other hand, is a term I now reserve for the full practice
of APM Acupuncture from the bodymind integrative approach developed 25 years
ago, now fused with the Western approaches of Schon and Polanyi’s to tacit
learning and the Neo-Confucian Learning of the Mind-and-Heart.

While many graduates hold themselves out as practitioners of APM, sometimes

while mainly practicing trigger Point Dry Needling, what I mean by APM
Acupuncture as a solo practice is laid out in its entirety in this current volume,
directed first and foremost at the continued training in APM Acupuncture at the Tri-
State College of Acupuncture, whose faculty, assistants, interns, alumni and

  55  
students I wholeheratedly thank for engaging in this long and still fascinating Way
with me.

  56  
INTRODUCTION:
APM ACUPUNCTURE KNOWLEDGE, SKILLS &
ATTITUDES--TREATMENT OF THE 10,000 THINGS

Students who have seriously studied the philosophical foundations of APM

Acupuncture presented in this book and earlier books I refer to, and who
understand and can articulate the main concepts listed on pp. 153-154, and who
understand how Ling Shu meridian acupuncture and Travell and Simon’s
osteopathically informed approach figure in Acupuncture Physical Medicine (APM)
possess the requisite knowledge to practice APM.

Students who are serious and committed to palpation-informed practice and to

needling as described in this book and who have mastered the 18 APM KATAS
possess the requisite skills to practice APM.

Finally, those who have approached and make a daily commitment to continue to
approach APM practice with seriousness, reverence and awe for the capacity of
each human being they treat to self-actualize and make necessary changes have the
proper attitude to refer to themselves as APM Practitioners.

These are the Ordinary Skills of APM, and with them one is equipped to generate
creative strategies to treat the 10,000 things as a humane practitioner doing good
work.

As for the High Skills of “APM Acupuncture©” practice, which I differentiate from
Acupuncture Physical Medicine (APM) as mentioned above, this involves a deep
learning of the Mind-and-Heart on the part of the practitioner, first, and ideally of
the patient as well. It also involves a deep understanding of acupuncture as a
bodymind energetic approach first articulated in Bodymind Energetics, where study
of parallel Western bodymind therapies is crucial.

  57  
I have arrived at a place where I feel ready to strive for practicing such High Skills
myself, after 33 years of study and practice.

I am committed to this goal, knowing I will never achieve it to my satisfaction, and

trusting that some who study with me will go much further than I am able.

To my Acupuncture Physical Medicine faculty, assistants, interns, students,

graduates and colleagues, I wish you all the satisfaction and joy and passion and
love this medicine has afforded me thus far. I am a better human being from this
practice, where the ‘spiritual pivot’ of the needle, which connects practitioner and
patient, makes authentic human relatedness and human becoming a powerful
affirmation of Life and of the ‘Heavenly Principle.’

And to those now engaged with me in striving to practice the High Skills of APM
Acupuncture with similarly engaged colleagues and patients, I look forward to our
journey along the Way.

  58  
ONE
Professional Dimension

1] Premise of APM ACUPUNCTURE Clinical Training:

This is the place where one learns to engage in the ORDINARY SKILLS of
acupuncture practice, and of authentic human relationship with Self and Others
(team members, supervisors and peer patients) for best care.

The Professional and the Human Dimensions of Practice:

The expectations regarding professional, ethical and moral conduct at the Tri-State
College of Acupuncture are informed by the following critical and core elements
which together define what it is to be engaged in being a student, faculty member
and graduate of the college, and serve as a necessary support for the sorts of
Communities of Reflective Practice (CORP) the college seeks to foster:
• ACAOM STANDARDS: Established as the national requirements for AOM
professional educational programs over 27 years ago, these masters degree
entry level standards insure that accredited programs meet stringent criteria
in all areas of its programs and operations and that graduates are
Independent AOM providers eligible for state licensure and NCCAOM
national board certification;
• CRITICAL THINKING AND REFLECTIVE PRACTICE STANDARDS AND ELEMENTS:
Adopted from the Center for Critical Thinking’s work on thinking about
thinking, and Donald Schon’s work on Reflective Practice, the college has
articulated the Western Disciplines of Mind that it seeks to foster in its
students.
• MINDFULNESS: Taught early in the first semester of Year I as an East-Asian
Learning of what Classical Chinese Medicine refers to as theMind-and-Heart,
which embraces the tacit dimension of learning with ones whole body and
mind and all the senses, in a way that fosters emotional intelligence from a
center of calm and focused attention to ones learning, as the bridge to
engagement in authentic human relatedness with self and others. This

  59  
 attitude lso entails a seriousness and reverence for the things one studies, as
they all relate to the human condition.
• TSCA CORE VALUES: The 7 core values, published with the code of ethics in
the college’s student and personnel manuals, constitute the central focus for
AOM professional practice expectations, and are addressed in courses on
ethics and practice management, counseling, and in the patient/practitioner
interactions in all clinical experiences, from an interdisciplinary perspective
(medical anthropology, sociology, philosophy, psychology, public health,
education) that adds the human dimension to such a professional education
and are: Compassion, Caring and Positive Regard; Accountability; Altruism;
Excellence; Integrity; Professional Duty; Social Responsibility.

The college has identified its premier core value as Compassion, Caring and
Positive Regard from an East-West perspective. From a Western stance, the
concept of acceptance, later articulated as positive regard, and later still, as
unconditional positive regard were developed by Carl Rogers as the core of
his humanistic psychology of the self-actualizing individual. In chapter 15 on
Roger’s client-centred theory (in “Embracing non-directivity; reassessing
person-centred theory and practice in the 21st century” edited by Brian E.
Levitt), Kathryn A. Moon summarized Roger’s position thusly: “Carl Rogers
founded client-centred theory upon the hypothesis that all living organisms
are inherently motivated to maintain and fulfil themselves as best they can,
each 'according to its nature' [...]This constructive life force is called the
actualizing tendency. Actualization is believed to be the primary motivation,
a universal need or drive to self-maintain, flourish, self-enhance and self-
protect [...]. Rogers posited six necessary and sufficient conditions for
effective psychotherapy [...], three of which (the 'core' conditions) give
therapists a facilitative way 'to be' with clients. These three conditions,
sometimes referred to as the 'therapist conditions' [...] -unconditional positive
regard, empathic understanding and congruence - when embodied in the
therapist, meld together into a manner of therapeutic presence [...] that is
trusting and respectful of the client. I consider this therapeutic presence to
be protective and sheltering of the client's ways of being, doing and
perceiving. Rogers' theory was put forward as inductively derived: given the
universality of the actualizing tendency, if certain necessary and sufficient

  60  
 therapeutic conditions are present in a relationship, then the individual will
self-maintain and flourish.”

In the East-Asian, specifically Chinese Confucian and especially Neo-

Confucian formulations, the central concern, parallel to Rogers’ views,
according to Tu Wei-ming, “is the process of becoming a sage, of becoming
fully realized as an authentic human being [...] the distinction between
authentic self and inauthentic self and that between partial self-realization
and complete self-realization (Humanity and Self-Cultivation, p. 17).” While
this might sound like an East Asian parallel and precursor to Roger’s
decidedly western humanism, Tu Wei-ming underscores the centrality of
Confucian “human-relatedness” and Neo-Confucian “unity of knowledge and
actions”(Wang Yang- ming) in the world, to change the world. He further
clarifies that in “many great spiritual traditions, human-relatedness as shown
in ones attachment to the world is considered detrimental to man’s
religiosity and therefore must be forsaken before one can fully experience
ultimate reality either in the form of a union with the ‘wholly other’ or in the
form of a unity with true selfhood” where the argument might run thus:
“human-relatedness must be totally eliminated because it gives rise to a false
perception of the self.” In this decidedly “antisocial” rendition, TuWei-ming
suggests, “it has been widely held that one of the most salient characteristics
of spiritual transcendence is to say ‘no’ to society at large (pp. 19-20).” The
Confucian Way is different on this fundamental point, such that “sociality is
not only a desirable trait but also a defining characteristic of the highest
human attainment [based on] two interrelated assumptions”—that the
“ultimate ground” of Man’s self-realization lies within. “Man has the inner
strength to actualize the full potential of his being, and his creativity is
inherent in his humanness”. Despite this natural self-sufficiency, “for man to
become a fully actualized human being,” Tu Wei-ming concludes, “he must
constantly engage in the process of becoming a sage (the highest form of
authentic humanity) [...] not by detaching himself from the world of human
relations but by making sincere attempts to harmonize his relationships with
others (ibid, p. 20).”
 IOM CORE COMPETENCIES: The Institute of Medicine identified five core
competencies to be embedded in all mainstream as well as complementary
and alternative health professions education to meet the demands of 21st

  61  
 century health care. These competencies figure prominently in draft
ACAOM First professional Doctoral standards and the college voluntarily
upgraded its MS in Acupuncture Program to include these eventual doctoral
elements, for a more comprehensive education that prepares its graduates
not only for private practice, but for work in mainstream and integrative care
settings. The five core competencies are: Provide patient-centered care
(work to empower patients to play a central role in their healthcare plans
and respect the patient’s own healthcare and other determining beliefs,
needs and decisions without bias or discrimination); Work in
interdisciplinary teams (ability to communicate, cooperate and collaborate
even if not in the same practice settings, based on patient needs and
preferences); Employ evidence-based practice (be information literate
and dedicated to obtaining best available authoritative evidence from textual
and research areas, including expert experience; with awareness of
limitations on research evidence in CAM fields in general (cf. IOM,
Complementary & Alternative Medicine in the United States); Apply quality
improvement (work to improve quality of care and minimize risks); Utilize
informatics.

  62  
2] Human Centeredness, Positive Regard and Lifelong
Learning

While the ultimate goal of the college’s accredited Master’s Degree Programs in
Acupuncture and in Oriental Medicine consists in graduating independent AOM
providers qualified for licensure, the college aims much higher: through the
example set by its most senior faculty in their Grand Rounds Master Classes, to the
caring and compassionate coaching and supervision of its clinical practice faculty,
and in every didactic classroom experience, the college faculty of practitioners
works to help each student learn in her or his own way how to internalize and
embody the art and science of Acupuncture and Oriental Medicine in a manner that
empowers them to engage in lifelong learning.

These elements together articulate an independent AOM provider as one who has
internalized and exhibited (and been assessed on) professional (ACAOM required
OSHA, HIPAA, CNT, AOM knowledge, skills, attitudes), ethical (adherence to code
of ethics) and moral performance and behavior. Here moral behavior is defined as
a dedication to an authentic human relationship with every person engaged in the
clinical encounter (patients, teammates, supervisors, self) from a position of
acceptance and positive regard.
This moral dimension maintains that the patient-practitioner relationship must start
from a salutogenic (health-making) perspective that aims at the patient’s self-
actualization. Such a perspective is based on the belief that the patient’s experience
of illness and narratives (Kleinman) are central, and care is centered on the patient’s
desires, wishes and needs. Such care aims to prod each patient’s innate wisdom and
will to thrive, to self-actualize, and to say yes to life. Such a stance on the patient-
practitioner relationship is investigated at the college from interdisciplinary Eastern-
Western angles to provide a robust and flexible model that is adaptable to any
person’s perspectives on the ethico-religious and spiritual dimensions, where the
only belief that unifies them all is that human life is precious in all its transformations
and elaborations.

The Neo-Confucian Way, which I am slowly building into APM Acupuncture©, taken
as a philosophy for how to live in the Real world, entails a code of ethics and moral
conduct aimed at a more humane society and world at large. “Confucian

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physicians” held this perspective from the 11th to the 14th centuries in China. With
the rise of Neo-Confucianism, the model of the “Sage- King” was internalized, such
that each person was seen as capable, within her or his inborn limitations and
stations in life, of becoming a sage, having been born wise, through an effort of
body, mind and all the senses. This effort of self-cultivation required that one set
out on the Way as Confucius instructed, with this inner Sage as the guide, passing
through the developmental stages of “scholar-apprentices (shi)” and then
“exemplary persons (junzi)” who command respect because they have “travelled a
goodly distance along the way, and live[d] a goodly number of roles. A benefactor
to many, [the junzi) is still a beneficiary of others like himself. While he is still
capable of anger in the presence of inappropriateness and concomitant injustice, he
is in his person tranquil (The Analects of Confucius: A Philosophical Translation by
Roger T. Ames and Henry Rosemont, Jr., pp. 61-14).” Except in rare instances, these
translators tell us, “the goal of the junzi is the highest to which we can aspire” as the
“loftier human goal”, of becoming a “sage (shengren) [...] is a distant goal indeed
(ibid, p. 62).” The way of human becoming (self-cultivation, “innately knowing the
good” and embracing humaneness, ibid, pp. 48-49) that leads one from being a
scholar-apprentice to an exemplary or “authoritative” person is a progression from
apprenticeship as dedication and commitment to lifelong learning and self-
cultivation, to that of the “exemplary” or “authoritative” person who engages in
authentic human relatedness, “ ‘growing (sheng)’ these relationships into vital,
robust, and healthy participation in the human community (ibid, p. 49).”

This moral dimension, which starts from a position of positive regard toward all
human beings, makes the training of professionals good at their art and science—
their craft, also a training in human relatedness where students learn ways to
communicate, cooperate and collaborate with others for the common good— by
means of quality and humane AOM health care.

From this viewpoint, independent AOM providers informed by the APM perspective
are dedicated to AOM care as a servive to society, and as a way to foster the
human dimension in health care in our country, where it is far too often neglected.

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3] The History of a Compromise—The TCM Organization of
Acupuncture Practice

THE PROBLEM:

As I began meeting founders and educators from the other schools of acupuncture
starting in 1982, during their formation of the National Council of Acupuncture
Schools & Colleges (now CCAOM), I was struck by the absence of what I came to
call the jingluo filter and jingluo pattern identification as a way to develop an
acupuncture treatment plan. Most of the other schools focused on teaching the 14
meridians (where the two extraordinary vessels, du and ren mai were taught not as
part of the 8 extraordinary vessel network with its own treatment applications and
strategies, but as landmarks that demarcated the ventral and dorsal midline on the
basis of which location of points on the torso could be taught), and the use of distal
antique or command points combined with front-mu and back-shu points. As I
began teaching in several of these other schools, and teachers from these schools
began teaching in mine, I saw my role in these early days as a translator of what I
perhaps erroneously referred to as French meridian acupuncture in the tradition of
Nguyen Van Nghi, MD. There, one found a comprehensive presentation of the
jingluo filter, with detailed exploration of the 12 “regular meridians”, and their
associated “secondary vessels” (12 divergent, 12 transverse luo, 15 longitudinal luo,
12 tendinomuscular) and the 8 extraordinary vessels, comprising 71 jingluo
(translated as “channels and collaterals” in most PRC texts that came much later).
This puzzled me, because Felix Mann’s early text in English on the “meridians of
acupuncture” from around the same time as Van Nghi’s earliest writings was widely
available, and listed 59 meridians (he did not designate the 12 luo anastomosis-like
pathways from each of the 12 regular meridian’s luo points to its paired meridian’s
source point as actual meridians, even though all texts portrayed this little shunt as a
dotted line without further mention). The earliest problem for me with this picture,
was glaring. Where had all the meridians gone? What happened to the jingluo filter
that reduced 71, or 59 meridians to 14? And what were the implications of this for
acupuncture practice in North America?

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Correcting for an Error

As Maciocia states in The Channels of Acupuncture, “The organs and their relevant
channels form an invisible energetic unit: problems of the Internal Organs can
effect the relevant channels, and, conversely, problems that start by affecting
channels can penetrate the Interior and be transmitted to the organs (p. 97).” The
fact that he starts this clarification by capitalizing “Internal Organs” displaces the
total connection between a meridian and its internal branch, which connects to its
paired meridian of the opposite polarity (Lung to Large Intestine etcetera). The
role of the internal branches, rooted in the Sea of Blood and Qi, of enabling inside
(the function of organs, glands, deep tissue, Blood and Qi) and outside to
communicate is already distorted in Maciocia’s decidedly modern, TCM
interpretation.

Dr. Yitian Ni, in her Navigating the Channels, reminds us of the classical functions of
the channels and collaterals, namely to: “Integrate the whole body” providing a
network connecting Zang and Fu, the interior to the exterior, which “links each part
of the body to every other part, creating an organic whole; “Circulate the Qi and
Blood”, so that “the organs and tissues can be nourished and lubricated […], their
functions can be regulated, and […] a relative equilibrium of normal life activities can
be maintained; “Demonstrate the location of disorders”, such that the pathogenic
effect from one organ or part of the body can pass to another area, and
“meanwhile be reflected on the body surface through the channel system: hence in
an attack on the lung regular meridian and organ (hand taiyin), the pathogenic
factors can be transmitted to the paired large intestine, “resulting in a tenderness,
or other abnormality on the body surface along the Lung and Large Intestine
Channels (ibid, p. 1); “Transmit the needling sensation”, which can move along the
channel system to the affected area: “When properly applied, this function
regulates and activates the flow of Qi, balances Yin and Yang, and restores the
normal function of the organs and channels (ibid).”

Maciocia goes on to a study of the symptoms and signs of the twelve main
channels (jing mai) (ibid, pp. 98-106), reminding us that channel problems can arise
from: an exterior invasion of wind, cold or dampness leading to bi syndromes;
overuse or repetitive strain; or sports and other injuries leading to Qi stagnation,

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which of course are the three causes of cutaneous region and muscle channel
disorders (the “yang” or wei level of channel invasion). He then adds, almost as an
afterthought that, finally “channel problems can of course spring from Internal-
Organ disharmonies (ibid, p. 98).”

He then moves on to the crux of the problem as I see it, with an “error” that is
based on a ZangFu bias which is characteristic of modern TCM acupuncture. He
states the obvious, that ”Channel Pattern Identification describes the pathological
changes occurring in channels.” He then suggests that these signs and symptoms,
from Chapter 10 of the LingShu, can be confusing as they may include “some from
the relevant organ and sometimes even from other organs.” He cites the case of
the main Lung channel, which might have signs and symptoms from: the Lung
channel (pain in the upper arm, and fullness and distention in the chest); the Lung
organ (cough); and the Large Intestine channel (pain in the supraclavicular fossa)
which he notes is “related” to the Lung channel (ibid).

What Dr. Ni took as a normal part of the internal /external and YinYang regulatory
function of the main channels, connecting the external Lung channel to its internal
Lung organ, and connecting the Lung organ to its paired yang Large Intestine
bowel, which itself is connected to its Large Intestine channel, Maciocia decides to
present as “confusing”. His choice of terms is precise, and meant to create this
“confusion”: “sometimes even from other organs” and “is related” make it sound
curious that Lung and Large Intestine organ and channel signs and symptoms would
appear together in the classic description of the main channels.

Once having created this confusion, which the reader certainly wants cleared up,
Maciocia gives the TCM solution developed in the early 1960’s:

“Thus channel patterns include some symptoms and signs from the organs
themselves. These can safely be ignored, as for organ problems it is much better to
use the Internal Organ (ZangFu) Pattern Identification (ibid).” He then proceeds, for
each main channel, to give the “pure channel symptoms” and the “organ
symptoms” in a manner that is incorrect and not in keeping with the LingShu
Chapter 10, as it presents the classical signs and symptoms.

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This is either because Maciocia does not care to be clear, wishes to confound the
confusion, or, which is entirely possible, is seriously confused himself.

Whatever the case, Maciocia’s discussion of main channel Pattern Identification is

clinically flawed, and underscores the fact then TCM acupuncture teachings over
the past 47 years or so have replaced the differentiation of internal organ
symptoms of main Jingluo patterns with ZangFu pattern differentiations.

This process extended far beyond the PRC, as it affected the teaching of Main
Channel Pattern Identification in the entire English-speaking world. In North
America, as AOM colleges were obliged to keep up with new TCM texts from PRC,
and as the NCCAOM national board examinations were developed based on TCM
texts in large part, an error, or a deliberate oversight was built into jingluo education
and practice with wide repercussions.

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4] The Big Picture:

The hallmark of the Tri-State College of Acupuncture’s Program in Acupuncture lies

in its commitment to diversity, and to training students to be able to compare and
contrast, and ultimately integrate from the three main styles taught at the college
that stem from classical and modern Chinese, Japanese and French styles of
practice in North America today. APM Acupuncture is firmly dedicated to such an
integrative and pluralistic approach to practice in North America. From this
Persopective APM is already integrated with Classical Chinese Acupuncture (CCA)
and informed by modern approaches from East and West as explained in the
preface.

The Knowledge, Skills and Attitudes of an integrated APM/CCA approach are

delineated in Acupuncture Physical Medicine, Acupuncture Osteopathy, and
BodyMind Energetics by Mark Seem, Ph.D. Note that APM ying level treatment
utilizes many of the same treatment strategies as Classical Chinese Channel theory,
as articulated in Yitian Ni’s Navigating the Channels, for selection of distal and local
points of the regular meridians, and treatment strategies for the secondary vessels
and eight extraordinary channels. Her text is based in large part, as is the work of
Drs. Chamfrault and Van Nghi whose texts served as the foundational French texts
of the Quebec Institute of Acupuncture curriculum in the late 1970’s. Likewise
needle technique in APM at the Ying level is consistent with CCA and TCM. APM
adds a jing level use of extraordinary vessels derived from French meridian
acupuncture, as well as a wei level approach that includes CCA and TCM treatment
of Bi syndromes with acupuncture, as well as more classical approaches to the
secondary vessels as taught by Van Nghi, and a modern approach to trigger point
myofascial release through acupuncture dry needling derived from Travell and
Gunn. A good half of APM treatment is therefore consistent with the CCA
approach, whence the label APM/CCA for Year II Acupuncture Clinical Practice
(ACP) sessions.
♦  APM/CCA knowledge: This knowledge base assumes a solid grounding
in AOM foundations, namely the theory of acupuncture filters (yinyang, 5
phases, etcetera); the normal function of the 12 ZangFu; the 3 Heaters;
acupuncture point location for the regular meridians, and acupuncture
palpation examination for reactive points at the wei level, for mu and shu
points and for reactive mu/shu-like points (mu-point boogey); the main

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 trigger points in the Taiyang, Shaoyang and Yangming Zones ; meridians of
the jing, ying and wei level and the APM acupuncture imaging protocol for
use of meridian strategies at each of these 3 levels; the 3 zones; the 3
meridian circuits; the hypothesis that ‘yin tends toward deficiency/yang tends
toward excess’; the 8 conditions that inform an APM physical examination
during the palpation and treatment planning phases of APM
treatment(upper/lower; front/back; right/left; yin/yang): all of the above
constitute specific acupuncture factors of care in APM/CCA.
Acupuncture reframing/imaging; tongshenming; bodily felt sense; focusing
(Gendlin); the experience of illness; bodymind continuum constitute the
nonspecific factors of care in APM/CCA.
♦  APM/CCA Skills: these skills are delineated below as separate skills under
five broader categories of overall competency referred to here as Skills
Sets.
♦  APM/CCA Attitudes and Values: Ones attitudes and values toward
health, illness, suffering and the role of the caregiver, as well as ones
awareness of ones own position on the bodymind continuum [with a
tendency to react more somatically, with physical symptoms, or
psychologically, with emotional distress at the symptoms, or somewhere in
between], inform how one practices acupuncture. In APM, ones intention
begins with an enormous empathy for the litany of suffering and the
experience of illness of those who endure chronic pain, chronic stress, and
chronic emotional distress. Informed by this empathy, APM takes a
humorous, salutogenic approach that asks each patient suffering from such
chronic suffering to consider that it could be worse, that no one ever
promised them a life free from suffering, that pain and suffering are part of
the human condition, and that aging and illness include increased pain and
suffering. A salutogenic intention challenges the patient to recognize that
most of the time, they are healthy with no healthcare intervention, and that
they are capable of coping more effectively, with less pain and distress.
Within this intention is a value of the acupuncturist as change- agent, as
catalyst to prod the patient’s will to be well. APM practitioners value the role
of acupuncture in such chronic conditions, which constitute a good 70% of
what they treat. In such cases, acupuncture is often of major, even primary
importance.

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In the case of patients who have a serious diagnosed disease, APM practitioners are
acutely aware of the relative role of acupuncture and Oriental medicine in such
cases, and see APM as secondary or tertiary care, aimed at support, alleviation of
pain and discomfort and distress. APM practitioners have tremendous respect for
conventional medical care in such cases, and always encourage patients to seek the
best medical care possible, never overstating acupuncture’s role in the overall plan
of care. For patients who freely and knowingly refuse to undertake the standard of
conventional medical care, APM practitioners discuss openly and frankly the worth
of acupuncture care and decide with the patient whether or not to continue
acupuncture treatment for their condition. APM practitioners are fully aware of
their legal scope of practice in whatever states they practice, and never work
outside of this scope.

Finally, in the case of clients, who freely choose acupuncture for well-being or
health maintenance, APM practitioners respect such free choice of wellness care,
while never inflating acupuncture’s importance or making claims without evidence
to back them up.
Whether an APM/CCA practitioner is serving a primary, secondary or tertiary role in
a patient’s overall plan of care, s/he is aware of this relative role, and also aware that
the patient- practitioner relationship is such that proper use of somatic and verbal
rapport, a good tableside manner, might initiate in even the most difficult situations
an instance of “tongshenming [penetrating divine illumination]”, a classical TCM
approach to the doctor-patient relationship, where something said or a simple
touch by the practitioner can set up a space for healing that is safe and powerful at
the same time. Ultimately, then, an APM/CCA practitioner’s intention in reframing a
patient’s suffering into something that acupuncture might be able to address is that
the patient is her or his own primary healthcare practitioner, and capable of healing
from even the most serious physical or emotional illness. Confronted with the
unexpected and the exceptional in their care of patients, APM /TCM practitioners
will be dedicated to lifelong learning.
It is expected that all students entering Year II APM/CCA ACP class will have the
required knowledge base outlined above, and that they will do the required
readings before each class and come with their copy of Travell and Simon’s text(s)
for ready reference of trigger points (which is considered an open-book knowledge
base until each trigger point has been mastered).

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It is understood that the attitudes and values of an APM/CCA practitioner will take
more or less time depending on a student’s prior life and healthcare experience.
The directed independent study Learning Portfolio will be the place where students
can reflect on these values and demonstrate an appreciation, if not a total
internalization at any given point, of these values which will continue to evolve and
shape their behavior as more and more mature, and wise, independent acupuncture
providers. Cf. Acupuncture Physical Medicine, pp. 9-60 for a discussion of APM’s
specific perspective on empathy, suffering and chronic fatigue/visceral agitation.

APM is often referred to as symptomatic by some who prefer to remain ignorant

of the classical acupuncture approach as espoused in the end of Scroll One of the
Ling Shu where we are taught that while some believe acupuncture is unable to
treat chronic complaints, this is because they do not know how to wield a needle in
such a fashion to ‘remove thorns, wash away stains, untie knots and breach
obstructions’. Those who do know how to perform these dispersal techniques are
able to clear the way, by first clearing away surface, ‘yang evil’, then a little deeper,
to clear away ‘cou li’ subcutaneous level ‘yin evil’, so as to be able to promote grain
Qi, thus enabling the body to build Qi and Blood (ying level, post-natal Qi)) from
proper transformation and transportation of food and drink without overly tapping
into prenatal Qi. These, classically inspired acupuncturists, know that treatment of a
patient’s specific complaints, through distal and local specific strategies to clear
away these excesses, are very capable of treating chronic and complex complaints
solely with needles (and moxibustion) by treating the meridian system and clearing
obstructed points and areas along those pathways.

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5] APM/ CCA Practice Guidelines for Charting Diagnoses for
ACP and Clinic:

1] Visceral agitation patterns: with adrenal involvement, sympathetic nervous

system arousal and ANS signs and symptoms, are charted thus:
• Taiyang Excess/ Du Mo excess (‘spinal irritation’)
Kidney/Heart Protector Meridian Dysfunction
Treatment Principle: Disperse Taiyang Excess, disperse Du Mo, Regulate
Kidney and Heart Protector Meridians
• Chong Mai/middle heater branch Dysfunction/ Constrained Liver Qi
(‘diaphragmatic constriction’ with possible Liver, Spleen, Gallbladder or
Large Intestine Dysfunction)
Treatment Principle: Regulate Chong Mai (middle heater branch), regulate
Liver, Spleen, GB, LI
• Chong/Dai/Ren Mai Disharmony/ Lower Heater Dysfunction (‘pelvic
collpase’, possibly with dampness, heat, Blood Stasis, Constrained Qi)
Treatment Principle: Harmonize Chong/Dai/Ren; Regulate lower heater
(eliminate dampness, disperse Heat, clear Blood Stasis and move Blood and
Qi)
• Upper Heater Dysfunction (‘cardiac alarm’, with Lung, Heart or Heart
Protector Dysfunction; Kidney/Heart Meridian Disharmony; Kidney/Lung
Meridian Disharmony)
Treatment Principle: Regulate Upper Heater (Lung, Heart and/or Heart Protector)/
Harmonize Kidney and Heart Meridians or Kidney and Lung Meridians

2] The treatment of visceral dysfunction and functional disorders: (Foot

Yangming Excess for example in a case of reflux and IBS) may also be treated
classically according to the Ling Shu as regular meridian disorders and treatment of
the corresponding circuit: tonfication of the source point of the associated yin
meridian, in this case Sp 3, or the ying and shu points, SP 2 and 3; dispersal of the
paired yang meridian luo point, so ST 40 in this case; dispersal or tonification based
on palpation of local points along any of the regular meridians within the circuit,

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with special attention to the yang meridians: so 19, 18, 16, 15, 14 on the left for
abdominal and chest discomfort in that area from the reflux, bilateral ST 24-27 and
SP 15 for IBS S&S of bloating.
• Taiyin/Yangming Circuit Dysfunction
Treatment Principle: Regulate Taiyin/Yangming Circuit
• Shaoyin/Taiyang Circuit Dysfunction
Treatment Principle: Regulate Shaoyin/Taiyang Circuit
• Jueyin/Shaoyang Dysfunction
Treatment Principle: Regulate Jueyin/Shaoyang Circuit.

3] For Tendino-Muscular Meridian Conditions:

♦ (meridian name) TM excess/ muscle channel bi syndrome (ie: Liver TM excess
OR Liver muscle channel bi syndrome)
Treatment Principle: Disperse TM meridian excess, promote free-flow of Qi and
Blood, Invigorate the muscle channels.

If there is wind, dampness or cold, add to diagnosis: “with wind, dampness or cold”;
add to treatment principle: “disperse wind from; resolve dampness in; or disperse
cold and warm” the channel.

4] For Zone Conditions:

 Taiyang Zone Dysfunction/ Taiyang-Shaoyin Meridian Dysfunction
Treatment Principle: Regulate Taiyang Zone, regulate Taiyang-Shaoyin
• Shaoyang Zone Dysfunction/ Shaoyang-Jueyin Meridian dysfunction
Treatment Principle: Regulate Shaoyang Zone, regulate Shaoyang-Jueyin
• Yangming Zone Dysfunction/ Yangming-Taiyin Meridian Dysfunction
Treatment Principle: Regulate Yangming Zone, regulate Yangming-Taiyin

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6] APM Learning Objectives

By the end of this Year II ACP section on APM/CCA practice, students will be able
to successfully perform the following 5 Skills Sets at a level of PASS or GOOD on
two separate occasions on two different peer-patients, thus demonstrating
readiness to progress to their first rotation in the college’s acupuncture community
clinics.

1. APM PALPATION/ INTAKE

The palpation phase of the AOM physical examination is pivotal in APM. It is here
that the patient-practitioner relationship is solidified through hands-on identification
of the patient’s holding pattern. Locating the holding pattern with ones hands allows
the practitioner to validate a patient’s experience of illness without labeling or
interpreting it: “Here it is!” rather than “This is what it is!” In APM palpation, one
starts locally, as close to the center of the holding pattern as possible. If the intake
indicates probable upper trapezius involvement in temporal headaches, then the
hands-on palpation would most effectively start by checking the temporalis TrPs to
start where the patient is complaining, and then move immediately to the trapezius
TrPs. The palpation moves to distal points, dispersing with firm acupressure the
whole while, and ends with a brief location of all the other main jing and ying level
points so that the patient has a sense of what is to come, and to begin the dispersal
of Excess, by supporting the Root.

2. APM ACUPUNCTURE TREATMENT PLAN

Identify the Zone to be treated in widespread Musculoskeletal and Pain Disorders
and state the complete APM Protocol for Jing, Ying and Wei Levels for that Zone;
or Identify the tendinomuscular or other secondary vessel meridian(s) to be treated
and a complete traditional Chinese or French meridian distal and local protocol for
that meridian(s) with a simple root treatment; identify the Heater to be treated and
an APM/CCA distal and local protocol including jing and ying levels.

3. APM/CCA ACUPUNCTURE TREATMENT/TECHNIQUES

APM/CCA integrated acupuncture techniques differentiate between neutral
stimulation, which can be performed on any point and is best for highly reactive,
needle sensitive patients; dispersal techniques which should only be used on Excess

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points found by palpation; and tonifying stimulation which should never be done on
Excess points, and is especially indicated on deficient distal points like source points
and tonification points, and local deficient mu or shu (like) points.

4. COMMUNICATION/EDUCATION/REFRAMING--VERBAL RAPPORT
Communication, education and reframing skills occur at the same time as the
specific acupuncture skills are being performed, in order to: train patients what
sensations to expect; encourage patients to be present and go with the experience;
and reframe the person’s complaint(s) into acupuncture holding patterns. Verbal
rapport is thus used to build trust, educate, and communicate with the patient to
create a safe environment for the treatment. During the verbal reframing, every
opportunity should be seized to inspire hope in the patient and encourage positive
change that they will be able to resume more normal activities. Patients must
understand that there is no talking during needle removal.

5) MAINTAINING SOMATIC RAPPORT

Somatic rapport skills occur at the same time as the specific acupuncture skills are
being performed. Somatic rapport is sought for the same reasons as verbal rapport,
to provide a safe environment for the treatment, to encourage the patient to go
with the treatment, and to inspire hope and encourage positive change.

6) INSPIRING HOPE
Throughout the treatment an APM acupuncture practitioner engages the patient’s
will to be well, from a salutogenic rather than a pathogenic perspective, so that
language and silence are used as another tool to prod and to reframe a mind-set
stuck in pathology into one of hope that change is possible. Clinic-interns at the
college train in basic reframing techniques drawn from Eriksonian Hypnotherapy
and Neuro-Linguistic Programing with Melissa Tiers to better inform this choice of
language and silence, which is parallel to the classical Chinese concept of
tongshenming-penetrating spirit clarity, where one prods the Mind-and-Heart to a
place of equilibrium so that the inborn ‘intelligence of existence’ might emerge.

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7] PRIORITIZING THE HUMAN DIMENSION IN CARE:

ACP is a safe, controlled, supervised environment where you learn the actual
behaviors that constitute acupuncture care of patients. While you will be being
treated by a peer-practitioner who may even be your friend, you must role play in
ACP, as if you were the actual patient and the actual practitioner—the RECEIVER
and the GIVER of care.
Consider APM/CCA ACP clinical practice as the practice of specific treatment
forms each week—called katas in Japanese Karate. Each week, you will practice a
form (ie: Taiyang Low Back Pain Form) as exactly as you can, given the actual
reactions and sensitivities of the peer- patient. In this way you will amass a
repertory of over a dozen broad protocols that will serve you in every clinical
condition you encounter in the summer acupuncture community clinical rotation.
In your role as peer-practitioner, you must proceed with the palpation, the
reframing, and the education of the patient while eliciting bodily-felt feedback as
per the directions below. You must inform each peer-patient what is occurring at all
phases of the treatment, educating them about the sensations they are feeling and
what is happening, and what to expect after the treatment and how to care for
post-treatment soreness. You must also seek to inspire hope that the condition can
change and anchor the peer-patient on what they wish to do once their condition
improves with simple “parting words”.
In your role as peer-patient, it is your responsibility to provide constructive
feedback on somatic and verbal cues from the peer-practitioner as you would hope
a patient would, including sensations you are experiencing, reactions to techniques
you are having and any emotional reactions that are distressing. This will greatly
enhance students’ ability to improve their specific acupuncture related skills as well
as the non-specific skills of verbal and somatic rapport, reframing, education and
instilling hope that change can occur. Note that this all will feed into the RAP
Learning Portfolio, where you will learn to record your experiences as giver and
receiver of care as your repertoire of acupuncture experience grows.

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8] ACP PRACTICE GUIDELINES FOR NEEDLE TECHNIQUES

A] For the Jing and Ying levels, the integrated APM/CCA approach makes use of
classical
Chinese techniques consistent with TCM:
Jing Level: Extraordinary vessel distal opening points (SI3/Bl62 etcetera) are close
to the bone (marrow, jing). In needling shallowly, 1/3 of an inch at most, one is
already near bone. Needle into the subcutaneous fascia over the bone, with precise
point location to enter the point. Neutral mini lift and thrust, with twirling is
sufficient until there is a slight grab felt by the practitioner. The patient will begin to
feel a heavy sensation. On Yin opening points, stop at the first sign of deqi. That is
enough. On Yang opening points, the deqi can be stronger. REMEMBER DE QI
RESPONSE MUST BE TAILORED TO THE PATIENT’S “DE QI TOLERANCE LEVEL”.
Do these points first to begin to create/open the circuit involved. Leave these points
at the depth the grab was encountered. Do not pull back to surface.
Ying Level: Regular meridians are deeper within the fascia and “hidden from view”.
The distal command points are places where the meridian is closer to the surface
and easier to access with rather shallow needling. The LING SHU lists distal
command point depths as follows:
Foot Meridians:
Yin meridians: 1/10-1/3”
Yang meridians: 2/5 to 3/5” (or slightly more)
Hand Meridians:
Yin or Yang Meridians: 1/5”
8/16/11 17
1 fen = 2.5 mm = 1/10”: Needle Depths:
Liver =1 fen = 1/10” Gallbladder = 4 fen = 2/5” Kidney = 2 fen = 1/5” Bladder = 5 fen
= 1/2” Spleen = 3 fen = 1/3” Stomach = 6 fen = 3/5”
Approach these points perpendicularly to the surface of the skin.
For Yin points, use lift and thrust with or without twirling with small amplitude and a
focus on the slow thrust in, as if pushing a weight into a dense area. Feel for the
resistance at the tip of the needle. This is the beginning response of the tissue
under the needle as forces converge around the needle tip. When you reach the
depth where resistance is met/felt, stop inserting and just twirl until there is a slight
grab (yin tends toward deficiency so you are doing a mild stimulation here). If there

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is no grab, quickly pull back to the surface but do not pull out; redirect slowly in
stages. This is a modified “warming” technique. For sensitive patients you can omit
the twirling and just thrust slow and heavy, then lift quickly, then redirect slow and
heavy. If the response is very slow to come (low blood pressure, low thyroid, cold)
be careful as it may hit like a hammer blow. For the average reactor, you can go to
the point of mild deqi on these points. Leave the points at the depth where the grab
or deqi is encountered. Do not pull to the surface.
For Yang Meridian excess Points, insert needle swiftly to the required depth, about
1⁄2 inch, with or without twirling as you insert and lift slowly to the surface,
repeating until de qi is obtained; maintain the twirling, wider amplitude (yang tends
toward excess so you are doing mild dispersal here to get things moving. If the
point is very excess, a stronger dispersal is required and will generate a propagating
qi sensation from the point up or down) until there is a distinct de qi sensation on
the part of the patient (within their de qi tolerance), and/or a strong grab like a fish
biting on the line for the practitioner. You can also insert to required depth quickly,
then lift slow and heavy, focusing on the lifting as if there were a weight being
pulled up out of the water, like a bucket filled with water.

Mu and Shu points:

Mu points must be angled as per textbook instructions, usually oblique. Insert slowly
until you meet resistance, and then twirl gently into the resistance until heaviness
converges around the point to tonify. To disperse, increase the amplitude of the
twirling and focus on the out/lift; or slowly lift as if lifting a bucket of water out of
the water, as if there were a great weight being pulled up. This can be repeated,
fast in/thrust, slow heavy lift/out movements. Propagating qi sensations will usually
occur.
Shu points in APM are to be needled about 1/3-1/2” deep from Bl 11-22; 1/2 – 3/4”
from Bl 23- 25 , angled oblique slightly down and in toward the spine. They can be
stimulated perpendicularly, paying careful attention to depth, then redirected
oblique if they are to be left in situ. Some practitioners stimulate perpendicularly,
until the required sensation is achieved, then remove. These points can be tonified
or dispersed as per mu points. Do not do APM trigger point pecking technique on
these points or they will behave like trigger points, not shu points. If a shu point is a
trigger point as well, you can release the trigger point first with pecking technique,
then needle as a shu point, with mild tonifying or dispersing technique, directly into
the muscle. Once stimulated, withdraw to the surface and leave oblique so that they

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cannot be pulled deeper by the contracting tissue as the patient is lying there
unattended. In APM Mu and Shu-Point Boogey obtains, which means that points are
picked for each of the three heaters based on reactivity, not exact point location,
and are typically done according to Triple Heater Regulatory technique where at
least two heaters are treated.
Always treat a lower heater mu or shu point before doing any points in the upper
heater, to prevent strong releases of heat and liver wind. If a strong reaction occurs
with upper heater points, calmly remove the upper heater point and compress the
area with calming acupressure for a few seconds, reassuring the patient. Then
restimulate distal yang needles to “bring the qi down”. Pull over a supervisor
immediately.

B] Wei Level Distal and Local Points:

Distal Wei Level Points: These Yang Points may be treated with TCM dispersal
technique, needling the actual point if tender, propagating the qi downward; or as
trigger points into the actual trigger point (peroneus longus trigger point near GB
34 to serve as distal wei level point to release the lateral thigh and hip for example).
Local Ashi Points: Any ashi point may be needled wei level shallow oblique insertion,
or slowly straight into belly of TTP (TCM technique) as per the peer-patient’s
tolerance level.

WHEN there is an actual trigger point present, the preferred technique in these
APM/CCA ACP sessions (de qi tolerance taken into account) will be the APM
fasciculation technique derived from Travell, also known as sparrow pecking in
classical Chinese acupuncture.
After accurately locating the trigger point with Travell’s text open to guide you,
apply dispersing acupressure for 10-30 seconds to ready the point for release.
Reassure the patient that if this recreates part of their referred pain pattern or feels
like one of their worst tender spots, that is verification that this needs to be
released. Show them how it might twitch by manually creating a twitch reaction.
Tell them to let you know when they feel the de qi response, and then when they
feel the twitch. Explain that you will stop stimulating if they say the response is too
strong.
For new trigger points you have not encountered, or is the peer-patient does not
actually have a trigger point at that site, and if you cannot get a supervisor’s
assistance, perform wei-level shallow oblique needling, tugging on the tissue and

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releasing fast. The needle should be ROOTED (ie; the tip is firmly embedded and
the needle is not wobbly).
WHEREVER POSSIBLE, IF THERE IS AN ACTUAL TRIGGER POINT PRESENT, and
with a supervisor present, insert slowly trying various small changes in direction
(not fanning as in Travell), inserting to the outside of the muscle or just into the
muscle, with the left hand compressing the fascia over the point (which is
acupressure being applied along with the needling). This compression is not as
heavy or hard as when you found the trigger point, just enough pressure to
compress the fascia into the muscle. The twitch might come immediately, or it
might begin as a de qi sensation before twitching.
The goal of the left hand here is to guide/knead the trigger point toward the needle
tip. In this way you are at the outside of the muscle with quite shallow insertion for
most points. Maintaining this compression with your left hand, which you ease off
of repeatedly to allow the muscle fasciculation to occur, and once the patient has
felt a de qi sensation, start slowly pecking into the exact direction that created the
de qi response. Peck unevenly, at different rates, to “surprise” the muscle. In some
muscles, like the upper trapezius and levator and SCM, you might need to insert
into muscle belly to get the beginning of a fasciculation. In most cases (except for
levator scapula), you can then withdraw to just being slightly in the muscle, or just
at its surface, and apply the above technique.

If a point does not start to respond rather quickly, lift the needle to the surface with
dispersal technique (focusing with intention on the lift/out movement) and leave
shallow. The there may be no actual trigger point present. You may be needling into
a trigger point referral zone, which is part of the tendinomuscular meridian, and
shallow needling is fine, but actual trigger point technique may not be warranted.
Or the area may be fibrotic if the muscular contraction is longstanding, and a twitch
may not occur until this fibrotic tissue is softened up(if it can be) with tuina, guasha,
or moving cupping.

You must inform the patient that there may be soreness, especially where points
fasciculated, due to release of lactic acid after the treatment, for up to 24-48 hours.
If any points started to bleed during removal of needles, you must inform patient
area might bruise slightly while compressing point to stop bleeding. Apply a band-
aid if necessary They should take a hot bath or shower afterwards when they can
and drink a lot more water or diluted Gatorade to help flush the lactic acid from the

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tissues. No exercise or strenuous activity after the treatment and until the post-
treatment soreness has subsided. They should also be told not to try to test the
sore area to see if it is looser or less sore. Physical therapists can apply stretch
techniques after the treatment to good effect, but no massage, ultrasound,
ultrastim or ice until the soreness has worn off.

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9] Classical Chinese Acupuncture Jingluo Theory and APM:

Jingluo Study At the College-- A Palpation-Based Approach:

What is evident as one studies the theory and learns the practice of acupuncture
from a jingluo perspective, is that palpation plays a major role. In Japanese
Acupuncture styles, palpation of the Abdomen (Hara) or radial artery pulses and
other parts of the body is relatively gentle, as are some needle techniques.
Contrariwise, in some classical Chinese acupuncture approaches, such as Dr.
Wang’s “applied channel theory”, palpation starts and ends much deeper, as do
many of his needling techniques. Where Japanese meridian therapists often try to
elicit as little reaction to the needling as possible, judging if the needling has been
adequate by what they themselves feel under their hands, practitioners of classical
Chinese acupuncture, such as Dr. Wang, might seek a “de qi” response at every
needle, which might be sore or achy to the patient compared to the Japanese
approach. Many North American practitioners would situate themselves somewhere
in between these two approaches to palpation and needling.

In Years II and III, the Japanese Acupuncture curriculum will shift to study with
arguably the most prominent North American Japanese acupuncture practitioner,
Kiiko Matsumoto Sensei. In ACP sessions and a Spring Intensive each year, Sensei
Matsumoto will engage you in a highly pragmatic approach to regulation of Yin
(ventral aspect) and Yang (dorsal aspect), sections one and three of her typical
treatment approach, as well as to treatment of the Patient’s Specific Complaint with
distal-specific and local points and techniques (section two of treatment) aimed at
reducing pressure and pain from the channels, thus clearing away knots and
obstructions to restore free flow of Qi and Blood. Sensei practices in a manner less
Yang, perhaps, than Acupuncture Physical Medicine, but decidedly more Yang than
Meridian Therapy, that is aligned, like APM, with removal of holding patterns and
clearing away of obstructions that block normal function and create painful and
dysfunctional signs and symptoms of distress.

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TWO
Philosophical Foundations of APM

10] APM: Beginning with the Ling Shu:

“…I am grieved by not being able to provide for those afflicted with disease”( Ling
Shu, Scroll One, p. 1).

So begins the first line of the Ling Shu (“Spiritual Pivot”), the first complete account
of the “way of the needles”. In this classical text, the Yellow Emperor, Huang Di,
asks his court physician, Qi Bo, to elucidate the essentials of acupuncture, of the
channels and collaterals and extraordinary vessels, of their pathways and points, and
of the needling techniques for assembling the Qi, or dispersing it. In this account,
we learn of the “Ordinary” and “High Skills” of acupuncture.

Let us follow this first Scroll, where the story of acupuncture and the Way of the
Needles is first laid down in its entirety.

Huang Di continues his lament at not being able to properly care for the sick thus: “I
wish they did not have to endure the poison of medicines and the use of stone
probes. I prefer to use those fine needles that penetrate the channels, harmonize
the blood and qi energy, manage the currents and countercurrents, and assemble
the exits and entrances. Please unravel this for future generations and enlighten
them in the proper methods so this therapy will not be destroyed for aeons. See to
it that it is easy to use, difficult to forget, a classical record […] Begin with the
fundamentals of classical acupuncture. I wish to hear of those essentials (Ibid).”

Qi Bo goes on to elucidate the principles for using these fine needles which “are
easy to say but difficult to master”, and he states the first over-riding principle thus:
“Ordinary Skills of acupuncture maintain the physical body”. He clarifies this a few

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lines later, stating, “Ordinary techniques guard the gates”. Any acupuncturist, it
would seem then, can treat the physical body and extremities (gates, especially
from elbows to wrists and knees to ankles) that protect against external invasions
that might threaten the kingdom within.

“High Skills”, on the other hand, we are taught, “maintain the spirit” and one must
learn how to “use spirit to reveal the spirit and the guest at the door (Ibid).” The
translator of this modern version of the “Spiritual Pivot”, Wu Jing- Nuan, clarifies
that “guest” in this context means the “invader” which, he states, “must be honored
and shown respect”, lest its power be underestimated. “Shen”, the term translated
typically as spirit, refers to the intelligence of existence, the deep knowledge and
wisdom all living creatures carry within. In the West, mind-body traditions often
articulate a very similar concept as “inner wisdom”, the knowledge we all carry
deep inside which knows all that we need to know to thrive and embrace Life fully.
In similar fashion, the Chinese language and Chinese medicine also speak of “shen
ming”, or spirit clarity.

After explaining how to tonify and disperse according to the imbalance of the
patient, while attending to the spirit and spirit qi, Qi Bo stresses that one will be able
to tell whether the treatment is having a proper effect by reading the vital signs of
the patient, which indicate that the spirit, and spirit clarity, have been prodded to
good effect: “Look at the patient’s color. Observe the eyes. Know how the Qi
disperses and returns […] Listen to the patient’s movement or stillness. Know his
balance and his imbalance (Ibid, p. 4).”

This refers, I believe, to attending to: the patient’s complexion, which should
normalize to a significant extent after the insertion of the first few distal needles to
harmonize Yin and Yang, and again when the needles are removed, even though the
complexion may well go through dramatic changes during the treatment, where the
5 colors appear, separate and finally blend into a more healthy complexion overall;
of the the presence or absence of shen in the eyes and the return of shen, sparkle,
brightness and color, often within the first few needle manipulations ;the reaction to
needing, with the Qi effect gathering around the tip of the needle making it solidly
rooted, or propagating Qi at a distance; the patient’s speech patterns, breathing
and other sounds, which should grow more calm, quieter, at peace as the initial
YinYang regulatory treatment is performed (often referred to as Root treatment);

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assessment of the patient’s pulses (carotid compared to radial as well as other
arterial pulses) and the points themselves, showing excess, deficiency or stagnation.

In their “ practical dictionary” of Chinese medical language, Wiseman and Feng

define “Shen” or spirit in the wider sense as “that which is said to be present in
individuals with healthy complexion, bright eyes, erect bearing, physical agility, and
clear, coherent speech (p. 550).”

When treating patients in Grand Rounds at the Tri-State College of Acupuncture, I

will often focus, and the ceiling mounted video will follow, the changes in the
patient when “the qi has been reached”, when spirit clarity is returning to a formerly
lusterless complexion, where the patient’s eyes and gaze were dull, their breathing,
shallow, and point out that this change toward spirit clarity actually often happens
within the first minutes, even seconds of needling, when mild de Qi has been
achieved on initial, distal points that were deficient ( causing the needling sensation
to gather at the tip of the needle or even sink deeply into the point ), or stronger de
Qi has been elicited to propagate the needling sensation ( “how the qi disperses and
returns”). At that point, dull eyes whose color was hard to discern often become
radiant and full of color, the complexion becomes full of luster and normal color
returns, the breathing (“patient’s movement or stillness”) settles into a deeper,
more relaxed state, and an agitated patient quiets down, while a lethargic patient
starts to become more animated. One could also check the pulses (radial, carotid)
or abdominal findings (hara) to see if they are more normal, but in fact once the qi
has been reached and the vital signs change in this way, there is no need in my
experience for further checking as the signs of return of spirit clarity radiate for any
practitioner who takes a moment to mindfully look, listen and hear.

The story gets a bit complex to follow at this point: ordinary skills seem to be less
powerful, less essential than high skills, as they only guard the outer, physical body,
and the “gates” (extremities and the joints, especially from wrists to ankles).

This first Scroll lays out the distal, essential shu transporting and yuan source points,
the critical points learned in all classically informed and modern TCM teachings, on
the extremities from the fingers to the elbows, and from the toes to the knees. In
this discussion, it would seem that these points, and especially the 12 source points,
are Ordinary skills that can cure the diseases of the viscera when the channels have

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been injured and their organs have been reached, skills any acupuncturist must
master.

Thus we learn that ordinary skills are in fact essential skills, of treating the 12 distal
shu-transporting and source points of the regular meridians when the disease has
moved from the surface to impact on the respective viscera.

What are these ordinary Skills? Actually, there appear to be four main ones:

• Needling techniques (tonification, dispersal, dredging);

• Obtaining the arrival of Qi (de Qi/Zhi Qi);
• Observing the patient’s vital signs for evidence of change (in complexion,
shen returning to eyes, breathing improved, circulation of Qi and Blood
improved and other signs of change, in pulse, etcetera;
• Pulling out Thorns, Washing away Stains, Untying knots, Breaching
obstructions.
The first three skills aim to regulate Yin and Yang, with distal points. The last skill
seems to refer to treatment of the patient’s complaint itself, identified by palpation
as “thorns”—areas where Qi is stuck; “stains”—where the color of the skin,
capillaries and veins (the cutaneous regions and minute luo vessels) is abnormal;
“Knots”—where palpation reveals tight, hard indurations in fascia and muscle (ashi
points, kori, trigger points, all signs of excess, in the luo vessels and muscle
channels); and “Obstructions” where one must move Qi through, underneath or
around the area, as in adhesions, scars, fibrotic tissue, or chronic ashi points.

The first Scroll therefore emphasizes first regulating Yin and Yang with distal
regular meridian points, which should yield improvement in vital signs, and then
attending to thorns, stains, knots and obstructions, which are local signs of excess,
stagnation, blockage. Whether a style prefers to focus more on distal points or local
points to deal with these excesses, relieve symptoms, and address the patient’s
specific complaints, the first chapter of the Ling Shu includes that this attention to
the patient’s chronic complaints is a part of the Ordinary skills any acupuncturist
should possess. In such treatment of local areas that are discolored, tight, inflamed,
there should be signs of local improvement. This should be even more the case
after a few treatment, when improved circulation of Qi and Blood, and release of
excesses, leads, for example, to more normal color and texture in scars, or in the

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ankles, once brown with stagnation in elderly patients, or to less fibrotic soft tissue,
or looser muscles. In my personal experience it is not enough to treat distal shu-
transporting, source, luo and xi-cleft points, to attain such changes in locally excess,
inflamed or stagnant areas. In this, I see acupuncture as a physical medicine akin to
tui na, anma, shiatsu, sotai, guasha and stationary and moving cupping.

These obvious local techniques can be used instead of needles of course, but I
have made a career of practicing acupuncture only, with excellent results in this
physical medicine domain. I stopped using moxibustion early in my private practice,
because the first building where I worked, and the one where I now work in my
own cooperative apartment, forbade it, as do many buildings in the NYC area
according to faculty and graduates of the college. I also stopped cupping and
guasha, because many of my first elderly Jewish patients reacted quite negatively
to a medical professional charging for what they saw as folk techniques their own
mothers used on them, and because of the bruised-like marks which they found
disagreeable. Finally, I quit doing acupressure and shiatsu early on as well, because I
developed familial arthritis in my 30s, and massage made my hands ache and grow
numb.

One might say I have worked like the straight chiropractors of the old days who
only did chiropractic manipulations, and with excellent results. I am a straight
acupuncturist.

That being said, I encourage students to use all AOM modalities they have learned,
depending on the patient and their own proclivities.

These ordinary skills are part of the curriculum of all North American colleges of
Acupuncture and Oriental Medicine, whether TCM, 5 Element, or Meridian based.
They seem to be the common knowledge, which is tested on North American
national board examinations given by the NCCAOM and used by many states as the
basis for licensure upon graduation from such colleges. Ordinary skills-- common
knowledge--, and yet often referred to in North America as “Root” treatment, a
designation which one would think would be reserved for discussion of the “High
Skills”.

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So then what of these “High Skills” which, we are taught, “maintain the spirit” and
“use spirit to reveal the spirit” while attending to the disease (guest at the door)?

This theme, of attending to the patient and the patient’s disease with ones heart and
spirit repeats itself throughout the discussions of needling in this classical text.

It would therefore seem that a requirement for practicing High Skills would be for
the practitioner to be able to navigate this relationship with the patient from a place
of spirit clarity her or himself. Chinese medicine postulates that the heart stores the
spirit, and so the practitioner must have a calm heart, not muddled by the seven
emotions, and focus her or his spirit on that of the patient, attending to the deep
intelligence and wisdom of existence, and the will to live and be well that dwells
within all living beings. The change prodded by the informed manipulation of the
needles, which must reach Qi to be effective, portends the “onset of a therapeutic
effect [which] is faster than shooting an arrow (Ling Shu, p. 1)”. Elsewhere this
classic text clarifies that once the Qi has been reached and the vital signs of the
patient have improved as discussed above, even though the disease itself will not
necessarily show signs of improvement, the disease will in fact already have lost
some of its hold.

And how are these “High Skills”, which control the “moving power and its Way”, the
Yin and Yang Root of the Kidneys, the prenatal qi and the mingmen fire that support
life, which is “inseparable from its space”, and which “is clear, quiet, and subtle
(Ibid), the space of the Tantien, achieved?

Again this first Scroll is full of paradox and complexity. In order to manifest High
Skills, one must follow “the way of acupuncture” defined, simply, thus: “to tonify
hollowness, to disperse fullness, to dredge stasis”. One does this, by paying
attention to the movements of the needling: first “slow, then quick” which lead to
tonification (slow in, fast out to sink the yang qi deeper, to yangify), or first “quick,
then slow” which lead to dispersal (fast insertion, which elicits propagation away
from the point, done repeatedly with slow withdrawal to enhance the
propagation/dispersion, to withdraw the deep yin, to yinify).

Thus, immediately after speaking of High Skills, and of the use of spirit to treat
spirit, Qi Bo proceeds to detail how to tonify and disperse and dredge with needles,

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after first eliciting qi. For two pages, we learn of the nine needles and their use, how
deep to needle, how to needle distal and local points, defined as “the manipulation
and the way of the needles”. We learn how to use the needling hand to “make a
vertical insertion”, stressing that “the spirit seems to be at the tip of the needle”,
and finally, again with a calm heart and mind, to “focus awareness on the patient” so
as to read the vital signs for evidence of therapeutic change, which will come fast.

It appears that High skills are a concept that implies practicing Ordinary Skills with
focused attention, mindfully, not distracted by anything, with spirit clarity and a
mind not disturbed by the 7 emotions.

High Skills, based as they are on the spirit clarity of the practitioner, would be hard
to manifest as a beginner, who must learn over time how to remain mindful and
focused as the needling has its, often powerful, effects. To do this, like any East
Asian art, one must practice, and focus on the act of needling itself, looking at the
skin, not allowing it to become bunched up, keeping the needling surface taut like
the surface of a drum with the non-needling hand which maintains this taut surface,
while the needling hand is ready for whatever effects the needling generates, which
may reveal a tiger being held by its tail as we are told later in this classical text.

High skills therefore seem to refer to focusing on the patient, not being distracted
by anything, keeping ones attention on the skin, the flesh, the needle, the point one
is stimulating, staying attentive for therapeutic changes in the patient’s vital signs.

To be able to do these needle manipulations safely and effectively is required, as

these constitute the common, very ordinary skills any practitioner must first master.
And this takes time, and diligent practice. But with perseverance, and attention paid
to ones own development of mindfulness and spirit clarity while needling, these
Ordinary Skills can become High Skills.

The first Scroll ends by addressing the critique of some people, who “say chronic
disease cannot be cured. This is speaking incorrectly. The skillful acupuncturist can
take hold of the disease in the same way that he pulls out thorns, washes out stains,
unties knots, or breaches obstructions. Disease, although chronic, still can be
ended. Those who say diseases are incurable have not mastered the technique of
acupuncture (Ibid).”

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The next 80 Scrolls detail how to perform pattern differentiation of the regular
meridians, the secondary collaterals and the extraordinary vessels, with detailed
description of signs and symptoms of each type of meridian dysfunction, a story of
the “jingluo”, of the channels of acupuncture and the way of the needles that
contrasts starkly with the Traditional Chinese Medicine story.

This modern TCM story, constructed only recently, in the 1960’s to 1970’s, first
told in English in The Outline of Chinese Acupuncture, then in Essentials of Chinese
Acupuncture and then in its successor volume, Chinese Acupuncture & Moxibustion
was a story bereft of the jingluo, of discussions of Man between Heaven and Earth
and influenced by the forces of the Cosmos, with no discussion of Shen or spirit of
any significance. The original TCM approach developed in the 1960s to 1970s in the
PRC seems to have stripped acupuncture of its High Skills, of its shen and of its
soul.

In the early days in the development of the North American AOM profession, the
founders and key players of the schools at that time struggled with what texts
should become the foundational, authoritative texts for accredited schools, on the
basis of which national board and state licensure examinations might be developed.
It was clear in those early days that many practitioners had been more influenced
by European acupuncture traditions, like J.R Worsley, Van Buren and Mary Austin’s
Five Element styles, Felix Mann’s texts based on translations of other, meridian-
based texts from PRC from the earliest days of TCM, and French Meridian
traditions, and a home-study program offered by the Occidental Institute of
Oriental Medicine.

As we founders and teachers of those North American schools of acupuncture met

to develop the infrastructure for an AOM profession (AOM being chosen as the
official designation, because it recognized that it was “Acupuncture”, first and
foremost that had captured the North American public and medical imagination,
and “Oriental Medicine” to make peace with all East Asian traditions which felt TCM
was just one style, while “Oriental” was inclusive of Japanese, Korean, Vietnamese
and other East Asian traditions, even if anthropologists at the time were already
replacing “Oriental” with “East Asian”) . We struggled over the disparity between the
European influences, some via Vietnam through France, which seemed to

  91  
predominate in the schools on the East coast and in Chicago, and what we soon
came to refer to as the California Model of TCM, where herbs and acupuncture
were required in short order as part of State approved schools and for licensure.

After much struggle, and owing to the fact that the main texts in English at the time
from East Asia were TCM texts, and after the publication of The Web That Has No
Weaver which made learning TCM much easier for North American students, these
early pioneers, myself included, achieved a compromise where basic TCM
foundations would serve as the basis for accredited schools, and national board
examinations. At the same time, the council of AOM colleges was adamant,
however, owing to the influence and steadfastness of the East Coast and Midwest
schools, that AOM schools could teach whatever other styles of acupuncture they
wished, as long as these TCM foundations were addressed in the core curriculum.

During this period, in North America but also in Europe which seemed to follow suit
a few years behind us, texts rich in more classical styles of practice, especially
classical Chinese acupuncture, disappeared: Royston Low’s Secondary Vessels of
Acupuncture, Felix Mann’s Meridians of Acupuncture and Chamfrault and Van
Nghi’s texts detailing jingluo practice all went out of print. At the same time, a large
number of TCM texts, in translation or by East Asian and Western English speaking
authors, proliferated, making the TCM foundational knowledge base that much
more secure.

And then something interesting started to happen in about 1990. Other texts, from
other styles of acupuncture that were based on Classical Chinese Acupuncture,
started to emerge, in translation, and written in English by practitioners in North
America, that told different parts of the way of the needles from meridian, five
phase and other classical perspectives. During this time, several texts appeared in
English on various Japanese styles, including the tradition of classical meridian
therapy, as well as on European meridian acupuncture and new approaches in PRC
based on more classical approaches. Dr. Yitian Ni’s seminal text Navigating the
Channels of TCM appeared at that time, with a foreword that stressed that the
advent of TCM as the main style in North America, while good for those wishing to
practice Chinese herbology and ZangFu (organ) differential diagnosis and
treatment, proved detrimental to those who wished to learn how to perform a

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jingluo differential diagnosis of the channels, collaterals and extraordinary vessels,
specifically, as part of meridian-based acupuncture treatment.

And so here we are, in 2011, with several new books on the meridians that are very
different from TCM texts. Yet North America colleges must still teach TCM
foundations, and national board examinations, and state licensure examinations, are
still based primarily in that one, modern, Chinese tradition that began in the late
1950’s, and is already showing signs of potential demise in PRC, where new,
younger voices are calling for discarding TCM differential diagnosis in favor of
biomedical diagnosis, and for a “contemporary medical acupuncture”.

There are more English language texts on different styles of acupuncture,

especially meridian-based acupuncture and acupuncture treatment of pain,
musculoskeletal and sports injuries, available in English today than there were texts
in English on TCM acupuncture thirty years ago when the compromise to make
TCM the foundational knowledge base was reached.

What I would like to try to do with this Reflective Practicum is to start a movement
for revisiting this biased TCM foundational knowledge base, thus loosening the hold
this style has held on North American Acupuncture education, licensure and
practice for 25 years.

I hope to to illuminate the story of a forgotten path, the Other Acupuncture, that
was based in texts just as authoritative as the ones that have become TCM primers,
texts which made their way, through a curious and circuitous route, to England, and
to France, via Vietnam, and to Montreal and the New York City region, which also
existed and were written by experts in Classical Chinese Acupuncture from the
academies of Chinese medicine, who were about to be replaced by State mandated
colleges and teachers of TCM, with a unified, orthodox curriculum that
extinguished the spirit, the power, and the elegance of Classical Chinese styles.

It may well be that the time has come to revisit the foundational knowledge base
that has ossified education in acupuncture in North America, to allow for a more
comprehensive, and effective approach to treatment that is pragmatic, not
orthodox, and able to adapt to actual clinical reality in the case of those patients we
treat every day. In such a return to the beginning, we would do well to insure that

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our acupuncture education prepares our students to treat what they will encounter
most frequently in their North American practices, namely chronic pain and its
associated dysfunction, musculoskeletal and sports injuries, repetitive strain and
cumulative trauma disorders, as well as chronic stress, fatigue disorders, and
functional disorders affecting the autonomic, hormonal, cardio-respiratory,
gastrointestinal, genito-urinary and reproductive systems. We could then select
other authoritative texts to drive acupuncture education and examinations, where
these common disorders would be represented in their proper proportion, thus
displacing inappropriate internal medicine disorders and their ZangFu patterns,
which belong to Oriental Medical (read, Chinese Herbology and Pharmacology)
teachings and test

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.

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11] Classical Chinese Acupuncture-Ordinary Skills

THE PROBLEM:

As I have looked closely over the past year or more at why and how the jingluo
filter teachings at the college have been somewhat eroded at the college,
something I saw in the practice of students in clinic but could not quite put my
finger on, I realized that I had followed in the same process articulated by Maciocia,
by allowing the teaching of the signs and symptoms of the regular meridians to be
supplanted by those of the ZangFu.

Early North American Acupuncture Practice

As I began writing this Reflection, I scoured over the earliest books in English that I
used to teach my first students, when textbooks in English were scarce and the
main TCM text in English was still Outline of Chinese Acupuncture. In those early
PRC texts, there were only 14 meridians portrayed, with no classical signs and
symptoms from Chapter 10 of the Ling Shu and where disorders were presented as
more or less biomedical diagnoses with points with no TCM differentiation or
rationale for the points either, or even a TCM pattern diagnosis in ZangFu terms.
When this PRC text for the English-speaking world was republished in a new edition,
in around 1981, it did contain TCM theory, and even a short description and
pictures of the other secondary and extraordinary vessels, with insufficient
information with which to be able to make a jingluo pattern identification. In the
early days, when TCM texts first entered North America, the Five Element tradition
developed by J.R. Worsley in Leamington Spa, England, had graduated some of the
earliest trained practitioners of acupuncture in North America. This tradition was
brought to the States by Bob Duggan and Diane Connelly, who founded the
Traditional Acupuncture Institute (TAI) in affiliation with Worlsey’s institute, based
on that tradition. I became close with Duggan, and other faculty from TAI as it was
known then (now TAISophia) and was even a member of their advisory board at
one point. I taught frequently at TAI, and Bob Duggan and later Jim McCormick, a

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classmate of Duggan’s from the first Leamington Spa class, and Lorie Dechar, even
later, an early graduate of TAI, taught at Tri-State (and Jim and Lorie still do).

I was struck by the difference in focus of their education, which was highly
influenced by the humanistic psychology movement that existed in those days and
that Duggan and Connelly and other TAI faculty were involved with, as compared
to the TCM based education that was becoming the norm in California schools.
Given that I was the first president of the new council of colleges, and intimately
involved with establishing the first national board examinations in acupuncture
through the NCCA (now NCCAOM), I was immersed in debates about schools of
thought and traditions, and Duggan and I were immediate allies and fierce
defenders of the right to diversity in acupuncture education, while some of the
California schools were beginning to demand that the national standard in the
United States be the TCM tradition from the PRC.

I took on the role of mediating this debate, between what was being called the “5
Element” versus the “8 Principle” perspectives. In those days I developed a simple
way of differentiating one style of practice and practitioner from another by simply
paying attention to which of the main diagnostic filters each style, or practitioner,
privileged over others that may have been shortchanged, or even ignored
altogether. What became clear was that practitioners of the “5 element” tradition of
Worsley’s used the 5 element filter far more frequently than the YinYang filter
(which they resorted to just to differentiate between excess and deficiency
conditions, and to perform tonification and dispersal needling techniques) whereas
“8 principle” advocates expanded the YinYang filter to include far more detail about
signs of Hot and Cold, Internal and External, and even Yin and Yang patterns. As for
the Qi, Blood, Fluids, Shen and Essence filter as it was often referred to in those
days (before Shen disappeared from TCM discussions as a way of assessing signs
and symptoms in a diagnostic process), the 5 element practitioners talked
extensively about Shen,
( given that Worsley reordered the regular meridian system to start with the Heart,
rather than the Lung which controls Qi and its movement as in all classical and
modern Chinese and Japanese texts—because the Heart “stores the Spirit-Mind”),
but gave little mention of Blood or Fluids. Conversely, 8 principle practitioners of
what soon became referred to as TCM acupuncture talked far less about Qi or

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Shen, and spoke in great detail about Blood, and of the thin and the thick fluids,
phlegm and Fire.

Finally, what both approaches had in common, much to their surprise, was that they
centered their teaching and practice around ZangFu pattern identification: the 5
element practitioners preferring to focus more on the psychoemotional aspect of
the 12 “officials” rather than on their visceral functions and disease signs and
symptoms, while TCM practitioners of acupuncture ignored to a greater or lesser
extent the emotional side which did appear in the classics as we saw in last month’s
Reflection, focusing more strictly on the TCM detailed ZangFu pattern
identification, and differentiation of Qi, Blood and Fluids to differentiate signs and
symptoms of disease.

What neither approach contained, which situated what I was trying to do at the Tri-
State College of Acupuncture in yet a third position, was the jingluo filter which
taught how to regulate Yin and Yang by means of appropriate use of treatment
strategies from the regular meridians—where 5 element strategies were just one
option among others, as well as from the secondary (especially luo and
tendinomuscular meridians) and extraordinary vessels which these two main
approaches seemed to not make use of at all. In this process, I became so involved
in these debates, and invited to teach was most different about the “French
meridian” traditions I had studied at other AOM colleges, that I focused most
heavily on teaching the secondary and 8 extraordinary vessels, and allowed the
regular meridians, and the principal foundation for the jingluo filter, to slip away and
be replaced little by little, by TCM textual explanations. The only solution which it
took me over two decades to realize was to return to the Ling Shu, and especially
to Chapter 10 where regular meridian pattern identification, from a jingluo filter
perspective, is laid out clearly.

Circuit-Needling

There are three detailed clinical discussions in English of the Ling Shu, by Yitian Ni,
Shudo Denmei and Zhao and Jun Wang. Giovanni Maciocia’s ambitious The
Channels of Acupuncture must also be mentioned as an academic resource with
useful charts, but the repetitive and at times over indulgent nature of the

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presentation makes it very difficult as a clinical text, which for instance hopelessly
confuses any attempt at understanding the luo collateral, muscle channel, Cou Li
layer, cutaneous regions and minute luo vessels and luo regions. Also, owing to an
unfortunate dismissal of organ interior symptoms as part of regular meridian
differentiation (in favor of TCM Zang Fu pattern differentiation as shared in last
month’s Reflection Two), and an alarming misunderstanding about the critical role
of ashi points and palpation for actual tender points versus favorite textbook points
for muscle channel problems, I am lead to question whether Maciocia practices the
acupuncture that he preaches in this unwieldy tome. Useful as background and
additional reading for the initiated acupuncture educator or practitioner, it is
misleading and confusing as a foundational, or clinical text for students or
neophytes to the jingluo approach.

What is clear in studying the Ling Shu in these texts is that they are focused on what
Paul Unschuld refers to as “circuit-needling” with the palpation phase of the four
examinations focused on points, and arterial pulses, throughout the body as
opposed to diagnosis of the meridians via the sole wrist pulses, as advanced for the
first time in the Nan-Ching. Unschuld stresses that the interest in the Nan-Ching
“remained restricted to theoretical discussions and the practice of pulse diagnosis.
Actual clinical practice in traditional Chinese medicine hardly followed the
“conceptual stringency” of this text, and of the “doctrines of systematic
correspondence” or of pulse diagnosis at the wrist as the sole means of
assessment of meridian circulation, Unschuld clarifies, concluding on this point:
Therapeutic practice—that is, circuit-needling—continued along the lines dictated by
experience, not theory ( NanChing: The Classic of Difficult Issues translated and
annotated by Paul U. Unschuld, University of California Press, 1986, pp. 40-41).”

In Dr. Yitian Ni’s text, Navigating the Channels of Traditional Chinese Medicine she
presents a summary of channel pathology from Chapter 10 of the LingShu which is
fairly complete, which TCM has left out, and then detailed lists of disorders and
their signs and symptoms of channel versus organ disorders, which derive from her
vast clinical experience and other texts listed in her bibliography.

Based on this approach, if one knows the basic signs and symptoms of the main or
regular channels, it is easy to then reference the list of external, “channel” disorders
versus internal, associated “organ” disorders, and then move to the clinical

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application section where she discusses the use of the main points from the
meridian in question, in order of importance, and point combinations with other
regular, secondary and extraordinary channel points. She even has an index of
symptoms in the back of her book, taking one to the pages where such point
combinations are discussed with specific disorders of the various systems of the
body.

She does not, however, discuss the point strategies she uses, so a careful study is
in order to recognize, for example, that her favorite distal points for the regular
Lung channel are the Luo point (Lu 7), the Source point (Lu 9), and the He-Sea point
(Lu 5), and her favorite local points, Lu 1, the Mu point. A useful exercise for
anyone interested in gaining a deeper appreciation for regular channel pattern
identification, and secondary vessel and extraordinary channel differentiation would
be to take each channel one by one, and analyze the point strategies of the points
Dr. Navigating lists for recurrent strategic patterns.

Regarding the use of local meridian points Dr. Ni stresses in her introduction that
any local point from a meridian may be used to treat local symptoms in the area of
that point, a primary principle of “circuit-needling” and meridian palpation as used
extensively in APM.

A Japanese Meridian Approach

In Shudo Denmei’s text, translated into English by Stephen Brown as Japanese

Classical Acupuncture-- Introduction to MERIDIAN THERAPY, there is a detailed
discussion of the symptomology of the twelve meridians, as this is often termed, as
well as the five Yin organs. Shudo starts this study with the statement that
“symptomology of the yin organs implies pathology of the yin aspect. The Li-Zhu
school of Chinese medicine holds that the yin always tends toward deficiency, and
the yang toward excess” and regarded the Spleen and Stomach, and the middle
burner to be the most important focus of middle burner warming treatment (ibid,
p108).

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Shudo adds that the meridian therapy schools of thought in Japan define this
hypothesis as follows: “the yin organs and meridians have a tendency to become
deficient, and the yang organs and meridians to develop excessive conditions
(ibid).” Shudo Sensei continues by presenting the signs and symptoms for the “five
yin organs” (Pericardium is deleted), from the Su Wen and the Nan-Ching Japanese
translations. Certain symptoms from the Su Wen are deleted in the Nan-Ching
version. Shudo concludes that as for the yang organs, there is much less discussion
in the classics, and their signs and symptoms “resemble those for diseases of the
same organs in modern medicine (ibid, p. 110).” For these symptoms, he cites
Chapter 4 of the LingShu.

Shudo then lists the symptomology for the twelve regular meridians. He cites the
discovery of the Ma Wang Tui manuscripts in 1973, which are thought to be a few
centuries older than the Yellow Emperor’s Inner Classic (Huang Di Nei-Ching)
comprised of the Su Wen and the LingShu. As he presents the signs and symptoms
for the twelve regular meridians, then, Shudo cites both the Ma Wang Manuscripts
and Chapter 10 from the LingShu. This presentation seems the closest to the
original that is available in English.

Shudo begins by citing two phrases from the Ling Shu, which were poorly
understood until the discovery of those earlier documents. These phrases, which
appear in Chapter 10 of the LingShu are: “ ‘when disturbed, disease occurs’ (shi
dong ze bing) and ‘when giving rise to disease’ (shuo sheng bing). These two
phrases are the way in which regular meridian symptoms are presented in Ling Shu
Chapter 10: “when disturbed, disease occurs” refers to an external disruption in
meridian Qi (channel symptoms) which can be treated by “treating the meridians
involved”; “when giving rise to disease”, on the other hand, refers to internal
conditions where channel Qi disruption “progresses beyond a certain point [and
involves the organs]” (Ibid, p. 112, citing Kuwahara, 1976). These concepts are
discussed in Chapter 22 of the Nanjing where “when giving rise to
disease”(sousheng) denotes a disorder at the level of Blood, as clarified in a private
communication with Stephen Brown regarding his translation above.

In Wang and Wang’s text, there is a careful if sometimes rigid reading of the Ling
Shu reorganized so as to allow for a clinical approach—“Ling Shu Acupuncture”. In

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their presentation, which unfortunately repeatedly claims to represent the true and
correct acupuncture, with everything that came in later classics and modern TCM
as aberrations, the organization of the discussion is immediately clinical: Diagnosis
by Comparing Renying and Cunkou (carotid and radial artery) pulses for regular
meridian dysfunction; the entire jingluo filter (regular meridians and secondary
collaterals, finishing with 8 extraordinary meridians and the relationship between
meridians and Zang-Fu organs; the muscle and cutaneous regions; acupoints;
acupuncture techniques and contraindications. There are very useful charts and
diagrams throughout, with a detailed list in chart form of the regular meridians (pp.
90-92) from Chapter 10 of the Ling Shu and translation of the Su Wen Chapter 22
on the ZangFu organs (p. 164). They do, however, following PRC/TCM texts, almost
completely eliminate the role of the emotions and any discussion of Shen.

Regular Meridian Pattern Identification

Following are the S&S of the Arm Taiyin Lung Meridian as an example of Chapter
10, (as cited in Shudo Denmei’s text, pp. 113-126; see also his detailed and excellent
discussions of each set of signs and symptoms. Also see Ni’s text, pp. 17-103 for
her detailed clinical applications).

Shudo Denmei begins his study of Chapter 10 by shedding light on the terms used
to differentiate between disorders affecting the meridian only (exterior), and those
where the disorder has moved deeper to include the associated organ as above,
which bears repeating in Shudo’s own words.

This clarification was made possible when scholars compared the Ling Shu to the
earlier Ma Wang Tui burial site manuscripts known as the “Moxibustion Classic”.
Based on this comparison, the meaning of two critical terms--“When disturbed,
disease occurs” (shi dong ze bing )” and “When giving rise to disease” ( suo sheng
bing ) was elucidated:

“ ‘When disturbed, disease occurs’ refers to abnormal conditions arising when the
meridian [Qi] is disrupted, and the progress of this disturbance can be checked by
treating the meridian involved…’When giving rise to disease’ refers to conditions in

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which the disruption [of Qi] in the meridian progresses beyond a certain point [and
involves the organs]” (Ibid, p.112, citing Kuwahara, 1976).

I will break out these two sets of symptoms, for clarity, as well as the last set of
symptoms that relate to excess and deficiency of Qi. I refer the reader to Shudo’s
text for the more detailed comparison of the Ma Wang Tui manuscript symptoms,
compared to those in Chapter 10 of the LingShu (ibid, pp. 113-126. The reader is
also referred to Shudo’s description of disorders of the sense organs and parts of
the body, which are very useful clinically (ibid, pp. 126-132) and a similar discussion
in Maciocia’s text cited above (ibid, p. 98) which are commonly learned in any
acupuncture tradition.

Let us follow Shudo and the translation he used for the arm Taiyin Lung Meridian:

Arm Taiyin Lung Meridian

Meridian (Exterior) S&S:

“When disturbed, disease occurs”:

Distention and fullness of the lungs, wheezing, coughing, pain in the supraclavicular
fossa. When severe, arms folded over the chest (while catching ones breath) and
blurred vision.

Organ (Interior) S&S:

”When giving rise to disease”:

Heat in the face, wheezing, coughing, dry throat, irritability and fullness in the chest,
pain along the channel, depletion, and heat in the palms.

Excess and Deficiency:

”When the Qi is excessive”:

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Pain in shoulders and intrascapular region, sweating from wind-cold, frequent
urination and yawning from wind.

”When the Qi is deficient”:

Pain and coldness in the shoulders and intrascapular region, shortness of breath,
inability to take in deep breath, urine color change.

Internalizing Jingluo Symptomology

In his always pragmatic fashion, Shudo Denmei shares the difficulty he experienced
in attempting to just commit to memory such symptoms, stating that he “drew in
the location of all the symptoms on a figure of the body, and marked them with a
simple notation for easy reference (p. 113).” Another useful tool, he suggests, and
then supplies in his book, is a chart of symptoms organized by body region. Dr. Ni,
on the other hand, provides charts that further differentiate and list symptoms of
the Channel as opposed to the Organ. She then lists clinical applications such as
exterior syndrome, immuno-deficiency, respiratory disorders, nose and throat
disorders etcetera, with her point palette of lung meridian points in order of
importance in her experience and based on classical sources. She concludes with
point combination with points from other channels, and lists an index of symptoms
in the back of the book that bring the reader back to these charts.

Making the effort myself to learn the classical symptoms of the regular meridians,
secondary vessels and extraordinary vessels, which make up the jingluo filter, as I
first started translating and teaching from Van Nghi, I quickly realized that I could
not retain the information unless I combined it with palpation of distal and local
points from these pathways during the palpation aspect of the four examinations.

I found it essential from the beginning to resist an overly academic study of the
meridian system, and to focus instead on internalizing and embodying a tacit feel
for each aspect of this system based on what one feels underneath ones fingertips,
and what one sees in observing the body surface and patient’s structure and
bearing.

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In refining this teaching, which I inherited from the Quebec Institute of Acupuncture
and especially from its French-Vietnamese influence via Chamrault and Van Nghi’s
texts and teachings, I followed these two French authors in their celebrated
L’energetique humaine where they discussed the jingluo filter in three successive
chapters, Wei, Ying and Jing, facilitating an understanding and clinical use of these
classical treatment strategies:

• Wei level treatment refers to the strategies for the muscle channels and
cutaneous regions for myofascial disorders, which I refer to as “surface
energetics”.
• Ying level treatment is the nutritive Qi level, the level that “promotes Grain
Qi”, and refers to the strategies for the regular meridians and their
associated organs, which I refer to as “functional energetics”.
• Jing level treatment refers to the strategies for the 8 extraordinary vessels,
mobilized according to Van Nghi’s teachings, when the regular
meridians/organs are under assault such that two or more meridians/organs
are targeted. This is a very modern reading, perhaps influenced by Hans
Selye’s theory of the stress response, and his General Adaption Syndrome. In
this model, the GAS enables a small group of internal functions to mount the
defensive against unabated external stressors, in order to protect the
majority of internal organ functions and structures from this onslaught. In
the French-Vietnamese teachings perspective influenced by Van Nghi, it is
the role of the extraordinary vessels to become operational in order to
protect the 12 regular meridians/organs. I developed a set of 4
adrenal/stress patterns to map out protocols for using the extraordinary
vessels in such chronic stress disorders, as shared in last month’s Reflection,
based on these teachings, in my Acupuncture Physical Medicine (pp. 85-120)
as I shared in chart form in last month’s Reflection.

The 12 Regular Meridian Circuits

When teaching the 12 regular meridians (jingmai) it is essential to recognize the

way in which they are comprised of three circuits of four meridians each that
follow a parallel almost closed-circuit flow: from deep in the Sea of Qi and Blood of

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the interior, and the associated yin Organ (Zang), a circuit begins by exiting on the
upper chest, next flowing down the inner arm (Yin aspect) to the finger; then
transforms into its Yang paired meridian and flows up a parallel pathway on the
dorsal, outer arm (Yang aspect) to the shoulder, neck, face and head; where it
meets its Lower/Upper connected Yang meridian of the same name to flow down
from the face to the neck, chest, or upper back, abdomen or mid and lower back,
upper legs, lower legs and foot to the toe, where it transforms into its foot Yin
meridian pair, then flowing back up the inner Yin aspect of the foot, lower leg,
upper leg, front of the torso, making a descent deep in to the Sea of Blood and Qi
again, and then starting all over in this semi-closed loop fashion, carrying Qi and
Blood (oxygenated blood) to all areas of the body, carrying back deoxygenated
blood, renewing itself with a fresh supply of nutritive Qi with each circuit loop.

Regular Meridian Symptomology:

Below I will present the signs and symptoms of the 12 regular meridians as three
circuits in this way, as another way of aiding in internalizing and embodying this
data for ready clinical access, integrating signs and symptoms from Shudo and Ni’s
presentations, based on the Ling Shu.

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TAIYIN/YANGMING CIRCUIT – Regular Meridian (Jing Mai)
Pattern Differentiation

Hand Taiyin/ Hand Foot Yangming/ Foot

Body Area Lung Yangming/ Stomach Taiyin/Spleen
Signs & Large
Symptoms Intestine

Face, Flushing Toothache, Facial pain, Root of

swollen ashen tongue rigid,
Head, cheeks, complexion, hot jaundice
yellow eyes, face, nose bleed,
Neck dry mouth, nasal
nosebleed, congestion,
Throat Dry throat swollen cervical neck
throat/thirst pain, skin rashes Vertigo
around mouth,
swollen painful
throat,
submandibular
pain
Perspires easily,
Yawning, Violent warm diseases, Whole body
General sweating & shivering whole body heavy
pain from from cold, chilled as if
wind-cold inability to doused by
warm up water, frequent
stretching and
yawning
Cardio- Shortness of No organ S&S Breast pain, Chest
Respiratory, breath, heart pain (ST irritability
Chest/Upper irritable 18-15), flank pain
Back breathing, (SP 21), front of
cough, body hot

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 wheezing,
fullness of
chest, hugs
oneself while
shivering,

Gastro- Borborygmus, Nausea from

intestinal, Gastric pain No Organ edema/distention eating,
S&S due to cold, stomach pain,
Abdomen Abdominal belching,
discomfort, passing gas
constant hunger, and
ascites, area hot defecating
or cold, pain in brings great
intestines relief,
diarrhea with
mucous and
blood
Genito-urinary,
Gynecological, Frequent No Organ Yellow urine, Scanty urine
Reproductive, urination S&S pain in lower
Lower Back abdomen (ST 26-
30)
Lower
abdomen and
channels Heat in the Pain along extremities
palms, pain Heat, swelling channel (ST 32- heavy, medial
along and pain LI 43), rigidity of thigh and
channels, esp. 12-15; index knee, middle toe knew swollen,
LU 3-10 finger dysfunction chilling and
dysfunction numbness
along SP
channel of
calf, big toe
dysfunction

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Mental Signs & Obsessions Mental Aversion to Mental
Symptoms * that are confusion, people and fire, sluggishness,
future defective rapid heart beat, melancholia,
directed, elimination of shuts oneself in obsessive
feels ideas, when frightened, thoughts of
vulnerable stubbornness, prone to mania, the past, fixed
complacency singing, and rigid
in being disrobing and ideas,
wrong, rigid running about, sleepwalking,
thinking, depression, agitated
distressed by death wishes, sleep,
cold mentally nightmares
overwrought,
mentally slow
LU 7-luo LI 2 –dispersal ST 44-43 ashi for SP 3- source
Point Palette LU 9 source LI 4-source heat/Xu Li SP 2-
LU 6 – cleft LI 6-luo for ST 36, 37, 39- tonification
LU 5-dispersal Toothache lower Sea points SP 2&3-ying
Lu 3-4 ST 40-luo and shu
window to SP 4- luo
sky ST 25-LI/ST SP 5-dispersal
Lu 1-2/SP 20- union SP 6- three
Taiyin union ST 18/xu li heart leg Yin
pain/heart burn, SP 8-cleft
Stomach Fire SP 9-Sea
SP 10-Blood
SP 21-Great
Luo
Associated Local for S&S Local for S&S SP 20/Lu 1-
channel points Local for S&S Ashi for pain Ashi for pain Taiyin union
Ashi for pain Local for S&S
Points from Points from LI, Ashi for pain
Points from ST, LU, SP SP, LU for circuit
LI, ST, SP channels for Points from
channels for circuit ST, LI, LU for
circuit circuit

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(* Cf. Seem, citing Faubert, Acupuncture Imaging pages 27-28. These charts are derived from Shudo
Denmei, with information from Ni, Seem, Faubert.)

Regular Meridian Treatment

In the Ling Shu Chapter 9, treatment of the regular meridians is presented thus:

1] If Spleen is deficient, Stomach is excess

(carotid pulse four times stronger than radial pulse): tonify Spleen with one needle;
disperse ST with 2 needles. If carotid pulse is “restless”, disperse Large Intestine
(for circuit).

While the actual points are not indicated in this chapter, chapter One stresses
needling the source point for yin meridians, and a later chapter suggests needling
the ying (spring) and shu (stream) points for disorders of yin of yin. Dispersal points
for Yang meridians could be dispersal points themselves, luo points, jing-well points,
he-sea points, xi-cleft points for acute disorders, or fire points. So one could tonify
Sp 2 or 3, or both, and disperse ST 40 and ST 36 for example, and disperse LI 2 and
LI 5.

If the reverse is true, with radial pulses stronger than carotid, this is Yin
meridian/organ excess:

2] If Spleen is excess (radial four times stronger than carotid): disperse Spleen with
one needle (Sp 5 for example); tonify Stomach with 2 needles (ST 38
Fire/Tonification Pt and ST 36). If radial pulse is “restless”, disperse Lung meridian
(Lu 10 or Lu 5 for example for the circuit as above).

We used to see the late Dr. Ki Min Kim, a master Korean constitutional acupuncture
practitioner after whom the Tri-State College of Acupuncture Library is named, do
this carotid/radial diagnosis, and root treatment based on this chapter of the classic
text, using the Five Phase “4 needle technique” strategies as the base, followed by
careful dispersal of local excess, constrained and stagnant points/pathways.

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Regular Meridian Disorders for this Circuit from Dr. Ni

Note:
Any point on a regular meridian may be used as a local point for signs and
symptoms in that area on that meridian.

A] Hand Taiyin Lung meridian

Exterior syndromes, the cold or flu; allergies with sneezing and itchy eyes and nose;
immuno-deficiency/frequent colds, low energy, cold hands and feet, CFIDS, chronic
diseases; respiratory disorders with cough, asthma, breathing difficulties; nose and
throat disorders, rhinitis, sinusitis, pharyngitis, laryngitis, tonsillitis; edema, enuresis,
retention of urine or urinary difficulty; diarrhea, constipation, hemorrhoids; GERD;
sinus(ST 2-3), temporal (ST 7-8), Occipital headaches (all treated by LU 7); sighing,
mental distress, weeping, grief; Bi syndrome along muscle channel.

B] Hand Yangming Large Intestine meridian:

Toothache; Yangming headache; facial paralysis, trigeminal neuralgia and TMJ (ST
5-8); rhinitis, sinusitis (LI 20-ST 2); Nosebleed; sore throat and vocal cord disorders,
thyroid disorders; diarrhea, facial edema, sweating/ dry mouth, throat, stool,
concentrated urine, dry skin); yang ming febrile disorders; rashes, eczema, boils,
psoriasis; abdominal pain, epigastric pain, nausea, vomiting, belching, cough,
asthma, chest pain; lassitude, spontaneous sweating, low immunity; Bi syndrome
along muscle channel.

C] Foot Yangming Stomach meridian:

Excess and deficient digestive disorders with excess hunger or poor appetite,
burning sensation or cold sensation in the stomach, and in either case epigastric
pain, abdominal fullness, distention, diarrhea constipation; yangming headache,
sinusitis, rhinitis, stuffy nose, nose bleeds; sore, swollen throat, gums, toothache;
facial paralysis, trigeminal neuralgia, TMJ; yangming febrile syndrome; general
lassitude, sallow complexion, spontaneous sweating, palpitations; stomach fire;

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violent or withdrawn behavior (mania or depression); swollen, painful, cystic
breasts; Bi syndrome along channel el; wei syndrome with whole body weakness
and atrophy of the muscles.

D] Foot Taiyin Spleen meridian:

Deficiency or excess digestive disorders as for stomach; edema, heavy sensation

of face, head, whole body; post-prandial fatigue; dampness disorders and s&s; high
cholesterol; obesity; atherosclerosis; masses and nodules; Qi & Blood deficiency;
Spleen Qi sinking with prolapses, dizziness, vertigo, lightheadedness; constant
worry, low spirits, difficulty concentrating, poor memory, depression, palpitations;
Bi syndrome along channel; wei syndrome with whole body atrophy and flaccidity,
especially of lower body and extremities.

Personality Patterns

For a detailed summary of J.R. Worsley’s depiction of the 5 Element personality

types, and Dr. Yves Requena’s 8 Temperaments, see my Bodymind Energetics,
pages 85-107. While character typing is described in the classic texts, I caution
against taking such depictions of complex human beings too literally. With that
caution, and with the realization that a person may exhibit characteristics from
more then one temperament or type, such information is useful in providing
practitioners with another lens through which to view the people who seek their
help. One can also juxtapose the emotional (shen) signs and symptoms presented in
chart form from chapter 8 of the Ling Shu from last month’s Reflection to further
narrow down the specific meridian-organ system or systems involved within a
circuit. This applies to the next two circuits as well.

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SHAOYIN/TAIYANG CIRCUIT – Regular Meridian (Jing Mai)
Pattern Differentiation

Hand Shaoyin/ Hand Taiyang/ Foot Taiyang/ Foot

Body Area Heart Small Intestine Bladder Shaoyin/Kidney
Signs &
Symptoms

Face, Yellow eyes, Yellow eyes, Yellow eyes, Yellow eyes,

hearing loss, eyes tearing, dizziness,
Head, swollen eye pain as if blurred vision,
cheeks, popping out, jaundice,
Neck submandibular vertex flushed face,
swelling, neck headache, dark
Throat Dry throat pain, sore occipital comlexion, dry
throat headache, tongue, hot
nape of neck mouth, dry and
pain, nose sore throat,
bleed hoarseness,
Alternating appears as if
No desire to chills and about to be
General drink fever, captured
epilepsy,
derangement,
Cardio- Heart pain Intense Thoracic back Wheezing,
Respiratory, posterior pain cough,
Chest/Upper shoulder and coughing up
Back, arm pain (SI 8- blood, heart
14) as if pain, irritability
broken,
inability to
turn neck
(stiffness at
SI-14-17)

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Hand Arm pain Arm and hand
channels (heart 3-7), pain (SI 8-4)
heat in palms

Gastro-
intestinal, Hypochondriac Mid back pain Hunger but no
region pain desire to eat,
Abdomen watery
diarrhea

Genito-urinary,
Gynecological, Hemorrhoids,
Reproductive, Lumbar pain,
Lower Back, gluteal area
pain
Foot channels
Tight Lumbar spine
popliteal pain, inner
fossa, hip thigh pain, Pain
joint pain and and cold along
inability to leg channel
bend, pain in (Kid 9-11, pain
calves as if and heat in the
torn, little toe soles
dysfunction

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Mental Signs & All shen Poor mental Changeable Anxiety, pain in
Symptoms * disturbances, assimilation, moods, over- the pit of the
insomnia, insecurity, enthusiasm, stomach,
anxiety suspicion, sadness,
jealousy, lack physical and
of mental fatigue,
confidence, antisocial
lassitude tendencies,
laziness

Point Palette HT 8- fire SI 2-water Bl 67- Kid 3-source

HT 7-source SI 3- tonification Kid 2-fire
HT 7&8-ying tonfication BL 65- Kid 2&3-ying
and shu SI 4 –source dispersal and shu
HT 5-luo SI 5-wrist BL 64-source Kid 4-luo
HT 6-cleft SI 6-cleft BL 58-luo Kid 1-dispersal
HT 3 (Sea) SI 7-luo BL 40-Sea Kid 7-tonify
SI 8 –Sea Back Shu Kid 10-Sea
HT 1 and 2 SI 9-14-ashi Points Kid 15.5-
adrenals
Local for S&S Local for S&S
Associated Ashi for pain Local for S&S Ashi for pain
channel points Ashi for pain Local for S&S
From SI, Kid, Ashi for pain From Bl, Ht, SI
Bl for circuit From HT, BL, For circuit
Kid for circuit From Kid, SI,
HT for circuit

Treatment of Regular Meridians

In Chapter 9 of Ling Shu:

1] If Kidney is deficient, Bladder is excess (carotid pulse three times stronger than
radial pulse): tonify Kidney with one needle (Kid 7 for example); disperse BL with 2
needles (Bl 58 and BL 65 for example). If carotid pulse is “restless”, disperse Small
Intestine (SI 1 and SI 6 for example) for the circuit.

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 2] If Kidney is excess, Bladder is deficient (radial pulse is three times stronger than
carotid): disperse Kidney (Kid 1 for example) with one needle; tonify BL with 2
needles (Bl 67 and 60 for example). If radial pulse is “restless”, disperse Heart (Ht 9
and 8 for example) for the circuit.

Regular Meridian Disorders for this Circuit from Dr. Ni

Note:
Any point on a regular meridian may be used as a local point for signs and
symptoms on that meridian.

A] Hand Shaoyin Heart meridian:

Heart and Lung disorders like cardiac pain and palpitations, arrhythmia, shortness of
breath, cold extremities, sweating, red, purple or pale complexion; heat syndromes
with whole body hot, dry mouth, red face, hot flashes, tongue ulcers, boils; red,
painful, swollen eyes; mania, depression, fainting, schizophrenia, anxiety, hysteria,
mood swings, laughing or crying without apparent reason, nervousness,
restlessness, insomnia, scattered thinking; severe pain or spasm of internal organs,
post-traumatic or post-surgical pain, cancer pain; skin rashes, itching, pain; pain
along channel (Ht 1-8) and costochondritis/non-cardiac chest and upper back
muscle pain.

B] Hand Taiyang Small Intestine meridian:

Occipital headache, deafness, earache, tinnitus; red, swollen, painful inner and outer
canthi of eyes, blurry vision, excessive tearing, yellow sclera; mouth and tongue
sores and ulcers, toothache; swelling and pain of cheeks, lymph glands, parotid
glands, TMJ syndrome; cold and flu, allergies; febrile diseases with yellow urine and
night sweats; edema, retention of urine, painful and yellow urination; diarrhea,
indigestion, stomach pain, abdominal pain and distention, constipation; pain of lower
lateral abdomen referring to back and testicles, as with inguinal hernia, epididymitis,

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urethral stones, ovarian cysts; Bi syndrome, pain along muscle channel (scapula &
posterior shoulder from SI 14-9, elbow near SI 8, forearm near SI 7-6, wrist near SI
5-4 and little finger dysfunction.

C] Foot Taiyang Bladder meridian:

Cold, flu, allergies; occipital headache; eye disorders with tearing and pain; rhinitis,
sinusitis, nose bleed; urogenital, gynecological and male reproductive disorders;
disorders of any ZangFu especially when chronic or deficient treated via the Back-
Shu points (combined with Front-Mu points); mania, depression, epilepsy,
schizophrenia; emotional disorders of any organ, treated with second line of
Bladder meridian; Bi syndrome and pain affecting muscles, tendons, ligaments and
joints throughout nape of neck, upper, middle, lower back, sacrum and hips,
hamstrings, posterior calves and heels, little toe dysfunction; acute or traumatic in
jury to neck, back, lumbar region, spine, lower extremities

D] Foot Shaoyin Kidney meridian:

Kidney deficiency with fatigue, low back pain, pain along spinal column, muscular
atrophy; deafness, tinnitus, chronic tooth, gum and throat disorders; poor memory,
forgetfulness; hair loss; deficient yin and yang signs and symptoms; Kidney and
Bladder disorders with edema, facial puffiness, impotence, infertility; treated for
chronic disorders of the other ZangFu; channel deficiency and Bi syndrome with
pain and weakness of the lower back, hip and knee, spinal column, degenerative
disorders of bones and joints; wei syndrome with cold, pain or heat in the soles.

Personality Patterns

See discussion under the first circuit above.

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JUEYIN/SHAOYANG CIRCUIT – Regular Meridian (Jing Mai)
Pattern Differentiation

Hand Jueyin/ Hand Foot Foot Jueyin/

Body Area Pericardium Shaoyang/ Shaoyang/ Liver
Signs & Triple Heater Gallbladder
Symptoms

Face, Yellow eyes, Hearing loss, Dull, lusterless Dull, lusterless

red retro- complexion, complexion,
Head, complexion auricular pain, headache, dry throat
outer canthus outer canthus
Neck and cheek pain, bitter
pain, tinnitus, taste,
Throat swollen sore submandibular
throat pain,
supraclavicuar
pain (GB 21)

Constant Sweating Excessive

General laughing sweating, chills
and shivering,
repeated
sighing
Cardio- Heart pain, Posterior Maxillary pain, Distention in
Respiratory, severe shoulder pain chest pain, chest and
Chest/Upper palpitations, (TH 15) breast pain, hypochondriac
Back, distention of hypochondriac region
chest, axillary region pain
swelling (GB 22-24),
difficulty
moving torso
(GB24-Liv 14
stiffness)

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 Contraction Posterior
Hand and pain in arm, elbow,
channels elbow and wrist, hand
forearm (Per pain (TH 14-
3-6), heat in 3), ring finger
palms dysfunction
Gastro-
intestinal, Distended Vomiting
sub costal
Abdomen region

Genitor-
urinary, Diarrhea with
Gynecological, undigested
Reproductive, food, inguinal
Lower Back, hernia, scanty
or dribbling
Foot channels Hip, lateral urine, swollen
thigh, knee, scrotum,
ankle, and foot “Shan”, pelvic
pain (GB 30- pain, lower
40), heat in back pain,
ankles and inability to
feet, aversion bend forwards
th
of foot, 4 toe or backwards,
dysfunction Liv 5-6
nodules
Mental Signs & Depression, Emotional Bitterness, Irritability,
Symptoms * sexual upset at lack of control, anger,
perversion, family/friend irritability, difficulty
aversions, breakups, unfaithfulness, developing
phobias depression, lack of ideas,
suspicion, courage, depression,
anxiety, poor timidity, lack of energy

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 elimination of hypochondria
harmful
thoughts

Per 8-fire TH 3- GB 41-dai mai Liv 3-source

Point Palette Per 7-source tonification GB 40-source Liv 2-
Per 7&8-ying TH 4-source GB 38- fire/dispersal
and shu TH 5-luo fire/dispersal Liv 2&3-ying
Per 6-luo TH 7-cleft GB 34- and shu
Per 4-cleft TH 10- Sea/tonification Liv 5-luo
Per 3-Sea dispersal GB 36-cleft Liv 6-cleft
Per 1-2-heart GB 26-daimai Liv 8-he-sea/
and breast TH 17, 21-23- GB 24-mu tonification
pain ears/tinnitus
Local for S&S Local for S&S
Local for S&S Local for S&S Ashi for pain Ashi for pain
Associated Ashi for pain Ashi for pain
channel points From Liv, TH, From GB, Per,
From TH, Liv, From Per, GB, Per for circuit TH for circuit
GB for circuit Liv for circuit

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Treatment of Regular Meridians

In Chapter 9 of the Ling Shu:

1] If Liver is deficient, Gallbladder is excess (carotid pulse twice as strong as radial

pulse): tonify Liver with one needle (Liv 3 or Liv 8 for example) disperse GB with 2
needles (GB 38 and GB 34 for example). If the carotid pulse is also “restless”,
disperse Triple heater (TH 1 and TH 10 for example) for the circuit.

2] If Liver is excess, Gallbladder is deficient (radial twice as strong as carotid):

disperse Liver with one needle (Liv 2 for example); tonify Gallbladder with 2
needles (GB 43 and 40 for example). If radial pulse is “restless”, disperse
Pericardium meridian (Per 8 and 9 for example) for the circuit.

Regular Meridian Disorders for this Circuit from Dr. Ni

Note:
Any point on a regular meridian may be used as a local point for signs and
symptoms on that meridian.

A] Hand Jueyin Pericardium meridian:

Heart and blood vessel disorders with palpitations, cardiac pain, restlessness, high
lipid levels; mental and emotional disorders, delirium, fainting, incessant laughter,
depression, mania, anxiety; chest and lung disorders with stuffiness and restrictions
in the chest, cough, restricted breathing, asthma; stomach disorders, stomach pain,
epigastric distention, hiccups, nausea, vomiting, food poisoning; channel disorders
with pain and swelling of the armpit, upper arm, elbow, forearm (Per 2-6), hot
palms and hand and foot spasms; stiffness of the nape of the neck, chest and
hypochondriac regions.

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B] Hand Shaoyang Triple Heater meridian:

Fluid disorders, edema, puffiness, enuresis, retention of urine, frequent urination;

upper heater disorders like chest pain, palpitations, cough; middle heater disorders
like epigastric pain, nausea and vomiting; lower heater disorders like lower
abdominal distention, fullness, diarrhea, constipation; endocrine and lymphatic
disorders like hypo or hyperthyroidism, diabetes, swollen glands; high lipid levels,
fibroids, masses, tumors; channel disorders including shaoyang syndrome with
chills and fever; channel disorders affecting the sense organs like migraine
headache, ear pain, deafness, blocked feeling in ears, tinnitus, cheek and face pain
along course of channel including TMJ syndrome and toothache, swollen glands,
sore throat, pain in the mandible and around the ears, purely channel Bi syndrome
pain with difficulty laterally flexing the neck and pain down medial deltoid, upper
arm, elbow and forearm to top of hand, ring finger dysfunction.

C] Foot Shaoyang Gallbladder meridian:

Gallbladder and Liver disorders with bitter taste in the mouth, belching, nausea,
vomiting, poor appetite, abnormal bowel movements, dark lusterless complexion,
abnormal bowel movements, hypochondriac pain; Urogenital disorders with
swelling and pain and itching of scrotum, external genitalia, inguinal hernia,
leucorrhea, difficulty urinating; emotional disorders with depression, deep signing,
poor judgment, indecision, mood swings, frequent anger, insomnia; shaoyang
channel syndrome with alternating chills and fever; channel disorders affecting the
sense organs with temporal headache, eye pain, pain in the cheek, swollen glands,
swelling and pain in the neck, mandible, deafnesss, tinnitus; Bi syndrome affecting
the lateral side of the body from lateral ribcage to lateral hip, ITB, peroneal
distribution of lateral knee, lower legs and lateral ankle and foot with 4th toe
dysfunction (GB 22, 29-30, 31, 34, 37-39, 40-44).

D] Foot Jueyin Liver meridian:

Liver Qi and yang disorders with fullness, distention, pain of hypochondriac region,
dizziness, blurred vision, tinnitus, dry mouth with bitter taste, flushed face, jaundice;
emotional disorders with depression, mood swings, nervousness, frequent anger,

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frustration, plum pit Qi in throat; stomach and spleen disorders with epigastric pain,
distention, flatulence, belching, eating disorders, vomiting, diarrhea; lung and heart
disorders with stuffiness of chest, cough, shallow breathing, deep sighing,
palpitations, dream disturbed sleep; abnormal growth including cysts, nodules,
masses; channel disorders with spasms of feet and hands, headache, low back and
lumbar pain extending to scrotum, hernia pain, pain and swelling of lateral lower
abdomen (dai mai), spasm and tightness of joints and muscles and pain along
course of channel.

Personality Patterns

See discussion under the first circuit above.

Practicing Circuit-Needling

Let’s take the example of a patient who presents on palpation with discomfort in the
right hypochondriac region and tenderness on palpation near GB 24 and Liv 14, as
well as tenderness at CV 10, where Liver Qi can become constrained in the middle
heater, and CV 18, where Liver Qi can become constrained in the upper heater,
whose primary complaints are lateral migraine headache and dizziness with a
strong wiry pulse.

Observation shows shen to be clearly present, but with a moody disposition

bordering on anger, a tendency to sigh and to breathe very shallowly, even
hyperventilating when he grows animated, with a shouting quality to his voice. He
also reports a frequent need to address serious anger issues in his therapy.

The patient’s secondary complaint is frequent myofascial pain in the upper traps
and lats and generalized muscle tightness.

From a jing-luo perspective this matches foot Jueyin Liver regular meridian
symptomology primarily, with additional symptoms of foot Shaoyang and hand

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Shaoyang regular meridian dysfunction leading to an APM diagnosis of
Jueyin/Shaoyang Circuit Dysfunction and constrained Liver Qi, as well as foot and
hand Shaoyang muscle channel excess.

A] Yin-Yang Regulatory Treatment would begin with the source point of the foot
jueyin meridian, as well as the ying and shu points for disorders of yin of yin, Liver 3
(tonified) and 2 (dispersed), and the luo point of foot Shaoyang, GB 37 along with
the Fire point of foot Shaoyang, GB 38 both dispersed) to bring down the rising
yang symptoms and clear the lateral head Shaoyang and upper trapezius areas of
blockage as well as promote Liver/Gallbladder harmony. Local points CV 10, where
tender and where Liver Qi can become constrained in the middle heater, the tender
area of GB 24 and Liv 14 on the right, and the tender area near CV 18 would all be
dispersed to clear the hypochondriac region and ease the breathing.

B] Patient-Complaint Treatment would select local points from the yang

channels in this circuit, where local symptoms tend to accumulate (yang protects
yin) as follows: for the lateral headache, tender ashi points along the GB and TH
pathways of the lateral scalp, including GB 8 and points along a line with it in the
temporalis muscle and the Shaoyang area local lateral headache extra point,
Taiyang, needled with TCM dispersal technique and never as muscle channel
Trigger Points, with distal Triple Intestine 10 (Kiiko Matsumoto’s TH pathway point
level with LI 10) and LI 4 to complete the 4 gates and as a powerful headache point;
for the dizziness, GB 20, the extra point anmian (in the Shaoyang region between
the GB 20 and TH 17 points) and GB 8 (already treated), with distal TH 3.

If this were a chronic problem, given that there are three regular meridians and two
ZangFu involved, I would add the extraordinary vessels as per Van Nghi’s use in
such chronic conditions, using the infinity combination so suited for
Jueyin/Shaoyang dysfunction: Sp 4/ Per 6 for the constrained Liver Qi in the ribcage,
chest and CV 10 area, and GB 41 and TH 5 for the Shaoyang symptomology. This
would comprise a jing level supportive treatment to regulate Jueyin/Shaoyang and
relieve the Shaoyang area symptoms.

In subsequent visits and once the primary complaint starts to resolve I might add
release of the myofascial constraint areas with Trigger Point Dry Needling to the
upper trapezius near GB 21, the supraspinatus near TH 15, and the lats near GB 22.

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This could be supplemented at any time with the influential point for tendons, GB
34.

  124  
12] Yang Tends Toward Excess--thorns, stains, knots and
obstructions

THE PROBLEM:

“Ordinary skills of acupuncture maintain the physical body […] Some people say
chronic disease cannot be cured. This is speaking incorrectly.”

(LS, Scroll One)

During the course of this on-line project, I have come to realize as I shared in the
Preface that the “ordinary skills of acupuncture” include the Ben (root) and Biao
(symptomatic) aspect of routine acupuncture treatment, and that there has been
much time spent discussing Root versus Symptomatic treatment, as if the former
were more important than the latter, and required higher skills, when they are both
in fact part and parcel of good solid acupuncture.

5 Element and 8 Principle Treatment

In both the 5 element and the 8 principle discussions of 25 years ago, each of these
approaches argued that it was treating the Root. In Worsley’s “Five Element”
approach, practitioners were strongly dissuaded from using needles to treat
symptoms (which would make one a “Local” doctor using local meridian points for
symptoms), as it encouraged its students from the very beginning, after removing
whatever basic blocks (which were, interestingly, often meridian blockages but not
taught or appreciated as such) to keep a focus on the imbalanced Official (Zang or
Fu) and the Causative Factor (CF), a concept Worsley borrowed from English
homeopathy with its associated concept of “law of cure”. In doing this, there was

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frequent mention of treating the “bodymindspirit”, a New Age concept that had
entered acupuncture circles, and especially with a focus on the Spirit which was
privileged as a level of intervention.

In the TCM approach, on the other hand, the focus was still on the primary ZangFu
pattern, but from a decidedly physical perspective that gathered data about stools,
urine, breathing, sleep, pain, weakness, etcetera, much more like an internal medical
practitioner of western medicine with a similar focus in treating the patient on the
physical level of organ dysfunction and disease.

Lines were drawn, and those entering the study of AOM to help people deal with
complaints started to lean much more heavily in the direction of “8 Principle”
acupuncture, later referred to as TCM.

While TCM played lip service to the classical notion that Internal ZangFu problems
were caused by disorders of the 7 emotions, it was Worlsey’s approach that took
this concept the furthest in those days. Each approach was certain it had the
correct way of treating the Root, and each style, from my perspective, missed the
main point of acupuncture, that in fact has to do with knowing how to navigate the
channels to deal with those thorny, knotted, messy obstacles which present
themselves as symptoms, which bind our patients in chronic holding patterns and
which, once they become chronic, make escape quite difficult without some hands-
on help. And it is especially there, in each of these two main style’s lack of
education or training in palpation and touch, that treatment of the meridians
(jingluo) got so seriously shoved into the background.

Where Worsley himself was a gifted physical medicine practitioner before learning
acupuncture, who resorted at every turn to physiotherapeutic and osteopathic
manipulations to clear away these thorny obstacles and open the way for a Root
acupuncture treatment, the North American teachings that derived from his work
would have to wait for Fritz Smith’s brilliant “zero-balancing” method, developed to
fill the gap in this 5 element training tradition, to learn how to lay on hands to
promote “free-flow” through the channels and collaterals.

While I grew to be quite impressed by the sincerity of the education in Worsley’s

Five Element style, I became dizzy with the gyrations such practitioners would go

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through to avoid inserting a needle in places that were knotted, obstructed, and
screaming for relief, and confused and dismayed by the associated lack of interest
in navigation and treatment of the meridians of acupuncture in their classical sense.

It felt to me as if the Worsley tradition, in short, was intentionally not embodied,

seeing itself instead operating on some rarified “spirit level”.

Root and Symptomatic Treatment

During this period of development of North American acupuncture, the issue of

Root versus Symptomatic treatment lead practitioners to galvanize under one or
the other pole, with 5 Element practitioners claiming the higher, Root ground and
stating that 8 principle/TCM acupuncture was purely “local doctor” treatment of
symptoms.

For a detailed, although decidedly TCM, internal medical (and therefore herbalized)
perspective on Root and Manifestation in TCM, see Maciocia’s The Foundations of
Chinese Medicine, pp. 312-323, which I will briefy summarize here.

Maciocia stresses that treatment principles can be discussed in four distinct yet
interrelated ways:
♦ As Root (Ben) and Manifestations (Biao): Upright Qi is the Root relative to
Pathogenic Factors which are the Manifestation; Root is etiologically the root
of a disease while the clinical manifestations are the Manifestation; Root is
the initial condition while Manifestation is the later developments of the
condition; Chronic disease is the Root relative to Acute disease which is the
Manifestation. “They are not two separate entities, but two aspects of a
contradiction, like Yin and Yang” (p. 312). Maciocia makes the oft-quoted
statement that “[g]enerally speaking, treating the Root only is sufficient to
clear all clinical manifestations in most cases” …”when the clinical
manifestations are not too severe”(p. 313”. The Root and the Manifestation
would be treated together, an approach he admits is widely used in chronic
conditions, “when the clinical manifestations are severe and distressing for
the patient” or when “the clinical manifestations themselves are such that
they would perpetuate the original problem”p. 314). When the

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 manifestations/symptoms are severe, usually in acute conditions, he goes
on, it is often necessary to treat the manifestations first. You are referred to
Maciocia’s chapter for the more detailed discussion regarding situations
where there are more than one Root, in which case each Root must be
treated; one Root giving rise to several different manifestations, where the
treatment is still directed primarily at the Root; and situations where the Root
and Manifestation coincide which he states “can only happen when the
clinical manifestations are caused by external physical trauma, such as in an
accident”(p. 315). Here the stagnation of Qi and Blood in the channels leads
to pain because the pain is the stagnation of Qi and Blood.
♦ When to support Upright Qi, when to eliminate pathogenic factors: Maciocia
defines upright Qi as the “body’s resistance to disease” […] “used only in
relation and in contrast to pathogenic factors” (regardless of whether they
are external such as wind, cold, damp, heat, or internal such as interior wind,
blood stasis and stagnation of Qi, phlegm and fire). An Excess in this
circumstance refers to the presence of an exterior or interior pathogenic
factor, where the upright Qi is still intact enough to fight the pathogenic
factors, he clarifies. A Deficiency, on the other hand, refers to a weakness of
upright Qi and an absence of a pathogenic factor. Finally, a mixed
Deficient/Excess condition, which he adds is far more frequent clinically than
a purely excess condition, refers to a condition where upright Qi is weak, but
pathogenic factors are also present. Treatment must therefore be directed
at tonifying or dispersing (expelling) or both.
♦ When to tonify, when to disperse: Tonifying upright Qi is only applicable,
Maciocia underscores, in interior conditions. This can be accomplished with
acupuncture, exercise, diet, Qi Gong, meditation, rest or herbs, he clarifies.
He quotes the saying “support upright Qi, to eliminate the pathogenic
factors”(p. 316). In exterior conditions it is almost always sufficient to expel
the pathogenic factors and the upright Qi will be strengthened, whence the
saying “eliminate the pathogenic factors to strengthen upright Qi”(p. 317)
This can be done by using dispersing acupuncture techniques, cupping or
bleeding. Maciocia concludes that a strategy commonly used for exterior
and interior conditions, when the body’s upright Qi, its resistance, is low, is
to expel the pathogenic factors first, then tonify the upright Qi (only when
there are no more signs of pathogenic factors being fought off does one
tonify upright Qi he states). While this is a required approach in acute or

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 urgent cases, it is also commonly used “in chronic cases where the
symptoms do not have a character of urgency, but are nevertheless, very
distressing and painful”(p. 319). This is the case in chronic visceral and pain
disorders, and the APM/CCA integrated approach usually adopts this
approach, of focusing on expelling the pathogenic factors, but also
simultaneously supports the upright Qi for balance. I agree with Maciocia
that one must be very careful when dispersing excess to suggest to patients
not to overdue it with exercise or activities which may aggravate the
dispersal and lead to undue soreness and fatigue. They would do well to
rest, and/or meditate to calm the body and mind and gather resources. If
there are signs of the body fighting something off, a fever, even if low
grade, chills, a feeling that one is coming down with something or just
getting over it, I do not treat their original chronic condition, say chronic
Taiyang Zone pain in the low back and buttocks, as this would invite the
current EPF to enter more deeply. This is also why physicians counsel
patients not to work out during a cold or flu, but rather to stay home and
rest.
♦ Treating the constitution. This refers, Maciocia stresses, to the “Three
Treasures (San Bao)—Essence (Jing, prenatal, hereditary Qi and inherited
constitution gauged by general vitality, symptoms, pulse and eyes- leading to
strong bones and good mental faculties and memory); Qi (acquired or
postnatal Qi, which can be gauged by symptomatology, tongue, pulse); and
Shen (the state of mind is “primarily a result of the interaction of Jing and Qi
and is also reflected in the eyes”). The heart pulse will also be strong but not
overflowing. Constitution can also refer to treating according to the Five
Elemental types. Maciocia raises the issue of whether one should treat the
constitution in the absence of clinical manifestations, which he believes only
an experienced practitioner can ascertain. He concludes that it is generally
better to treat the constitution toward the end of the course of treatment to
“consolidate the results. On the other hand, one must pay attention not to
exceed in treating the constitution and stir up problems unnecessarily”(p.
323).

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Japanese and Acupuncture Physical Medicine Perspectives

This issue of Root versus Symptomatic treatment has also been a major source of
debate, at times heated, in the Japanese Acupuncture field over the last half
decade, where conventional acupuncture practitioners and meridian therapists
argue their views on the subject. In his seminal text, master practitioner Shudo
Denmei summarizes the issues and debates, by first stating clearly: “It should be
emphasized that both root and symptomatic treatment are necessary and
important. No authority on meridian therapy claims that treatment of localized
areas is unnecessary. Sometimes local, symptomatic treatment may even have a
beneficial effect on the balance of Qi in the body as a whole (Japanese Classical
Acupuncture: Introduction to Meridian Therapy, translated by Stephen Brown,
Eastland Press, Seattle, 1990, p. 152).

Shudo sensei then goes on to summarize the two opposite views, with some
meridian therapists claiming that root treatment effectively deals with 70-80% of
symptoms, while others state that “symptomatic treatment is necessary because
practitioners of meridian therapy lack confidence in the effectiveness of root
treatment (ibid),” even questioning the line drawn between root and symptomatic
treatment “on the basis that some practitioners of meridian therapy actually spend
more time on symptomatic treatment (ibid).”

Shudo sensei concludes that there is a major misconception among some

conventional acupuncture practitioners in Japan that “practitioners of meridian
therapy believe that root treatment is all that is necessary, but the truth is that
symptomatic treatment is by no means neglected in meridian therapy (ibid).”

Shudo sensei then concludes: “The only real difference between meridian therapy
and the conventional approaches to acupuncture in Japan is that root treatment is
performed to balance the body energetically before the specific symptoms are
treated ibid).”

With that clarified, Shudo sensei’s own simplified approach to root treatment is
presented, and consists in the treatment primarily of tonfication points, as well as
master points on the “mother” meridian, to treat the primary yin meridian/organ

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deficiency as phase one of treatment, based on Nan Jing five phase treatment
strategies.

Shudo sensei’s approach is consistent with the tonification at the ying level of the
most deficient yin meridian/organ, and/or balance of the jing level extraordinary
meridians before moving on to treat the local, symptomatic complaints of the
patient, in APM, which incorporates Shudo sensei’s hypothesis that “yin tends
toward deficiency, yang tends toward excess” as a central focus for chronic
complex disorders specifically, as well as for internal visceral complaints in general.

KM style acupuncture, likewise, begins phase one of treatment by regulating the

Yin, ventral aspect of the body by needling distal points often selected based on
Nan Jing five phase theory, to regulate constitutional and Organ imbalances before
moving on to treatment of the patient complaint and the yang, dorsal aspect of the
body.

Finally, TCM, which has borne the brunt of five phase criticisms that it only treats
symptoms, also often begins with treatment of distal essential points to address the
underlying pattern of disharmony, and then adds local specific points to address the
patient complaint.

In selecting distal points for this first, YinYang regulatory phase of treatment, the
term the college prefers to “Root treatment”, meridian therapy, as well as KM, APM
and TCM styles of acupuncture as taught at the college, all teach to select from the
5 shu-transporting/5 phase elemental points, the yuan-source points, the luo-
connecting points and the xi-cleft points. Where meridian therapy and KM style tend
to select these distal “command” or essential points based on Nan Jing five phase
theory, APM and TCM tend to select these points for their functions as jing-well,
ying-spring…he-sea points more consistent with earlier Ling Shu theory.

These four styles also have different ways of assessing if the treatment is
proceeding in an effective fashion: with meridian therapy reassessing the pulse
during the treatment to check for positive change; KM style rechecking the hara
and other reflexes for this evidence of change during the treatment; APM looking
for expected reactions to the needling of the first phase of points (sinking deeply

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into the point for tonification, spreading out and/or propagating away from the
point for dispersal); and TCM rechecking pulse and tongue the next visit.

But all of these styles and practitioners are in fact also assessing the effectiveness
of the treatment as it is being administered, whether consciously or tacitly, by
looking for more general signs of positive change already enunciated in the first
chapter of the Ling Shu: “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 (Ling Shu or The
Miraculous Pivot translated by Wu Jing-Nuan, University of Hawai’i Press, 1993, p.
4).

Vital Signs of Change

I believe too little is made of these observations of change, some of which I learned
from practitioners at the Traditional Acupuncture Institute in Maryland almost three
decades ago. And I believe there is a tendency to privilege assessment by the radial
pulse, which is prone to very subjective interpretation by the acupuncturist, rather
than learning to read the signs of energetic change in the circulation of Blood and
Qi by observing these changes directly: looking for improved facial color, for the
shen to return a sparkle to the eyes, and listening for more relaxed breathing and
more relaxed speech, looking for a more relaxed demeanor, and listening, watching
for and questioning how the qi and blood are moving, changing temperature,
releasing constrictions (creases across the abdomen, x’s in the back of the neck,
compressed wrinkles in areas of spinal stenosis, release of muscular holding
patterns). These things can all be seen, and those observing will concur on the
changes noted far more consistently, I would submit, than those checking the pulse.

Finally, if one makes positive change in the pulse the sole arbiter of therapeutic
change, the classical rules of assessment have been ignored, which call for
assessing in as many fashions as possible, to glean as much information as one can,
until this information is able to be assessed tacitly, which I believe is the case with
all senior practitioners. And no practitioner taking the pulse during the treatment is
failing to also take in changes in complexion, tone of voice, breathing patterns
etcetera, all of which will influence how they interpret the pulse.

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It might be interesting to devise a research study to see if assessing therapeutic
change without taking the pulse by some practitioners coincides with therapeutic
pulse changes assessed in that way by others.

That being the case, Shudo Denmei makes a point that is a truism in APM, KM and
TCM style practices as well: “When it comes to symptomatic treatment, there is
practically no limit to the variety of approaches and techniques that can be
employed. Symptomatic treatment is an area in which every practitioner can display
his own talent and unique skills. Each of us must spend a lifetime developing our
own treatment style (Shudo, ibid, p. 153).”

This would certainly be true in the three main styles taught at the Tri-State College
of Acupuncture, where local treatment of the patient complaint are varied indeed:

• KM style use of various needling techniques and depths, moxibustion, patchi-

patchi, ion chains and diode rings, sotai, etcetera;
• APM use of classical Chinese bi-syndrome and modern trigger point dry
needling techniques, pre-acupuncture palpation, pacing and leading ones
therapeutic comments and silences to prod change (based on Ericksonian
hypnotherapy and NLP techniques), and prodding of the “bodily felt-sense”
(Gendlin), as well as education of the patient about their holding patterns and
armoring (Reich, Keleman);
• TCM use of stationary and moving cupping, guasha, indirect moxibustion, tui
na, Qi Gong and Daoyin exercises.

Treating Excess: Surface Manifestations and the Patient-Complaint

In excess disorders the jingluo, the soma, and especially the cutaneous regions
(zones) and tendinomuscular meridians need to be dispersed as the primary
strategy. In APM, YinYang regulatory treatment at the ying level in such cases
simply consists in supporting the yin paired meridian’s primary Zang (supporting the
Kidneys for Taiyang Zone, Liver for Shaoyang Zone and Spleen for Yangming
Zone) and completing the circuit for zone excesses, or needling the 4 gates or

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distal jing-well and other tender points for tendinomuscular excess to clear the
jingluo and promote smooth flow of Blood and Qi.

In deficiency conditions the ZangFu are the main target of treatment, but the
French acupuncture strategies that lie at the foundation of APM treat these visceral
disorders and diseases through the extraordinary vessels as well, which are
activated when the organism is confronted with the strain of chronic disease or
dysfunction. Here a jing level treatment of the extraordinary vessels is done first,
and then a ying level treatment of paired yin meridians to any yang zones affected
is executed, to regulate yinyang circuits at the same time as removing chronic
muscle channel obstructions by addressing ashi and trigger points.

It is in this sense that APM focuses on the need to disperse excess in the three Yang
Zones (the cutaneous regions) or the tendinomuscular (muscle) channels, thereby
fortifying the body’s defenses/upright Qi.

This is also why APM focuses on addressing up-regulation/hyper-reactivity in the

extraordinary vessels, especially, chong, du, dai and ren, which are called into play,
according to certain French acupuncture understandings, when the body is
perpetually attacked, to protect the ZangFu against this steady onslaught.

The point is, that excess conditions must be dispersed. I believe it is a mistake to
treat the constitution alone in the presence of excess in the zones and/or muscle
channels and luo vessels, as this excess will block Qi and Blood and the ensuing
stagnation and constraint will create a vicious cycle of pathogenic activity that will
generate more excess. Here is where lifestyle counseling, especially regarding
getting proper rest, sleep and stress reducing activities like Yoga, meditation, Tai Qi
and Qi Gong can be so critical. Tui-Na and massage, moving cupping and GuaSha
are also a vital part of treatment of excess, to keep the body supple and functioning
optimally. If Excess in the jingluo is left unaddressed, this will lead to stagnation of
Blood, constrained Qi, Phlegm and Fire, the internal pathogenic factors. These, too,
must be dispersed.

This focus on dispersing Excess as a primary strategy is clear from the LingShu and
later texts that develop this notion in the classic discussion of “tri-level” needling.

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Here is Huang-fu Mi’s version in the Jia Yi Jing or Systematic Classic of
Acupuncture & Moxibustion (Blue Poppy, 1993):

“As for that which is termed tri (level) insertion for promotion of grain qi (ie; the
correct qi), one first inserts the needle shallowly, barely penetrating the skin to
drive out yang evil. Next one needles to drive out yin evil [inserting the needle]
slightly deeper to penetrate the skin and flesh but not penetrating the parting of the
flesh. Finally, one needles still deeper, penetrating the parting of the flesh to
promote the emergence of the grain qi (p. 279).”

“The so-called arrival of the grain qi implies that supplementation has replenished
(the channel) and drainage has evacuated (the channel). Thus one may know that
the grain qi has been attained (p. 305).”

“Once the evil qi has been removed, despite a failure to regulate yin and yang, the
disease will display signs of improvement. This is why it is said that supplementation
is sure to replenish, while drainage is sure to evacuate, and that although the
disease may not appear to have diminished following acupuncture, it will have
indeed been mollified (p. 306).”

It takes a tough kind of compassion, and focus, to disperse Excess and evacuate
evils in patients with chronic conditions, where the excess is laden with pain,
suffering, and even at times abuse. The going can get rough at times. But the result,
freeing patients from some of this excess, from holding patterns that have been
constricting or suffocating them, is worth the effort for practitioner and patient
alike.

To focus on the constitution alone, then, to attempt to gently tonify patients with
Excess conditions with acupuncture is, and here I agree totally with TCM and
Maciocia, an error. This could be done if the patients were addressing the excesses
in another somatic, physical practice, like Rolfing for example. But somewhere the
Excess has to be dispersed, or these Exesses will build up and lead, potentially, to
what yoga refers to as a Kundalini experience where the Excess remains trapped in
the patient’s nervous system. This can lead in extreme cases to never-ending
nervous system agitation.

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Beyond Root and Symptomatic Treatment

After much reflection on how North Americans tend to ascribe more significance
to Root, than to Symptomatic treatment, I discussed this issue with Kiiko
Matsumoto, who was rather surprised at how one might think a tree might have
only roots or branches and still be a tree! This lead to a decision at the college to
refer instead to: “YinYang regulation, using the essential points (distal command and
local Mu and Shu) to treat primary Organ or Constitutional patterns; and Treatment
of the Patient-Complaint, using reactive points, which focuses on the complaint, and
its signs and symptoms as manifested by the patient. This reformulation
underscores the fact that one must address the patient’s complaint if one wishes to
practice patient-centered care, as this part of the treatment focuses on the patient’s
experience and story of illness and distress, not ours. This reformulation also
hopefully puts to rest the fantasy, pronounced by those who profess to have the
deep secrets, that one can treat chronic complex disorders by “root” treatment
alone, a fantasy that has lead far too many practitioners to clinical failure after
failure.

Treating the Patient-Complaint and Holding Patterns

As I reorganized the curriculum of the Quebec Institute of Acupuncture into a more

workable model that integrated in TCM ZangFu pattern identification (the “ZangFu
diagnostic filter”) in the second year, and after a thorough grounding in jingluo
pattern identification in Year I, that viewed visceral symptomology as part of the
internal branch of the 12 regular meridians, I found Chamfrault and Van Nghi’s
earlier categorization in L’energetique humaine more useful than Van Nghi’s later
French-Vietnamese one based on the Vietnamese Trung Y Hoc, in his Pathogenie et
pathologie energetique en medecine traditionnnelle chinoise.

In the earlier text, Chamfrault and Van Nghi organized the teaching of the jingluo
filter by category of meridian, and therefore category of point strategy, to be
utilized in formulating a comprehensive treatment plan based on jingluo pattern
identification. This categorization was broken down into Ying, Jing and Wei as
follows.

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Ying & Jing Level Treatment

The Ying level is comprised of the 12 regular meridians, and internal branches
(parallel to the 12 divergent meridians) which function as a circuit as presented in
the previous Reflection. Here, one identifies the regular meridian that is most
affected, and its circuit, and utilizes the source, or ying and shu, or tonfication or
other essential command point on the Yin meridians, and the luo, dispersal, xi-cleft,
or other essential command point on the paired yang meridian. The yang meridians
are primarily used to address the symptomatic presentation, while the yin meridians
address the underlying regular meridian dysfunction. If one has already made a
TCM ZangFu pattern diagnosis, say in preparation for an herbal recommendation,
one can just select the corresponding regular meridian and its associated circuit to
develop a jingluo treatment plan.

When the internal associated organ and bowel are affected, resulting in internal
visceral symptomology, one can add the local front-Mu and/or back-Shu points to
address the ZangFu directly.

A] Ying-Level Local Treatment of Patient-Complaint

The main difference in this jingluo approach, from TCM acupuncture treatment, is
that points are selected based on their dynamic effect on the circulation of Qi
(what the early French authors referred to as the ‘energetics’ of the points) rather
than based on supposed indications, and that local points are selected from the
meridians in the area of the complaint, by palpating for obstruction and excess.
Thus one might palpate and find tightness and constriction over the lungs in a
patient suffering from chronic obstructive pulmonary disease (COPD) in the
following configurations, with the local obstruction guiding the distal YinYang
regulatory treatment as well:

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 • Tight Tender Points (TTPS, not to be confused with Trigger Points or TrPs)
in the area of the Taiyin union, Lu 1-2 and Sp 20 (beginning of hand taiyin
lung and end of foot taiyin spleen), indicating a Taiyin dysfunction;
• The above TTPs, with exquisite tenderness at ST 14-16 and LI 17, indicating a
taiyin/yangming dysfunction;
• TTPs at Lu 1 and Liv 14, indicating a blockage in the circulation of Qi from
foot jueyin liver to hand taiyin lung OR in Metal and Wood (Metal controls
Wood);
• TTPs at Lu 1-2 and Kidney 23-27, indicating a hand taiyin lung and foot
shaoyin kidney dysfunction (disorder of Metal and Water/ Mother and Child);
• TTPs at CV 18-17 and CV 23 with plumpit Qi, indicating a dysfunction of
Wood and Water/ Liver and Kidney/ Mother and Child.

This palpation of the target or symptomatic area has been a hallmark of the
meridian approach I have practiced for three decades, and was most elegantly and
simply stated by Dr. Ni in her clinical text, when she stressed that any local point on
a meridian may be used to treat local symptoms in the area of that point. For those
who palpate distally and locally, to assess the state of excess and deficiency of the
“beginning and ends” of the meridians, a rich array of circuit palpation and
treatment is readily available that is always patient-centered, because it starts by
assessing that area of the body-person (shenti) that brings the patient to our office
and affords us the privileged opportunity to witness and support their efforts at
change.

I have started with this discussion of local treatment of the patient’s complaint in
visceral disorders of the ZangFu to stress that in such cases, the local
“symptomatic” treatment addresses the ying level of the regular meridians based
on the classical notion of assessing and treating the beginnings and ends of the
meridians, not trigger points in the muscle channels.

In such ying level visceral disorders, one may add treatment of the 8 extraordinary
vessels with their distal opening points, a characteristic of Van Nghi style French
meridian acupuncture, but also of Manaka style Japanese style treatment, where
ion-pumping cords are attached to the distal opening points instead of needles.

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I list common local ying and jing level points of union for addressing the patient-
complaint in my earlier Acupuncture Imaging, p. 26, and especially in chapter 7, on
“bodymind-energetic palpation”, pp. 66-78, as well as in the drawings of the greater
meridian units in my earlier BodyMind Energetics, chapter 2.

Main union points that I routinely observe, assess and release are:

• TH 22-23 and GB 1-3 as well as the extra point “taiyang” for Shaoyang
lateral head pain, dizziness, vertigo, headache, migraines;
• TH 15 and GB 21 for Shaoyang upper back, trapezius, supraspinatus pain and
dysfunction;
• TH 16 and GB 20, as well as the extra point “anmian” for Shaoyang/Jueyin
tinnitus, temperature problems including excess sweating and hot flashes,
and neck pain;
• Bl 1 (not needled) and SI 18 for Taiyang facial pain, trigeminal neuralgia and
sinusitis signs and symptoms, which has come to include Bl 2 and ST 2
where tender in the same area of facial pain and sinus symptoms;
• Bl 11 and SI 9-14 for rotator cuff disorders and shoulder pain and
dysfunction;
• ST 2 and LI 20 for Yangming facial pain and sinus symptoms;
• ST 3-4 and LI 19 for trigeminal neuralgia;
• LU 1-2 and SP 20 for Taiyin chest pain, respiratory disorders, shoulder pain
and dysfunction;
• Kid 27 and HT 1 (HT 1 replaced by subclavius trigger point near ST 13) for
Shaoyin Thoracic Outlet-like signs and symptoms of neck pain and arm
repetitive strain signs and symptoms;
• Liv 14 and Per 1-2 for Jueyin chest pain, panic disorder, shoulder pain and
dysfunction, respiratory problems.

B] Jing-Level Local and Distal Treatment

The Jing level is comprised of the 8 extraordinary vessels, which function outside
of the 12 main meridians but kick in when disorders are complex or chronic and
two or more regular meridians, and their associated organs, are at risk. Treatment
here is directed toward stimulation of key points to address dysfunction in the

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chong, dai, ren and du vessels (Sp 4, GB 41, Lu 7, SI 3), with their paired vessels’
key points (Per 6, TH 5, Kid 6 and Bl 62).

Local points from the extraordinary vessels involved can also be selected to
address visceral or somatic symptomology that constitute the patient’s complaint,
distress and suffering. While APM has specific stress patterns (the Four Patterns of
Fatigue/Visceral Agitation presented in Reflection II) to address common chronic
adrenal patterns of our day, APM is predicated upon a solid grounding in jingluo
theory and treatment, and I frequently resort to treatment of an extraordinary
vessel or vessels on their own, with little or no treatment at the ying level.

This is common for me in addressing gynecological and reproductive problems,

where I treat distal opening points for chong, dai and ren, but also address excess
and deficiency along the local points of these meridians, so GB 26-28 (dai), Kid 11-
15 and ST 30-26 (chong) and CV 2-4 (ren). I also often treat a series of local HJJ
points in spine disorders, with the infinity opening point treatment for ren and du: Lu
7/Kid 6; SI 3/Bl 62, as a du mai treatment (HJJ and adjacent BL meridian points, as
well as the muscle channel multifidi, being seen as part and parcel of du mai).

I felt the need early in my teaching career to focus heavily on teaching the
extraordinary vessels when English language texts did not exist and Chamfrault and
Van Nghi’s texts were the main resources. When these texts went out of print, there
was still Royston Low’s book on the secondary vessels, which then went out of print
as well, and Felix Mann’s early text on the meridians of acupuncture, which recently
went out of print but appears to be circulating in an unofficial on-line version, has
also disappeared. Since Mann recanted all of his earlier books based on classical
theory, support for training in the secondary vessels and extraordinary vessels was
scanty indeed.

And then Dr. Ni published her brilliant Navigating the Channels, which we use as the
main authoritative text at the college for jingluo clinical pattern differentiation and
treatment.

That said, any serious student of a jingluo approach should study Maciocia’s book
on the channels carefully and repeatedly, as it is full of clinically useful and
classically informed information, even if an awkward text to use in the clinic itself.

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His study of the extraordinary vessels alone contains everything Chamfrault and
Van Nghi wrote, is consistent with Felix Mann’s early text on the jingluo, and with
Ni’s text. His treatment of the extraordinary vessels fills 10 chapters and over 270
pages, and is a book unto itself that I highly recommend.

C] Wei Level Muscle Channel Local Treatment

Finally, APM focuses on Wei level treatment in all myofascial and many
musculoskeletal Bi syndromes where the treatment is comprised of the 12
tendinomuscular meridians (muscle channels) and the 15 primary luo vessels, which
are activated according to classical theory to protect the regular meridians and the
skeletal system from external attack, injury, repetitive strain and wear and tear, thus
diverting the brunt of the attack to the larger muscle channels and superficial
cutaneous regions (Zones), which occupy the broadest area and thus serve best to
offer this protection. In chronic emotional disorders, affecting the internal
meridian/organ complex, the muscle channels and cutaneous regions often serve as
a shock absorber to take on the bulk of the trauma, thus creating physical
symptoms and myofascial holding patterns, which Wilhelm Reich referred to as
“Character Armor” as a correlate to, and perhaps more manageable form of such
complex emotionally laden problems.

In its simplest version, one merely palpates along a muscle channel and performs
wei level oblique shallow needling (a needling approach known as Bao Ci), to point
after point in the symptomatic area as well as distally on the channel involved (jing-
well and other tender ashi points), and this is done in APM most frequently on the
Yang tendinomuscular meridians. One can also incorporate trigger point dry
needling based on referral patterns, an extremely pragmatic addition to classical
muscle channel treatment, and these muscle channels can be treated by region as
well, with points from all three Yang or Yin meridians of the arm or leg depending
on region affected. Distally, one can treat the jing-well point as the furthest point
from the symptomatic area, the jing-river point if the problem has become chronic
and rheumatic affecting the joints, the luo-connecting point if its target area is
within the symptomatic region, or excess reactive points on palpation along the
same channels.

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 While release through a special “sparrow-pecking” needling technique is my
preferred way to release active local trigger points, especially if acute, or if newly
inflamed in a chronic condition, which I lay out in my A New American Acupuncture:
Acupuncture Osteopathy, I also often simply use rapid lifting and thrusting to deep
muscle ashi points if sparrow-pecking does not lead to rapid fasciculation and
release, which can be the case in chronic pain where the fascia has become
fibrotic, in women right before or during menstruation when their cou li layer is
congested and full of damp Sha, or in patients with very low Blood Pressure or with
Low Thyroid conditions.

While some practitioners who have trained with me might make almost exclusive
use of my APM Trigger Point Dry Needling technique for local excess ashi points, I
discriminate much more than that, and reserve such a technique for actual
myofascial trigger points, and rarely when I am treating ying level regular meridian
or jing level extraordinary vessel local areas of the specific patient-complaint. I also
incorporate trigger point release into full-scale jingluo acupuncture treatments for
any complex or chronic disorder, based on my approach to the three Yang Zones
as outlined in chart form and in clinical protocols in Acupuncture Physical Medicine.

What characterizes APM style above all else is its focus on careful palpation not
only distally, but locally along extraordinary vessel, regular meridian, and
tendinomuscular meridian and luo vessel pathways for areas of excess and
deficiency to be needled to relieve symptoms, remove obstructions, and promote
the flow of Qi and Blood.

Acupuncture PHYSICAL medicine is thus aptly named, to underscore a style akin to

AOM bodywork, where laying on of hands is central and critical to clinical success.

The Jingluo Filter at a Glance

Based on this way of categorizing the jingluo filter, jingluo pattern identification and
APM treatment planning consists of the following elements:

• The 3 circuits (of the 12 regular meridians): select the circuit based on the
primary Yin regular meridian involved, and treat its corresponding paired
Yang meridians, thus treating at least 2 out of 3 meridians in a circuit;

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 • The 3 levels (ying, jing, wei ): to the above regular meridian/circuit treatment,
add the corresponding extraordinary vessel treatment of key distal and local
points, if the disorder is complex or chronic and involves two or more
regular meridians and their associated organs; OR just treat the
extraordinary vessel involved as the main root treatment;
• The 3 Zones (Taiyang, Shaoyang, Yangming): when a chronic myofascial or
musculoskeletal pain and dysfunction condition is involved, especially when
it is comprised of symptomatic areas at multiple sits within a zone and
especially if there are regular meridian concomitants, treat and entire zone
with its APM protocol, selecting wei, ying and jing level strategies to address
the complex disorder from several angles;
• One hypothesis: Yang tends toward excess (so select the yang regular
meridians to address local visceral symptomology (such as TH 23 and GB 1
for migraine headache and TH 16 and 17 and GB 20 for tinnitus; and the
yang muscle and/or luo channels for bi syndrome and repetitive strain or
injury); Yin tends toward deficiency: tonify the most deficient yin regular
meridian (derived from Shudo Denmei’s simplified meridian therapy
protocol);
• Combine and sequence needle selection and stimulation based on the 8
conditions: select points from the foot and the hand meridians, and from the
right and the left, and from the front and the back, and from Yin and Yang
meridians, to regulate Yin and Yang.

8 Conditions of Point Sequencing

The 8 conditions figure into jingluo treatment planning at the point where one
decides how to combine the selected treatment strategies in terms of location
where each point is needled. Following the basic principle of treating on the
diagonal to regulate Yin and Yang meridians, most common in the treatment of two
paired extraordinary meridians (SP 4 on one side, and Per 6 on the opposite side,
for example, thus regulating right and left and upper and lower with just two
needles), I treat the distal ying meridian points in the same fashion: if doing the 4
gates, I needle Liver 3 on one side, and LI 4 on the other (thus regulating upper and
lower, right and left and yin and yang with just two, or at most four needles). When
multiple distal points are selected (say ST 36, 37 and 39 as lower he-sea points,

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and/or as distal points of chong mai, I just needle each point where most tender, or
arrange them, perhaps ST 36 and 37 on one side, and ST 39 on the other, based on
the number and location of the other needles so as to avoid unnecessary bilateral
treatment.

In brief, based on the 8 conditions, I alternate between distal leg/foot, and distal
arm/hand points on the diagonal, and complete my distal points to regulate Yin and
Yang meridians, from the extraordinary vessels and regular meridians, and then add
local mu or shu points if the viscera are involved, as well as local points on these
meridians to address local symptoms, and finally distal and local wei level excess
yang points to disperse muscle channel excess and clear the obstructions.

Maciocia presents numerous treatment strategies for treatment based on the 8

condition method of point sequencing in his The Channels of Acupuncture,
Chapters 8-10, pp. 107-177, and especially in chapter 11, pp. 177-215.

Summing Up

As I routinely tell students, a way to remember that one can treat from all three
jingluo levels (jing, ying and wei) is imagine each level being done with different
therapies and no acupuncture thusly

• The jing level, by the patient her or himself, in daily prescribed Qi Gong
practice;
• The ying level, with herbal remedies and dietary recomendations followed
daily;
• The wei level, with tui na in the office, and self-administered moxa at home
by the patient.

All three levels can also be treated only with acupuncture, something Acupuncture
Physical Medicine does routinely.

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13] Acupuncture as Physical Medicine—Location, Palpation,
Living Points

THE PROBLEM:

While these early discussions of acupuncture practice, and later of Acupuncture &
Oriental Medicine (a consensually agreed upon compromise term that, while
cultural anthropologically incorrect, satisfied non-PRC East Asian practitioners as
being the most inclusive, where Oriental Medicine was a code word for Chinese
Herbal Medicine) focused on resolving this debate between 5 element and 8
principle practitioners, some Japanese-trained practitioners, most notably Kiiko
Matsumoto, were beginning to teach around the nation. This brought with it in
rather rapid fashion a preferred use of disposable Japanese needles inserted
through tubes, and a major focus on palpation not only, or not even, on the pulses
at the wrist, which both the 5 element and 8 principle practitioners performed, but
palpation of the abdomen( Hara), the meridian pathways and the points themselves
for reactivity. As Kiiko Matsumoto become a more and more frequent clinical
faculty teacher at our college, I gladly distanced myself from this tiresome debate
to focus on the acupuncture I had learned, and to learn new skills of palpation-
based practice which, while stressed as a prelude to acupuncture treatment in the
Montreal teachings, was far more advanced and discriminating in the Japanese
approaches I was observing and reading about. The problem for me had ceased
being about the absence of the jingluo filter in most other acupuncture traditions in
this country, but of the lack of actual attention to palpation from the French-
Vietnamese meridian teachings of Van Nghi and other French physicians whom I
observed and invited to teach at the college.

The problem for me was to find ways to reinforce the training in jingluo practice
with a strong hands-on focus, and the Japanese styles shared by Sensei Matsumoto
with us all in the early days, were a great inspiration in that direction. This allowed
me, and the college, to take a distance from the academic debates about theory
that had plagued the 5 element/8 principle discussions.
 ________________

Before reflecting on these Japanese influences on APM palpation at the college, it

is important to note that Kiiko Matsumoto’s introduction of a Japanese perspective
also shifted radically the way in which I viewed where treatment of “ben” and
“biao”, “roots” and “manifestations” figured in the treatment of chronic complex
disorders of our time.

Stemming from her study with Yoshio Manaka, MD, She taught how one could start
with an extraordinary vessel treatment strategy to regulate the core, say with SI3/Bl
62 and Lu 7/Kid 6 as contralateral pairs (Infinity Treatments). Next, she would show
how Manaka treated the regular meridians/organs to regulate Yin and Yang (treating
Front and Back), ending with treatment of structural imbalances and elimination of
tight tender points. Patients would then be taught self-care exercises and treatments
to be carried on in between treatments.

This way of treating extraordinary vessels, regular meridians and the surface (ashi
points) was parallel to Chamfrault and Van Nghi’s way of framing the jingluo filter
as 3 levels: jing (extraordinary vessels), ying (regular meridians) and wei( cutaneous
regions and tendinomuscular meridians).

Still today, Kiiko Matsumoto teaches that one can treat 3 or so Constitutional and
Organ patterns with distal point combinations which is consistent with APM
treatment of point combinations for the extraordinary vessels, and the regular
meridians/organs, or with TCM treatment first of point combinations of 2-3 ZangFu
in many cases. I all 3 styles, one then moves on to treatment of the
“manifestations”, which is to say all the signs and symptoms that constitute the
patient’s complaint TODAY. Point combinations include distal and local needling,
and local use of ancillary techniques like cupping, guasha, magnets, electrical
stimulation, diode rings and chains, tui na, etcetera.

I say this just to clarify that when one really looks at each style, including TCM,
there is no way to say one treats only Root or Manifestations, Ben or Biao, as each
of the 3 styles treats both.

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What differentiates styles much more, I believe, is the role they assign to palpation
of the body as a whole to gain information about where to treat and how to needle.

Informed Touch:

In the first educational research colloquium sponsored by the Tri-State College of

Acupuncture in 2002, the issue of needling technique and intention regarding
obtaining qi, targeting qi, the arrival of qi, and propagation of qi were addressed by
means of demonstrations by five senior practitioners with twenty or more years of
experience each at that time practicing, and teaching: Wei Liu, trained in a family
style of tui na and as a TCM orthopedic specialist, with expertise in classical
needling techniques and their modern transformations; Kiiko Matsumoto, who has
spent the previous two decades bringing an eclectic Japanese acupuncture to
America, informed by modern Japanese masters and the classic texts; Arya Nielsen,
a graduate of the first class from the New England School of Acupuncture where
she studied and followed the combined acupuncture, moxibustion and guasha
approaches of the late Dr. So and studied Chinese Herbology with Ted Kaptchuk;
Mark Seem, who has developed Acupuncture Physical Medicine based on French
meridian acupuncture traditions, Japanese acupuncture inspirations, especially
regarding more superficial needling, and the late Dr. Travell’s needling of
myofascial trigger points; William Skelton, trained in Taiwan in a traditional hands-on
approach that emphasized distant points and working the affected area to free it
up, with great focus on effective needling of reactive points versus needling
according to theory.

These five senior practitioners, each demonstrating for an hour before a panel of
distinguished acupuncture researchers from Harvard, the University of Vermont,
the University of Maryland and the private domain, and our faculty, all concurred, as
some of the active participant researchers noted, that the goal, the intention of
needling seemed to be to initiate change by creating some sort of feedback loop
or circuit created by needling distant or distal points first, along with activation of
local areas through palpation, stroking, needling, guasha and other techniques. It
was also noted that all five placed great emphasis on treating “active” or “reactive”
points that were palpable as points that are tight, tender, indurated, as opposed to
textbook acupuncture point locations.

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In her seminal work, the late Janet Travell stressed that the X marks that appear in
her pictures of muscular trigger points denote likely areas where one might find a
trigger point, and are meant TO GUIDE THE PALPATION FOR REACTIVE POINTS,
not to serve as precise locations. She stressed cross-fiber palpation to find
indurated bands of taut muscle. Hong, a colleague of Travell from the University of
California at Irvine, has recently commented that ‘while all trigger points are
acupuncture points (ashi points), all acupuncture points are not trigger points’.
There is more to acupuncture, it seemed clear, than tight, tender, reactive points,
although such points appear to be a critical factor in effective treatment, especially
when there is musculoskeletal pain, stiffness, and associated dysfunction.
Proponents of Travell and Simon’s work are even suggesting doing away with the
numbering sequences in Travell and Simon’s texts, which led some to the belief that
trigger points do in fact have fixed locations, to further underscore the need to
palpate for reactivity in the region of motor points.

Effective Acupuncture Points:

In his two texts available in English, Shudo Denmei underscores the importance of
locating effective acupuncture points. He differentiates between the Sawada
traditional school, which emphasizes palpation and treatment of active, indurated
points, and the meridian traditional schools that stress more subtle manipulation,
very shallowly, especially of the “essential” command points (distal shu-
transporting/five phase, xi-cleft, source and luo, and local mu and shu). In his latest
book, dedicated to the above issue of “finding effective acupuncture points”(the
English name of his second book), Shudo Denmei stresses that for finding essential
points, especially on the yin meridians, he palpates gently along the course of the
meridian feeling for depressions (Yin tends toward deficiency), whereas for
palpating yang meridians, he palpates for areas of excess, for indurations (Yang
tends toward excess). While he treats excess and deficiency on such essential yin
meridian points, he adds that he usually just needles the indurations for the yang
meridian excess points. Palpation for depressions for the essential points from
elbows and knees down, as well as for mu and shu points is how the classic texts
teach point location for these points, and classics like the Ling Shu place great
emphasis on the use of these “essential” points, which, as Shudo Denmei concludes
in his text, can be quite amazing and seem to have a power all their own, with quite
shallow needling and minimal stimulation.

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Like Shudo Denmei, I look for excess, especially in pain disorders, and teach the
yang cutaneous regions (the zones and their corresponding tendinomuscular
meridians), as the most expeditious way to hunt for these yang, excess tender
points.

In his text Finding Effective Acupuncture Points, translated by Stephen Brown,

Shudo Denmei talks about three depths where reactive points and areas might be
located: points on the surface, points between the surface and the subcutaneous
tissues, and points in the fascia and muscle tissue, with even deeper points at the
deepest layer (pp. 7-13).

A] Points on the surface, which may feel cooler or warmer than surrounding areas,
some points will feel depressed, some points will feel more moist or dryer
(rougher) than surrounding areas, and some points at this level will be congested,
especially on the abdomen, feeling like an inflatable pillow.

To palpate points on the surface, skin layer, one may use either hand to stroke with
the belly of the middle, index or thumb finger, or with two to four finger pads at
once, stroking up and down, back and forth or in a circular motion with gentle
pressure.

B] Points between the Surface and the Subcutaneous Tissues may be approached in
the same fashion, with a little more pressure and/or a kneading action, or even by
pinching with fingertips, or a bigger grasp with the bellies of fingers and thumb, or
even bigger grasp between the thumb and the index finger bent into a “J” shape.

This layer is palpated for areas or points that are thicker than others, small lumps or
nodules that can be felt by moving the thumb against them with the skin and
adipose tissue pinched up, or hypersensitive points that sting when pinched.

C] Points in the deeper fascia and muscle layers are palpated for “indurations”, that
is to say knots, hardness of the tissue when palpated with deeper pressure. These
can come in many shapes, “including lines, circles, and other odd shapes. Therefore
it is sometimes difficult to distinguish the induration from the shape of the muscle
itself.” This is parallel to trigger point palpation as presented by Travell and Simons.

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Shudo Denmei has a few approaches to palpation at this deeper layer: pressing with
the tips of the thumb, index or middle finger, separately or two or three together,
with the fingers straight; bend the finger (crooked) and pressing with the belly or
pad of one of these fingers or thumb. One can apply vertical pressure up and down
to feel the borders of the induration; apply circular pressure; press up and down
and sideways (cross-fiber) with a kneading motion; or hook and dig in with finger(s)
or thumb tips.

Points in deeper areas like the abdomen, hips or lower back can be quite deep
especially when practicing abdominal (hara) palpation and trigger point palpation.

The Yin and yang of Palpation:

Starting from a Yin approach to palpation, regarding the amount of pressure to

apply Shudo Denmei states clearly, “the less force that is used, the better.” He goes
on, “[t]his applies regardless of the depth at which we palpate a point, but is
especially true for tender or indurated points. When we use excessive pressure,
every place we press might seem like a tender point (ibid, p. 11).”

Master Shudo goes on to discuss the Chinese terms “men and xun” which appear
in the Huang-di Nei Ching (Su Wen and Ling Shu) and mean to “stroke lightly”. In his
approach, the surface itself is palpated gently feeling for “something catching on
(or sticking to) our fingertips (ibid).” When palpating along meridian pathways, he
strokes gently this way in the direction of the meridian flow, using the middle, or
middle and one or two other fingers, “primarily around source points (ibid, p. 12).”
This same gentle stroking of the meridian becomes more focused on specific
depressed areas, when palpating for the actual acupuncture points.

When feeling for excess and deficiency to apply dispersal or tonification

techniques to regular meridians in Japanese meridian therapy, he clarifies, one
palpates gently this way. Strong pressure, on the other hand, used for the third level
of palpation of fascia and muscle, is aimed at detecting muscle channel tender
(trigger) points.

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The Sawada style of Traditional Japanese Acupuncture, which Shudo Denmei first
trained in, is known for its strong palpation of tender points in the muscle channels.
Even then, Shudo Denmei stresses, his own teacher in this style used far less
pressure than Sawada himself. There are therefore more yang approaches even
within this overall quite Yin, Traditional Japanese approach to palpation and
treatment.

In his Applied Channel Theory with Jason Robertson, Dr. Wang shares a different
approach based on the same Chinese terms, “men and xun” which he translates as
“feeling” and “palpating”, along with “an”, which means “pressing” ( pp 337-338). He
cites the same classical text. He then cites Huang-Fu Mi’s celebrated text several
hundred years after the Huang Di Nei Ching, the Jia Yi Jing (Systematic Classic),
where the technique of channel palpation and the significance of findings to disease
are developed. Moving away from the Huang di Nei Ching in preference for the
later Han dynasty classic, the NanChing, Dr. Wang reduces channel palpation to the
channel pathways below elbows and knees, palpating with the lateral edge of the
thumb belly, up the channels while holding the ankle or wrist with the other hand. In
this approach, Dr. Wang advocates palpating the channel in three progressively
deeper sweeps, “to discern structural changes along the course of the channels,
which includes not only changes in muscle tension but also nodules, bumpiness, or
granularity (ibid, p. 338).” While Dr. Wang does discuss the finding of “soft-weak”
areas on the surface, denoting a deficiency, he states that this is found with “mild
pressure”. The other findings, at the second and third levels, are hard and tight
nodules, which Shudo Denmei would expect to find at third or even deeper level
only. Wang’s approach therefore appears more in line with Sawada style muscle
channel palpation, more appropriate, perhaps, to muscle channel tender point
assessment and treatment.

The biggest difference is in the palpation for the actual acupuncture points, which
Shudo Denmei expects to find as depressions in the skin layer, where the fingertip
gets stuck as it falls into the “hole”(acupuncture points are described as holes or
caves in classical Chinese texts) during gentle palpation, whereas Dr. Wang
advocates using pressing (“an”) for tenderness: “When searching an area for the
precise location of an acupuncture point, it is often helpful to look for tenderness
or pain (ibid ).” Having experienced both forms of palpation with practitioners of
each of these, more Yin or more Yang styles, I can state that Dr. Wang’s palpation

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starts one or more levels deeper, and is quite uncomfortable throughout the
channel palpation, compared to the meridian therapy approach to palpation.

Palpation Tolerance

We have developed a simple concept at the Tri-State College of Acupuncture for

dealing with this apparent contradiction, especially when practicing classical
Chinese acupuncture, tui na and APM more yang styles and dispersal techniques.
Since people’s reactions to pain and discomfort are very relative, with one person’s
soreness not even phasing another person, we must teach patients how to share
with us that level where, even if not pleasant, the palpation or needling technique is
perfectly tolerable. We therefore do stronger techniques slowly, watching and
feeling for the patient’s reaction and stopping if possible before it is too
uncomfortable, hopefully “hurting good” as massage patients often remark. The
strongest pressure at the deepest level, as well as more superficial levels, that one
can tolerate, is that poerson’s “palpation tolerance” level. It is critical, in my opinion,
to test the “de Qi tolerance level” with each new patient to insure needling and
performing palpation and tui na within their comfort-zone.

By training in more gentle and stronger styles of practice, practitioners will have
palpation and treatment techniques that fit their patients’, and their own, proclivities
and sensitivities. The ultimate challenge, and the sign of a good practitioner, is the
ability to practice stronger palpation and techniques where required or where a
patient prefers this, even if the practitioner her or himself prefers to be palpated
and treated more gently, and vice versa, being able to practice gentle techniques
even when you feel stronger ones might be more effective, when this is required to
stay within a patient’s comfort level and safety zone.

Acupuncture Felt-Sense

Regarding the sensation experienced, the modern Japanese traditions cited by

Shudo and Matsumoto stress the “arrival of Qi”(zhi Qi) which is what the
practitioner feels, over “obtaining qi” or deqi, which is what is stressed in Chinese
and Korean traditions, and centers on what the patient feels. I have referred to the
sensations patients feeling when de Qi or zhi Qi is obtained, as well as the internal

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shifts they and the practitioner becomes aware of, on a “bodily felt-sense” from
Eugene Gendlin’s work on “focusing”.

Chinese and European traditions have often stressed de Qi as at least as important,

if not more important than zhi Qi. If one practices the above test for each patient’s
“de Qi tolerance”, I believe we are in the presence of a continuum from zhi Qi, the
initial reaction of muscle or fascia to the needling, and de Qi where this reaction is
sufficient to be clearly felt by the patient as sore or achy but still tolerable. And
since one person’s reaction to zhi Qi might be that this feels sore and achy already,
this would in fact be de Qi for that patient. I now suggest to students that what is
important is to learn to attend to what is happening underneath the top of the
needle, and with more experience, I believe all practitioners start to feel the fascia
responding and tacitly develop a “feel for” when this needling has already led to zhi
Qi, which they can feel, within the patient’s tolerance level.

But this just refers to the initial response to the needling, the first step as it were. I
am always attending to the reaction I feel is most appropriate, and for some signs
of appropriate change, a “shift” in the patient that I can always perceive but not
necessarily name (a relaxing of fascia and muscle in the obstructed area, a more
relaxed demeanor, a more normal breathing pattern, a settling of the patient into
the table to “receive” the treatment rather than brace against it, etcetera. If this
does not occur, and even if there has been zhi Qi or de Qi, I continue the
stimulation a bit longer to get the desired results, which usually only takes seconds.
I have watched Kiiko Matsumoto do the same thing, which she usually denotes to
the patient by saying “Oh Sorry!” while still needling for a few seconds. I often
simply say in such instances that they are going to feel this, stating “Here we go!”
and in seconds the sought after effect arises, such as causing the Qi sensation to
sink into the point, or to propagate away from the point, up or down the channel
(as for Sp 4, or St 36 respectively).

In the above-mentioned Needling Colloquium, Matsumoto stressed zhi Qi, and

talked about classical focus on “targeting the Qi” carefully with the needle, getting
the exact angle right. When she palpates for essential points like Kidney 4, she feels
for the precise point, which is often tender, with her needling hand, while her other
hand palpates for changes in Hara imbalances detected there. If the Hara changes
by pressure on the distal point, such as Kidney 4, Qi has been correctly targeted,

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Matsumoto argued, and needling of that precise location at the exact same angle of
pressure with a needle will produce the greatest effect.

Liu, Nielsen, Seem and Skelton all placed emphasis on feeling a reaction with their
supporting hand, like the fish biting on the line analogy from the Ling Shu, which
Shudo also references (acupuncture as a “left-handed” affair), thus feeling for the
arrival of Qi at the site of needling, as well as a de Qi sensation perceived by the
patient as a mild to strong acing, distending sensation that could sink in the local
area, or spread out around the point, or propagate away from the point, up or
down .

Reframing Needling Sensation/Training Good Acupuncture Patients:

Regarding Intention and reframing of the patient’s experience of such strange

sensations, at least for their first few treatments, Matsumoto clearly reframes the
patient around focusing on changes in the Hara, and uses palpation of distant
points, and their effects on local Hara or other Reflexes, and the delicate interplay
between these reactions (of distant active point to local reflex) as her way of
reframing their experience of treatment: by the end, when she is able to initiate a
change in a Hara or other key Reflex, the patient is clearly effected, impressed
(“interesting, isn’t it!?” she often remarks when change occurs).

She consolidates this focus on the “bodily felt-sense” of the patient to the needling
when she removes the last pieces of tape from tight tender points she palpated
initially, stating rather dramatically—“Take Away!”

Liu and Seem seemed to place a lot of attention on creating movement and change
right at the sight of needling, and propagating Qi sensations, reframing the patient’s
experience by focusing on these sensations and movement induced by needling: Liu
reframed often, in grand rounds the two days after the colloquium, by simply
looking knowingly into the patient’s eyes when a significant sensation (de Qi) had
been obtained, encouraging them to go with the bodily-felt sensations for a few
moments, thus sharing his intention, that initiation of such sensations is good,
therapeutic, and that change will ensue, by his silence, his concentration, and also
his humor, which he pointed out he needed to develop to reframe his American
patients’ reactions to such powerful de Qi sensations.

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I stressed that as the director of education and chief clinical instructor of my own
acupuncture College for the first two decades, I had to struggle with how to teach
de Qi and zhi Qi, and the reframing of these sensations, especially in light of a trend
in America to brand acupuncture, as did the Serein needle company, as “the
Painless One!”

I clarified in this demonstration in front of my colleagues and these researchers that

I reframe the patient’s experience of acupuncture needling sensations by helping
them focus on the holding pattern of constrictions and deficiencies found on the
initial palpation, with a focus on the sensations experienced from the needling to
affect the holding pattern. I lead them to focus on the holding patterns, and then
pace my needling and comments to their readiness to release the constrictions (a
practice derived from Ericksonian hypnotherapy). I set up the process for change
from the needling by teaching the patient what the de Qi sensations will feel like,
and engage the patient in sharing his or her experience of needling, of feeling
strange and sometimes strong, sometimes subtle, but often powerful sensations,
sharing my intention that if they experience such de Qi sensations (the “bodily-felt
sense”), or if Qi sensations propagate as anticipated and shared with the patient, the
treatment will be effective. In this way I make a suggestion that change is what will
occur, and that this is what I anticipate to initiate therapeutic changes, and then
when de Qi is achieved (within then patient’s tolerance level), I always respond
positively (“Great!” or “That is rally going to help!”), to reinforce the suggestion and
allow it to sink in. I would suggest that patients can do this in short order if
educated (led to) to attend to these changes from their shenming, their spirit
clarity, their deep intelligence of existence, because all human beings have this
ability to earn tacitly, as Polanyi argues, from all the senses, which feels to the
patient like a bodily awareness that cannot be easily labeled, which Gendlin simply
referred to as the bodily felt-sense.

After reading Tu Wei-ming’s discussion of master Wang Yang-ming’s Neo-

Confucian concepts of “inner experience” I realized this was exactly in keeping
with Polanyi’s concepts of “indwelling,” or “tacit knowing” which Schon later
translated as “know-how” and “a feel for”.

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In Wang-Yang-ming’s teachings (1472-1529) the central notion is t’i which Tu Wei-
ming translates as “to embody” bespeaking a “concerted theme of total
commitment, involving the entire ‘body and mind’ […] T’i-hui therefore means to
understand experientially, as if one has ‘encountered’ or ‘met’ in person, that which
is to be understood […] It 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. However, such an experience is neither mysterious nor
subjective, although its meaning can be readily acknowledged only by those who
have tuned their minds and bodies to appreciate it […] As a result, when the Neo-
Confucian master suggests to his students that the only way to take hold of a
certain dimension of his teaching is to ‘embody it’ (t’i-chih), he is absolutely
serious”. This involves thinking, or rather a discipline of mind that includes
mindfulness and a reflective practice, rather than logical, critical thinking, where a
student learns to think not only with his head but with his entire ‘body and mind’ […]
To think with one’s whole being is not to cogitate on some external truth. It is a way
of examining, tasting, comprehending, understanding, confirming, and verifying the
quality of one’s life. Underlying this kind of reflection is a process of digging and
drilling that necessarily leads to an awareness of the self not as a mental construct
but as an experienced reality”( Tu-Wei-ming, Humanity and Self-Cultivation, pp. 103-
105).

I would suggest that what we are teaching our students, and our/their patients, is
how to tap into their inner intelligence, their shenming (spirit clarity) during the
treatment, and to open up to receiving the changes that are heralded by a “bodily
felt-sense” of what is referred to as zhi Qi or de Qi but which is much more than
these Chinese medical concepts: it is a lived inner experience that, withal a few
treatments and a little somatic education from the practitioner, becomes something
the patient owns each treatment.

We are teaching our patients each treatment how to be a better acupuncture

patient, which is to say, how to allow their inner intelligence to make all the
necessary changes to better tune or attune their Qi (tiao-qi) by yielding to and
going with the bodily felt-sense provoked during the treatment and for days
afterwards. I deal in great detail with this concept of “felt-sense” in the western
literature in my Bodymind Energetics and refer the reader to that text for an
elaboration of these western concepts.

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What has proven truly eye-opening to me in the process of studying the pre-TCM
text that started off this series of reflections, the Zhong Yi Xue Gailun (which
Yanhua Zhang, in her Transforming Emotions lists as the first formal textbook of
Chinese Medicine in the PRC) is that the Confucian and Neo-Confucian ways of
engaging in learning in an “embodied” way, with mind and body, was at the base of
any serious study of Classical Chinese Acupuncture and Medicine for two thousand
years, until this Confucian tradition, both as religion and as philosophy, was
outlawed and uprooted from mainland China during the cultural revolution that
followed.

Concurrence and Change:

Returning to the colloquium in needling sensations mentioned above, Skelton also

focused on making the patient feel something at the site of needling, but then
would tap with his other hand along the body toward the symptomatic area, to get
things moving, to reframe the patient to experience this dance of sensations and
movement, having them move their affected arm or shoulder or hand or back,
engaging them in observing, like a research scientist, to see if anything was
changing.

Nielsen quickly obtained deqi, distally, then focused on the counter-irritation effects
of guasha to first congest, then decongest a symptomatic area to induce better
flow of qi and blood, in a way similar to osteopathy’s notion of strain-counterstrain.
She also used needles locally in the most reactive areas where guasha was to be
administered, to further free up the flow.

All five practitioners palpated carefully for the points they were going to treat, and
engaged the patient in a somatic reframing, where the somatic rapport, as Nielsen
stressed, was a clear part of the treatment, uniting the practitioner’s Intention on
creating change, the patient’s will to heal, and the attention placed on what was
happening throughout the treatment.

“The Painless One!” branding of Acupuncture in America, which I jokingly refer to

as the “whimpification of American Acupuncture”, is a big problem. This conception

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does not just come from the marketing of Japanese needles inserted through
tubes, although the cultural effect of shifting American practitioners from Chinese
or Korean, tubeless needles, where one had to have good insertion techniques,
cannot be ignored. But many Chinese practitioners also explain to the patient, when
the patient winces or cries out that the needling hurts, “That’s not pain!” As Flaws
explains clearly in his excellent Sticking to the Point, in China the practitioner first
asks if the patient is feeling the deqi sensation, and if so, will then add for
clarification “does it hurt or not (Tong bu tong)? Thus, in China, “Acupuncture
should be bu tong or painless. However, many Westerners will experience even
proper deqi as pain. In English, soreness, cramping, and heaviness are species of
pain. Whereas in Chinese, soreness (suan) or distention (zhang) is bu tong (p. 121)”.

Tong refers, Flaws stresses, to “a sharp, cutting, biting pain” and suggests incorrect
needle placement. If the patient feels tong, the needle is repositioned. To say “the
painless one” misses this cultural clarification, and implies one will feel nothing, and
in fact many of my patients who have been treated by other acupuncturists often
say to me early on in the first session: “ I thought you weren’t supposed to feel
anything?” This is further complicated by the fact that Japanese patients seem to
prefer very little if any deqi sensation, perhaps due in part to acupuncture being a
profession for the blind. To feel discomfort when being needled by someone who
cannot see might more readily be interpreted as the blind practitioner hitting a
nerve or vessel or tendon. This may in part explain why Japanese practitioners
prefer to focus on zhi qi, which the practitioner can often feel before de qi is
induced to a point where the patient feels it too strongly. All of the master
practitioners in this colloquium caused the patient to feel many things, but did so in
a way that was not threatening, not unbearable, even when the sensations were
quite strong. Liu and Seem clearly sometimes created quite strong sensations, akin
to the “It hurts good” sensations of deep therapeutic massage, but made it clear to
the patients with their comments and body language that this effect was to be
expected, and was a sign that treatment would be effective. Matsumoto, who
prefers to use very thin needles and quite shallow insertions with little if any deqi
sensations induced by the needle, still often creates quite powerful sensations with
her pressure, or with patchi-patchi induced fasciculations, for pain or stroke
patients, and the spreading sensations of her distal needling techniques can be
experienced as quite strange, and powerful, by many patients, even though there is
far less, if any, deqi. None of these practitioners was promising that patients would

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feel nothing, and seemed to imply by their presentations that to feel nothing would
mean doing nothing for the patient. Sensations were induced, change was initiated,
and the patients’ experiences were significant. Each practitioner seemed to work
like Matsumoto, to encourage the patient to see how “interesting” this strange
practice of needling and fire and scrapping was.

Selection of Points:

In November, 2003 TSCA and its “center for acupuncture educational research
(CAER) hosted a second colloquium, in conjunction with the Society for
Acupuncture Research’s annual research meeting at Harvard, focusing on
locating/utilizing active-reactive points as opposed to textbook points, a topic that
derives logically from the first colloquium.

At the College, we teach an amalgam of approaches to needling and to location of

effective points, most influenced by Matsumoto’s and Seem’s approaches, as two
very different styles, that encourages students to develop their own appreciation
for locating and needling points effectively.

While Shudo Denmei stresses “finding” effective points, at the College we stress
“effectively locating and stimulating” points. Perhaps this is very similar. But given
that each master practitioner will have her or his own “POINT PALETTE” of favorite
points, which Shudo shares with us in his newest book from his own experience, a
cynic might conclude, as some medical physician acupuncturists in England,
following in Felix Mann’s direction, do, that any point can be effective if one finds
actual, active/reactive points, or if one needles them properly. This is especially true
of highly reactive patients, termed “strong reactors” in England, where the most
minimal stimulation can yield fast and dramatic results. Such cynics believe one can
dispense almost totally with classic acupuncture theory, and Skelton’s presentation
at the colloquium underscored this view.

So whereas practitioners of meridian therapy might always feel for “active and
reactive points” whether on yin or yang meridians, I tend, more in line with TCM
needling and point location, to needle actual essential points based on falling into
the hole where they are classically described to exist, and then to stimulate to

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make the point active/reactive, as in the Ling Shu, by tonifying (first slow, then
quick) or dispersing (first quick, then slow). I always do this on distal regular
meridian points, mu and shu points and on local points along the regular meridians
that I select to treat symptoms in that area (Lu 1 and Sp 20, with Liv 14 for chest
congestion for example) which amounts to selecting empirical points for
symptomatic relief, to address the patient’s “manifestations” (signs and symptoms)
and to relieve their pain, dysfunction, discomfort and distress. This seems to me to
be somewhat different from the Japanese approaches to needling cited above, in
that it creates activity and reactivity, according to the patient’s tolerance level at
TSCA thus tapping into the point’s potentiality or “readiness to react”.

The Japanese traditions are highly influenced by the blind practitioner traditions and
the reverence for as mild a stimulation as possible, something that appears to align
better with Japanese patient expectations and preferences.

While practitioners of Japanese meridian therapy often feel for change in the pulse,
which can prove mystifying for patients and students observing such treatments,
Kiiko Matsumoto, who has worked in this country the bulk of her long career, has
developed a highly effective way of using changes in the Hara, which she uses as
the centerpiece of her acupuncture reframings, that also prods the patient’s bodily
felt sense of change. It is the patient reaction to the recheck of tapped tight tender
points including the Hara findings who agrees whether the tenderness has changed,
not the practitioner telling the patient the change has occurred based on what the
practitioner is feeling in the pulse.

Needling Yang Versus Yin Meridians:

I needle yang meridian tender points more strongly, until there is a propagation
away from the point, either down toward the foot or hand, or up toward the knee
or elbow depending on the location of the local obstruction. If the qi propagates all
the way to the symptomatic site, that is excellent, but not necessary and not the
most usual response. Research in China shows that qi can be made to propagate
more readily, and over a longer distance, by warming the skin if the patient is cold
(one could put mylar on the patient during the initial palpation and assessment
phase to warm them up, and put it back on once the needles are in place if it is cold

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out, or if the room is chilly), by stroking along the skin in the direction one wishes
to propagate the qi, and by applying pressure on one side of the point to induce the
propagation in the other direction. If one can get the propagation to extend three
inches or so, that is sufficient for a good effect.

I agree with Shudo that one does not need to get major reactions at all points
selected, and that a reaction at some key root as well as symptomatic points is all
that is needed. Wei Liu stressed this as well. One should pay special attention to the
essential distal points, and mu and shu (and related empirical) points, the root part
of the treatment, to have an effect that begins to draw patients into the process
(reframes them), engaging them in the change that is occurring, what they are
feeling, how things are moving. I then end with a large focus on release of the local
holding pattern, be it myofascial with a musculoskeletal or structural problem, much
like Travell’s work, or more subtle in a viscerosomatic/somatovisceral problem with
zangfu presentations, such as chronic fatigue or complex chronic respiratory,
gastrointestinal, gynecological, genitourinary and stress disorders. Holding patterns
in these cases are peeled away slower in most instances, especially by students and
new practitioners, by focusing on yinyang regulation (tiao qi).

What is different in APM, is that I stress also releasing the local holding pattern of
such internal and stress disorders, while a TCM approach might well just add local
mu and shu points without any attention to releasing the actual constrictions in
these areas. These local points are from the regular meridians, not the
tendinomuscular meridians, and often amount to treating the beginnings and ends
of the meridians (where taiyin, yangming etcetera come together, such as Lu 1 and
Sp 20 for taiyin respiratory signs and symptoms (manifestations) and St 2 and 3 and
LI 20 for yangming upper respiratory, sinus and allergy manifestations. This is based
on Yitian Ni’s clarification regarding regular meridians and their manifestations that
one can always treat local points for signs and symptoms in the area of that point,
based on the dictum: “the closer the closer”. These points are invariably excess, and
so I disperse with lifting and thrusting that focuses on the lifting motion and twirling
rapidly to break through the regular meridian obstructions and get Qi and Xue
moving.

This is in marked contrast to dispersing local tendinomuscular meridian ashi or

trigger points, where I use a technique I derived from trigger point dry needling a la

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Travell, to cause the muscle to fasciculate which is similar to Chinese “sparrow
pecking” technique, except that it is always done directly over an identified (and
strongly pressed to start the strain-counterstrain action at the site) trigger points,
which consists in then releasing the grasp and stretching/compressing slightly the
fascia over the trigger point with the non-needling hand, while pecking as if a bird
going in for seeds, 2-3 times rapidly at the site, then lifting and hovering a moment
before rapidly pecking again. This often causes the muscle trigger-point to
fasciculate and release in a way the practitioner and patient can feel, and one can
often observe.

This issue became complicated over the years as I was trying to build Travell’s
trigger points into the teachings here at the College, also because I jokingly refused
to refer to qi in the second year, while students were practicing trigger points with
me and my skills review staff. Students often become frustrated or confused as
third year students when I entered their treatment booths and showed them how to
cause qi to sink locally, or propagate, rather than seek a trigger point release. I
started to realize three years ago that many students thought I treated most points
as trigger points, because we spent so much time in year two skills practice
together practicing trigger point release. For this reason I have now taken over
direction of the three needling classes where first year students first learn how to
needle, to stress these various approaches to different sorts of points and to instill
a deep respect for the subtlety involved. It is hard for students to hold so many
different perspectives in mind at the same time in clinic, and we are therefore
attempting as much as possible, especially in grand rounds but in the new
Acupuncture Clinical Practice (formerly skills review) classes as well, to instill a
respect for classical Chinese and modern Chinese and Japanese needling
techniques, along with myofascial trigger point techniques, that challenge students
to take an energetic (classical) as well as a myofascial (modern) view of what is
happening at the tip of the needle, and how this effects change in those they treat.

Expectations:

In closing, it is essentially an issue of practice, and we now expect students, from

the first year on, to try to emulate senior practitioners not just in their treatment
strategies, but also in their actual techniques, and their ways of reframing what
patients feel during the course of a treatment. To educate patients to become

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better and better at receiving, acting and reacting to each session, from their own
bodily felt-sense of change.

It is crucial in the art of acupuncture, to place ones intention, ones heart or shen, on
the larger picture, with the goal of serving as a change-agent prodding the patient
to heal herself by removing some obstructions and blockages, by releasing them
from some part of their acute or chronic holding pattern. But as Shudo stresses in
the conclusion to his second book, “[t]his can be compared to art or calligraphy
where the work of an amateur and master is worlds apart even though the same
materials and tools are used. This is why acupuncture is an art. This being the case,
we can only needle each point with care on a daily basis to hone our skill (p. 241)”
In other words, the art of acupuncture involves our Intention, but this Intention is
what is omnipresent, in the background, how we start out each day, a silent
mindfulness meditation to ourselves, or a prayer to set the tone.

Our Attention on the other hand must be on the work, the practice, the art, the
practice of doing, while seeming to do nothing or wuwei, thus placing our attention
on the actual act of doing the practice, honing the skills that are essential to achieve
mastery. Lofty intentions with no skill will not work. Contrariwise, Shudo concludes,
“Technique is important, but the intention behind it is even more important (p. 242)”

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THREE
High Skills & Self-Cultivation

PREFACE:

In Tu Wei-ming’s chapter 13 (Humanity and Self-Cultivation, pp. 186-215) on "Yen

Yuan: From Inner Experience to Lived Concreteness" he shares a central Neo-
Confucian approach to inner work, meditation, and self-reflection focused on the
relationship in self-cultivation between cultivation of inner experience and being at
one with the 'great body (ta-t'i)' or deep structure of the Mind(and-heart) on the
one hand; and cultivation of the 'small body (hsiac-t'i) or surface-structure where
feelings and emotions play out in the Real of the outside world (Yen Yuan) or
transcendence beyond this body and the emotions where all 'human evils' reside
according to Chu-Hsi (Reflections on Things at Hand). (ibid pp. 205-211 especially).

Yen Yuen has a radically different view of ritual and its role, as well as sitting and
walking meditation, compared to Chu-Hsi which informed later Neo-Confucians like
Wang Yang-ming. Whereas Chu-Hsi sees the 'reverence' and awe for All that Is (he
Heavenly Principle, Coherence) as something one can only attain by cultivating the
'great body', and in silent meditation where one would ultimately connect with the
All through this rarefied practice and embrace the good, while most people would
remain at the surface where evil resides, Yen Yuen and WangYang-ming follow
Mencius in positing the goodness of human nature and the belief that anyone can
attain reverence by engaging in self-cultivation and renewing daily ones resolve to
walk the Way of the Sage which seeks authentic human relatedness which, when
attained, contains the heavenly principle. In this view, one could develop reverence
and awe for the All (T'ai Qi, Ti'en), the heavenly principle, the coherence in all things
in daily affairs, as Yen Yuan taught:

"The ancients taught men to do housework, and while doing housework to practice
reverence. They taught the proper ways of dealing with people, and in these to
practice reverence. They taught rituals, music, archery, riding, reading and

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mathematics, but in arranging the order of the rituals, in the law of the notes, in
studying the bow, in control of the horse, in pounctuation, and in calculation, there
was nothing without the practice of reverence. Therefore it is said, 'Be reverent in
handling public affairs,' 'Be reverent in your daily affairs,' and 'Be truly reverent in
your action.' All these emphasize the constant practice of reverence by the
complete devotion of the body and the mind. If the traditional methods of the
ancients are being laid aside and the practice of reverence is sought in quiet-sitting,
meditative self-control, slow-walking, and soft-talking, it is like using the empty form
of a Confucian term to do the real work of Buddhism (ibid, pp 208-209)."

The discussion about the cultivation of 'inner experience' and 'lived concreteness'
and Yen Yuan's critique of 'quiet-sitting' starting on pages 200-201, where he
stressed that it is only by practice of something practical, something useful,
something that can enable one to better engage authentically with self and others
(the practices listed above, which some Daoists would add other martial arts to).
The discussion of Yen Yuan's insistence on ritual practice in any of these arts as an
'incessant commitment to self-perfection' is "a daily, in fact hourly affair, and by
necessity it has to assume a concrete form is also of critical importance: “Of
course there is little excitement in such trifling acts as rising early, dressing
properly, eating moderately, refraining from superfluous talking, walking at an
unhurried pace, sitting straight, and keeping a diary consistently. But like the training
of a lute virtuoso, to integrate all these seemingly fragmentary acts into a holistic
expression of the ritualized personality requires a lifetime of commitment [...] The
act of a specific ritual practice is not only a record but also a self-revealing gesture.
It in a sense offers a solution to the perennial Confucian problem of 'inner' and
'outer' (nei-wei), for it bridges the gap between an inner effort of self-cultivation
and its outer manifestation in the family, the state, and, indeed, the entire universe.
[...] After all, to study the lute is to acquire a skill, but to engage in ritual practice is
to master oneself. The art one must learn in mastering oneself is that of self-
cultivation. Unlike the study of the lute, one cannot for a minute lay down one's
instrument and rest. The moment one forsakes ritual practice, one has already
deviated from the course of self-cultivation. Constant practice does not guarantee
a competent performance (ibid, pp. 200-201)."

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   166  
14] The Spirit Uprooted—Classical Chinese
Medicine Loses its Humanity

The Problem:

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).

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.

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 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

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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).”

Larre and de la Vallee paraphrase the oft-quoted 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.

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.4-5).” 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).”

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).”

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

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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).”

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).

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.

Rossi and Maciocia each lay out classical and modern categories of shen disorders
(patterns 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.

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).”

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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).”

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).”

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.

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”:

• 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);”

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 • Spiritlessness: Lack of mental energy, abnormal breathing, apathy, “torpid
expression, dark complexion and dull eyes, low voice, slow, halting speech,
and incoherent response to 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).”

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. 26-27 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.

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ZANG /Spirit EMOTION S&S DEFICIENCY EXCESS

Anxiety, Fear, terror, Sadness Uncontrollable

Heart/shen worry, lost control, laughter
thoughts and the muscles
apprehension are consumed
injure shen

Oppression Restlessness The four limbs Abdomen

Spleen/yi and anguish and disorder, do not swollen,
that do not the four limbs function, the difficult
dissolve injure do not lift up five organs menstruation
yi are not in and urination
harmony

Mania and
oblivion,
Sadness and abnormal
Liver/hun sorrow behavior, Fear Anger
convulse the genitals
center and retract,
injure hun muscles
contract, ribs
do not lift up

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 Euphoria and Mania, the Nose Laboured and
Lung/po joy without mind does not obstructed, hoarse
limits see others, passage of air breathing,
injure po the skin dries difficult, Fullness in the
out breath short chest, lifts the
head to breath

Kidney zhi Intense and Forgetfulness,

incessant flanks and
anger injure spinal column Reversal-jue Swelling, the
zhi painful, five zang are
Kidney Cannot bend not calm

jing Fear and forward or

apprehension backward
injure jing

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 ethico-religious 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.

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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.

In these traditions, which Confucian scholar Tu Wei-ming refers to as “humanity and

self-cultivation” 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.

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
(Tu Wei-ming, Humanity and Self-Cultivation: Essays on Confucian Thought, Cheng
& Tsui Co., Boston, 1978, pp 6-7).

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 self-cultivation is therefore deemed simultaneously
an act of internal self-transformation (ibid, p. 85).”

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

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syncretic culmination of the ‘Three Teachings’ (ibid)” that spanned the 11th to the
17th centuries.

In his detailed study of the Neo-Confucian Master Wang-Yang-ming (1472-1529),

Tu-Wei-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 self-effort and a
teaching which must be “embodied”—a “learning of the body and the 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 self-knowledge (ibid).”

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!”

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”,

  175  
Master Matsumoto has shown great reluctance to submit her teachings based on
the sum total of her inner experience to rigid formulas. As Wang Yang-ming 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.

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 East-Asian 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.

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, feeling and doing when they
practice in clinic. And I inevitably come down on the side of better practice.

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

  176  
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.

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.

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.
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 self-control, 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 Wei-ming 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).”

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.

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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 Studies PhD mentor
at Harvard) and his work.

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.

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.

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:

1. “One should take an easy-going attitude toward life and have few desires;
2. One should form good eating habits;

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 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 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).

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.

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.

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.

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 to master these skills,
which he relegated to the treatment of serious internal diseases with Chinese
medicinals.

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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 Signs & Point strategies AOM Lifestyle
Symptoms Coaching

________________ ______________ _______________ ______________

running on empty, YinYang Regulation Counsel patient to

Du Mai Excess type-A, adrenal start stress
exhaustion (drops- Jing: SI3/BL 62 for reduction/relaxation
Kidney Yang/Heart dead in bed at night) du and yangwei Mai response activity for
Protector overall agitation
Dysfunction works and plays
hard, lives world Ying: Kid 2(Fire) and Take hot bath with
Water/Fire Imbalance muscularly, reacts to 3(source)/ying and sleep inducing bath
world somatically shu; salts, sleepy time tea
Precipitating factors Bl 58 (luo); BL 23 or other soporific
may be trauma of a very productive, (tonify or disperse while meditating or
physical or very active at work, carefully if lower listening to soothing
emotional nature sports, socially back muscles are music last hour
(car accident, attack rigid) on right before bedtime
by dog, abuse) Ever-Ready Bunny especially, and BL
14-43 on left (Kidney Stress importance of
Superman, Yang/Heart Protector solid sleep to restore
Superwoman, dysfunction adrenals
Supermom or Dad
Patient Complaint
End result—Adrenal Engage in physical
collapse and CFS To above add BL 18, activities that distress
20/triple heater muscles per exercise
regulatory; SP 6 and tolerance level (do
Patient Complaints: Ht 7 for insomnia; not exercise at night
Local multifidi if if suffering from
o Neck & back spine is irritated insomnia)
pain in stress from stress
muscles Do stretching for
o Lowback Can turn over at end tight neck, back,
syndrome and do yintang for lumbosacral
with adrenal 10 more minutes. muscles

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 exhaustion-
back goes Wei level shallow Get pillow-top
out under oblique needling to mattress or egg-
stress most tender points in crate mattress
o Fibromyalgia fibromyalgia or cover; side lying
o Insomnia and highly sensitive or pillow, or cervical
agitated reactive patients, pillow if sleeping
sleep leave needles only 5 face up
minutes
Suggest
Release most hypnotherapy,
symptomatic TrPs EMDR,
per patient’s de Qi psychotherapy to
tolerance in stress deal with behavioral
muscles (traps, and post-traumatic
paraspinals, gluteals, issues
piriformis)

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Diaphragmatic Signs & Point strategies AOM Lifestyle
Constriction/ Symptoms Coaching
GI Distress/
chong mai middle
heater dysfunction
_______________ _______________ ______________
_______________

YinYang Regulation
Constrained Counsel patients that
tight rectus &
Liver Qi “their problem is
oblique muscles- Jing:
their Life”
viscerosomatic
Up-regulated
SP 4(R)/Per 6(L) for
SNS overacts on PNS Dr. Shen advice- eat
tight chest chong and yinwei
mai regularly 3 x day,
(pectoralis level with
Taiyin/YAngming never late at night,
ST 18-Liv 14)
Circuit dysfunction never while working
Ying:
at desk or standing,
Tight SCM (plum pit
Liver/Spleen slowly, quietly
Qi) LI 4/Liv 3
dysfunction
Liv 14 (and GB 22 or
Do not indulge in
Per 1), SP 6
Spinal Irritation and fatty foods or
Patient Complaints:
up-regulated SNS alcohol
may be precipitating Patient Complaint
o IBS, bloating,
factors for this Check out if they are
undigested ST 36-39 &
pattern of visceral wheat, lactose, or
food, ST 25; CV 10, 12, 13;
agitation corn intolerant or
diarrhea ST 24-18 on left
have celiac disease
and/or ST 25 (Bil) all where
constipation, tight and constricted
Do not drink ice-cold
abdominal (dispersal, not TrP
drinks
pain, gas needling)
o Reflux or
In reflux and GERD,
GERD For Xu-Li, add CV 12,
raise back of bed 6”
o Relief in ST 14-16(left), ST 18
to prevent acid
Crohn’s (L); ST 44-43 where
reflux
Disease or tender either or both
colitis sides
Above all, teach
abdominal breathing
For heartburn to
as AM and PM stress
chest, add CV 18to
reduction activity

  183  
 17 and lateral Kid before arising and
points; or Kid 22 and falling asleep, while
Per I if left sided in bed face up with
heartburn knees bolstered with
pillows, or whenever
hyperventilating (5
minutes)

  184  
Pelvic collapse Signs & Point strategies AOM Lifestyle
chong, dai, ren Symptoms Coaching
dysfunction
Lower heater
______________ _______________ ______________
dysfunction
________________
Flaccidity in middle YinYang Regulation Coach patients to
heater abdominal develop core
Spleen Qi Sinking with
muscles, tightness Jing: strengthening
or without
and constriction routine for middle
Constrained Liver Qi
below navel, Chong-Dai Infinity heater; stretches for
in Middle heater as
pressure and pain at Treatment: SP lumbar region;
possible precipitating
Kid 15.5 to Kid 11 4(R)/Per 6(L) for
factors for this
and ST 26-30, and chong mai; GB Yoga or Qi gong for
pattern of visceral
CV 7-2 (chong mai 41(L)/TH 5 (R) for lower heater
agitation
lower heater dai mai strengthening
branch), tight lower
external obliques
(dai mai); tight linea Ying: counseling/therapy
alba (ren mai) for sexual
Three leg yin source dysfunction
points SP 3, Kid 3,
Liv 3; Sp 6 and 9; Liv counsel women with
Patient 9 for constrained vulvadynea to seek
Complaints: Liver Qi in lower PT specializing in
heater; manual therapy who
o Prolapsed specialize in this
organs:
Patient Complaint
post-
birthing;
uterus,
Local chong, dai and
bladder,
ren mai points in
right kidney,
lower heater; local
hemorrhoids
Liv, Sp, Kid meridian
, hernias
points in lower
(Shan)
heater; local points
o PMS,
over visceral
amenorrhea,
irritation (ST 30 for
disrupted
ovaries, CV 4-6 for
menses,

  185  
 infertility uterus etcetera);
and CV 2 down, to right
impotence and left to propagate
o prostatitis, Qi for lower heater-it
vaginitis, is.
cystitis,
pelvic floor
syndrome;
o sexual
dysfunctions
such as
erectile
dysfunction
or frigidity

  186  
Cardiac Alarm Signs & Point strategies AOM Lifestyle
Upper-Lower heater Symptoms Coaching
dysfunction

_______________
______________ _______________ _______________

Kidney Yang/Heart
Free-floating YinYang Regulation Coach patients to do
Protector Dysfunction
anxiety, dread, fear abdominal breathing
of impending doom Jing: as above

Kidney/Lung Qi
Shallow breathing, Chong-Dai Suggest stress
Dysfunction
hyperventilation, Treatment: SP reduction or
heart palpitations 4(R)/Per 6(L) for relaxation response
induced by stress panic attack, anxiety, programs for coping
palpitations in with stress
Pelvic collapse and/or
Non-cardiac chest patients with Kidney
diaphragmatic
tightness and Yang & Heart Suggest meditation,
constriction may be
discomfort from Protector yoga, Qi gong
precipitating factors
diaphragm to under dysfunction
for this pattern of
armpits and sternum Suggest mindfulness
visceral agitation
(3 yin muscle Ren & Yinchiao mai: training for
channel referral Lu 7/Kid 6 for practicing anytime/
patterns) with shallow breathing anywhere
tightness in and hyperventilation
rhomboids and syndrome in patients Suggest
paraspinals in upper with Kid/Lu Qi biofeedback,
back dysfunction hypnotherapy,
EMDR,
Psychotherapy for
Patient Ying/Patient behavioral and post-
Complaints: Complaint: traumatic issues

o Anxiety, Kid 15.5 for

panic attack, adrenals;
heart
palpitations; Per 4 &5 with CV 18-
o cardiac 17 for chest
neurosis; constriction

  187  
 o costro-
chondritis 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

  188  
   189  
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.

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.

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
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).

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).

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 (…) (ibid).” Other studies cited find that
regular church attendance in healthy individuals reduces mortality by some 25%,
and that regular church attendance can reduce cardio-vascular disease, which may
be related to the “healthier lifestyles adopted by churchgoers (ibid, p. 678).”

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

  191  
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 mind-body 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 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.

  192  
15] The Dao of the Sages of Antiquity

THE PROBLEM:

As I slowed down the process of these reflections in Thanksgiving, 2010, after

having discovered the Chinese text, the Zhong Yi Xue Gai Lun (that was translated
into Vietnamese and then into French, and then by me for the Quebec Institute of
Acupuncture into English), I started to realize an “error” had been made by Van
Nghi in his translations of this text. Aiming his work at the French Medical
acupuncturists, who were fascinated by the story of “human energetics” as laid
down by Soulie de Morant, Lavier and Chamfrault, and who often practiced
European natural therapies like herbology and homeopathy, Van Nghi omitted the
sections of the Zhong Yi Xue Gai Lun on herbal medicine, thus making the text read
mainly like an acupuncture textbook. Felix Mann, also a medical doctor in England,
did the same years earlier, when his Meridians of Acupuncture, which drew heavily
from the Zhong Yi Xue Gai Lun which he studied in PRC in 1962, only 4 years after
its publication, also only referenced the sections on acupuncture, the meridian
system and how to treat with needles and fire, and omitted herbal medicine or
daoyin practices.

The Zhong Yi Xue Gai Lun was, however, the first textbook for the new TCM
colleges on Chinese Medicine (zhong yi) as opposed to Chinese Acupuncture &
Moxibustion (zhen jiu). Prepared by academies of Chinese Medicine by scholars in
the field, it contained the Daoist naturalist theories of Heaven, Earth and Man and
the Taiji, Yin and Yang and the Five Phases, as well as theories on calculating the
current stems and branches of the Chinese calendar to predict climate and weather
patterns and live accordingly. This text also included detailed sections on five phase
pattern discrimination and treatment, and on treatment of the entire meridian
system of regular, divergent and luo vessels, muscle channels and the 8
extraordinary meridians. The early books on acupuncture that came out of the PRC
omitted most of this naturalist theory, especially on the 5 phases and the meridian
system as a whole. Qi Gong, which had a chapter devoted to its practice in the
Zhong Yi Xue Gai Lun, was also omitted from these early TCM texts, apparently

  193  
because they were based on “feudal” (read Daoist/religious) theory that was not
consistent with Maoist materialism.
What had never occurred to me was that TCM, following Maoist doctrine, severed
all references to the wisdom of the sages of antiquity, and the practices of self-
cultivation that figured prominently in the works of Lao-Tzu and Confucius. Chinese
medicine had not only lost its soul, but its very Chineseness.

Returning to the Sources/Setting out on the Way

While few English-speaking scholars of Acupuncture and Chinese Medicine read

classical Chinese, we are fortunate to have philosophical discussions of the key
concepts of acupuncture and Chinese medicine from the late Claude Larre, a Jesuit
priest and former president of the prestigious Institut Ricci, which is responsible for
translation of classical Chinese texts, and Elisabeth Rochat de la Vallee, now
president of the Institute and a long-time colleague of father Larre who both taught
at the Quebec Institute of Acupuncture. We are also fortunate that Paul Unschuld, a
German scholar of classical Chinese medicine, has overseen translations of the
Huang Di Nei Jing Su Wen and the Nan Ching and is currently overseeing the team
that is translating the Huang Di Nei Jing Ling Shu. We are also fortunate to have
excellent philosophical translations of Daoist and Confucian texts by scholars Roger
T. Ames and Henry Rosemont Jr, among others, and texts on Neo-Confucian
masters, such as Wang Yang-ming by Tu Wei-ming, who served as a mentor to
Linda Barnes during the religious studies part of her dual doctoral degree and who
is now teaching his work on “humanity and self-cultivation” at the college.

Starting near the beginning, the first chapter of the Su Wen finds Huang Di, the
Yellow Emperor, asking Qi Bo, the “Heavenly Master” (ostensibly a Daoist sage)
how it is that “the people of high antiquity” lived to be over 100 years old while the
people today live only half that long.

“Qi Bo responded: ‘The people of high antiquity, those who knew the Way, they
modeled [their behavior] on yin and yang and they complied with the arts and the
calculations. [Their] eating and drinking was moderate. [Their] rising and resting had
regularity. They did not tax themselves with meaningless work. //Hence they were
able to keep physical appearance and spirit together (SW, pp. 30-31).”

  194  
Wang Bing, the compiler of the edition of the Su Wen translated by Unschuld, was a
Daoist, and felt that this discussion of following the Way was referring to self-
cultivation, advocated by Daoists and Confucianists well before the Huang Di Nei
Jing was compiled.

Huang Di goes on to ask Qi Bo about the people of high antiquity who attained their
full 100 years, including “true men”, “accomplished men”, “sages” and “exemplary
men”(SW pp. 42-44).

In their philosophical translation of The Analects of Confucius, informed by the

Dingzhou fragments and other archeological finds, scholars Roger T. Ames and
Henry Rosemont, Jr. define these stages of commitment to the Way of the sages in
a way that sounds identical to this first chapter of the Su Wen, thus pointing to the
fact that these concepts from antiquity were made their way into Daoist and
Confucian teachings on the Way.

Lest we think that this discussion of setting out on the Way of the sage is
straightforward, Confucius himself is reported to have said: “In the niceties of
culture [wen, character included in the translation], I am perhaps like other people.
But as far as personally succeeding in living the life of the exemplary person (junzi,
character included in the translation), I have accomplished little (Analects 7.33, p.
118).”

Confucius is reported to have continued thus: “How would I dare to consider

myself a sage (sheng, character included in the translation) or an authoritative
person (ren, character included in the translation). What can be said about me is
simply that I continue my studies without respite and instruct others without
growing weary (AC, 7.34, p. 119). This “commitment” to staying on the Way, to
lifelong learning is the key to the way of the Sage.

One who has walked the Way a long time and practiced daily, and who becomes an
exemplary person (junzi) has achieved calmness of the “heart-and-mind” and “is
calm and unperturbed; the petty person is always agitated and anxious (AC 7.37, p.
119).”

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Ames and Rosemont, Jr. clarify that at least three of these concepts about
“categories of persons” were in use before the time of Confucius and thus
represent the wisdom of antiquity and serve as the very bedrock of what it means
to be a human being in China.

These three categories of persons who walk the Way as road builders are the shi
(“scholar apprentice”), the junzi (“exemplary persons”) and the sheng or
shengren(“sage”). These three are contrasted in the classics, and in Confucius’
work, to the xiaoren (“petty person”).

The scholar apprentice (shi), Ames and Rosemont, Jr. clarify, “has set out on a path,
a road, but he still has a long way to go, and there is much yet to be done (p. 61)”.
This path is a spiritual path of self-cultivation, where material well being and “selfish
desires” are extirpated.

In the Analects, our translators clarify, passages about the scholar apprentice show
that this person is striving to become an exemplary person (junzi). The latter has
travelled a longer way and has taken on several roles in society, making him a role
model for others to learn from. “A benefactor to many, he is still a beneficiary of
others like himself. While he is still capable of anger in the presence of
inappropriateness and concomitant injustice, he is in his person tranquil […] and is
therefore a respected author of the dao of humankind (ibid, p. 62).” Reaching the
status of the junzi is as far as most of us can attain, but there is “an even loftier
human goal, to become a ‘sage’ or shengren”, a “distant goal indeed (ibid).”

What is striking about this Confucian view of one who sets out on the Way from
being a scholar apprentice to aspiring to become an “authoritative person (ren or
shengren) is that it is a project undertaken with others. “For Confucius, unless there
are at least two human beings, there can be no human beings (ibid, p. 48).” The way
or dao of the authoritative person “is not something we are; it is something that we
do, and become. Perhaps ‘human becoming’ might thus be a more appropriate
term to capture the processional and emergent nature of what it means to become
human. It is not an essential endowed potential, but what one is able to make of
oneself given the interface between one’s initial conditions and one’s natural, social,
and cultural environments (ibid, p.49).”

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The authoritative person, the ren or shengren is engaged in the process of
“growing” human relationships into vital, robust, and healthy participation in the
human community (ibid).”

Dao, seen in this Confucian sense as the “way of becoming human” is not a “given”.
The “authoritative person must be a ‘road builder’, a participant in ‘authoring’ the
culture for one’s place and time […]. It is this creative aspect of ren that is implicit in
the process of becoming authoritative for one’s own community (ibid, p. 50).”

This discussion based in antiquity and carried forth by Lao Tzu, Confucius and later
Daoists and Confucians is most likely what the classical Chinese medical texts like
the Yellow Emperor’s Classic are referring to. Grounded in such a rich and long
historical foundation, classical Chinese medical texts need merely refer to the sage
to evoke this entire Way of the sage.

But this way has been lost, Qi Bo clarifies in the first chapter of the Su Wen.
Doctors of antiquity were ostensibly treating people who were engaged in self-
cultivation to achieve a calm heart-and-mind by transforming the emotions and
following a life in tune with Heaven and Earth and the seasons, thus dealing
themselves with the ordinary problems of the physical body through daoyin self-
cultivation practices today referred to by some as qi gong, healing sounds and
meridian patting. When they went to a doctor, it was with more serious problems
requiring “high skills”, and doctors focused on these high skills that treated the shen
(spirit).

Today, Qi Bo clarifies, people are not engaged in self-cultivation, and hence they
come to the doctor for all sorts of problems they should be able to handle
themselves, which are not potentially fatal, but which now preoccupy the Han
dynasty practitioner.

I reread the first page of the Ling Shu very differently than I did a year ago, for the
ordinary skills that preoccupy the typical doctor are what he must call upon to treat
problems that, while not fatal, have caused undue pain and suffering for those
suffering from a new city-state lifestyle. High skills, which would be out of place
with such citified people, would slowly disappear without the need, or the
knowledge to put them into action. The discussion of “ordinary” and “high” skills in

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the first chapter of the Ling Shu, which is where I started the reflections in THE
OTHER ACUPUNCTURE, is a repeat of the laments in the Su Wen for a time when
people doctored themselves and only called upon physicians when things were
very serious.

This sounds so remarkably similar to our own times, and should make us sit up and
take notice.

The lesson here is that if people learned daoyin self-cultivation and life nourishing
practices and practiced these daily, and lived more in harmony with nature and
followed moderation in all things, and focused on authentic human relatedness and
becoming human in relationship with others, they would not suffer from many of
the chronic disorders of stressful living. If this were true, practitioners of
acupuncture and Chinese medicine would be able to devote more time to serious
disorders and to pressing problems like weight, diabetes, asthma, and depression.

One way of changing our current practice of Acupuncture and Oriental Medicine in
North America would be for AOM colleges and their graduates to teach people
how to engage in these Daoyin practices and become more self-reliant, hardier,
less reliant on medical, CAM or AOM treatment for their own well-being, starting
with Daoyin practice on the part of AOM practitioners.

In the denigration of the “ordinary” skills of acupuncture in the Yellow Emperor’s

Classics, I believe we must see a critique of how “petty” people were becoming in
the new city-life, where they ignored the wisdom of the past and threw caution to
the wind as the frenzy of this life-style took its toll.

The Su Wen summarizes the Dao of living in tune with the wisdom of the sages of
antiquity as quoted above, and goes on to lament how differently people of today
are who have lost the Way:

“The fact that people of today are different is because they take wine as an
[ordinary] beverage, and they adopt absurd [behavior] as regular [behavior]. They
are drunk when they enter the [women’s] chambers. Through their lust they exhaust
their essence, through their wastefulness they dissipate their true [qi]. They do not
know how to maintain fullness and they engage their spirit when it is not the right

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time. They make every effort to please their hearts [but] they oppose the [true]
happiness of life. Rising and resting miss their terms (SW p. 33).”

The text goes on by clarifying that such a reckless and haphazard lifestyle and
overwork lead people to only live to half their lifespan. The sages of antiquity
stressed the importance of guarding ones essence and spirit, and of a calm heart-
and-mind. As the Su Wen goes on, in this way, “the mind is relaxed and one has few
desires. The heart is at peace and one is not in fear. The physical appearance is
taxed, but is not tired (ibid p. 34).” Commoners accepted what they had to eat and
drink, and their clothing and station in life and did not long for a different lifestyle. In
this way people knew true satisfaction. Unschuld adds Wang Bing’s decidedly Daoist
take on this passage here: “They had reached a state of no request. That is the so-
called ‘satisfaction of the heart’. Lao zi has stated: ‘There is no greater catastrophe
than not to know satisfaction. And there is no grater calamity than to long for gains.
Hence, those who know the satisfaction of satisfaction, they will be satisfied
constantly.’ Hence, those who do not speak of being satisfied with material items,
they have knowledge of [true] satisfaction. Those who are satisfied in their hearts,
they know satisfaction. Not to give free rein to desires, this is identical with the
natural state of things’ (Ibid, p. 35).”

Coping with Daily Life

If Daoyin practices of self-cultivation are not medicine, then what they treat are not
diseases strictly speaking. And if people before the Han dynasty and before the
Yellow Emperor’s Classic was written routinely engaged in self-cultivation, of the
body and mind and all the senses, and strove to attain a calm heart-and-mind, then
the afflictions of the heart-and-mind would have been far fewer, and related to
serious events, of loss, of suffering, of despair, rather than to the common travails
of city-life and its stresses, to use a very modern but perhaps appropriate word.

In such a Utopian vision the average person would not experience undue
discomfort or distress from the strains of an active life, and would only seek
medical care rarely and only when disease struck which could not be handled alone.
In such a society, everyone would potentially possess ordinary skills of meridian

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and point patting, healing organs with sounds and breathing, maintaining a healthy
sexual practice, while avoiding excesses.

This is remarkably similar to modern day North American mind-body and stress
reduction approaches, which advocate self-care of practitioner and patient alike
with practices like meditation, yoga, T’ai-Qi, derived from the East; and Ericksonian
hypnotherapy, NLP, Pilates and Gyrotonics from the west to name a few practices
that have entered the domain from New Age Medicine, to Holistic Health, to
Complementary and Alternative Medicine, to Integrative Medicine, and now to the
m ore inclusive Complementary and Alternative Health Care.

What is clear and quite remarkable is that Classical Chinese Medicine was
predicated upon Self-Cultivation, which it lost as life became more focused on the
busy city-state.

AOM practitioners who return to these self-cultivation practices themselves, with

the aim of sharing these practices with their patients while maintaining Self, would
be in a position to offer an ancient approach to self-care consistent with their
medicine, with an openness to parallel practices from East and West to suit the
times and their patients’ proclivities.

Way of Learning Classical Chinese Medicine

One of the most powerful things about the slow-down in writing THE OTHER
ACUPUNCTURE, as a monthly affair, is that it gave me time to carefully reflect on
how the college itself abandoned self-cultivation practices that it taught in the fist
decade, as the North American TCM Cultural Revolution took its toll, making TCM
an orthodoxy to be fought against, lest the ability to teach and learn anything more
classical, or from other East Asian or European approaches, be shoved into
oblivion.

By April of 2011, several students asked the college and me to make some online
resources available to them through our library and learning resources, to render
possible access to information on a return to the classics and classical Chinese
medical practices. This lead to a college subscription to Classical Chinese Medicine,

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a web-based resource founded by Heiner Fruehauf, PhD, director of the School of
Classical Chinese Medicine of Portland’s National College of Naturopathic
Medicine.

This also lead, only recently, to a link from the college’s library webpage link to the
Association for Traditional Studies video series of Classical Chinese Medicine and
Daoyin practices with Andrew Nugent-Head, MSOM, ATS’s Founder and President.

Through this interactive process, and a student’s familiarity with ATS and the videos
of Andrew Nugent-Head, I contacted him about attending his San Francisco
seminar slated for Spring 2011, introduced myself and asked if he and ATS would
ever consider him teaching at the Tri-State College of Acupuncture In New York
City.

Within a few months of almost daily email dialogue between Andrew Nugent-Head
and myself, he and ATS arranged for him to teach his MaDanyang Heavenly Star
Points Seminar, and to spend 3 subsequent evenings with faculty and recent grads
exposing them to the 8 Healing Sounds Daoyin Practice, and to a Grand Rounds
treatment so that we might see how he worked. I attended all of this, was a
demonstration model for the weekend seminar three times and was treated in the
Grand Rounds. The synchronicity of where the college wished to go regarding a
return to Classical Chinese Medicine and Daoyin self-cultivation practices, and of
Andrew and my deep conviction that acupuncture is physical medicine and that all
of Classical Chinese Medicine is rooted in an embodied way of learning and
practicing, led to a joint venture between ATS and the college. In this collaboration,
Andrew Nugent-Head has already committed to training our physical medicine
clinical faculty in his tangible Qi approach, grounded in Daoyin practice, and to two
cycles of a revived 300 hour post-masters advanced credit bearing course that will
eventually be one of the major areas of concentration that graduates will be able to
select as their major in the college’s eventual First professional Doctoral Program
to start I July 2012 and run for 10 months each time. It is the aim of this
collaboration that at the end of the second cycle, a sufficient number of college
faculty will be trained so as to be able to train MSAC and eventual DAc students in
the foundations of Andrew Nugent-Head’s training, so that he would focus on
training 4th year doctoral students and other experienced licensed AOM-
practitioners in more and more advanced skills.

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This will greatly enhance the college’s Strategic Plan goals of bringing the classics
back into our training, including a study of Confucian and Neo-Confucian
approaches to cultivation of the Heart-and-Mind, a required first year course in the
“human dimension” that Confucianism represented throughout Chinese history and
which constituted its Chineseness, and a revamping of AOM bodywork and Daoyin
courses to be more tangible and integrated into the acupuncture training.

As a core group of the college’s faculty embark on study with Andrew Nugent-
Head, and engage in regular Daoyin practice themselves, the college will begin to
be in a position to endorse and reinforce a very Confucian Way of Learning
Classical Chinese Medicine.

In this Way, these faculty, me included, will have to commit to becoming ‘scholar-
apprentices’(shi), those who aim to become ‘exemplary practitioners’, role models
for students, junzi. In this process, we will have to take a deep look at our
commitment to lifelong learning, to our practice of self-cultivation, and to our goal
of becoming inspirations for future practitioners.
As I looked at the definitions of exemplary persons, of junzi , I realized I could
never hope to attain a higher position than that. While I had indeed become a road
builder in the AOM profession over the past three decades, and helped establish
and usher along this new field, which the authoritative person (shengren) would be
expected to do, I was still, and perhaps always will be prone to anger and will need
to work at all times to attain a calm heart-and-mind. I recognize that like my own
role model in all this, Neo-Confucian Wang Yang-ming, I must attend to my own
self-cultivation at all times. I also have a lot to learn, as a scholar-apprentice, from
those like Andrew Nugent-Head who have studied and learned in pre-PRC Chinese,
with a sense of the classics one can never get otherwise.

What is exciting is that the college is in a position to infuse its training in Disciplines
of Mind with Neo-Confucian self-cultivation and Embodied Learning parallel to the
Tacit Dimension espoused by the late Donald Schon, founder of Reflective Practice,
and his precursor, Alfred Polaani.

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16] Self-Cultivation East and West—the Human imperative

THE PROBLEM:

It has been one year since I have been working on these Reflections. What started
as a query into what Traditional Chinese Medicine cast out, or willfully forgot in
order to forge a New Medicine for a new era in Chinese history, has transformed
into a deep appreciation for the very Chineseness of classical Chinese medicine,
informed by a Daoist for sure, but especially Confucian understanding of Humanity
and Nature. As I dig deep into Neo-Confucian Wang-Yang-ming’s Instructions for
Practical Living, which he demands, I feel as if I have encountered a colleague, a
comrade in arms, a friend. I have only encountered this feeling once before when I
was introduced to the work of Nietzsche, in spring 1973, starting with the
Genealogy of Morals, a gift from Michel Foucault that inaugurated me into the
Nietzschean project. As I read Wang-Yang-ming my training in Nietzsche resonates,
and it was only a few weeks ago when I reread Part II of Michel Foucault’s last
book, The Care of the Self, on “self cultivation” in the Golden age of Rome in the
first two centuries of our era, that I recognized to what an extent Nietzsche before
him, and Foucault came to focus heavily on what the ancient Romans and Chinese
referred to as self-cultivation: the relation of Self with Self and Self with Others,
ones humanity. In this Reflection, I will compare and contrast Foucault’s study of
self-cultivation in Rome, and Wang-Yang-ming’s Neo-Confucian re-articulation of
this ancient Chinese practice.

Self-Cultivation in Rome

Foucault was known for musing that the only statement a human being could never
utter is “I died”. The ability to speak about ones death, or after ones death seemed
to intrigue Foucault, who was my mentor and friend from 1973 when he taught at
State University of New York at Buffalo where I was pursuing a PhD in French
Studies, until 1983 shortly before he became the first prominent Frenchman to die
of the newly labeled AIDS. That was June 1984, and a few months later his last
volume in the ‘history of sexuality’ appeared in French as Le souci de soi translated
two years later into English as The Care of the Self.

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Like Nietzsche’s last work, this last in a series by Foucault was published
posthumously, and so each did find a way to have the last word, to speak from the
grave as it were, to send their reflections into the future resonant with their
powerful voices and minds.

Why this preoccupation with Self after such groundbreaking philosophical works
one might ask? Foucault would perhaps answer, as Confucians and Neo-Confucians
would, that there is no preoccupation to match this one.

“This ancient Western ‘cultivation of the self’ can be briefly characterized by the
fact that in this case the art of existence—the techne tou biou in its different
forms—is dominated by the principle that says one must ‘take care of oneself’”,
which was a very ancient theme already in Greek culture Foucault tells us (The Care
of the Self, p. 43).” And in his Apology, “it is clearly as a master of the care of the
self that Socrates presents himself to his judges. The god has sent him to remind
men that they need to concern themselves not with their riches, not with their
honor, but with themselves and with their soul (ibid, p. 44).”

While Greek and Roman philosophers, who saw their work as practicing the “art of
existence”, where care of oneself figured prominently, were the first to engage in
this practice, this became a rather widespread endeavor to which any learned
person could aspire and entered into many different and competing doctrines that
instructed one in the art of living. “It also,” Foucault tells us, “took the form of an
attitude, a mode of behavior; it became instilled in ways of living; it evolved into
procedures, practices and formulas that people reflected on, developed, perfected
and taught. It thus came to constitute a social practice, giving rise to relationships
between individuals, to exchanges and communications, and at times even to
institutions. And it gave rise, finally, to a certain mode of knowledge and to the
elaboration of a science (ibid, pp. 44-45).”

In the first two centuries of the imperial epoch this “’art of living under the care of
the self’ reaches its high point Foucault goes on, “it being understood, of course,
that this phenomenon concerned only the social groups, very limited in number,
that were bearers of culture (ibid).” This cura sui, this care of the self had several
essential elements:

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  As an injunction to philosophers in many doctrines that called for ‘turning
and returning to oneself; in his Discourses, Epictetus stressed: ‘Man [ ] must
attend to himself; not, however, as a consequence of some defect that
would put him in a situation of need and make him in this respect inferior to
the animals, but because the god [Zeus] deemed it right that he be able to
make free use of himself; and it was for this purpose that he endowed him
with reason (ibid p. 47).” Hence philosophers sought out others who might
instruct them in this art and practice;
 It takes time, and one must decide what portions of the day to devote to it,
upon rising, to reflect on what lies ahead, or in the evening, to reflect on
what has transpired. The possession of oneself in such moments was viewed
as central to a happy existence and time well spent. “This time is not empty;
it is filled with exercises, practical tasks, various activities. Taking care of
oneself is not a rest cure. There is the care of the body to consider, health
regimens, physical exercises without overexertion, the carefully measured
satisfaction of needs. There are the meditations, the readings, the notes that
one takes on books or on the conversations one has heard, notes that one
reads again later, the recollection of truths that one knows already but that
need to be more fully adapted to one’s own life: a veritable ‘retreat within
oneself’ as Marcus Aurelius argued—‘it is a sustained effort in which general
principles are reactivated and arguments are adduced that persuade one not
to let oneself become angry at others, at providence, or at things ibid p.
51)’.” One did this not as an act of solitude but as a social practice where
philosophers seek counsel from other wise men, a true “soul service”
bringing men together with “reciprocal obligations (ibid)”;
 The close correlation between care of the self already in ancient Greece,
and medical thought and practice. In this tradition, which has enormous
implications for the development of the notion of original sin in Christianity,
as Foucault concludes, everyone must recognize “that he is in a state of
need, that he needs to receive medication and assistance “ when it comes to
disorders of the ‘soul’, a central preoccupation of the philosopher and the
various schools of practical philosophy, which according to Epictetus are
‘dispensaries for the soul (ibid p. 55).’
 In this practice of the care of oneself as care of the soul, a whole ‘”art of
self-knowledge developed, with precise recipes, specific forms of

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 examination, and codified exercises (ibid, p. 58):” tests and exercises in
abstinence to see what one can do without, ‘fancied poverty’ (ibid p.60); self-
examination, in the morning to be well prepared for what was to come, but
especially the evening self-examination, alone with oneself, as one prepares
for “blissful sleep ‘Can anything be more excellent than this practice of
thoroughly sifting the whole day? And how delightful the sleep that follows
this self-examination—how tranquil [ ], how deep [ ], and untroubled [ ],
when the soul has either praised or admonished itself (ibid p. 61)’.”
 ‘Conversion to Self’ as an ‘ethics of self-control’: “This is the part of our time
that is sacred and set apart, put beyond the reach of all human mishaps, and
removed from the dominion of fortune, the part that is disquieted by no
want, by no fear, by no attack of disease; this can neither be troubled nor
snatched away—it is an everlasting and unanxious possession, even a
pleasure one takes with oneself (ibid p. 66).” What one guarded against in
such practices was the danger of the desires, ‘voluptas’, “undermined by the
fear of loss, and to which we are drawn by the force of a desire that may or
may not find satisfaction. In place of this kind of violent, uncertain, and
conditional pleasure, access to self is capable of providing a form of what
comes, in serenity and without fail, of the experience of oneself” or as
Seneca phrases it, “your very self and the best part of you (ibid pp. 66-67).”

As Foucault concludes, from his vantage point in this history of sexuality, and how
Western culture came to define it, shape it, pathologize it and treat it, the seeds for
Christian original sin are already there in ancient Greece and the Golden Age of
Rome where “[s]exual pleasure as an ethical substance continues to be governed by
relations of force---the force against which one must struggle and over which the
subject is expected to establish his dominion (ibid p. 67).” While the forces of sexual
desire against which one must struggle are not yet associated with “evil”, Foucault
goes on to trace the progress of these practices of self-cultivation and points to
their transformation whereby the Catholic confessional, and much later the
[Freudian] psychotherapeutic setting, view these forces as evil which the believer,
or the patient, needs help to counter, with professionals of the soul who no longer
educate their clients in self-cultivation, but in subservient admissions of guilt or
desire that they are never really expected to conquer.

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Confucian and Neo-Confucian Self-Cultivation

While practices of self-cultivation started much earlier in ancient China, they

reached their epitome at about the same time as parallel practices in the first two
centuries of the Christian era in Greece and Rome. But there are notable
differences.

As Tu Wei-ming argues from the start of his Humanity and Self-Cultivation, “if we
take seriously the process of learning to be human, the Confucian persuasion, far
from being a static adherence to a predetermined pattern, signifies an unceasing
spiritual self-transformation (page xxi).”

In his Forward to Tu Wei-ming’s text of 1998, Robert Cummings Neville states

boldly: “For the first time in history, it is possible for any self-conscious participant
in a world-wide philosophical culture to speak of Confucianism in the same breath
with Platonism and Aristotelianism, phenomenology and analytic philosophy, as a
philosophy from which to learn and perhaps to inhabit and extend (ibid, p. I).” He
goes on to state how the worldwide philosophic culture “was almost exclusively
Western in inspiration” even though Confucianism “has been perhaps the dominant
intellectual influence in East Asian cultures (ibid).” That it now plays a role in that
worldwide discussion “is the result in large measure of the work of Tu Wei-ming
and a small group of colleagues (ibid).”

Neville shares how a group of Western trained Chinese thinkers who write mainly in
English joined with a group of Western professional philosophers and sinologists
“that has entered the world culture of philosophy as ‘Confucians’ (ibid, p. III).” This
group of thinkers, like those of the Kyoto school of philosophy founded by
Japanese philosopher Kenji Nishitani who was a contemporary and colleague of
Heidegger, the latter a student of Nietzsche, engages in a confrontation with their
otherness: professionals in Chinese ethico-religious studies engage seriously with
Nietzsche and Heidegger, while experts in these Western philosophies engage the
otherness of Daoism and Confucianism. The goal is nothing less than a world
philosophy that would bring a sense of urgency to the revival of humanity and self-

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cultivation, for the good of human beings and their environment (Heaven and
Earth).

Tu defines the Neo-Confucian approach to self-cultivation as decidedly Mencian in

impetus thus: “man is a moral being who through self-effort extends his human
sensitivity to all the beings of the universe so as to realize himself in the midst of
the world and as an integral part of it, in the sense that his self-perception
necessarily embodies the perfection of the universe as a whole (ibid, p. 79).”

To this decidedly human view of self-cultivation, with no theistic notions of grace or

divine intervention, Neville continues in his forward with regard to Tu’s own
Confucianism, that the “impediments to self-cultivation are miseducation,
selfishness and moral torpor (ibid, pp. VII-VIII).” Tu stresses the essential nature of
the “fundamental choice” which requires a total commitment to the way of the
sage and self-perfection as a ceaseless process of life-long learning requiring
“constant reaffirmation (ibid, p. VIII).”

The remainder of this reflection will focus, following Tu’s insights, on Neo-
Confucian Wang Yang-ming’s ‘instructions for practical (moral) living’ (cf. A.S.Cua,
The Unity of Knowledge and Action: A Study in Wang-Yang Ming’s Moral
Psychology) and its focus on; ‘inner experience and embodied knowing’; the ‘unity
of knowledge and action’; the ‘extension of knowledge’; ‘humanity’ or ‘ human
becoming (jen/ren); the ‘regulation of human affairs’; ‘extirpation of human (selfish)
desires’.

Inner Experience and Embodied Learning/Knowing

“Wang Yang-ming,” Tu tells us, “once characterized his learning as the ‘learning of
the body and mind (shen-hsin-chih-hsueh). Tu appreciates the complexity of
attempting to explain in the written word such an oral teaching and way of learning
that might replace an ‘experiential’ knowing with a “conceptual understanding (ibid,
p. 139)”. Believing the “exemplary” teacher (junzi in pinyin) who has walked a long
way along the Dao but has far to go, “must try to transmit the content of the
learning to his students through his entire body and mind”, Wang Yang-ming’s way
of learning is not only a learning about whatever one is studying, but is also a

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learning how to become a human being, with sagehood as the guide. This focus on
becoming a genuine person, one capable of authentic human relatedness, is
tantamount to self-actualization, “of the universal humanity in oneself (ibid p. 140)”,
seen as a never ending process that made him have to endure “a hundred deaths
and a thousand hardships (ibid, p. 141).”

Tu points out that this form of “self-learning” in no way conflicts with the famous
Socratic dictum and practice, ‘Know thyself’.

What is striking about Neo-Confucian “learning”, Bols informs us, is that a ‘theory
about learning’ accompanied the commitment to learn: This is where
internalization figures, for “what simply must be internalized, or believed, is a
theory about how to understand, cultivate, and realize in practice something that
we humans can experience personally because we possess it innately (Bols, pp.
157-158).” This theory of learning developed by the Neo-Confucians “gave those
who internalized it a ready means of making sense out of the everyday human
experience of acquiring knowledge, thinking, feeling, and making choices (ibid).”

Learning how to learn, rather than memorizing the great texts, is what
characterized Neo-Confucianism. This learning was infused with the Heavenly
“principle” or coherence in all things.

While desire is always desire attached to things, which involves selfish desire, the
emotions are part of the human condition. “The process of creation includes all
things without bias or partiality. So too, the sage: he responds emotionally to things
as they actually are without personalizing the matter. Those of us who aspire to be
sages through learning should aim to be broadly inclusive yet impartial. When
something comes up, we respond spontaneously, in a simple and straightforward
way without calculation or hesitation. If you focus instead in trying to block out
external temptations and distractions, you will never get to the end of it (Ibid, p.
172).” The sage responds with emotions appropriate to the situation, and his
emotions “are not tied to his own particular biases but to the state of the thing itself
(ibid).”

But what does this learning actually entail?

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The Extension of Knowledge

In Neo-Confucianism, as Bols explains it, “Learning combined two kinds of effort.

First, one needs to practice seeing the coherence of things outside the self,
‘extending knowledge by fully apprehending the coherence of things’ (or
‘investigating things’). Second, to see the coherence of things external to the self is
simultaneously to become aware of that coherence in the self, as the coherence of
one’s own mind.” In this Neo-Confucian perspective, which is quite extraordinary,
someone who engages in learning with a full commitment of the mind, body and all
the senses, already sees that the coherence in their mind is at one with the
coherence in Nature, and identical to the Heavenly principle that sees coherence in
all things. Coherence (li), often translated as principle, is what serves as the
foundation for the transformation of Qi, the mutations of yin and yang, the great
taiji.

If we take this into the realm of Classical Acupuncture/Moxibustion and Chinese

Medicine, this would imply that the practitioner who commits to lifelong learning
and who sees learning about Chinese medicine as, at one and the same time,
learning about Self and Others, every clinical encounter is aimed at authentic human
relatedness where the aim is to attain, prod, and initiate coherence as that which
makes the therapeutic changes powerful, and meaningful.

The practitioner does not make something happen, but rather initiates change that
is at one with the coherence of all things: this change is immediately recognized by
the patient as significant, because the patient already possesses a knowledge and
deep experience of coherence.

“This does not”, as the great master Neo-Confucian Zhu Xi pointed out, “preclude
misapprehension in practice [whence] the corrective role of teachers and friends
and of careful reading in order to reduce it (ibid).”

This sort of mindful learning entails remaining aware of what is taking place in the
world around us, so that we can respond appropriately to it. While Wang Yang-ming
stressed an experiential approach to learning where book knowledge and
cumulative knowledge were suspect, Zhu Xi and others argued for the importance

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of an external, cumulative process of learning through reading. “Internally, one
shuts out distractions, brackets out presuppositions and prejudices, focuses
attention on the text at hand, and proceeds to work through the text in an orderly
manner. One may need to consult other interpretations, and one must aim to see
how all the various elements form a whole, “but at a certain moment one ‘gets it’
and the text’s coherence becomes apparent (ibid, p. 174).”

The Unity of Knowledge and Action

In his brilliant case study acclaimed philosophy professor A.S.Cua focuses closely
on just one aspect of Neo-Confucian Master Wang Yang-ming’s philosophy as
‘instructions for practical living’, namely the doctrine of the ‘unity of knowledge and
action. In this text, Cua stresses that Wang Yang-ming’s instructions for living a
moral life, stemming from “innate knowledge of the good” (ibid, p. 2), focuses not
on intellectual, but practical knowledge. While practical knowledge of this sort has a
cognitive content that can be stated in theoretical terms, practical knowledge
always presumes its ability to be enacted, to inform action. “But much of our
practical knowledge is knowledge-how which, for the most part, is inchoate, and
thus an agent may have it without being able to articulate his knowledge in a
coherent way—say, in terms of a set of rules of skill (ibid, p. 4).”

This concept of know-how is identical to what Michael Polanyi termed ‘tacit

knowledge’, and Donald Schon, as the way professionals think-in-action, which I
investigated in an earlier reflection. It is this concept of practical knowledge that
informed my concept of reflective acupuncture practice (RAP), modeled after
Schon’s work on professional knowledge, embodied knowing and ‘knowing more
than one can say’.

While I thought I was applying cutting edge western concepts of reflective practice
to the training of AOM students, what might actually have happened is that I hit up
against this problem of how to teach acupuncture and related techniques as
practical versus intellectual knowledge in a way that is in fact inherent to this
practice. In other words, I could have saved myself a lot of time if I had been
trained in Wang Yang-ming’s philosophy of “practical” knowledge, namely

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knowledge that can immediately be enacted, at the start of my acupuncture
education.

Humanity or Human Becoming

The Neo-Confucian concept of the way of the sage is that of following ones innate
knowledge of the good, working to rid oneself of selfish desires and evil, through a
deliberate reflection on ones actions, conduct, and practice in the world with Self
and Others.

In the training of AOM practitioners at the Tri-State college of Acupuncture over

the past decade, I have worked to integrate in reflective practice as part of the
training, and this has been greatly facilitated this past year by study of Wang Yang-
ming’s philosophy. While he did not practice medicine, he did practice Daoyin
physical arts and hence was trained in a hands-on way that has doubtless influenced
his teachings.

In this approach, where one is expected to internalize the way of the sage, aiming
to become someone capable of human becoming in its grandest sense, everything
that one does with others, ideally, would be authentic human relatedness, free from
selfish desires and self-interest. Whatever ones work, say in Acupuncture and
Oriental Medicine, would also and at the same time entail practice in human
becoming, where this practice would potentiate the “heavenly principle” that sees
human nature and Nature as identical, and that brings coherence to all that one who
walks the Way does. Such practical knowledge is identical to what is called
shenming, spirit clarity and parallel to the knowledge of how to live a practical
(engaged) life that is morally good (life embracing for self and others).

The Regulation of Human Affairs

From the outset Wang-Yang-ming insisted that a prospective student make a prior
commitment “to the vocation of becoming a sage” before he would take him in as
a student. In Wang Yang-ming’s approach to the investigation of things, which
becomes more a “regulation” or “rectification of human affairs” (ibid p. 150), Tu
suggests, self-realization is seen as a dynamic process “in which man’s subjectivity

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becomes a real experience rather than an abstract concept” and underscores the
inner dimension of ethico-religious cultivation (ibid, p. 145).” For Wang Yang-ming,
as compared with Zhu Xi’s philosophy of teaching and learning, the focus is on
manifesting the ‘inner sage’ in the real world at any moment, rather than seeing this
as a gradual process. While some Neo-Confucian masters stressed the practice of
quiet sitting, which Wang-Yang-ming also espoused for a brief period, he soon saw
the real issue as the “sincerity of the will” aimed at “the examination of ones subtle
thoughts and deliberations”, a more profound and rigorous kind of self-reflection to
which he directed his teachings.

What makes Wang Yang-ming’s approach to learning so relevant to the study and
practice of acupuncture and Chinese medicine is that he, himself, was an adept of
Daoist physical cultivation practices (Daoyin), the military arts and Buddhist
meditation ( Bols, Neo-Confucianism in History, p. 188), and thus his practice
encompassed cultivation of Body, Mind and Spirit.

This practice is aimed at ‘preservation of the Heavenly principle (t’ien-li)’, which

constitutes the coherence (Bol’s preferred translation, following Peterson, Ibid p.
163 of li, more commonly translated as “principle”) of Humanity, Heaven and Earth
(the environment) and all things in between.

Positive Emotions and Ridding the Self of Selfish Desires

In working to realize the coherence in all things, one runs up against the
problematic of the human desires and a selfish attraction or attachment to things in
the external world, which led Daoism to seek individual longevity and even
advocate flight from society, while Buddhism taught that things of the world were
not real and that enlightenment consisted in transcending this world of illusions. In
opposition to this position, a “positive evaluation of the emotions, in distinction to
selfish desire, allowed [Neo-Confucians] to claim that engagement with the world
was essential to self-cultivation (Bols, p. 178).”

The Neo-Confucians, and especially Zhu Xi and Wang Yang-ming, postulated a far
more complex and multilayered role for the emotions, as opposed to selfish
desires, in healthy human affairs.

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As Bols argues, “Neo-Confucians blamed the end of antiquity and the failure of
people to realize their innate coherence on the human susceptibility to desire”
which they understood “as the physical body’s instinctive response to external
stimulation (ibid, p. 170).”

While classical ideas suggested that all things, and all people are constituted of qi,
Neo-Confucians suggested that since each person is endowed with a different qi,
allowing individual qi to rule society would result in “violent competition for self-
satisfaction (ibid, p. 171).” The Neo-Confucians postulated that all humans are
aware of coherence, the unity of things and that this coherence is what would allow
people to respond spontaneously, with the full array of appropriate emotions, to
external events (ibid).

“The idea that the individual could learn to respond spontaneously to events
because of his awareness of coherence allowed Neo-Confucians to make a
distinction between desire (yu) and emotional responses (qing). Feeling angry or
happy about something can, of course, be prompted by mere physical stimulation,
but when one responds with anger and joy from an awareness of
coherence, by definition the response serves the common good. A person with this
awareness does “not need to calculate, to think about what means best serve a
desired end. Neo-Confucians reserved the term ‘emotion’ (or feeling) for emotional
responses filtered through an awareness of coherence (ibid).”

Learning, in the Neo-Confucian approach, does not attempt to rid one of the
emotions, which should be able to be manifested when the conditions warrant, but
to train us to be able to respond appropriately to events as they unfold.

“When something comes up”, Bols translates, “we respond spontaneously, in a

simple and straight forward way without calculation or hesitation.”

In this way of the sage, where one acts from an inner sense of “rightness”, if one
responds with happiness, it is because what “one is dealing with ought to make him
feel happy, and when he is angry, it is because those things deserve anger (ibid, p.
172).”

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As someone educated and trained in Daoist and Buddhist practices, Wang Yang-
ming’s critique of both as being self-interested (concerned with one’s own salvation
rather than helping those in need) may have had more substance than the general
Neo-Confucian critique. Whereas certain Daoist and, later, Buddhist teachings saw
society as something to be avoided, or transcended, and where Buddhist teachings
saw things as the “illusory product of their own desires”, Neo-Confucians like Wang
Yang-ming claimed that “things were real in themselves” and also “that their way of
learning enabled them to find in things themselves the norms for those things” and
that differences in constitution, and corresponding emotional states, affected ones
own effort’s at self-cultivation (ibid). Confucians even recognized, as clarified by
Ames and Rosemont in the The Analects of Confucius, that the junzi, or “exemplary
person” who has walked a good distance along the Dao, and can serve as role
model for others, still benefits from others like himself to help him keep on the path
as “he is still capable of anger in the presence of inappropriateness and
concomitant injustice, [although] he is in his person tranquil (page 62).”

This path consists in the commitment at the start to walk the Dao of the sage,
striving to become if not an authoritative person (ren or shengren), then at least an
exemplary person who can serve as a role model, in our case as an AOM
practitioner and teacher as an exemplary person (junzi).

At bottom this way of engaging in ones life work, which includes work on self and
with others (self-cultivation), starts by embracing the inner wisdom that knows the
‘equilibrium before the stirring of feelings’, that calm, mindful state of the heart-
and-mind that all East Asian meditation practices seek to instill. Knowing that this
equilibrium is always possible, that AOM treatment and teaching can always return
to this state of mindbody equilibrium, one is ready for anything that may come up
for the patient, and within oneself in such a way as not to be distracted from the
practice and the work.

The bias in this Confucian and Neo-Confucian approach is that Humanity is

precious, and that the inner wisdom people all possess from birth is the ‘heavenly
principle (t'ien-li)’ that constitutes the ‘coherence’ of all things such that Human
beings are at one with this coherence, which is Nature. And Nature is inherently
good for Confucians, especially since Mencius, and one can reach the “innate
knowing of the good” by achieving the equilibrium before the feelings are stirred.

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An AOM practitioner committed to being the best she can be, always embracing
lifelong learning, who is engaged in daily Daoyin practice including meditation, and
daily refection on how she managed human affairs, has clearly set out on this Way.

This sort of reflection, on how she transformed emotions that threatened to

become petty, selfish or even evil, so as to embrace the authentic human
relatedness of the patient-practitioner encounter, constitutes walking the Dao,
moving along the path. While she will most likely never become a sage, she stands
a good chance of becoming an exemplary person, a junzi who works to rid herself
of pettiness, selfish desires, and evil, so as to embrace and do good in her
interactions and work with others and on behalf of herself.

Such a way of teaching and practicing Acupuncture and Oriental Medicine

constitutes the practice of High Skills, which these reflections started with a little
over a year ago. And so my reflections have come full circle, and I have learned a
great many things. I am now engaging on a daily basis not only with a larger set of
Daoyin Practices (physical self-cultivation) thanks to the encounter with Andrew
Nugent-Head, but a daily practice of digging deep into the Instructions for Practical
Living by Wang Yang-Ming (translated with commentary by Wing-tsit Chan,
Columbia university Press, NY, 1963) and working to build self-cultivation of mind
and shen into my daily life.

There are no church or institutional requirements for being a Neo-Confucian

beyond the commitment to the Dao of the sage, and to lifelong learning as
practice. I believe one who is in the process of human becoming, engaged in AOM
practice as authentic human relatedness, and who engages in self-cultivation of
body (Daoyin practices), mind (Mindful and Reflective Practice) and ones AOM
art/craft could be considered to be a Neo-Confucian practitioner of Acupuncture
and Oriental Medicine.

In her provocative article on Neo-Confucianism and medicine, Charlotte Furth

shares that the Neo-Confucian Master, Zhu Yi, “praised medicine as a ‘lesser Way
(xiao dao character in the original article)’ of learning (Furth, The Physician as
Philosopher of the Way: Zhu Zhenhen [1282-1358] p. 423).

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Many historians, Furth tells us, saw this merely as “a vocational option for
unsuccessful civil service examination candidates (ibid).” She cites Paul Unschuld’s
claim 20 years ago in his Medicine in China: A History of Ideas (pp.154-188 in 1985
edition) that Neo-Confucianism did in some ways shape the practice and even
some innovations during that time.

And so it may be that there was a time, from the 1100-s to the 1500’s, where some
medical practitioners in China saw themselves as Neo-Confucian and dedicated
themselves to authentic human relatedness, to the very human dimension of self-
cultivation and self-actualization, for practitioner and patient, as central to the art
and science of Chinese medicine.

If one were to emulate that dual practice, of Neo-Confucian self-cultivation and

perfection of ones art and science, this would constitute a practice informed by the
wisdom of antiquity, that is remarkably parallel to similar efforts within
Complementary and Integrative Health Care today, with an awareness that the
Chinese practices of self-cultivation are at least 3000 years old and are a natural
concomitant to Acupuncture and Oriental Medicine practice in North America in the
21st century.

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PART III
APM ACUPUNCTURE CLINICAL
PRAGMATICS

17] The Steps to APM/CCA Clinical Practice-- From the 4

Exams to Authentic Human Relatedness: A Case in Point

THE PROBLEM:

One of the big risks in developing basic protocols in order to teach students the
“Ordinary Skills of Acupuncture” is that students and practitioners may miss the
complexity of the process, and begin to merely apply these basic protocols with
little attention to what is actually required, or to the larger changes that could take
place, or that are taking place outside the practitioner’s awareness, thus selling their
own practice, and their patients, short in many cases.

Protocols and Practice

The use of repetitive protocols and strategies can also lead to boredom or even
burnout which might account for how some AOM graduates keep gravitating from
one seminar to another without ever settling in on a personal style all their own.
This issue is something Kiiko Matsumoto has also grappled with for the past 25
years, where many students have trouble following her deft and ever adaptable
series of checks for reflexes, and needling, and surveillance for signs of significant
changes that redirect how the needling and moxa and ancillary techniques are to be
applied. Some who finally feel they are grasping it will grow despondent if Kiiko
Matsumoto Sensei goes into their booth only to critique their time spent on a basic

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protocol, which they may be doing exactly as described in one of her recent books,
when the actual problem the patient came with has not changed yet. She will often
resort to a different series of techniques, which might include Sotai from her earlier
practice days, or a different ordering of the needling and moxibustion,
demonstrating in the real-world clinical arena that it is the actual patient, and her
problem, that drives the treatment, not a rigid application of protocols. As someone
who kept prodding Kiiko Matsumoto Sensei to develop a more clear series of steps
for her approach, which I have done for APM/CCA, I find myself often discouraged
by the overly rigid way in which some of my students, and graduates, and even
faculty practice this approach.

At times like those, I greatly appreciate her serious reservations against

standardizing her approach in any way, and her readiness and ability to go outside
the protocols that do emerge from her last two books whenever the clinical reality
requires it. This series of Reflections so far has been my attempt to problematize
the development of the APM/CCA approach over the past three decades, so as to
reveal more of the depth and breadth such an approach can take on for anyone
who grapples, as I had to, with the various traps and gaps that arose in the process.
What I practice is based first of all on my own person, on my store of experiences
in the world, good and bad, in sickness and in health, and no one has had the same
personal experiences as someone else. Secondly, APM/CCA is based on everything
I have learned about the body, the mind, and things spiritual, from within and
outside of AOM studies, which again no one else would ever replicate in the same
way. And finally, the things that continue to fascinate me about acupuncture, about
needling, my allergy to moxa, my interest in having recourse only to those “fine
needles”, without cupping, without guasha, without tui na, and in the Neo-Confucian
approach to ‘embodied learning’ will not be replicated exactly by someone else,
and numerous versions of this practice will emerge, by graduates, and even by
people who just read my books, who will refer to their practice as APM, or
something similar.

After three decades of practice I am as convinced as I was a decade ago that I had
to attach a name to my approach and I am comfortable with the one that I have
chosen. It fits what I do, what I have developed over my professional career. It
situates acupuncture as Wei Ke—External medicine aimed, as Yitian Ni says so
elegantly, at ‘navigating the channels’, which is how it has always been articulated in

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China. But I have no interest in attempting to watch over how those who use this
practice name what they do when they leave the college, if they ever even trained
here.

So as I end this Sixth Reflection, speaking about what I love, what I do, what I
continue to practice without ever believing I will be done making changes if they
seem necessary to teach this better, I realize that in the end no one trained at the
Tri-State College of Acupuncture will ever practice exactly like any of the faculty
they have trained with. In the very fertile atmosphere that we have created here,
which breeds diversity and creativity, every faculty member, and each graduate, will
eventually shape a practice that integrates in aspects from many sources, some
from one main style, others from other styles, mixed with their own very special
personal qualities, to exhibit an integrative approach that can pull from multiple
sources to meet the challenges of the clinical realm.

As practitioners gain more and more experience using these ordinary skills of
acupuncture, and as they mature as clinicians and just with the passage of time and
the wisdom greater experience affords, every practitioner will have experiences
they cannot explain merely based on these ordinary skills.

In such moments that will renew their sense of awe at what can transpire just with
the twirling of a few needles, they will recognize that they knew the moment they
said something, clarified something to the patient, perhaps while performing the
physical examination or even while needling a point, but just as often before leaving
the patient for 10 minutes or so after all the needles have been inserted, or even
when saying a last thing to send the patient off, that spirit clarity has just been
initiated, that the patient has just had a bodily-felt sense of their acupuncture
holding pattern, of what was bringing them to this place and this practice to remove
some of these obstructions: an experience that is so intense, so important as to be
beyond words. At such moments, a practitioner totally in tune with the patient might
say something no more articulate than: “Pretty intense, No?” – making any further
conversation about what just happened redundant.

In those moments, quite rare as a new practitioner and more and more frequent as
one works on ones own self-development and ones own humanity as a practitioner
and as a person, such instances of High Skills will reveal the deeper and more

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profound layer where the arrival of Qi and the encounter of the patient’s and the
practitioner’s Shen converge, beyond logic, beyond theory, instances perhaps of
what the Dao De Jing refers to as “wuwei” where much happens with apparently
little action taking place, as if by itself.

It is with that proviso that I will share aspects of a case, from the Four Exams
through the patient’s final reflections on our work together, that proved quite
complex, with a series of parallel conditions stemming from very different causes,
some more physical, some more psychological, and some clearly spiritual, which
were able to be treated, if one looks just at the acupuncture point strategies, in
fairly similar ways.

The meaning of this apparent paradox, and the way in which any experienced
acupuncture practitioner can navigate the channels and treat complex conditions
through what appear to be very similar “moves” , through the performance of
apparently “ordinary skills of acupuncture”, making acupuncture nevertheless
endlessly adaptable, is borne out in the real-world of human relatedness with our
patients. This adaptability is at the crux of what makes acupuncture a practice
situated in the ‘tacit dimension’ where one must always strive to know much more
than one can say, to engage as Neo-Confucian Master Wang Yang-ming would
stress by drilling into the depth of a practice and all its ‘moves’, to interiorize it, to
embody it and to trust in that tacit dimension where we meet our patients in the
raw.

In such moments, any well trained practitioner knows that at any time, and with any
needling technique, one might be about to be confronted by a fierce power, the
power of the patient’s holding pattern, her pain, her suffering, her distress and the
intense experience of all that, at a level of intensity that may prove quite
overpowering.

The ability to reflect back on such extraordinary moments in acupuncture practice,

coupled with time and experience, will allow any acupuncturist well trained in the
“Ordinary Skills of Acupuncture” to attain those “High Skills” that are called for in
such challenging moments. And when that starts to happen, one has become a
Reflective Acupuncture Practitioner, who never would have arrived at that point
without first attaining the ordinary skills that serve as a prelude to those higher

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ones. To strive too early for the high skills, without going through the discipline of
ordinary practice, will lead to a practice where the practitioner is quite impressed
with his own skills, even as the patient and her experience of illness is being
ignored.

Introduction to Chaos: a litany of complaints—The Four Exams as Authentic

Human Relatedness

Edith entered my office “originally skeptical about acupuncture”.

She suffered from a litany of complaints centering around her right lower quadrant
muscle spasms and discomfort, as diagnosed by her physical therapist.

I was already engaged in the process of the Four Exams, attending to her
manifestations, like flags flapping, some quietly, some more vigorously in the wind,
as I observed her movements, watched her facial expressions as she shared
something of her experience of illness. As she dove into a litany of complaints with
a certain frenzy and frustration, I sank, as I always do when the signs and symptoms
come too fast and furious, into a mindful space from which I could attend to what
she was sharing without trying to figure out the logic of it all.

In this mindful approach to the Four Exams, aimed at attending to the signs and
symptoms as a composite whole, as a gift from the patient who is sharing her
experience in her own way with me, there is no place for me for the clinical,
professional approach one sees in TCM, where each sign and symptom has
predetermined clinical meaning leading to a ‘logical’ diagnosis.

Rather, I pay attention to what I hear, see, sense with my entire body and mind, and
all my senses, waiting for a sense that I am starting to ‘get it’, to know where I want
to begin the Palpation Exam to search for the ‘thorns, stains, knots and obstructions’
that are at the root of all chronic disorders as the Ling Shu tells us at the end of
Chapter I.

There are some who turn some aspects of the Four Exams, meant to gather data in
the form of relevant clinical manifestations, into “diagnosis”—leading to
fundamental misnomers such as ‘pulse diagnosis’ or ‘tongue diagnosis’ or ‘facial

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diagnosis’. It is my considered opinion that privileging any of these data
gathering/fact finding activities over others reifies them, and leads to a practice that
is Practitioner-, not Patient-Centered.

It may be that pulse and tongue assessment are closer to a diagnostic activity than
the other aspects of the Four Exams, especially for a practitioner of Chinese
Medicine (read, ‘internal’, herbal medicine). I can only speak to the tacit approach
to intake, assessment and treatment planning in acupuncture as I have come to
experience, and hence know it.

It is this tacit experience that I wish to share in following Edith and her
transformations in our work together.

The Four Exams—Taking It All In

At 53, and now in the throes of menopause, this successful medical writer appeared
weary, lacking in vitality, with a collapsed posture that mirrored her description of
her experience of illness. Though she had no difficulty making eye contact, her
glance was wary and she admitted feeling cynical about the possibility of a therapy
like acupuncture being able to make sense of and alleviate complaints that had
eluded “orthopedists, internists, gastroenterologists, a physiatrist, an ENT, an
allergist, and a physical therapist”.

As she described being “subjected to X-rays, MRIs, a sonogram, an endoscopy, a

colonoscopy, and allergy tests” over the course of four months, her voice grew
almost desperate, yet resigned, with a quickening pace in her verbal description
that was accompanied by shallow, constricted breathing and a visible tightness in
her throat muscles.

Edith’s experience of her primary complaint was underscored by the fact that,
having studied a wide array of biomedical clinical sciences and psychology, she had
full faith in “the established medical profession” which, in this instance, “was unable
to find a solution to [her] presenting problem: a severe abdominal spasm, lower
back pain, and assorted upper and lower gastrointestinal complaints”. After months
of testing, Edith ended up in the care of a physical therapist who began work on the

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muscular aspect of her problem, and who referred her to me for acupuncture,
knowing that I, too, worked on releasing such muscular holding patterns.

As Edith shared her story with me, I could not help but notice her agitation
stemming from a fundamental skepticism about the treatment she was
contemplating with me. I set about immediately reframing her complaints into
acupuncture and myofascial images of constraint—holding patterns—that would
ready her for the palpation phase of my initial examination. I remarked frequently
that while her symptoms may have proved baffling to her physicians, she was
describing acupuncture patterns that were classic and, hopefully therefore,
treatable.

In addition to her severe muscle spasm which the physical therapist had located in
the right lower external oblique, she also suffered from lower back pain stemming
apparently from an old herniated disc at L5-S1, irritable bowel, gastritis and reflux, a
painful coccyx and a “cool” sensation in her throat, with secondary menopausal
symptoms clouding the picture. Her appetite, which used to be fine, was reduced
to eating “to get by”. She denied being thirsty and preferred hot drinks, and
consumed 6 glasses of water a day, drinking alcohol only on weekends with meals.
She preferred salty foods and disliked bitter as well as spicy food.

Her gastrointestinal symptoms included belching, mouth ulcers, bloating, acid

regurgitation and indigestion and the primary severe abdominal pain, with a feeling
of “food stuck in the throat after swallowing”. Her bowel movements were painful,
and she suffered from irregular bowel movements oscillating between constipation
with hard stools and loose stools or diarrhea with undigested food present. She
resorted to laxatives when constipated.

Her urogenital symptoms included frequent urination and recurrent yeast and
bladder infections, with “terrible” sexual energy. She suffered occasional
discomfort during sexual relations, mainly due to vaginal dryness and irregular and
uncomfortable menstrual symptoms associated with menopause, which included
hot flashes and night sweats. She reported four pregnancies, and two deliveries, but
made little mention of her children.

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Her energy, which used to be great, was “terrible now”. Her energy was best in the
morning and peaked in the late afternoon. While she reported growing easily
fatigued, she walked every day for exercise and kept to her regimen of back
exercises as well.

Emotionally, she felt “lousy right now -- very anxious, nervous”, and was
experiencing occasional depression, anxiety, nervousness, and fear attacks. Her
abdominal discomfort and the associated distress played a large role in these mood
changes, as did her menopausal hormonal shifts.

She reported enjoying her work, but found it “very stressful”. She suffered from
disturbed sleep, and found it difficult to stay asleep due to shifting her position in
bed owing to the abdominal pain and her husband’s snoring. This, coupled with the
report of occasional painful sexual relations, were the only references to her
husband.

Both her lower back pain, which she reported as dull, and abdominal discomfort
and spasms, which she reported as severe, were relieved somewhat by heat and
were worse at the end of the day.

She denied a history of smoking and reported normal to low blood pressure. In the
past she had bouts of what her internist diagnosed as benign arrhythmia, with
occasional irregular heartbeat and cold hands and feet. She had dry skin and scalp
psoriasis.

Her mother, still living, had high blood pressure, osteoporosis and thyroid
problems, and her father died at the age of 45 from coronary disease. She had no
siblings, and one of her grandparents had diabetes.

Her medical tests revealed an old L5-S1 herniated disc, which did not explain her
abdominal spasms according to her physicians, and reflux and gastritis. Edith’s
medications included Acifed and carafate for the gastric distress, valium for what
was clearly now being seen by her physicians as a nervous condition, the liboderm
patch for her menopausal/ hormonal symptoms and motrin occasionally for her
menstrual and other discomforts.

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Her pelvic and abdominal sonograms were normal and a later CT scan was also
normal.

Feeling for Holding Patterns

I gather my symptoms in an exhaustive intake form that the patient fills out, which I
scan for likely locations of holding patterns, patterns of somato-visceral or viscero-
somatic constrictions, which might also entail what Wilhelm Reich referred to as
“character armor”. After a brief face-to-face interview to go over the intake form
and to begin to solidify the patient-practitioner relationship, I ask the patient to get
ready and lie on the table while I go out to complete my “acupuncture imaging”,
looking carefully at the form and the patient’s own drawing where they shade in the
areas where they feel pain or discomfort, to visualize from an acupuncture
meridian and three heater perspective, the most likely location of the patient’s
holding patterns (jingluo obstructions).

In this case palpation was facilitated by the fact that her physical therapist, whose
work I knew well and who did in depth myofascial examinations of her patients, had
lead Edith to identify muscular constrictions and dull discomfort in her lumbar
muscles bilaterally, and in her coccyx area. Her right lower external oblique was the
site of her severe abdominal pain, and my palpation confirmed bilateral quadratus
lumborum trigger points, which did not reproduce the patient’s primary complaint
when steady pressure was applied but rather dull discomfort locally. Palpation of
her right lower external oblique and latissimus dorsi muscle trigger points, near GB
26, 27 and 28, and Spl 21 respectively, were exquisitely tender and did recreate her
pain which I explained to her was a very optimistic sign that acupuncture release
might well improve her symptoms. I showed her pictures of Travell’s referral
patterns for the lower external oblique and latissimus dorsi muscles, and explained
how the acupuncture meridians of dai mai and the great luo of the spleen had pain
referral pathways that were identical.

Further meridian and mu/shu palpation also revealed extreme tenderness at GB 41

bilaterally, right Spleen 4 and 6, and the Stomach meridian from Stomach 36-39,
worse on the right, as well as deep tenderness at Kidney 16 area bilaterally, right
worse, Stomach 24 and 25 on the right, conception vessel 10 (tight) and 12 (empty

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with no tone), Stomach 25-26 left, and the right mu points for the Liver and
Gallbladder, namely Liver 14 and Gallbladder 24. This palpation was guided by the
pathways of dai mai and chongmai, the Stomach leg yangming meridian and what I
term mu-point boogey influenced long ago by grand rounds at the Tri-State College
of Acupuncture with Kiiko Matsumoto. Her free-form abdominal Hara palpation and
palpation to check distal points and local releases revolutionalized my own
understanding of mu and shu points, and acupuncture points in general, which I
came to see as moveable, living areas that had to be palpated for tight, tender or
gel-like constrictions (kori, equivalent to adhesions, trigger points and fibrotic
tissue, depending on severity and chronicity). This Japanese attention to palpatory
findings has characterized the teachings of the college ever since, and corrected
for an overly intellectual French meridian perspective, which was academically
compelling but too often lacking in such palpatory sophistication.

Given that Edith was a medical writer, I referenced Travell’s last chapter in the old
volume I, on abdominal and thoracic trigger point referral patterns. I also gave her a
5 minute mini-course during the intake, which she followed easily, on viscero-
somatic and somato-visceral interactions, according to Travel. I explained that her
condition, which originally appeared viscero-somatic, where visceral dysfunction or
disease creates somatic surface, myofascial discomfort (ruled out by the pelvic and
abdominal sonograms and CT scan), might well be a case of somato-visceral
distress where myofascial constrictions created her visceral discomfort and
functional disturbance(what would even two decades ago have been labeled
psychosomatic) . In that scenario, I explained to her, continuing my acupuncture
reframing while palpating her oblique and lat muscles face up, it is possible the
muscle constrictions, stemming perhaps over a long period of time from her
posture while hunched over the desk writing, combined with her old back history,
may have conspired to create this severe muscle spasm and discomfort. She
agreed that her posture, which her physical therapist was working on with her,
might be a contributing factor, but cited considerable stress as well. I suggested
that her menopausal symptoms certainly did not help the situation, and mused,
being the same age as Edith, that middle age angst was no thrill either. I joked that I
could make my retirement fortune writing an amusing book on how middle age
should come with a user’s manual, which was the first time she laughed in this initial
encounter, even though I used humor repeatedly to try to bring some levity to the
rather strong palpation for trigger points, to prepare her for possible discomfort

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during the acupuncture stimulation of these local areas of irritation and distress
(which I refer to when teaching my students as assessment of a patient’s “deqi
tolerance level”, which is to say their tolerance to feeling the needling sensations
of acupuncture).

A Response of Guarded Optimism

By the end of the palpation phase of the examination, Edith expressed a willingness
to give three treatments a “shot”, as she quipped, which was what I suggested to
her, one that same day and two more spaced at weekly intervals.

It is important to note that the treatment had already begun as the intake
transformed into education and the palpation served to locate her holding pattern
and validate her experience of illness and begin the release of these tight areas.

In the concept of “tongshenming” which Ted Kaptchuk translates as “penetrating

divine illumination” in his introduction to Acupuncture in Practice with Hugh
MacPherson, it is thought that practitioners sometimes manage to set the healing
process in motion during the initial encounter, even before initiating the
acupuncture, massage or herbal treatments themselves. Some practitioners and
texts refer to this as the patient’s and doctor’s shen connecting, to catalyze a
healing response. Others, like Ted Kaptchuk, might refer to this as prodding the
patient’s placebo capacity.

If this relationship is forged during the palpation phase, it becomes impossible to

distinguish palpatory examination from palpatory treatment, as palpation becomes
therapeutic and begins to initiate therapeutic changes.

Clinical Manifestations and their AOM differentiation

 Primary & secondary complaint: the patient was very specific in listing her
complaints as follows: “oblique abdominal muscle spasm; lower back pain;
‘irritable bowel’; painful coccyx; occasional cool sensation in throat;

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 menopausal symptoms, which started suddenly in November, 2001, four
months before consulting me.

 Medical diagnoses of these complaints by patients’ physicians and other

healthcare providers: gastritis, reflux, menopause, herniated L5-S1 disc,
muscle spasm.

 Treatments to date for these complaints including medications: axid and

carafate for the digestive symptoms, valium for the overall anxiety and
discomfort/distress, liboderm patch for menopausal symptoms, occasional
motrin for pain, physical therapy to loosen spasms and strengthen back.

 Relevant family medical history: her mother suffered from hypertension,

osteoporosis and thyroid “problems”; her father died at age 45 of coronary
disease; her grandparents suffered from diabetes.

 Past personal medical history: no injuries, accidents or surgeries were

reported, but stress was underscored as a constant factor, growing more of
late.

 Diet: “eats to get by”: bran and decaf coffee for breakfast; yogurt or ½
sandwich for lunch; pasta, salad and juice for dinner; chicken 2-3 times per
week, dairy 4 days a week; 6 glasses of water a day and 2 cups decaf coffee
or tea; wine with dinner on the weekends only.

 Gastrointestinal S&S: belching, bloating, acid regurgitation, indigestion, food

stuck in throat after eating, painful bowel movements, alternating hard and
loose stools, undigested food in the stools, occasional laxative use.

AOM differentiation of above clinical manifestations: middle heater dysfunction/

constrained Liver qi/ Spleen Qi deficiency/diaphragmatic constriction.

 Urogenital and reproductive S&S: frequent urination, urinary tract infections,

terrible” sexual energy, hot flashes, night sweats, vaginal dryness.

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AOM differentiation: lower heater dysfunction/ Kidney-Bladder imbalance/pelvic
collapse.

 Energy and exercise levels: terrible energy which “used to be great”, easily
fatigued but manages to walk and do back exercises every day.

AOM differentiation: deficient Kidney Qi.

 Emotions and sleep: emotionally “lousy right now-very anxious, nervous”,

with fear attacks and disturbed sleep, waking 3-4 AM from shifting positions
due to husband snoring.

AOM differentiation: constrained Liver Qi, diaphragmatic constriction.

 Musculoskeletal S&S: dull, aching pain, better with heat and worse at night in
the lower back and right abdomen and ribcage.

AOM differentiation: cold bi right tendindomuscular meridian of Gallbladder and

great luo of the Spleen deficiency.

 Cardiovascular S&S: normal to low blood pressure, benign arrythmias in the

past, palpitations, occasional irregular heart beat.

AOM differentiation: deficient heart Qi.

 Skin and hair S&S: dry skin and scalp psoriasis.

AOM differentiation: deficient Yin.

APM Etiology & Pathology:

The Bodymind Continuum

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While this patient worked as an editor of psychology textbooks and journals, she
seemed to react to these new symptoms with physical symptoms of anxiety,
palpitations and viscerally, in the digestive track especially. She did not attribute any
of these symptoms to specific psychological factors, more generally referring to
her experience of illness as signs of stress. In fact, she had reached menopause,
was finding sexual relations painful and her sexual energy “terrible”, which many of
my female patients would have situated more centrally in the overall picture as the
distress that comes with aging, an end to reproductive capacity and the empty nest
syndrome, and pending retirement. She therefore seemed to situate herself more
on the body side of what I term the bodymind continuum, and sought physical
solutions for these complaints.

Acupuncture Imaging:

From a meridian perspective, this patient’s primary holding pattern occupied the
pathway of the belt channel, dai mai, which encircles the waist and travels along the
lines of the external oblique musculature, on the right in this case. The great luo
pathway of the Spleen was also implicated as this spreads throughout the lateral
ribcage. From a zangfu perspective of the three heaters, I would call this a case of
pelvic collapse, where constraint in the middle heater leads to collapse of Spleen
Qi, and congestion in the lower heater.

In classical acupuncture theory, yang, the meridian system, protects yin, the organ
system. Thus attacks on the body from the outside, whether in the form of
atmospheric assaults, repetitive strain, injury or any stressors that initiate the stress
response and an overactive sympathetic system and musculature prepared for
fight-or-flight(Selye), might lead to tendinomuscular excess.

In the absence of signs of external pathogenic invasions in cases like this patient’s,
and with comprehensive medical workups that were all negative, I started by seeing
this perhaps as a case of a complex, “somatovisceral” holding pattern:
myofascial/somatic constrictions encompassing visceral symptoms with the
associated distress. Early on, given my training in Van Nghi’s French meridian
perspective, I learned to appreciate that such disorders might be located within the

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superficial meridian systems, but might lead to deep-seated emotional distress as
the resulting visceral (zangfu) symptomatology continued to elude medical
diagnosis. Such patients who returned frequently to their physicians were more
often than not seen as hypochondriacs in the age of psychosomatic medicine, and
the modern version of this perspective would ignorantly assign the blame to
“stress” without realizing that stress involves a very real physiological set of
reactions that could exact a serious toll on the body if left unaddressed. Such a
disorder as this had come to be seen as minor, something a physical therapist might
address, thus ignoring the deep experience of distress this patient was
experiencing, and the obvious fear that some serious, and perhaps life threatening
disorder, was going undetected. After all, her father had died of a coronary at the
age of 45.

In looking at the meridian aspect of a disorder I incorporate Travell’s referred

pathways of myofascial trigger points, as a much more detailed way of speaking
about meridian energetics in general, and of the tendinomuscular meridians and
cutaneous regions in particular, those aspects of the meridian system that can be
seen and touched, in particular.

Trigger point referrals:

In a careful review of Travell and Simon’s Myofascial Pain and Dysfunction: the
Trigger Point Manual, the picture of myototic unit of interactive muscle trigger
points emerged, implicating the external and internal abdominal obliques, psoas,
erector spinae, multifidi, rotatores, serratus posterior inferior, all of which assist the
quadratus lumborum in extension and may be activated by a side-bent, cross-legged
posture like the one she described when she told me how she sat at work.

Travell underscores the fact that poor elbow support at the desk can be a further
contributory factor.

Palpation of the psoas and paraspinal musculature yielded no tight or reactive

trigger points, which one might have suspected had her lumbar disc problem been
involved in this abdominal pain.

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The serratus posterior inferior was reactive, and trigger points here can cause
nagging, annoying achiness in the lower thoracic region. The external obliques,
lower near Gallbladder 26-28 and upper near Liver 14 to Gallbladder 24, including
the serratus anterior near Spleen 21, were all exquisitely tender and tight. This
corroborated the meridian assessment of dai mai and the luo of the Spleen.

Travell and Simon’s explanation for visceral symptomatology from these abdominal
and back trigger points is worth noting in its entirety: “Active TrPs in the upper
portion of the abdominal external oblique muscle, which overlies the ribcage
anteriorly, are likely to produce ‘heartburn’ and other symptoms commonly
associated with hiatal hernia. These ‘costal’ and ‘subcostal’ TrPs in abdominal
muscles also may produce deep epigatric pain that occasionally extends to other
parts of the abdomen (MPD, vol. I, p. 941).”

The picture grew more complicated as I learned from her in a followup treatment
that she had been diagnosed with a small hiatal hernia at one point by a specialist, a
clear Spleen Zang deficiency sign that would allow for Liver Zang invading Spleen
dysfunction which she did exhibit, and Spleen Qi Sinking dysfunction as well.

Travell and Simons stress how confusing and enigmatic such abdominal symptoms
often prove. “Understanding the reciprocal somatovisceral and viscerosomatic
effects of TrPs helps to unravel some of this uncertainty. Myofascial TrPs in an
abdominal muscle may produce referred abdominal pain and visceral disorders
(somatovisceral effects) that, together, closely mimic visceral disease. Conversely,
visceral disease can profoundly influence somatic sensory perception and can
activate TrPs in somatic structures that may perpetuate pain and other symptoms
long after the patient has recovered from the initiating visceral disease(ibid, p. 951)”
They go on to share their experience of active abdominal trigger points, especially
in the rectus abdominus, which “may cause a lax, distended abdomen with
excessive flatus. Contraction of the abdominal muscles is inhibited by the TrPs so
that the patient cannot ‘pull the stomach in’. This apparent distension is readily
distinguished from that due to ascites on physical examination(ibid, p. 952)”. They
conclude that right upper quadrant pain caused by contracted upper external
oblique trigger points might easily lead to pain and discomfort that might be
confused with gallbladder disease.

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Travell and Simons site a series of common stress factors that might activate such
abdominal trigger points:

♦ body fatigue
♦ over exercise of the abdominal muscles
♦ emotional tension
♦ straining during defecation due to constipation
♦ poor posture leaning forward for hours, thus tensing and shortening
abdominal muscles with failure to properly support the back

The authors underscore the fact that it has “been recognized since the 1920s
that persistent abdominal pain is as likely to originate in abdominal-wall muscles
or be referred from chest-wall muscles as it is to originate in abdominal
viscera”(ibid, p. 956).

Differential diagnosis of visceral diseases that can cause the same symptoms
of discomfort and distress as abdominal muscle trigger points include:

♦ articular dysfunctions
♦ fibromyalgia
♦ appendicitis
♦ peptic ulcer
♦ gallstone colic
♦ colitis
♦ painful rib syndrome
♦ intractable dysmenorrhea
♦ urinary tract disease
♦ hiatal hernia
♦ reflux esophagitis
♦ gastric carcinoma
♦ chronic cholecystitis or uretral colic
♦ inguinal hernia
♦ hepatitis
♦ pancreatitis
♦ ovarian cysts
♦ diverticulosis

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 ♦ umbilical hernia
♦ thoracic radiculopathy
♦ costrochondritis
♦ ascariasis parasites
♦ ascites

It is therefore essential that patients with undiagnosed abdominal pain be evaluated

by a physician to rule out visceral disease (ibid, p. 956).

The authors add that abdominal breathing, a common stress reduction technique, is
extremely valuable for somatovisceral abdominal pain.

____________________________________

Round One of Treatment (6 over 2 months, starting with once weekly for three
weeks):

Acupuncture Diagnosis: constrained chong mai and dai mai; diaphragmatic

constriction(APM); Middle heater dysfunction.
Treatment: Sp 4/ Per 6; GB 41/TH 5; LI4/ Liv3; Sp 6, St 36, 37, 39; Kid 2 and 3; GB
26-28, GB 24, Liv 14

Additional treatment for allergies in last treatment: Sp 5, LU 7, LI 4, LI 20, Bl 2, St 2

Round Two of Treatments (4 treatments over 4 months):

Reactions over the past 5 months: she received a diagnosis of genetic osteopenia,
which was ruled out as a cause of her primary complaint that brought her for
acupuncture, but clearly agitated her (growing older, developing genetic disease)
and was put on fosamax. She presents this time with right hip pain primarily.

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Treatment 1: Did side lying for right QL, serratus, lower external oblique and GB
29, 30, 31, 34, 38, 41(possible hip involvement—the complexity of aging) with same
root chong mai/dai mai treatment as initially.

Reactions to Treatment: the new hip area pain was “definitely better”.

Treatment 2: same root points but face down taiyang zone adding bilateral QL
trigger points and bilateral Bl. 23 for Kidney Qi, and right GB 30 which was now
symptomatic.

Reactions to Treatment: the patient reported feeling “definitely better”.

Treatment 3-4: same taiyang zone treatment for QL and right hip.

Round Three of Treatments (patient returns for 4 treatments over 6 weeks):

Reaction over past one year: The hips have been fine, the patient is here for a
follow-up up on right daimai area discomfort which is mildly symptomatic. When I
mentioned that it seemed she had really become very clear about when she felt a
return for more acupuncture made sense, she responded: “I’ve learned that when it
starts to bother me, a series of 3 or so treatments takes care of it”. I told her
perhaps one or at most two treatments might do it this time, as I always try to
empower the patient to only come to treatment when they feel they need it. She
answered very clearly that she felt safer planning on all three.

Treatment: Same distal and local chong/daimai treatment as initially.

Last treatment: The patient reported feeling “much better but not totally gone; I
want one more treatment.” I repeated the same treatment and did not see her for
quite some time.

Round 4 of Treatment:

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Reactions to Round Three of Treatment: Much better overall, the patient came 6
months later for a follow-up preventative series of 2-3 treatment on the right
daimai area discomfort, which was barely noticeable, plus new flexor carpi ulnaris
bilateral discomfort, from much more computer work .

Treatments 1-2: GB 41, 27, left, Liver 3, bilateral flexor carpi ulnaris TrPs near SI 7
and distal to Ht 3, bilateral Kid 3 and Ht. 7 (SI muscle channel).

Reactions to treatments 1-2: the new arm symptoms are totally gone, but she
wants 3rd treatment as preventative for right daimai area. The same daimai
treatment was administered.

Reactions to Round 4: Right quadrant abdominal discomfort 95% better; bilateral

flexor carpi ulnaris TrPs much better.

A Final Round:

Reactions to last series of treatments: The patient reported being fine for one and a
half years, since her last treatment of Round 4. She is here today for mild rt LQ
discomfort and some GI distress with abdominal discomfort.

Treatment: treat dai and chong mai, distally and locally as before, and release local
Sp 15, St 25 and Kid 16 on the right, where reactive, with distal St 36, 37 and 39.

Reactions to Treatment: Feels better but still concerned about return of right sided
GB 25 area discomfort.

Treatment: do side lying adding tender TrPs at iliac crest and GB 25 area and same
distal chong/dai mai treatment.

Reactions to Treatment: “Great for Two Days! I sense it is almost gone!”

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Last Treatment: do side lying as above, and then face down for QL bilateral and rt
hip GB 30 area (piriformis TrP) with huge releases of all trigger points Then do face
up for chongmai/daimai as before.

RAP-UP: Issues raised by this case from the patient’s and the
practitioner’s perspectives:

In the palpation phase of the examination- as- treatment, which is pivotal in the
Acupuncture Physical Medicine approach I have developed over the past two
decades, I of course try to make the patient comfortable, and give them as
accurate a feeling of what the acupuncture treatment is going to entail as possible
to allay any fears. As I proceeded in this fashion with Edith, I did so keenly aware of
her strong skepticism toward acupuncture for her condition.

But I also try immediately to validate the person’s experience of illness by always
by laying my hands on the areas of discomfort and distress that the patient
identified on the chart’s diagrams of the body, and during the Four Exams, and try
to match my verbal communication with my somatic communication, drawing on
acupuncture or trigger-point images and three heater findings while I am palpating,
to embody this phase in such a way that the patient has a more pronounced bodily-
felt sense, to quote Gendlin yet again, of their complaint. This phase of the
palpation marked a shift in Edith’s attitude toward me in particular and toward
acupuncture in general, as she displayed guarded surprise that I found the location
of her complaint so readily.

I capitulated to this patient’s clearly more physical explanations for her problems,
and therefore did not probe into her marriage, her children, her likes and dislikes,
her work, listening instead, and watching and sensing how she responded to this
discussion of her emotional life. While I did make some passing remarks about the
aging process and what the experience of menopause might entail, slipping in as it

  238  
were signs of empathy and compassion for her experience into our discussions
together, I made most of my communication center around what I located in her
body, and around her “bodily felt-sense” of these somatic constrictions. I focused
on the holding pattern that matched and validated her experience of right lower and
upper quadrant pain and the associated distress.

More like an osteopath than a psychotherapist, I found the strain in her body fabric,
in the belt channel that choked her, and strained it further through informed touch
and needling, to prod it to release, a few notches at a time, so that she might
breathe more easily and feel more at ease in herself. I also avoided an overly
psychological approach to my communication with her because of her career
editing psychological materials, and the fact that she was skeptical of acupuncture
from the start, and would have undoubtedly reacted with concern if I took on a
psychotherapeutic air.

The Human Dimension entailed in my work with Edith revolved around slipping in
suggestions of how the emotional strains of menopause and the subsequent bodily
changes, her children leaving home and the aging process in general could lead to
the constrictions she was experiencing. These comments and reframes were
performed during the actual palpation for her holding pattern and their acupuncture
release, thus grounding the comments in the physical realm of the palpation and
needling. A different patient responding to all these changes from the mind side of
the bodymind continuum would have most certainly required more talk time, and a
different way of reframing the holding pattern.

Progress to Date

At the time of this writing, a year had passed since the last treatment. In her
reflective assessment of her own initial intake form, Edith reported complete
absence of the abdominal discomfort and lower back pain, which she rated as a 0
on her own VAS scale (0-10), that brought her for treatment. She also reported
complete relief from the original painful coccyx , feeling of food stuck in the throat
and cool throat sensation, all rated 0 on the VAS scale. Her written report of the
other changes she experienced during and since acupuncture treatment display a
wry sense of humor that was almost totally absent in the initial encounter, obscured

  239  
as it was by her discomfort and distress. “ It is hard to believe”, she writes now,
“that I reported a poor appetite in 2002. I certainly eat more than ‘to get by’, and
have resumed nibbling (“when the warmer weather arrives, it will be time to get
back to outdoor exercise to shed several pounds gained over the winter!”). She also
reports greatly improved sleep, which she rated an 8 on her VAS scale four years
ago and now puts at a 3, with greatly improved energy as well. She admits to still
being a “type A person”, and still gets stressed over work and some family matters.
But she is very reflective of the need to begin tapering down her work load, and is
slowly utilizing the help of an assistant to step into her shoes during her absences
or eventual retirement or resignation from her current position.

The only prescription medication Edith takes now is Fosamax for osteopenia, as
well as over the counter calcium and fiber. “All in all”, she states now, “I consider
myself to be a ‘healthy specimen’”, in glaring contrast to her self-portrayal as a
sufferer of a “staggering litany of complaints” four years ago which now loom as a
distant, “albeit painful, memory, and I owe it to the acupuncture treatment I
received”.

Her menopausal symptoms have also lessened tremendously, with the passage of
time, and she never felt the need to address those with acupuncture, rating them
now a bearable 3 on the VAS scale.

Epilogue

Edith was not an easy acupuncture patient. With a background in anatomy,

neurology, biology, and psychology, and “a better than average understanding of
how the mind and body work in health and illness”, she displayed more than a
healthy skepticism toward acupuncture from the start. She would have never
considered acupuncture treatment on her own, and it took a direct referral from
her physical therapist, whom she respected tremendously, and who had excellent
results for a cat allergy in her treatments with me, to bring her to my door.
“Originally skeptical about acupuncture”, she soon became a “convert”.

My goal is to serve as a change-agent for my patients, helping to release

problematic holding patterns, thereby prodding them to become their own healers.

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The renewed vitality liberated by acupuncture release of such blockages leads to
emotional, spiritual as well as physical relief, as this case reveals. I believe that any
seasoned acupuncturist from any style or tradition of practice sees this sort of
change in their patients’ body, mind and spirit, and it is this sort of change that
provides the impetus for our continued work in this direction.

Edith reports being “thrilled to be included as a case study” for the faculty
development course that lead to this study.

Edith’s experience of acupuncture, which reframed her elusive, albeit severe,

complaints, into acupuncture images that lead to positive change overall, is
precisely what I hope for and of course do not always witness. Her final words
about this experience made my day when I first read them, and such experiences of
change through acupuncture continue to inspire and fascinate me after thirty two
years of practice and teaching.

“I have only superlatives when describing my acupuncture experience”, Edith now

reports. “I had to take a ‘leap’ of sorts to go for acupuncture treatment, and now
there’s no going back”.

What I have learned with patients like Edith, and from the readings and reflections
of the past 6 months, is that the Ordinary Skills are all those that allow us to take in
what we are hearing, seeing, feeling, sensing, initiate an intervention with needles in
the case of acupuncture, and attend to the changes that these interventions bring
about, while attuning (tiao) our interventions to these changes.

In a bright, aware, spirited person like Edith, who did reflect hard on her plight, it
takes small prods –Ordinary Skills, to set her own spirit and Heart-Mind in motion to
restore normalcy.

In other cases, a practitioner might need far more adept skills of reframing,
education, and support to help a patient gain greater spirit clarity (shenming). This
takes us into the realm of High Skills, where a Neo-Confucian doctor, for example,
would take it for granted that he must work at self-cultivation and attend to his own
spirit clarity and Heart-Mind if he is ever to be able to prod spirit clarity
(tongshenming) in his patients; this will be the focus of coming Reflections.

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Sources:

Seem, Mark. Bodymind Energetics: Toward a Dynamic Model of Health, Thorson’s Press,
Rochester VT, 1990

Seem, Mark. ACUPUNCTURE Physical Medicine, Blue Poppy Press, Boulder, CO, 2000,
especially pp. 91-92 and 112 – 114.
Travell, Janet and Simons, David. Myofascial Pain and Dysfunction: the Trigger Point Manual,
Volumes I and II (per muscle trigger points cited in this case study).

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18] Acupuncture Needling & Tacit Knowing: The Tangible
Dimension

THE PROBLEM:

At the same time that I was busy focusing on the best ways to teach the APM
approach, which included extensive training in Travell and Simon’s approach to
myofacial pain and trigger point referral patterns and TrP point location and
myofascial release, I tended to emphasize the physical medicine side in a way such
as to lead some students and some faculty to see my approach simply as trigger
point acupuncture, based mainly on Travell’s trigger points and dry needling
techniques to release them. It took me several years to realize that APM was being
stripped of its original classical Chinese jingluo way of practicing. While I never
stopped practicing that classical way, and merely added knowledge of trigger
points and a needle technique I modified for acupuncture needles that allowed a far
more shallow, wei level depth for many points, this focus on trigger points, and of
this technique—which takes some time to get a grasp of, diverted my attention
from what was being lost. I turned my attention, once I realized this, to teaching
students how to perform needling, starting not with TrP needling techniques, but
with classical tonification and dispersal techniques to distal points of the regular
meridians and at mu and shu points of the front and back in Year I. I also stress
these classical needling techniques as well as trigger point dry needling throughout
Year II APM/CCA ACP sessions, and in my Grand Rounds and Year Three clinical
supervisions. This return to classical regular, secondary and extraordinary meridian
needling techniques brought with it a return to what was most critical in the
practice of acupuncture as a hands-on practice aimed at eliciting a felt-sense in the
patient.

I. Acupuncture Know-How and the Bodily Felt-Sense

This way of teaching and learning implies internalization of skills so that they can be
replicated, in a way that is as immediate, and mindful, as possible, without thinking
about them: embodied learning as Confucianists would say.

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Clinical supervisors at the college expect any clinical intern to be able to articulate
the reasons for their APM/CCA treatment plan (and again I am only sharing what I
know best, namely the teaching of the APM/CCA approach, not the Japanese and
TCM approaches which are taught in their own ways by other clinical faculty
teams), citing the evidence from the signs and symptoms gathered in the four
exams, based on the APM/CCA foundational texts, that lead to the working
diagnosis, treatment principle and plan

But during the physical examination, and again once the treatment has been
approved, the 5 steps of APM/CCA treatment should be done from a mindful place
where tactic knowledge on the part of the clinical interns, and evocation of the
bodily-felt sense, and meaningful signs of change in the patient, drive the way in
which the treatment is conducted.

Tacit Knowing

At one point in the development of the teaching at the Tri-State College of

Acupuncture, I was struck by the fact that while there were a small number of
students who could learn immediately from me how to palpate the body, how to
locate depressions where acupuncture points were located, how to locate tight
constricted areas in the musculature where excess areas were located, and could
just as quickly learn how to needle these excess and deficient areas with very little
discussion just by watching and doing, there were many, many more students who
seemed to need to have much more explanation, much more theory, much more
explicit explanations of what was going on. This was very bothersome to me and
led me to consult a prominent New York clairvoyant who in an early session shared
with me what she was picking up, namely that I appeared to be someone who
knows what I knew in an instant, who in doing what I do takes in the whole and
knows whether or not that whole feels like it is accurate. It was a strange meeting, a
strange interaction, but it led me to start looking very carefully at how I and other
faculty were teaching clinical skills at the college, how we were teaching theory, the

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texts we were using, the outcomes our students were exhibiting.

In this process, I engaged in several experimental activities with colleagues, among

them Bryan Manuele, Co-founder and then Director of the Midwest College of
Oriental Medicine in Chicago, Illinois. Once, while I was in Chicago, we shared the
experience of treating patients while watching each other at a distance without
intervening. The challenge was to see if we could tell when in the interview our
colleague had a sense of what the diagnosis was, what the treatment was going to
be, and whether or not, at that moment, he had an explicit awareness of signs and
symptoms and differentiations, the meaning of these signs and symptoms, specific
acupuncture and Oriental medical knowledge that he had gathered together in a
diagnostic assessment in his head and then came up with logical treatment
principals and logical point selection. Or, was something else going on? That we in
fact discovered, after sharing what we observed, what we saw, what we felt, what
we noticed, what we took in, was that each of us seemed at a certain point in an
intake with a patient to have a sense of where we wanted to go to find a primary
obstruction. This was not a diagnosis, this was not a running through of
differentiation of signs and symptoms in our head, this was not an explicit activity,
this was not an activity, in fact, that we could even say to each other, and we found
it very hard to be explicit and articulate about what we were trying to share. What
we discovered was that, much like what the clairvoyant explained to me, we were in
fact trusting a kind of knowledge that came to us tacitly—knowledge we could feel,
knowledge we could see, a kind of know-how that just seemed to come, obviously
informed by our study of acupuncture and Oriental medicine, meridians, point
locations, diagnoses and needle techniques. We realized that in the doing of
acupuncture, in the practice of acupuncture we made no use of academic or
intellectual activities to come up with our treatment but rather seized on a
treatment, or rather seized on a moment, where we felt that we had a sense of the
problem for that patient, and having a sense of that problem already had a feeling
that certain acupuncture patterns, combinations of points, treatments we had done
in the past, would be a good place to begin.

And so, after quickly palpating the body, once we had this sense of the problem
and where, most importantly, this problem was located, we would then go palpate
and based on finding areas of tightness, of deficiency, perform an acupuncture
treatment in rather short order and know during the doing of this treatment

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whether or not this treatment was moving in the right direction. When we realized
that we felt it was moving in the right direction, we would let the patient know that
this was great, we would let the patient lie there for ten or fifteen minutes and
would actually be quite certain that this treatment would have a positive effect.
None of that process involved intellectual operations that confirmed a diagnosis,
but rather a process that looked more like reaching deep within for a familiar
pattern of treatment that in some way matched the patient’s complaint as a starting
point for navigating the patient’s bodymind. This was extremely helpful in the
elaboration of the teaching at the Tri-State College of Acupuncture and led to the
development of what we call Acupuncture Clinical Practice (ACP) and Grand
Rounds with Senior Faculty during all three years of the Master of Science degree
program in Acupuncture.

Implications for Clinical Training

In Acupuncture Clinical Practice, which is now a three-and-a-half hour class where

students begin their clinical training on peer students and practice as one would
rehearse for a play, or rehearse kata in karate, that they rehearse or practice full
treatments from three different styles of acupuncture, which amounts to building
up a repertory of whole treatments that they could apply in given situations as a
place to start. In Year Two they learn how to begin to modify somewhat some of
those protocols and in the actual clinic in the final clinical senior year they of course
are helped with supervisors to step out of the rigidity of protocols, to become
flexible and modify as need be those protocols to adequately address all of the
various conditions that they are encountering, to adapt to what they are actually
seeing in front of them, to their patients’ actual problems, and to be creative in
solving these clinical problems starting with these repertories of patterned
responses or practiced or rehearsed protocols that they have engaged in over the
first two years.

This investigation into how people learned and more specifically how they were not
learning from going from the rather tedious attempt at memorization of point
indications from Chinese textbooks, which we fast abandoned, and even
memorization of basic signs and symptoms of different Chinese patterns, we
realized that while that was a necessary activity in the lecture classes and was
foundational knowledge that they needed to commit to memory in order to have a

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foundation on which to learn and practice, what was critical in the actual
acupuncture clinical practice on peer patients first and then on community clinic
patients, was this ability to take in information with all of the senses, to make sense
of all of this information in such a way as to have a feeling or a sense of what the
treatment should be. And while we required that students be explicit in explaining in
their thinking, explaining their treatment protocols, explaining their treatment
strategies and point combinations to supervisors in the fist semester in order to
have a treatment improved, the fact of the matter is that when they observe senior
and master practitioners they often see people performing in a much different way.
That much different way of performing has a name and was studied in great detail
by Michael Polanyi whose book, The Tacit Dimension, is comprised of the Terry
lectures delivered at Yale University in 1962, where he developed his concept of
tacit knowledge and laid out the simple premise that we can know more than we
can say, something that the late Donald Schon, former Ford Professor Emeritus at
Massachusetts Institute of Technology continued on with in his development of the
concept of “reflective practice,” which is paramount in the clinical training at the
College.

The Bodily-Felt Sense

The bodily felt-sense is a term coined by Eugene Gendlin, PhD, to describe what the
client is feeling when she has what Freud termed a psychotherapeutic “AhHa”
experience while, impossible to clearly articulate in words, indicates that the client
has made, or is about to make a significant therapeutic leap in understanding. While
Freud felt this had to be followed by analysis, to state in language what had just
been felt at the deep, unconscious level, Gendlin argued that the focus needed to
just remain on the felt-sense, and the understanding would follow on its own. Milton
Erickson evolved a similar concept in his approach to hypnotherapy, where a focus
on tapping into the deep knowledge, the unconscious, was the goal of treatment, to
bypass the conscious mind and initiate meaningful, therapeutic changes.

This concept of a boldily-felt sense as a deep, older form of knowing the world
derived from Nietzsche, who sought to think beyond the body-mind split articulated
by Descartes, where the human spirit was obliterated, by spiritualizing the body
itself. After arguing that the Judeo-Christian established religions were no longer of
help in orienting mankind’s spiritual endeavors, with his celebrated proclamation

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“God is Dead!”, he worked to articulate a new philosophy for mankind in the
coming 20th century, based on a ‘joyful wisdom’, the title of the text where he
developed this concept. Establishing himself as a diagnostician of the spiritual
sicknesses of his day, Nietzsche stressed that “we require for a new goal also a new
means, namely a new healthiness, stronger, sharper, tougher, bolder and merrier
than any healthiness hitherto…(cited in BME, p. 4 and for a more detailed discussion,
ibid pages 236-237).”

Nietzsche clarified many times in his writings that such a new, bold way of thinking
about human healthiness, of what was best and strongest about humankind, could
only be acquired through an active exercise of one’s will, and an “active forgetting”
of old knowledge that no longer served to shore this decidedly spiritual quest.

With religion no longer seen as the way in which humans could embrace their true
spirit, Nietzsche challenged us to take on this quest personally, willfully, joyfully.
Carl Jung also stressed the need to rediscover the wisdom of the body, too long a
prisoner of the spirit in organized religious teachings, and to “reconcile ourselves to
the mysterious truth that the spirit is the life of the body seen from within, and the
body, the outward manifestation if the life of the spirit—the two being really one
(ibid, p. 4).”

This concept of a deep wisdom of the body that is spiritual at its core is parallel to
the Chinese concept of shen and shenming translated as mind or spirit, and as
mental or spiritual clarity respectively. In the Chinese concept, which is decidedly
pragmatic, spirit clarity amounts to the wisdom or intelligence of existence, of
being alive. Someone who manifests spirit clarity, spiritual health, has eyes that are
bright and make contact, a shine to the complexion, an alertness, a presentness.
This is in direct contrast to someone whose spirit is marred by the emotions and
who exhibits either a Yang, frantic, agitated stare, a frightened countenance, a fired
up complexion and manner of being; or a Yin, empty, vacant, absent stare, a
lusterless complexion, a depressed manner of being. These sorts of signs of
presence or absence of spirit are part and parcel of a classical Chinese medical
examination. In acupuncture treatment, where there are signs of a relative absence
or agitation of the spirit, this should begin to improve with the first few needles,
sometimes even with the first few words exchanged between practitioner and
patient. On a very basic level, then, much like in mindfulness meditation,

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acupuncture thus seeks to prod a person who is suffering from pain, discomfort,
distress, to turn toward life, to embrace life, to say yes to life, by connecting with
this deep wisdom, experienced when it is attained as a bodily-felt sense rather than
something to be expressed in words, an AhHa! Life experience that we are all given
to understand all along.

I will address the similarities and differences between the Western rationalistic and
essentialistic Mind focused on things in their ever smaller parts, versus the Eastern
Mind aimed at attending to the way things change, the process of change, a
process approach, in this month’s BLOG.

While mindbody medicine has become a main field of CAM practice, in many
different forms, the bodymind versions of this medicine have been downplayed.
The fact of the matter is, in the research on Indian yogis conducted by Dr. Herbert
Benson at Harvard decades ago, too little stress was place on the fact that these
Eastern practices were PHYSICAL disciplines. Through a disciplined use of ones
body, and ones breath, it was possible to achieve spiritual health. There was very
little mentally going on, except for developing a patient, and mindful stance toward
thoughts as they would inevitably flit in and out of awareness as one sought to
practice Yoga, T’ai Qi, QiGong, or Mindfulness or Transcendental meditation 40
years ago on this continent. Why, then, was this referred to as mind-body medicine,
when in fact it was fundamentally bodymind through and through? This is why I
chose the title “bodymind” energetics for my first serious attempt at explaining
what acupuncture was in the West, and had to keep correcting my editor as well as
those who wrote about the book when they would “correct” it to read mind-body
or at best body/mind.

While the concept of “bodymindspirit” which derived from the New Age Movement
in the 60’s in this country was a way to avoid the mind-body or body/mind split way
of discussing what is human, in the acupuncture world this has lead to a certain
tendency to criticize any approach to healing that fails to add “spirit” to the title as
deficient. Frequently over the past 30 years I have had some students and some
colleagues criticize my use of the term bodymind (rather than bodymindspirit) who
would go on to say I was good at treating the body, by which they meant

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“symptoms” but could not treat “the whole person”. Even Integrative Medicine
stresses treating the “whole person” including the “spiritual side”.

To me, as someone practicing acupuncture for over 30 years, I can just say I do not
know how it would be possible not to touch the spirit, understood in a classical
Chinese acupuncture way, when one seeks to be attuned to each patient “with the
heart and the mind” (Ling Shu p. 17). Elsewhere, the classics stress repeatedly “The
key to proper needling is to first attend to one’s own spirit” (Systematic Classic, p.
295). The first chapter of this classic, in fact, is all about the 5 Spirits and about the
fact that when Qi arrives, when Qi is obtained, the spirit may also be touched, and
so each needle must be manipulated with great awareness of this fact: “One should
remain calm and intent at all times, observing the response to the needle and
awaiting the arrival of the qi. (The response of qi) is said to be mysterious, subtle,
and without form. The appearance (of qi) is like the soaring of flocks of birds or
swaying of millet in the fields, which, though perceptible, cannot be discerned […]
As if perched above a fathomless abyss with one’s hand grasping a tiger, (when
holding a needle the spirit must not be distracted by anything) (ibid, p. 296)”

One does not have to keep talking about spirit to practice the high skills of
acupuncture, but rather dedicate oneself to mindful practice and practice this in
everyday life so that mindfulness becomes a part of being with a patient. This is the
topic of the all future Reflections.

II: The Way of the Needle

So now let’s talk about how acupuncturists, senior acupuncturists, master

practitioners are at one with the needle. When acupuncturists pick up a needle, as
opposed to students who are just learning to needle, they are not focusing on the
feeling of the needle in their hand; they have already developed the skill of being
very adept at loosening the needle from the tube if it’s a Japanese style disposable
needle, and this implement is just a part of their hand, not something they have to
think about for a moment, and of course that is something that only came about
with practice, by learning how to hold the needle in a graceful way so that the
needle and tube become one with the hand. And so when an acupuncturist, a senior
acupuncturist or a master practitioner picks up a needle, they are not attending to

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the needle, they are not attending to the tube, they are attending to the point on the
body that they have located visually, or by palpation, and if visually, will then go to
the body and palpate to find the point and in acupuncture physical medicine, in
classical Chinese acupuncture, in Japanese meridian therapy, these points are
moveable points. These points are not textbook rigid point locations. Rather these
are things that can be felt. So an acupuncturist who works from a palpation based
approach and who trusts the tacit knowledge in their fingertips, trusts what they see
and feel and sense through their hands. She will look for a point and once finding a
point, attending to the point, will use the needle, which is just an extension of her
hand, to go into the point, to search the point, to search the “Cave,” (one of the
meanings for the Chinese term that denotes an acupuncture point). She will search
for the active area, for a certain kind of sensation, a certain resistance, a certain
stuck feeling, a certain heaviness, a certain denseness, depending on the kind of
point. When she feels this, through the tip of the needle as an extension of the
fingers feeling this reaction, they she can apply the tonifying or dispersing needle
techniques to make the tissue respond in the way in a disciplined and predictable
way. This happens through practice, but all senior acupuncturists do this
effortlessly, and if they were to instead attend to the minute mechanical and
muscular activities that their needling hand is going through as well as their non-
needling hand to make the tissue respond in this way, they might very easily
become crippled and unable to function.

That being said, where Schon goes I believe further than Polanyi or, let’s say, is
more pragmatic than Polanyi in the education of professionals, in his idea of a
reflective practice and a reflective practicum with senior practitioners. If ACP and
clinic supervisors, as well as students, were to pay close attention to how senior
and master practitioners stand, manipulate the needle, move their hands, they might
be able to at times watch students who are in ACP training, look at how they’re
using the muscles in their hands, the muscles in their forearms, their posture, their
stance, whether they are sinking into the tantien or held tightly and rigidly, whether
or not their arm is strongly engaged or very weakly positioned over the patient, if
they are able in fact to notice and attend to what they usually do not attend to they
may well be able to make changes in the actions or practices of these students in
training that will make them be able to indwell more quickly and more fully in the
needling process, and make the needle an extension of the students so they can

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feel and attend to what is underneath the tip of the needle rather than what is held
between their fingers.

I’ve been looking at this carefully, and this is only my way of needling. There are
many different ways of holding a needle, using the needling hand and a non-
needling hand. Mine are based on very classical descriptions of these techniques,
but these are just my efforts, my way of making these techniques a part of me, a
part of my body, an extension of my body, something that comes second nature.
So, recognizing that there are many ways to do this, first of all, I believe that what is
critical in needling, if we now look at these minute mechanical actions, is to see the
wrist as the pivot. The wrist is not rigid. Many students needle either just with their
fingers trying to use it in a very tight way, almost like children who are first learning
how to write with a pencil, which they grip far too tightly. So what we need to do is
help beginning students have a very relaxed wrist. The wrist is relaxed and the
movement is fluid. So if one keeps the wrist relaxed, the fact of the matter is, if we
look at the forearm muscles while we’re doing this, if we were to do a soaring
crane type of movement with our hand where we bring all of our fingers together
and then touch all of our fingers, the pads of all of our fingers touching each other
toward the thumb, then the fingers become a small pointed beak of a bird. And if
we now were to keep our wrist very fluid, moving it first inward then extending it
outward, flexing it, extending it, moving it to the right and the left very loosely, we
can see, if we look at our forearm muscles, that our forearms muscles are very
much a part of this movement, even if the movement is small. So if the reader tries
this, moving first this hand that has fingers that are very engaged together, not hard
but definitely with force as if one were going to begin striking something as in
martial arts, this engaged hand also involves engaged forearms, and in fact as I do
this and feel I can see that I am not engaging the muscles of my upper arm, I am
not engaging the muscles of my shoulder, I am not engaging the muscles of my
chest, but all of those muscles—the upper arm, the shoulder, the chest—in fact have
settled into a very strong position where they can hold the forearm and hold the
hand. So the posture has to be erect, the shoulders have to be level. The body can
do this forever, the whole body is strong, the stance is balanced, one foot
somewhat in front of the other or shoulder width apart as in Qi Gong for example,
or Tui na massage, and in a strong stance like this, with the whole forearm
supported, the forearm and especially the hand with the help of the fulcrum of the
wrist is able to engage in such a way that the motion, either flexing toward the

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patient or extending the hand away from the patient is a strong movement and is
not just a movement from the fingers and is not a rigid movement from the whole
arm.

So if we look at this for a moment, we’ll see that in the first instance of tonifying
needle technique, which is first slow IN then fast OUT, if one imagines holding a
needle, or holds a toothpick for example, and starts moving in a big movement in
flexing the muscles, the forearm flexor muscles are very visibly activated. And a
teacher coaching a student in this technique could easily just go ahead and hold the
flexor muscles of the forearm and make sure that the student is engaging them, so
that if the student is just using the fingertips in sort of a rigid way that is not using
the forearm, the teacher as coach could say to the student, “just let these muscles
work, do this all the way from up here, do this from the flexor muscles all the way
up at your elbow, use the entire muscle.” That will help them focus on the “in” and
by doing that, in fact, as I’ve found in practicing on myself, just the contraction of
the forearm muscles holding the needle in place creates quite a strong sensation
when done properly because it is adding weight and force to the needle on an
inward movement, because the wrist is allowing the heaviness of the hand to move
inward, to flex, and the movement is a movement that is heavy on the in. I always
tell students when I am teaching this technique, “heavy on the in,” because the
focus is on the in. It is an engagement of the forearm muscles with a supple wrist.
And the final thing that is important whether tonifying or dispersing is that the
fingers are together just as they were in this flying crane technique. All of the
fingers ideally, or at least three of them, the index, the middle finger, and the
thumb, are holding the handle of the needle, not pinching it, the skin is not
blanched, the nail beds are not blanched, holding it very lightly in fact, and the force
that is holding the needle and the weight that is in the hand, coming first from the
flexor muscles of the forearm is generated through to the point, Large Intestine 4,
which is the first dorsal inner osseous muscle, and that muscle is fully engaged.
Many students have trouble with this. If one pinches the fingers very hard, that
muscle becomes engages and we can see that it becomes hard. But that makes the
needle sharp, rigid, a piece of metal instead of an extension of the fingers and of
the whole lower arm. So in releasing the grip on the needle and having the fingers
holding the handle of the needle very gently in order to prevent this from being a
sharp technique, the action during tonification has to come from the flexor
muscles, and the first dorsal inner osseus muscle, at Large Intestine 4, which has to

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be fully engaged, which creates weight down through the fingers, through the index
and middle finger and thumb, and this weight creates a reaction in the needle that
makes the subcutaneous tissue respond in a characteristic way to grab at the tip of
the needle. It’s a heavy motion that causes a heavy slow response, not a fast
response. This is a slow in, slow response of the muscle, even though the needle is
only into subcutaneous fascia. The Japanese often refer to this as “needle grasp.”

The classic texts describe this as a very gentle, almost imperceptible manipulation:
“Supplementation may be defined as tracking. Tracking implies (insertion of the
needle) I a seemingly casual way, as if nothing were being done, like the biting of
the mosquito. After retention, the needle should be withdrawn quickly, like an arrow
leaving a bowstring” (Systematic Classic, p. 292), and the left hand closes the hole
for several moments. The result is a gathering of tissue, a grasping of deeper
muscle, a toning up of a weakened or even somewhat flaccid tissue area. Often
there is a feeling or warmth, or even of a weight that has sunk into place that lasts
for several minutes. That is tonification.

Dispersal then, and here we are talking about twirling the needle, as well as moving
it in the opposite way, consists of wrist movement creating a fast in/ slow out
technique. What one does in fast in slow out is the opposite with the right hand. So
one first inserts the needle fast. This fast movement is with the forearm muscles, so
it’s exactly the same use of muscles as for tonification, but it’s done quicker. And
this kind of quick movement causes a fast grab of the muscle, and the fascia deep
beneath the needle—a fast reaction rather than a slow one. And then, still using the
wrist as the pivot, one now uses not the flexor muscles at all, but the extensor
muscle of the forearm on the top of the arm, the yang aspect of the arm as
opposed to the yin flexor aspect. One uses the extensor muscles, the extensor of
the index, ring, and middle fingers in the area of Large Intestine 10 and what Kiko
Matsumoto calls Triple Intestine 10, so on the triple meridian at the same level as
Large Intestine 10. If one feels there, and as a coach if one feels there, instead of
engaging the flexor muscles, one engages the extensor muscles all the way up to
the elbow, using the wrist as a fulcrum, still keeping the fingers engaged, grasping
the needle lightly but with very engaged hand, a strong hand, a hand that if
somebody came to hit it away as in martial arts, would be there, stay put, a hand
that is present, fully engaged, weighted. So now, with the same grasp on the
needle, with the same engagement of the Large Intestine 4 areas, the first dorsal

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inner osseus, one simply uses the extensor muscles which the teacher, the coach,
could but their fingers on, and with the wrist as a pivot engage the extensor
muscles which creates a heavy focus on the out. And the out movement should be
slow, so the extensor muscles are used very slowly after having quickly gone into
the point to create a quick grab. And it is important that it grab. If it doesn’t grab,
one goes out slowly and then in rapidly again several times and then out slowly
again.

The classic texts describe it this way:

“Drainage may be defined as head-on attack. Head-on attack means (rapid)

insertion (of the needle) while twisting to enlarge the hold, and (slowly) extracting it
so as to discharge the evil qi)” (ibid, p. 291).

So this simple technique, based on the tactics of fast in slow out uses a totally
different set of muscles—yang muscles for yang technique, extensor muscles—and
the fascia is slowly pulled away from the point, the point that is taut, the point that
has too much tone. And by pulling the fascia out and then letting the needle stay
shallow, the technique will actually create a release of the fascia rather than a
toning up of the fascia. So through these very precise uses of the forearm muscles
and engagement of the muscles of the hand, engagement of the fingers without
gripping tightly, one actually extends the needle, it becomes a part of the hand, an
extension of these fingers brought together. And by bringing these three fingers
together, the thumb, the index, and the middle finger, one is able to use the force
either of the flexor muscles to focus on the in or the extensor muscles to focus on
the out. This is something that I believe is easy to teach and easy to improve upon if
one is still having trouble doing tonification and dispersal needle techniques.

That’s it in a nutshell for the right hand. Now, if one adds twirling—twirling very
much engages the Large Intestine 4 area, it is very difficult to twirl without. But in
twirling, one engages the flexor muscles with the wrist flexed to tonify, or one can
twirl with the wrist extended away from the body to cause dispersal. So twirling
with the wrist either flexed or extended will create different reactions in the tissue,
and if one lifts and thrusts and twirls at the same time, these processes can be done
quicker, but it is by no means necessary. A way to build up the strength in the hand,
to make it a strong hand, and here I am thinking of acupuncture like Qi Gong or like

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a martial art, the hand must be and the forearm must be fully there. In martial arts,
even in Qi Gong, when someone is doing different motions in Qi Gong, the arms
are engaged, the hands are engaged. If someone were to come up against those
arms, which appear to be just floating in space, they would come up against
something quite solid. The arms engaged that way would be able to immediately
protect themselves and defend themselves. These would not be arms that would be
able to be pushed away easily. I think in acupuncture it’s the same thing, and I’ve
just come to this realization in making this new attempt at understanding the more
tacit aspects of what we do, that many students are hovering over the body in a
very light way. They somehow feel that being extremely light and loose is the way
to be gentle.

In my experience it’s that type of needling that is sharp and very much not engaged
needling and does not create the reactions in the patient hat the student hopes for.
So I believe that the practice of acupuncture has to be like Qi Gong, or AOM
Bodywork techniques, or even like a martial art in the sense that the parts of the
body that are being extended and attending to the other person have to be fully
engaged, strong, weighted, present. And by being strong and by having strength
and muscles engaged one is in fact bringing a force to the needle. Some people
would say this is Qi Gong being applied to the needle.

So, in order to strengthen the hand and the forearm muscles, what I’ve
recommended to students is to get a rather thick dowel rod. It could be just four
inches long—almost like the handle bar of a bicycle, and one might even be able to
find something like that in a sporting goods store, or just get a hard rubber cap that
fits over handle bars—in any case something about an inch in diameter, round, a
dowel rod, so something much thicker than a needle. And if one holds that like one
would hold a needle—I do it with my cane, for example—just the holding of it can
only be done by engaging the Large Intestine 4 area, the first dorsal inner osseus
muscle. It’s through that muscle that one holds a cane, one cannot just pinch the
fingers—it’s in fact impossible—even though one can pinch just the fingers around a
needle and not engage that muscle, which I’ve seen many times with students. So
by using this thicker needle, this dowel rod, one has to engage that muscle, and
then just twirling it back and forth is a very strengthening activity. And one can twirl
it back and forth slowly, rapidly, clockwise, counterclockwise, and watch, using a
very loose wrist, doing this first using the flexor muscles at the same time to build

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the muscles and to train the muscles and make these muscular actions tacit rather
than conscious. And then do the same thing twirling the dowel using the extensor
muscles on the top f the arm. And in this way one can very quickly build the
forearm and extensor muscles. Mine are quite developed and I never do anything in
the gym to use these muscles, this is all from having done acupuncture for thirty
years. So this would be the way to strengthen the arm, make the hand present,
heavy, engaged, weighted, so that there is force, weight in the hand ready to make
specific reactions happen from the needling.

That brings us the last part of the needling process, which is what to do with the left
hand. I cannot speak for styles that don’t use the left hand, which certainly is often
done. But in my approach, and the Ling Shu already states this very clearly:

“The right hand is used to hold and push the needle while the left hand assists and
controls” (p. 5). And later on in the same text:

“The left hand fixes the bone position, the right hand follows. Do not cause the
flesh to bunch up”(ibid, p. 230).

Acupuncture, in the classics, is clearly a left-handed affair. In Japanese meridian

therapy, which uses tubes, the role of the left hand is extremely important, and
that’s where I learned to use the left hand, was in learning to hold the tube. One
uses the left hand to grasp the tube, the thumb and index finger grasping the tube
at the very bottom where the needle tip will be. And by holding the tube right at the
bottom and then placing the tube on the point, one places a lot of weight, a very
weighted left hand or non-needling hand, and compresses the fascia so that the
tube is actually inserted quite distinctly into the fascia and is not floating lightly on
the skin. This will prevent sharp insertion when the needle is first tapped in. So in
this kind of technique, holding the tube at its tip between the index and thumb and
letting the other forefingers fan out as wide apart as is comfortable depending on
the part of the body or closer together almost like one holds a pool cue, almost
identical to that kind of way of spreading ones fingers, the whole left hand, the
whole non-needling hand, the edge of the palm, the edge of the pad of the thumb,
the whole heel of the hand is very firmly weighted on the patient. This is not an
insignificant process, because by weighting the area—and one can do it just with the
thumb and index finger as well, but it’s more powerful if one weights it with the

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whole hand—then as soon as the needle is tapped in, it is already at the proper
depth where stimulation can occur especially for tonification. And once it’s tapped
in and in my style where needles are used that are 34 gauge in most cases, I find
that the tap has to be two or three taps, not just one, and ideally the taps would tap
in such a way that the fingers do not touch the top of the tube, they just touch the
top of the handle of the needle. And if one does it properly, the needle is propelled
fairly deeply into the tube so that it’s deeper than the surface of the tube. The
needle has actually been propelled somewhat deeper than if one just pushed it in
slowly, which is sharp and not a pleasant way of needling. So tapping the needle a
couple of times rapidly, one spreads the thumb and index fingers slightly apart on
the non-needling hand, and relaxes the weight of the hand slightly where the thumb
and index finger are and stretches the skin and removes the tube. Now, with this
taught skin, one can do the first stage of the needle technique, which is to ensure
that the needle is into the fascia, the subcutaneous layer, which is called the Cou Li
in Chinese. So the needle is in this layer, which is also the Wei level, the Yang level.
At that point, one can let go of the needle, let go of the left hand, and now the
needle is at a Wei level depth and now one can direct the needle with the left hand
or the right hand. So what I now suggest that students do is reposition themselves.
If I want to just tonify, I now just put down my index finger very close to the needle
and create a slight weight on the area, compress slightly, and tug very slightly so
that the skin is taught right where the needle is. I make it taut like a drum—a very
slight weight in, a very slight tug, changing the direction of the needle if desired, or
just keeping it perpendicular. With the skin and fascia somewhat taut, I then do my
needle techniques: slow in, rapidly in, and so forth. When I’m doing trigger points, I
use Travel’s technique, which is to trap the muscle, which I first have felt cross
fiber, and once I find the most tender part of that taught band, I stretch my index
and ring fingers slightly apart. Actually, I do the same thing: I find the point cross
fiber, I place the tube right on the most tender spot and hold it with the thumb and
index finger first, tap it in, spread my thumb and index finger just slightly apart and
remove the tube. At this point, I recommend to let go of the needle with both
hands, and then to put the left hand, the non-needling hand, middle and index finger,
cross-fiber above and below the needle, so surrounding the needle, straddling the
needle, cross fiber, finding the muscle again and using the fingers to ensure that
they are placed right over the needle, but this time not hard enough and heavy
enough to find the tender point, just to keep the muscle trapped and that part of
the muscle weighted where the needle is located. And now, with very little pressure

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but stretching the skin again, I have students hold the needle again with a very
engaged hand and do quick movements in two to three times, and then slower out,
hovering for a second or longer, called sparrow pecking technique, like a a bird
pecking for seeds. So it’s quick pecks, the pecks are in a staccato kind of fashion,
so not even pecks, not rhythmic pecks, jerky pecks, pecks for a couple of grains
and then out, and then a couple more grains, and then out. So to artificially show
this at first to students, I recommend three pecks in and then one out. So peck,
peck, peck, out-HOVER, fast pecks in, slow out. Three pecks in, slow out. This is a
fast in slow out technique, and the focus is on the fast in. If one focuses on the slow
out it will usually not work. So it’s a focus on fast, fast, fast, slow-HOVER, fast, fast,
fast, slow,-HOVER changing the direction slightly each time as if one were pecking
for different seeds each time. This will, if there’s a trigger point in the area, cause
the muscles to fasciculate and twitch, often visibly, but even if not visibly,
perceptible to the non-needling hand, which is resting lightly this time on the area.
So in dispersal, the left hand is resting lightly, still with the skin taut where the
needle is. In tonification the hand is resting heavy because in tonification the focus
is on a heavy weight dropping into the area. In dispersal, the focus is on a rapid
movement in and then a relaxing of the fascia.

With these basic ideas and with some coaching, everyone can learn to do proper
tonification and dispersal techniques. And following Polanyi’s example of tacit
knowing, one can learn to attend to what lies at the tip of the needle and attend to
the reactions that one is looking for at the tip of the needle, rather than being
distracted by the handle of the needle or this implement awkwardly held in the
hand. The goal is to make the needle an extension of the forearm, an extension of
the muscles of the forearm and the muscles of the hand.

Tips When Needling the Root/Opening Moves

I have several specific things that I focus on when needling the first few points in a
treatment, points my dear friend and master acupuncture practitioner Dr. Eric
Stevens always refers to as “opening moves”.

Influenced again by Shudo Denmei’s pragmatic advice, that only a few needles
need special attention to set the Root treatment in motion, I seek meaningful de qi

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at the operational jing level points: SP 4, GB 41, LU 7, SI 3, and the source points for
the thre leg Yin, sometimes with Sp 6 instead or added to the source points as
follows:

 SP 4: I needle this textbook location, but between the bone and the muscle
(the adage to needle between the red and white skin makes no sense, as this
differs with different people, and can lead to needling the often exquisitely
tight, tender muscle especially on people with flat feet or plantar fasciitis-
type problems. I always needle this point on the right, as I want to needle the
paired Per 6 on the Heart Protector left side. I run my index finger with distal
phalange relaxed as per Shudo Denmei’s suggestion for palpating actual
acupuncture points (as opposed to indurations), from SP 2 for about an inch
until I fall into the hole just at the distal end of the bone where the finger
stops abruptly. I retreat with the finger a touch to place the needle on the
exact spot, angling the needle with tube compressed firmly into the point
(supported by left hand thumb and index finger rooted around the tube at
the base, into the flesh to prevent a sharp insertion) and tap several times to
ensure the needle has progressed all the way into the tube with its handle
top level with the top of the tube. One should never tap this point just once
with the # 3 Serein needles I use, or it will not insert deeply enough and be
sharp once the tube is removed.
With my non-needling left hand I tug with my fingers on SP 2 area, until I can
see the skin and subcutaneous fascia tug/drag and tighten all along the
trajectory of the meridian, right up to behind the medial malleolus. I always
tug this way when I want to initiate a propagating Qi sensation along a
channel, which “facilitates” the taut fascia, making it more yang and more
reactive. If the skin is cold I rub it to warm it, or even cover with Mylar for a
few minutes to warm it up. Rubbing or tapping along the trajectory where
the propagation is to occur will also hasten the desired results. I then insert
the needle very slowly into the resistance at the point, finding where it is
most reactive, dense, lime an eraser on a pencil which Kiiko Matsumoto
refers to as a “gummy” or “kori”. Needling in to this resistance until the
needle gets slightly stuck, I then twirl rapidly into it, or twirling and lift and
thrust focusing on the out movement, and the propagation is quick to arrive
for most people. Wherever the Hara has been tight on the abdomen,
especially in the middle heater along the Kidney, Stomach and even Spleen

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 or Liver pathways, this will release. I look for exaggerated skin creases on
the abdomen, which bespeaks constrained Qi at that level and an
upregulated sympathetic nervous system (with signs and symptoms of
nervous or overactive gut functions), and these will tend to decrease
markedly. The breathing invariably starts to improve with such initial Root
points, a sign that YinYang regulation is setting in. There may be rumblings in
the gut as well, and a definite change in the complexion. The eyes will also
soften and the person’s demeanor will normalize somewhat. The
propagating sensation will travel at least 4-5 inches along the Spleen
pathway, up toward the medial malleolus. If it can be made to ascend to Sp 6
level, it will usually travel up to the pelvic region and even umbilicus or
higher. Kiiko would call this targeting the Qi, and the change at gut level is
what makes such initial points have such a powerful affect on the
constructed Hara. The rectus abdominus will be much less constricted from
the navel to the subcostal region in most cases. I needle the paired Per 6 on
the left with neutral stimulation to get the slightest de Qi response travelling
toward the wrist;

 GB 41: I insert the needle slowly in the same fashion, on then left side,
angling under the bone into the textbook location toward Liv 3. My left hand
tugs/drags the skin and subcutaneous fascia again diagonally away from/in
the direction opposite to Liv 3 until I can see the drag right to Liv 3 and then
insert slowly into the resistance. As this is a Yang meridian I needle more
strongly until there is a deep penetrating de Qi response that is quite strong
(always within the patient’s tolerance level however) spreading throughout
the dorsum of the lateral foot. This will tend to relax the waist and pelvic
region and restrictions will begin to release, sometimes totally along the
pathway of daimai (GB 26-28, and the lower external obliques). I needle the
paired TH 5 neutrally for the slightest de Qi sensation, or modify this
opening move by adding left Liv 3 needled until there is a definite but
tolerable de Qi sensation, and add right LI 4 instead of TH 5 (thus adding one
diagnonal set of the four gate points to GB 41). I do LI 4 like Liv 3, until there
is a definite but tolerable de Qi sensation. I will often do this combination
together, so SP 4 on the right, Per 6 on the left, then GB 41 and Liver 3 on
the left, and LI 4 on the right as a modified “Infinity Treatment) treating
chongmai and daimai to target dysfunction and constriction in the pelvic

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 region and lower heater. I do SP 4 and GB 41 on the same side as hip pain
and dysfunction to target the hip area.
 Lu 7: I needle Lu 7 to open renmai at the exact textbook location, off the
trajectory of the rest of the Lung regular meridian, dragging away from the
elbow with my non-needling hand until I see the skin and subcutaneous fascia
tug all the way to Lu 5 or even Lu 4-3. I needle slowly into the dense area as
for Sp 4, and this will invariably create a rather strong and spreading de Qi
sensation in the area or even up the channel toward the elbow. When I want
to needle Lu 7 as the Luo point for carpal tunnel area thumb and palm pain
and numbness, I use Travell’s trigger point location for the flexor pollucis
longus, a good inch proximal to the level of textbook Lu 7, this time along
the Lu pathway, tugging the same way. Even though the needle is inserted
up the channel, this point will cause a deep spreading muscle sensation down
to the thumb and palm, and even make the thumb twitch—identical to what
one would want when treating the Luo of the Lung for palm and thumb pain.
I needle the paired Kid 6 at the textbook location, slowly and carefully
insinuating the needle between the tendons to 1/8” or so, and stimulate for a
very slight de Qi response;
 SI 3: As a yang meridian point, I needle for a stronger but tolerable de Qi
response, inserting the needle almost ½” across the interosseus muscles of
the palm toward LI 4. I stimulate BL 62, about 1/8” into the exact textbook
location between the two tendons, for a very slight de Qi response.
 The next set of Root points, this time from the regular meridians to target
the Ying level, will usually consist of the source point for whatever leg Yin
meridian in the circuit in question: when treating the Taiyin-Yangming circuit,
this will be SP 3 or Sp 6 as a common alternate; For the Shaoyin-Taiyang
circuit, Kid 3; and for the Jueyin-Shaoyang circuit, Liv 3. This is classic
needling of the source point for the yin meridians of the foot. I have learned
in thirty years of leading and supervising students as they engage in
acupuncture clinical practice treating student-patients for 200 hours over
two years, to establish treatment protocols that begin this way, with distal
leg ying level points to avoid an overly strong reaction with release of heat
or yang rising upward. If I have not already needled Sp 6, I usually add it
after Kid 3 or Liv 3. I needle Kid 3 either side, as there are two
kidneys/adrenals, Sp 6 always on the right and Liv 3 always on the left,
opposite their respective organs. When I needle source points, I insert the

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 needle very slowly after tapping in with tube held firmly as above, into the
dense resistance. For Kid 3 this will be very shallow, about 1/8”. I use one
finger f my left hand after removing the tube to gently tug the skin and
subcutaneous fascia I any direction just to make the skin where the needle is
inserted taut like a drum but not enough to pull the needle toward my finger.
I then needle slowly into the resistance, less than 1/8” for SP 6 and Kid 3, and
¼” to almost ½” for Liv 3, which I find reacts more like a Yang meridian
point. That said I see Liv 3 as a great point for Liver excess and am not in the
habit of treating Liv 8 for Liv deficiency, as the meridian therapy
practitioners like Shudo Denmei do. They advocate a very shallow insertion
for Liv 8. When I am treating yin deficiency, I prefer Sp 6. At Sp 6, I insert
very very slowly into the resistance barely encountered at first at the point,
and after hesitating a few second, pull the needle quickly to the surface, then
reinsert extremely slowly and with a very heavy needling hand rooted to the
area, edge of palm planted firmly on the patient’s lower medial shin and
invariably notice the resistance becoming more pronounced, and more
dense even though still very shallow. Once that occurs, I needle staying at
that depth rapidly until there is a pleasant mild de Qi sensation spreading
around the area.

Tips for Needling the Wei Level

This level of disorder is termed Wei Level by Chamfrault and Van Nghi, and denotes
disorders of repetitive strain, physical trauma, injury, and Wind/Cold/Damp Bi
syndromes affecting muscles, tendons and ligaments and bones.

In Acupuncture Physical Medicine, this level of physical medicine practice is

reinforced by a comprehensive study of Travell and Simon’s two-volume tome,
Myofascial Pain & Dysfunction: The Trigger Point Manual. In my book, A New
American Acupuncture: Acupuncture Osteopathy I argue that by including Travell
and Simon’s entire approach to palpation and needle release of trigger points into
the acupuncture study of the tendinomuscular meridians (also known as muscle
channels in English), the knowledge of how to palpate for, identify and needle
muscle ashi points is significantly enhanced, with the side benefit of affording the

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practitioner a more western medical way of discussing such disorders with patients,
their caregivers and other medical professionals.

I refer the reader to that text, where I list the main trigger points for each of the
three zones of the body –the Taiyang dorsal, Shaoyang lateral, and Yangming venral
zones. I give basic classical Chinese acupuncture protocols for distal points that
then use Travell’s trigger points as the local equivalent of tender Ashi points. Any
serious effort to train in a comprehensive treatment of the muscle channels,
however, must include the treatment table-side use of Travell and Simon’s two
volumes as ready reference to facilitate clinical use, and internalization, of these
trigger points, what they feel like, how to trap them, how to needle and release
them, in order that this knowledge might become second nature.

Again Maciocia shows his bias against (and deep ignorance about) the
comprehensive treatment of muscle channels, which any practitioner of East Asian
bodywork including tui na, anma and shiatsu would excel at.

After listing the main local points per body area, in his final chapter of the
aforementioned text, on bi syndrome, including sports and repetitive strain injuries,
Maciocia makes this telling statement: “Ah Shi points (points which are tender on
pressure, are also local points and form an important part of the acupuncture
treatment of Painful Obstruction Syndrome. In most cases, these will coincide with
normal channel points, but if other points are tender on pressure they can be
needled in addition to normal points (Ibid, p. 656).” He then proceeds to only list
“normal local points” over ashi points, except for one ah shi point he labels the
“epicondyle” point one cun behind L.I. 11, Quchi, which appears to be identical to
Travell’s ring finger extensor attachment trigger point.

If he were trained in trigger points, and how to palpate cross fiber to identify the
most tender ones (as shi points), he would know hundreds of such local points, all
of which would prove incredibly effective in clinical practice on such conditions.
The normal acupuncture points he does list for the muscle channel treatment of the
elbow, shoulder and knee are standardized points that appear in the simplest
modern TCM discussion of bi syndrome, and fall far short of what I would expect
an expert in acupuncture as a hands-on, physical medicine to know. Concluding his
ambitious effort at presenting a detailed English-language text on the secondary

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vessels in this way, especially when including the major texts by Drs. Yitian Ni,
Andre Chamfrault and Nguyen Van Nghi in his bibliography and further reading list,
does a great disservice to those native English students and practitioners who had
hooped to find this a useful clinical text.

As it is, regarding the clinical use of muscle channels for pain musculoskeletal pain
and bi syndrome disorders, Maciocia’s text offers nothing new, and misleads the
reader with images of the muscles in each muscle channel, without ever indicating
one should learn how to identify the trigger points in these muscles so laboriously
presented by Travell and Simons.

At the Tri-State College of Acupuncture, students study the myology of trigger

points and gain clinical facility in utilizing these invaluable texts in a myology course
in Year I, after their study of anatomy, that prepares them for Acupuncture Clinical
Practice with me and my team in the second year as they engage in two semesters
using AOM protocols that frequently incorporate Travell and Simon’s trigger points
into the practice. Student clinic-interns routinely resort to these Travell inspired
APM treatment strategies when confronted with simple to complex, chronic pain
disorders including athletic and performance injuries, repetitive strain and
cumulative trauma disorders, as well as chronic pain disorders stemming from the
full gamut of musculoskeletal disease. These sorts of complaints comprise a good
50-55% of the conditions treated in the college’s busy community acupuncture and
pain clinics, as well as in the practice of its faculty.

In APM, this myofascial pain knowledge base, and trigger point dry needling
techniques are therefore clinically necessary over half the time.

Once again Maciocia’s The Channels of Acupuncture reveals a decided bias against
the muscle channels (jing jin). As Maciocia states in the preface to Part 4 on these
channels, “The Muscle channels are not as important and as clinically relevant as the
Connecting channels. However, in the fields of musculoskeletal problems and of
Painful Obstruction (Bi) Syndrome, they are extremely important (p. 283).”

If musculoskeletal problems and Bi syndrome disorders make up over 50% of an

acupuncturist’s practice, how could one ever make such a statement? Unless, of
course, ones practice is predominantly comprised of internal medical disorders,

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which would appear to be the case in the North American practice of TCM. A look
at the key TCM texts will show only very short sections on painful obstruction/Bi
syndrome, and the muscle channels are seriously downplayed in the English-
language literature.

In my experience over the past thirty years, I have encountered TCM students and
TCM practitioners trained in North America at other AOM colleges who appear to
have little if any knowledge of the muscle channels or skills in palpating and treating
tender/ashi points—the central focus of muscle channel treatment. Students report
seeing virtually no NCCAOM board examination questions on bi syndrome for
example, with the preponderance of cases focused on ZangFu internal medical
conditions. Perhaps it is time the NCCAOM initiate a survey to ascertain what
acupuncturists really treat, which we did do at the college twice over the past
several years, and twice in faculty practices. Each time we learned that these
disorders occupy over 50% of what our clinics, and the clinics of our faculty, treat.

Another curious piece of evidence to suggest that knowledge of, and acupuncture
skills in treating muscle channel disorders is not part of every AOM college’s entry
level curriculum, is that the majority of ACAOM candidate or accredited post-
graduate doctoral programs in AOM have pain management as a specialization
area, indicating that they see this as a more rarified, specialized area, not a basic
entry level set of knowledge and skills all practitioners should have.

Acupuncture Physical Medicine treatment of these wei level tendino-muscular

meridians is straightforward for the distal points: use excess reactive points distal to
the area of pain and dysfunction, based on the principle, “the further the farther”.
The jing-well point is therefore always indicated as the point furthest from the
symptomatic area, and then moving up the channel, based on the needling strategy
of “Bao Ci” where one needles one ashi or tender point after another along the
muscle pathway based on palpation, one disperses with lifting- thrusting-twirling
technique focused on the outward lifting motion to propagate Qi along the muscle
pathway. If the luo point is tender, and especially if its target area is within the area
of the patient’s pain and dysfunction, this is an excellent distal point as well.

For local points, APM integrates Travell and Simon’s myofascial and tendon
attachment trigger points. Any practitioner serious about learning how to use these

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trigger points to supplement their knowledge of treatment of ashi points can readily
use their two volume “trigger-point manual” tableside and open-book, to guide
careful cross-fiber palpation. One can then either needle wei level oblique shallor
OVER these trigger points, a classic Chinese acupuncture technique, or for deep
muscle pain especially when aggravated by Cold, needle slowly into the belly of the
muscle until there is deep de Qi, or use sparrow pecking technique after this last
technique and after de Qi has been achieved. To do this, with the non-needling hand
straddle the point and apply a slight amount of pressure inward, but mainly apply
pressure laterally away from the point to slightly compress the underlying fascia,
keep the contours of the muscle clearly demarcated, and stretch the tissue to make
a more taut, rather than bunched up, surface. Then withdraw the needle to the skin
level, and begin to peck with a fast in, slightly slower out motion, repeatedly with a
slight hesitation of a bit less than a second on the out after 3-5 pecks, so: FAST in-in-
in (in-in), a bit SLOWER out and hesitate almost a second/ resume pecking like a
sparrow, now for gains a bit to the left or right or above or below for more grains,
FAST in-in-in (in-in), a bit SLOWER out and hesitate almost a second, and resume.
This usually causes twitching/fasciculation of the muscle underneath the fascia
being needled, even without piercing the muscle. If the muscle is slow to release in
this fashion, go in slowly again as in the beginning, and get de Qi, then peck slower,
fanning out in the 4 directions more deliberately (this is how trigger point injections
are done and are described in great detail in Travell and Simon’s manuals) until the
muscle twitches. At that point one can usually withdraw while pecking back to the
surface, pecking at the superficial fascia just over the muscle in question. Dry
needling of trigger points in most approaches just uses thicker longer acupuncture
needles, about 32 gauge and 1.5-2” long, so as to be able to approximate Travell
and Simon’s trigger point injection technique. One can also take trigger point dry
needling courses with MyoPain Seminars, which descended from the Travell
Seminar series and is still co-directed by Travell’s protégé/colleague, Dr. Robert
Gerwin. In this seminar, open to licensed acupuncturists and medical professionals
with the authority to perform dry needling in their respective states, participants
learn how to locate, identify and perform dry needling on the main trigger points
using acupuncture needles as above. The Tri-State College of Acupuncture which I
founded also occasionally runs a summer seminar series in APM dry needling which
is advertised on the college’s website for CEU courses at www.tsca.edu.

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Tips on Needling the Three Yang Zones/ Cutaneous Regions

When focusing on needling of the chronic myofascial holding patterns in the three
Yang Zones, as outlined in the previous chapter, one can bring to bear any number
of classical and modern acupuncture techniques and strategies:

1] wei level or trigger point dry needling as covered in the previous chapter;
classical Chinese and modern TCM bi-syndrome techniques outlined by Dr. Ni in
her discussion of tendino-muscular meridian treatment ( Navigating the Channels,
pp. 9-10), especially:“Bao Ci” for muscle bi syndrome that can affect a large area
with pains moving around (Taiyang scapula pains at times, at other times Taiyang
low back and buttocks pain, and at yet other times Taiyang hamstring and calf pain
in a dancer for example); “Fu ci” (the standard shallow, oblique wei level technique
where the needle tip ends up over the affected ashi/trigger points, but not into the
muscle trigger point itself and: “He Gu Ci” for a deep muscle bi pain disorder, with
one needle inserted perpendicularly into the belly of the ashi muscle point/center of
the trigger point itself, with two other needles inserted obliquely, wei level over the
tendon attachment (what Travell and Simons refer to as Attachment Trigger Points
or ATrPs), either angled toward the perpendicular needle, or away from it
depending on sources. When there is involvement of inflamed tendons or
ligaments, or bone (osteoarthritis), I prefer to use a modified “Duan Ci” technique
where one starts the needle shallow and perpendicular, at the yang, wei level. Then
one inserts the needle slowly to a deep level until very close to the tendon, ligament
or bone involved. Repeat this a few times until a deep de Qi sensation is obtained,
and then stay at the depth where this is felt, and apply very short and slow lift-thrust
manipulations until the sensation propagates deep into the tendon, ligament or
bone. In the PRC, this technique would actually needle into the structure involved to
cause bleeding, which would be considered a surgical intervention in North America
and must be avoided due to risk of deep and serious infection.

2] stationary or moving cupping; guasha;

3] heating techniques like moxibustion (direct or on the top of the needle or

indirect); hot packs, heat lamps; mylar applied over the treated area (which just
floats on the needles and generates tremendous heat when the skin is bare);

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4] Electro-stimulation without or applied to needles;

5] Deep sustained acupressure techniques from anma, tui na or shiatsu (ischemic

compression in Travell and Simons) to ashi/trigger points followed by slow release
(strain/counterstrain);

On Andrew Nugent-Head Yin Style Ba Gua Tangible Qi Needling

Techniques

While I feel I have come to be able to teach students how to do quite a decent job
with needling, over the past three decades, I am in fact mainly self-taught. The
faculty from the Quebec Institute, and even Van Nghi, who treated me a few times
so I can experience this, made little of needling, stance, posture, as so many TCM
practitioners I have met.

Luckily, Andrew Nugent-Head, founder of the Association for Traditional Studies,

has come forward after almost 25 years experience training in classical, Yin Style
Ba Gua that includes self-cultivation Daoin practices (8 healing sounds, point and
meridian rubbing and patting, and Qi Gong) with acupuncture training, and that
stresses the ability to do repeatable strong techniques that get predictable results,
with a strong focus in ashi point needling and hand techniques.

Andrew has contracted with then college to run CEU training for alumni, and will
teach students in the MS/Ac Program one day each of the Spring Intensive over the
3 years. Andrew has also agreed to offer his comprehensive training in
acupuncture, focusing on ashi point treatment as well as a classical set of yinyang
regulatory points, as the core of the Advanced Post-Masters course in Acupuncture
in Orthopedic and Trauma Disorders, which will become one of the majors a
student in the eventual Doctor of Acupuncture Program could select.

I strongly recommend that all second and third year students watch the
introductory free video presentations by Andrew Nugent-Head on his website, for a
view of his approach to training in hand techniques, and the tangible Qi lectures
which give a good, and very sophisticated sense of his approach to training. I am
honored, and humbled by someone with this level of skills and experience, and will

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be right alongside other TSCA faculty and graduates when he teaches at the
college, starting this October 2011.

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CONCLUSION AND BEGINNING
APM CONCEPTS AND KATAS-
DOWN TO BASICS

A. KEY THEORETICAL CONCEPTS OF APM

ACUPUNCTURE

Bodymind Energetics

GROUP 1
 Bodily-Felt Sense (Felt-Sense)
 Recollection of Being
 Bodymind Continuum (Side of the Psyche/Side of the
Soma)

GROUP 2
 Classical Western Psychosomatic Concepts and Selye’s
Stress Theory (body language; conversion stream;
somatic compliance; organ inferiority; vegetative
neurosis/visceral agitation; stress response and coping;
fight or flight (sympathetic dominance); rest and digest
(parasympathetic dominance)

GROUP 3
 Groddeck’s “the IT”;
 The Will to Get Well;
 Salutogenic vs. Pathogenic

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Acupuncture Imaging

GROUP 4
 Acupuncture Reframing/Imaging

GROUP 5
 Wei (Surface) Energetics
 Ying (Functional) Energetics
 Jing (Core) Energetics

A New American Acupuncture: Acupuncture Osteopathy

GROUP 6
 Strain-Counterstrain
 Myofascial Release
 Somato-visceral/ Viscero-somatic

GROUP 7
 Bi-lingual communication of tender points --i.e., Ashi
points near SI 9-14(Chinese Acupuncture); Teres
major, teres minor, supraspinatus, infraspinatus TrPs
 (Travell and Simon’s Myofascial Trigger Point Theory)

Acupuncture Physical Medicine

GROUP 8
 Adrenal Syndrome/Chronic Fatigue Syndrome
 Four Patterns of Fatigue

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 GROUP 9
 Repetitive Strain
 Mu-Point Boogey
 Visceral Agitation/Organs in an Uproar

APM Acupuncture: A Guide to Clinical Practice

GROUP 10
 Jingluo/Lingshu Acupuncture
 YinYang regulation
 Thorns, Stains, Knots, Obstructions

GROUP 11
 Calm Mind-and-Heart
 Neo-Confucian Learning of the Mind-and-Heart
 The Great Learning and Self-Cultivation

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 B. KATAS OF APM CLINICAL PRACTICE

In discussing the Logic of Year II APM Acupuncture Clinical Practice sessions, Peter
Dubitsky, MS, LAc, Director of Clinical Training and I landed on the martial arts
concept of “katas” or forms in Japanese Karate which fit perfectly for what we
were aiming to accomplish in this year, to ready students for the real world of
community clinic at the end of the year.

In katas, one usually practices alone, and the katas are meant to enable one to
internalize, or embody a set of offensive and defensive moves directed against
from one to several adversaries. Once one has internalized these forms or sets of
movements, once one ‘embodies’ them, they serve as a repertory from which one
can draw automatically in the real world of combat or competition or self-defense,
once they have been mastered, because one has done these moves before.

The late Donald Schon stressed, in his theory of Reflective Practice in the
professions, that experts are those who have internalized, embodied, made tacit a
large number of possible moves, so that they can react in what looks like an
intuitive way to the complexities of real-world problems they face, because they
have encountered and practiced responses to similar situations many times already.
He stressed the need for students in any profession to recognize this need to move
beyond book learning and logical thinking, to the tacit dimension (Polanyi) of
automatic response based on this deep, embodied learning, just like one learns to
drive a car, or ride a bike and it becomes second nature.

The following 16 katas, or sets of moves or prototype treatments have proven

sufficient to enable clinic interns at the college to adapt to most clinical situations
they encounter in the summer community clinic at the end of Year II, with the
support of a team, and access to clinical supervisors. While summer clinic requires
that students stay very close to these sets of moves, it will be expected that by the
end of their training, this internalized, embodied repertory of possible APM
Acupuncture moves will be able to be accessed in a much more fluid and free-form

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way that allows for integration with the other main styles learned at the college, to
make for ones own unique approach to acupuncture clinical practice.

As you approach the study for, and practice of these 16 APM katas, do so with your
deep commitment to internalizing them, and you will have a powerful set of clinical
moves to enable you to navigate the channels as Dr. Ni would say.

SESSION ONE--INTRODUCTION: YINYANG REGULATORY AND

PATIENT COMPLAINT TREATMENT IN APM/CCA

This KATA is a reflective one: reflect on basic APM Acupuncture JIngluo Pattern
Differentation as depicted below and come ready to work in small groups to
discuss and arrive at treatments for cases.

This presentation and sequencing for APM Acupuncture Jingluo pattern

differentiation and treatment is based, following the Classical Chinese Acupuncture
approach laid out in the LingShu and followed by Felix Mann and Yitian Ni, on the 12
regular meridians and their circuit systems.

One starts first in APM Acupuncture pattern differentiation by ascertaining which

circuit/system is involved: Shaoyin/Taoyang, Jueyin/Shaoyang or Taiyin/Yangming.
One recognizes and appreciates that each circuit begins in the Upper Heater
(Heart, Pericardium, Lung) where tian, the Heavenly principle and coherence in all
things fuses as Qi/Breath with Blood which comes from the Earth, from what one
eats and drinks. This fusion of Qi and Blood flows from the Heart and upper heater
to the brain and to the torso and extremities and back again. Wherever Blood
moves, shen is present as the intelligence of existence and deep wisdom we are
born with, which knows how to affirm and choose life. Modern discoveries that the
brain and the rest of the organism communicate via neuropeptides might be talking
about the same thing, and if so, it is known that the reptilian, oldest part of the brain
is where the bodymind attempts to keep on an even keel: responding to
emergencies for sure, but most of the time in service of auto-regulation and

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homeostasis. As one reads about Confucian and Neo-Confucian Learning of the
Mind-and-Heart in this book, it becomes possible to posit that what the ancients
meant by saying one must hold the needle as if holding a tiger by the tail over a
great abyss, with a calm mind-and-heart refers to attaining ‘the equilibrium before
feelings are aroused’ through ones own self-cultivation, so as to be able to prod
such auto-regulation and YinYang regulation in those we treat.

In selecting a circuit, a group of two yin and two yang meridians that connect lower
and upper, right and left, yin and yang, one is selecting a regular meridian system
with great potential to create positive change. Once the system has been chosen,
one determines whether to intervene at the level of the regular meridians/circuit,
the tendinomuscular meridians/secondary vessels, the extraordinary vessels, or
whether one needs to address the entire zone and its paired circuit.

It is at this last level of intervention , treating the zone that has become chronically
obstructed, and its paired yin meridians to make the circuit, with the option to also
treat the related extraordinary vessel pair that I now speak in a much more focused
manner about treating at the level of ying (regular meridians), wei (secondary
vessels, especially tendinomuscular) and jing (extraordinary vessels).

This re-conceptualization required grouping of APM Acupuncture Katas into the

three JInguo Systems first: then providing prototype treatments for: the circuit; the
tendinomuscular merdians; the related pattern of fatigue/stress/visceral agitation;
ending with the zone and addressing at least two out of three levels (wei for sure,
and Ying and/or jing for yinyang regulation).

In this way it should be more readily understood how to move from location of a
disorder in one of the three major regular meridian systems (circuits) to selection
of a tendinomuscular meridian and then the extraordinary vessels and finally a zone.
One has four basic options within each of the three regular meridian systems
(circuits), and all of this can be endlessly tweaked to meet the real problems we
encounter in service to our patients as follows:

1. Circuit Treatment for acute and chronic visceral dysfunction and symptoms
of visceral disease (See Circuit Chart);

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 2. Tendinomuscular (and luo) Meridian treatment of acute myofascial pain
syndrome, localized dysfunction of muscles, tendons, ligaments, joint
problems (muscle, tendon, bone bi syndromes); and acute flare-ups or
symptomatic relief in chronic pain and dysfunction (see WEI level of Master
APM Jinguo System Chart);
3. Exraordinary Vessel Treatment for the Four Phases of Stress/Fatigue/Visceral
Agitation (*)for chronic/complex disorders where the adrenals and stress are
a major component: ( the CNS via dumai, the ANS via the Three Heaters and
Local Triple Heater Regulatory treatment (Mu- Point Boogey: spinal irritation;
diaphragmatic constriction; pelvic collapse; cardiac alarm) using Chongmai
on the front as Sea of Meridians, Sea of ZangFu, Sea of Blood; and Shu-Point
Boogey treating Dumai and Foot Taiyang with Support of Kidneys for
Taiyang Zone and autonomic nervous system regulation through the Back
Shu-Points/spinal irritation);
4. Zone Treatment for complex and chronic neuromusculoskeletal disorders
with preponderant stress and visceral agitation: treating all three levels, WEI,
YING, JING;

*Note that detailed treatments for some common functional patient complaints
using the 4 patterns of fatigue/visceral agitation can be found in Acupuncture Physical
Medicine in Chapter VIII, pages 97-130.

KATA 1:
SHAOYIN/TAIYANG CIRCUIT DYSFUNCTION (REGULAR
MERIDIANS)
Anxiety, fatigue, pain in chest, upper and lower back, mood swings, restlessness,
scattered thinking.

• Pain in one or more areas of the back

• Anxiety, nervousness, sadness
• All shen disturbances
• Poor mental assimilation, mood changes, insecurity, over-enthusiasm
• Physical and mental fatigue

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 TREATMENT:
Yin Yang Regulation:

Kid 3/Bl 58 (source/luo) –tonify source; disperse luo points

Kid 2 and 3 (ying and shu)-tonify shu; disperse ying/fire if indicated
HT 7(source)-tonify
HT 7 and 8 (ying and shu)-tonify shu; disperse yin/fire if indicated

Distal: See circuit chart for comprehensive point palette

Treatment of Patient Complaint:

Dr. Ni: Any local point may be used to treat signs and symptoms in
the area of that point. This is especially relevant for viscero-somatic
symptoms of pain (tong) disorders that are not
myofascial/musculoskeletal.

Local:

Kid 16 bilateral-disperse for Kid yang excess/adrenal up-regulation;

tonify for KID/adrenal exhaustion
Kid 22-27 where tender (disperse to propagate, not to fasciculate)
for non-cardiac chest pain, tightness and emotional disorders;
CV 17 (MU for Heart Protector, meeting area of yin arm muscle
channels to open chest)-disperse to propagate down, to right, to left
to open chest, leaving down in 4th stimulation
HT 1(for information only: advanced, for serious blockage, can
provoke big panic/releases)-disperse
BL 67-40 for lower extremity pain
BL 54-22 for low back and buttocks pain
BL 21-13 for paraspinal pain
BL 10 for occipital pain
BL 2-7 for frontal forehead pain
SI 18 and BL 1-2 for sinus pain
SI 16-17 for neck pain

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 SI 9-14 for rotatator cuff area shoulder pain

Distal:
SI 1-8 for ulnar forearm and upper extremity pain
BL 67-40 for lower extremity pain
HT 9-3 for ulnar forearm pain
Kid 1-10 for lower extremity pain

KATA 2: SHAOYIN OR TAIYANG TM MERIDIAN EXCESS

(NOTE: For local ashi/trigger points, see appropriate wei level TrPs in master APM
Acupuncture Jingluo System Chart and Travell and Simons).

SHAOYIN:
• KIDNEY: myofascial pain and dysfunction in the inner foot muscles; soleus;
adductor longus; rectus abdominus; pectoralis major sternal division (KID
22-25). HEART: Myofascial pain and dysfunction in the forearm flexors(TrPs
near PER 4-5 and below HT 3); pectoralis minor.

TAIYANG
• BLADDER: myofascial pain and dysfunction in the lateral foot muscles; flexor
hallucis longus (BL 59 area); lateral gastrocnemius (BL 58.5); Soleus (BL 57
area); gluteus maximus, medius, minimus (posterior aspect); QL; paraspinals;
lower and middle trapezius; upper trapezius dorsal aspect; occipitalis;
frontalis. SMALL INTESTINE: edge of palm muscles; forearm flexor carpi
ulnaris; long head of the triceps; teres major and minor; infra- and
supraspinatus; posterior SCM; posterior scalenes; zygomaticus.

TREATMENT
Distal:

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Jing well points: HT 9, SI 1, Kid 1, BL 67; tender ashi/ trigger points near HT 8-3, SI
1-8, Kid 2-10, BL 66-40

Local:
See Wei level Taiyang Zone from Master APM Jingluo Systems Chart and Travell
and Simons for local ashi and trigger points. Note that in addressing the HT
TM meridian, one should check PER and LU TM meridians as well for areas
affected, and that all three arm yin TM meridians converge on the chest and
hypochondriac regions and affect the yin aspect of the upper extremities. When
treating Kid TM meridian one should likewise check SP and LIV TM meridians, and
that all three yin leg TM meridians converge on the pubic region, and affect the yin
aspect of the lower extremities and inner thigh. For the SI TM meridian always also
check TH and LI TM meridians, and for the BL TM meridian, always check the GB
and ST TM meridians.

KATA 3:
“SPINAL IRRITATION”/ ADRENAL SYNDROME - TAIYANG EXCESS/
DU MAI EXCESS/ KIDNEY/HEART DYSFUNCTION
Anxiety/Stress/Chronic Fatigue (excess phase)/ Insomnia.

• Type-A
• Insomnia
• Pain in one or more areas of the back
• Fibromylgia
• High Blood pressure
• Adrenal sydrome/up-regulated
Pre-class assignments/readings:
APM, pp. 101-108
Perform APM Assessment for this Pattern.

TREATMENT:
Yin Yang Regulation:

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 Jing:
SI3/BL62 Dumai/Yangchiaomai
(For fibromyalgia with exquisite tenderness at ashi points, use local
yangchiaomai points as local points, shallow wei-level technique so as
not to irritate; many cases of so-called fibromyalgia are myofascial
pain syndrome and benefit well from myofascial release of trigger
points.)

Ying:
BL 58/ Kid 3 (luo/source); BL 23 and BL 52; BL 14 and BL 43 (For
chronic fatigue with insomnia, heart palpitations, anxiety, overall
stress; one can always add Shu points for Zang, namely BL 14-43 for
upper heater, BL 18, 20, for middle heater as well, especially with
gastric symptomatology.

Treatment of Patient Complaint:

Wei:
Distal BL 59 and SI 8 1⁄2 if spinal irritation is accompanied by TTPs in
occipital neck, upper back, rotator cuff region (SI 9-14; BL 10-11);
Distal BL 58 1⁄2 to fasciculate to release lumbar region in low back
pain;

note: BL 58 is a ying level point as well as a distal wei level point, and
serves to release the paraspinal musculature in general but I have
found it best to needle to fasciculate for best affect.

Local TrPs in areas of pain (typically lower and upper back; or lower
back and neck); palpate as trigger points. Needle shallow wei-level to
start. Go back to most reactive TrPs and palpate (index and middle
fingers straddle the point and palpate by pressing straight down so as
not to tug on needle and cause sharp pain). If still tender, proceed
with trigger point dry needling technique to make point fasciculate.
See above explanation of trigger point technique, which will be
carefully demonstrated. Do trigger point dry needling technique with
supervisor present.

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KATA 4: TAIYANG ZONE DYSFUNCTION

Chronic myofascial pain and dysfunction in multiple areas of BL and /or SI TM

meridians with visceral agitation, stress (HT and/or Kid) and/ or preponderant
emotional component.

• Chronic myofascial pain and dysfunction in multiple upper and mid-back

areas with anxiety, panic, emotional ups and downs where pain is not
sufficiently alleviated by psychiatric, psychological, psychotherapeutic or
mind-body therapies or medications and/or has eclipsed the emotional signs
and symptoms
• Chronic myofascial pain in lower back, gluteals, hamstrings, soleus, heel
aggravated by stress and/or with fatigue and lack of drive

A] TAIYANG ZONE UPPER BACK PAIN

• Upper Back Pain
• Upper extremity pain
• Stenosis, DDD, DJD of the spine
• Fibromyalgia
• Neurological dysfunction
Pre-class Assignment/Readings:
APM, pp. 122-126;
MP&D, Vol I, chapters 21-25; Acu Handbook,
Perform APM Myofascial Assessment.

TREATMENT:
YinYang regulation(Jing/Ying):

Lu 7/Kid 6; SI3/Bl 62; Kid 2 and 3; Bl 58 (luo point); Bl 23 and/or 52 Treatment of

Patient Complaint(Wei) Level:

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Distal:
Bl 59 (upper back); SI 8 1⁄2 and SI 10(rotator cuff and upper back)
Local Trigger Points:
Infraspinatus; teres major and minor; supraspinatus (SI 9-14); Thoracic paraspinals;
trapezius (lower, middle, upper). Wherever there are palpable trigger points, you
should attempt APM trigger point technique on the most reactive trigger points.
Start distal and move up to the main pain area(s). This is “surrounding the Dragon’s
tail”. You finish with the most reactive trigger points that you palpated first—TO
REVALIDATE THE PATIENT’ EXPERIENCE OF ILLNESS AND COMPLETE THE
ACUPUNCTURE REFRAMING/IMAGING.

(I often remark “we’re almost done; I save the best for last”. When the trigger
points release I always use reassuring positive comments: “that’s great; that really
released well; I think we got that one” to underscore the focus on myofascial
release. Then I remind them how to care for the post-treatment soreness and what
activities to avoid. REFRAMING (validating a person’s experience of illness and
instilling hope that the condition can be changed through release of the holding
pattern) AND EDUCATION (what is going on during treatment, what will happen
after, what to expect over the course of a series of 3-4 treatments) ARE CRUCIAL
PARTS OF APM. The final part is to ENGAGE THE PATIENT’s WILL TO HEAL by
encouraging them to focus on those things they will do when their condition
improves. The possibility of CHANGE FOR THE BETTER is the message. )

Note:
In Fibromyalgia, be careful with local tender points; if mere palpation is exquisitely
tender, limit these points to points on yangchiaomai, or most tender spots and do
wei level technique; you can remove local needles, inserted after distal treatment,
as soon as they are all in, or leave 5 minutes or so—never longer than 10 minutes
and check in with patient. This same approach is true of all tender/trigger points on
STRONG REACTORS. If time permits you may practice this simple, shallow needle
treatment for fibromyalgia.

B] TAIYANG ZONE LOW BACK, BUTTOCKS, HAMSTRING, CALF AND HEEL

PAIN
• Low back pain

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 • Sciatica/piriformis syndrome
• QL spasm
• Stenosis, DDD, DJD
• Lower extremity pain
• Calf pain
• Heel pain
• Neurological dysfunction
PRE-CLASS ASSIGNMENT/READINGS:
MP&D, Vol 2, Chapters 3-10;
Acu Handbook, pp. 205-215; pp. 175-183
Perform APM Myofascial Assessment

TREATMENT:
YinYang Regulation (Jing/Ying):

SI 3/Bl 62: Kid 3 and Bl 58(source/luo); Bl 23 Bilateral; Bl 18 on right,

Bl 20 on left—all as Shu Points (Triple Heater Regulatory-one could
always add any Shu points or even Aggressive Energy Treatment
when treating Taiyang Zone).

Treatment of Patient Complaint/Wei Level: Distal:

Bl 58 1⁄2 APM trigger point technique to fasciculate (middle of outer

head of gastrocnemius longitudinally and laterally, with mild
compression with left hand after trigger point has been located with
snapping palpation) for QL TrPs/Spasm/ Bl 40.
Needle all reactive trigger points APM fasciculation style, or TCM into
belly and/or surrounding in the following muscles. Where the peer-
patient has no trigger points in one of these muscles, practice my
version of wei level shallow (but rooted) needling:

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 Quadratus lumborum
Iliocostalis Paraspinals
Gluteus Medius
Gluteus Minimus Posterior Aspect
Gluteus Maximus
Piriformis
Hamstrings
Soleus
Guadratus plantae

Note that TCM would focus on Bl 23(gentle twirling while inserting up to 1” being
careful to stay in muscle-muscle will often fasciculate: needle can then be removed,
or left in situ shallow); Bl 54 and GB 30, strong lifting thrusting twirling with 3”
needle, or simple lifting/thrusting with slight rotation of needle.
_______________________________________________________________________
Note: In radiculopathy with spinal stenosis, herniated or bulging discs, arthritis,
degenerative disc and degenerative joint disease, if inflammation is acute/severe,
needles local to area of symptoms might be like hot pokers; in such cases do wei
level technique—No fasciculations. Patient must be doing some sort of physical
therapy/rehab to strengthen and stretch compromised areas of compression and
acupuncture is adjunct to this permanent maintenance program that patient must
be encouraged to continue. AOM Hit Medicine, including tui-na and qi gong, herbal
linaments and wraps, internal herbal formulas and an exercise regimen are also
indicated. Patient should not receive acupuncture the same day as physical therapy,
chiropractic or other potentially inflammatory treatments. Patients often report
significant relief of discomfort and symptoms with 7-10 minutes icing on the spinal
levels involved, two to three times daily, which can be followed by moist
heat/hotpack.

In stenosis, huatuojiajia (multifidi) points often help but must be needled slowly (no
twirling) lifting and re-thrusting a few times until pressure and some deqi develops.
There will often be one or two small jumps. Avoid creating hot poker sensations.

NOTE: in the presence of radiculopathy if any needling at multifidi level or along

nerve pathways provoke poker-like hot reactions stop the local needling and stay
distal or treat analogous areas or opposite side; consider referring patient to KM

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style where local non-needling treatment like diode chains and rings, magnets
etcetera may be tried. In the presence of recalcitrant problems, and especially if
there is muscular weakness and atrophy involved refer the patient to her or his PCP
to see about consulting with a neurologist for EMG and other nerve conduction
studies to rule out serious radicular or other nerve entrapments or neuromuscular
disease (wei syndrome). Also consider referring the patient to a senior AOM herbal
practitioner if patient refuses or receives little or no benefit from biomedical
treatment.

C] TAIYANG ZONE NECK PAIN

• Headache (tension)
• Neck pain
• Stenosis, DDD, DJD
• Upper back pain
• Fibromyalgia
• Anxiety/stress
• Neurological dysfunction
Pre-Class Assignment/Readings:
MP&D, Vol I, chapters 5,6,16,19; Acu Handbook, pp. 303-313
Perform APM Myofascial Assessment

TREATMENT:
YinYang Regulation (Jing/Ying):

SI 3/BL 62; Kid 3 and/or 2; Ht 7; Bl 14 and/or Bl43 (versus 15); Bl 23and/ or 52 as Shu
points.

Treatment of Patient Complaint/Wei Level:

Start with strong lifting/thrusting/twirling of Bl 59 and APM trigger point pecking to

fasciculation of SI 8 1⁄2. SI 3 may be re-stimulated to disperse within patient’s de qi
tolerance, best done with slight lifting thrusting and rapid twirling
Proceed as in previous ACP sessions attempting APM fasciculation technique into
palpable trigger points as per peer-patient’s de qi tolerance. You may also practice

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TCM into belly and/or surrounding ashi points. Use wei level technique to areas
where trigger points are not present, in the following:
Lower, Middle, Upper Trapezius; Levator Scapula; trapezius attachments 1 cun
above BL 10-GB 20; all tender neck points.

Go back to most tender trigger points if you were not able to make them release
and attempt trigger point dry needling to fasciculate, especially at GB 21 and
levator scapula with supervisor present. Note that levator scapula and trapezius and
other deep cervicals can be released with one needle, most easily done face up as
per Dr. Roberta Shapiro’s recommendation. You may remove all Taiyang zone
needles, have peer-patient turn over and do this one point face up.
Note: Same as for lower Taiyang zone regarding radiculopathy due to spinal
stenosis/inflammation and need for rehab/maintenance/Daoyin program on ongoing
basis.

KATA 5: JUEYIN/SHAOYANG CIRCUIT DYSFUNCTION (REGULAR

MERIDIANS)
Fullness, distention, pain of hypochondriac region, chest and throat, back pain
spreading to pelvis, pain along inner calf and thigh, emotional disorders, pain in side
of lower and upper extremities; side of ribcage and chest; shoulder pain, lateral
neck pain; migraines; dizziness, depression, anger, irritability, hypochondria.

JUEYIN
 Hypochondriac pain, fullness, distention;
 GERD and IBS signs and symptoms like
heartburn, chest and throat pain and tightness
(‘plum-pit Qi’)
 Lumbar pain spreading to pelvic region and
scrotum; inguinal hernia pain
 Spasms and tightness of joints and muscles
 Mood swings, anger, depression, frustration

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  Thyroid disorders
 Migraines
 Mania, ‘hysteria’, chest and lung disorders
 TMJ-like pain and dysfunction
 Dizziness
 Tinnitus

TREATMENT:
YinYang Regulatory:

LIV 3/GB 37 (source/luo)-tonify source/disperse luo

LIV 2 and 3 (ying ands shu)-tonify shu, disperse ying/fire if indicated
PER 7(source)-tonify
PER 7 and 8 (ying and shu)-tonify shu, disperse ying/fire

Treatment of Patient Complaint:

Dr. Ni: Any local point may be used to treat signs and symptoms in the area of that
point. This is especially relevant for viscero-somatic symptoms of pain (tong)
disorders that are not myofascial/musculoskeletal.

Local:
LIV 14-PER 1 for hypochondriac region and chest pain, anxiety, emotional disorders
LIV 11-13 for abdominal pain
GB 1-2 and TH 23-24 for migraines and TMJ-like pain
GB 21 and TH 15 for shouder pain and tension headaches
GB 22 and CV 17 (mu of PER) for chest pain
GB 26-28 for inguinal and inner thigh pain
TH 14-15 for shoulder pain

Distal:
LIV 1-8 for lower extremity pain
LIV 9 for inner thigh pain
PER 9-3 for medial yin aspect forearm pain

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GB 44-34 for lower extremity pain
TH 1-10 for forearm and upper extremity pain

KATA 6: JUEYIN OR SHAOYANG TM MERIDIAN DYSFUNCTION

(NOTE: For local ashi/trigger points, see appropriate wei level TrPs in master APM
Acupuncture Jingluo System Chart and Travell and Simons).

JUEYIN
LIVER: Myofascial pain and dysfunction in the inner soleus; gluteus
medius and sartorius; ilacus; rectus abdominus: in the pelvic region
level with CV 2-3, in the abdominal region level with CV 10-11; in the
upper external obliques near GB 24 and LIV 14; PERICARDIUM: in the
lateral pectoralis major (near PER 1-2); in the sternalis area near CV
17-18; in the inner yin forearm flexors and hand muscles near PER 8.

SHAOYANG
GALLBLADDER: peroneals; vastus lateralis; ITB; TFL; piriformis; lower
external obliques; psoas; longitudinal aspect of latissimus dorsi; serratus
anterior; anterior upper trapezius; suboccipital muscles; temporalis. TRIPLE
HEATER: Myofascial pain and dysfunction in the ring finger extensor: short
head of the triceps; medial deltoid; supraspinatus; posterior SCM; posterior
scalenes; temporalis;

TREATMENT
Distal:
Jing well points: PER 1, LIV 1, TH 1, GB 44; tender local ashi, trigger points aloing
these tendinomuscular meridian pathways.

Local:
See Wei level Shaoyang Zone from Master APM Jingluo Systems Chart and Travell
and Simons for local ashi and trigger points. Note that in addressing the PER

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TM meridian, one should check HT and LU TM meridians as well for areas affected,
and that all three arm yin TM meridians converge on the chest and hypochondriac
regions and affect the yin aspect of the upper extremities. When treating LIV TM
meridian one should likewise check SP and KID TM meridians, and that all three yin
leg TM meridians converge on the pubic region, and affect the yin aspect of the
lower extremities and inner thigh. For the TH TM meridian always also check SI and
LI TM meridians, and for the GB TM meridian, always check the BL and ST TM
meridians.

KATA 7: ‘PELVIC COLLAPSE’: CHONG/ DAI / REN MAI DYSHARMONY

NOTE: a revised version of this treatment can be done in the Taiyin/Yangming

system relying on local points from the four meridians in that circuit for
relief/release of manifestations instead.
• Abdominal Pain in pelvic region
• Amenorrhea
• Dysmenorrhea
• Infertility
• Irregular menstruation/menopausal-hormonal changes
• Hernias, non-cancerous ovarian cysts, fibroid symptoms
• Chronic prostatitis, cystitis, vaginitis
Pre-class assignment/ Readings:
APM, pp. 112-114
Perform APM assessment for this pattern.

TREATMENT:

YinYang Regulation: Jing:

Sp. 4/Per 6; GB 41/TH 5 Jing:

Sp. 6 (shallow insertion heavy on the in until subtle resistance is felt;
stay at that level and with weighted hand, twirl until a deep spreading
sensation locally), Sp. 8, Sp 10 (for dysmenorrhea) with strong TCM
dispersal (may propagate up to pelvic region); Liver 3 and 5; Liv 9

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 Treatment of Patient Complaint:

St 30-29 where tender, gentle stimulation, for amenorrhea; strong

stimulation for dysmennorhea; GB 26 shallow, down toward GB 27-
28, twirling to propagate once kori is touched or mild deqi elicited
(note these local ying points are also jing points as they are local
chong and dai mai); tender ren mai points like CV 2-3 , 6-7 may be
added as well and needled with heavy on the in and weighted hand to
propagate down the channel or penetrate internally

KATA 8: ‘CARDIAC ALARM’/ UPPER HEATER DYSFUNCTION

NOTE: a revised version of this treatment can be done in the Taiyin/Yangming

system relying on local points from the four meridians in that circuit for
relief/release of manifestations instead.

• Asthma/breathing difficulties/dyspnea/hyperventilation syndrome/palpitations

• Bronchitis/COPD
• Anxiety/panic attack/stuck in stress reactivity affecting Lung and Heart
functions
• Chronic fatigue (Garden variety or CFIDS)
Pre-class Assignment/ Readings:
APM, pp. 115-120
Perform APM Assessment

TREATMENT:

YinYang Regulation:
Jing:
Sp 4, Per 6 (panic attacks, anxiety, agitation) for Jueyin/Shaoyang
System

OR

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 Lu 7/Kid 6 (hyperventilation syndrome, stress related breathing
difficulties) for Taiyin/Yangming System

Ying:
Per 7, 6, 4-5, Liv 3, GB 38 for Jueyin/Shaoyang System;

OR
Lung 9 or LU 5, LI 4, SP 3 or 5 for Taiyin/Yangming System

Treatment of Patient Complaint:

CV 18 and CV 17, Per 1, Liv 14, Kid 22-27 for Jueyin/Shaoyang panic disorder,
anxiety, agitation;

OR

Lu 1-Sp 20, St. 14-16, for Taiyin/Yangming dysfunction, where tender, for symptoms
of stress related asthma, difficulty breathing, hyperventilation syndrome, poanic,
anxiety, agitation

Additional Taiyin/Yangming and Shaoyin/Taiyang Circuit Points

TAIYIN/YANGMING
Lu 3-4(Window to Sky point for breathing difficulties and palpitations)

Lu 5(dispersal point) for bronchitis, COPD, emphysema, lung congestion in general

LI 4 (with Lu 7) to relieve exterior and for facial congestion for

allergies/sinusitis/rhinitis

SHAOYIN/TAIYANG

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Heart 7 and ear shen men for anxiety and panic attacks, with Kid 27; add Kid 15 1⁄2-
16 where tender for Chronic fatigue or CFIDS or as lower heater regulatory for
upper/lower heater distress/dysfunction

Can turn patient over and do short treatment of Bladder meridian Shu points, Bl. 13,
14, 17, 18 and 23

KATA 9: SHAOYANG ZONE DYSFUNCTION

A] LOWER SHAOYANG ZONE DYSFUNCTION

• Hip pain/lower Extremity Pain
• Arthritis, bursitis, DJD of the hip
• Sciatica
• Neurological dysfunction
Pre-class Assignment/Readings:
APM, pp. 126-127;
MP&D, Vol II, chapters 9,14, 20 and 49; Acu Handbook, pp. 185-203;
pp. 163-174

TREATMENT
YinYang Regulation (Jing/Ying):
GB 41/Sp 4(same side as hip complaint); Per 6 opposite Sp. 4; Liver 3 alone or with
Liv 2- one side or bilateral; LI 4,contralateral to Liv 3 or bilateral.

Treatment of Patient Complaint/Wei Level:

Distal:
Rework GB 41 and Sp 4 to strong de qi (per patient’s de qi tolerance level) if
necessary. GB 41 should spread throughout lateral dorsal aspect of foot; Sp 4 can
be done with modified stuck needle into kori, to propagate 4” or more along SP
pathway upwards, ideally to inner calf, even inner thigh and pelvic region.

Local (lateral lower extremities):

Peroneus Longus, Brevis and Tertius Trigger Points: Iliotibial Band and Vastus
Lateralis Trigger Points:

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Needle reactive distal yang meridian points with TCM strong dispersal technique
until qi propagates downwards several inches into tender points near GB 34, 37-39,
31 and GB 32 or APM trigger point technique to fasciculate into those muscles’
trigger points (ITB/GB 31 must be done TCM style and should travel up and down
thigh)
Local (Hip): TFL; ITB (can be local if that is one of the pain areas of the hip region,
or distal for the hip itself); Anterior Gluteus Minimus;
Lower External Oblique;
For Bursitis pain—surround most painful spot identified by patient over the bursa,
and needle 4 needles equi-distant in a circle, shallow oblique toward the painful area
without touching the painful area.
Attempt APM trigger point technique to fasciculate wherever trigger points are
present within peer-patient’s de qi tolerance; or do GB 29, 30 and 31 side-lying
TCM strong dispersal technique, if problem was only on one side.
_______________________________________________________________________
Note: Patients who begin to limp or have difficulty tying their shoes or pulling knee
back to chest or rotating knee inward without pain should be referred back to the
PCP for orthopedic evaluation for hip disease (labral tear, degenerative arthritis of
hip). While acupuncture can help release the concomitant myofascial trigger points
in such structural disease, the underlying structural irritation/degeneration will tend
to perpetuate return of the trigger points as part of a muscular guarding or
splinting. The more severe the tear or arthritic degeneration, the more rapid the
trigger points will return, making local acupuncture too inflammatory and counter
productive. Any form of physical therapy or manipulations to the region that the
patient is receiving from other practitioners may have the same negative effect.
Acupuncture is excellent pre- and post surgery for hip disease, to keep muscles
released pre-surgery, to lossen up muscles and scars 4-6 weeks post-surgery (once
surgeon OKs local myofascial release).

B] UPPER SHAOYANG ZONE DYSFUNCTION/ HEAD AND NECK

PAIN/HEADACHE
• Headache
• Neck pain
• Facial pain (TMJ)
• Upper back pain

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 • Repetitive strain injury
• Anxiety/stress
• High blood pressure
• Neurological dysfunction
• Tinnitus/vertigo
Pre-class Assignment/Readings:
MP&D, Vol I, chapters 21 and 7.
Perform APM Myofascial Assessment

TREATMENT

Distal:
YinYang Regulation (Jing/Ying) Level:
GB 41/TH 5 contralateral; Liver 3 and LI 4 contralateral opposite to
GB 41/TH5; “Triple Intestine” ring finger extensor TCM dispersing
stimulation; Liver 14 and/or GB 24; CV 6 and CV 10.
Treatment of Patient Complaint(Wei/Ying):

Local:
TH 15-supraspinatus
GB 21 Upper Trapezius
TH 16-posterior SCM TCM and TrP techniques (tinnitus)
‘Taiyang’ point TCM technique)
_______________________________________________________________________
Note: Other Local Points for Headache can be added to this treatment: GB 20 and
21, Temporalis TTPs level with GB 8, GV 20, Yintang; with strong stimulation first of
LI 4. If a patient is having a headache or on the brink of one, local stimulation should
be gentle either wei level technique or perform rapid medium amplitude with
strong dispersal, within deqi tolerance, of distal points.
Patients experiencing headaches or chest pain for the first time or out of character
for them must be referred to their PCP to rule out a serious visceral cause of their
disease.

KATA 10: TAIYIN/YANGMING CIRCUIT DYSFUNCTION (REGULAR

MERIDIANS)

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Pain in throat, teeth, face, breast, flank, palms, shins; upper respiratory tract
congestion; shortness of breath; gastric pain and distress; urinary dysfunction;
mental confusion, mania, depression, obsessive thoughts.

TAIYIN:
• Dry sore throat
• Vertigo
• Wind-cold S&S
• Whole body, lower abdomen and extremities heavy
• Shortness of breath, chest irritability, chest fullness
• Gastric pain and dysfunction
• Pain and stiffness along meridians

YANG MING:
• Toothache, facial pain, nasal and sinus congestion and pain
• Perspires easily
• Whole body cold, shivering
• Chest and flank pain
• Abdominal pain and dysfunction
• Distention
• Pain in lower abdomen
• Mental confusion, stubbornness, rigid thinking, mania, depression, suicidal
ideation

TREATMENT

YinYang Regulation:
SP 3/ST 40 (source/luo)-tonify source/disperse luo
SP 2 and 3(ying and shu)-disperse ying if approprtiate, tonify shu
LU 9 (source) – tonify
LU 9 and10 (ying and shu)-tonify source, disperse shu if appropriate
ST 36-39 and SP 6 transformation and transportation, all intestinal dysfunctions

Treatment of Patient Complaint:

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Dr. Ni: Any local point may be used to treat signs and symptoms in the area of that
point. This is especially relevant for viscero-somatic symptoms of pain (tong)
disorders that are not myofascial/musculoskeletal.

Local:
LI 18 throat pain
ST 5-7 TMJ pain
ST 2-3 lower sinus pain, facial pain
LI 20 and ST 2 nasal congestion
LU 1-2 and SP 20 Shortness of breath, chest irritability
ST 18-13 Breast pain, heartburn, reflux
ST 18 (with ST 44) xu-li
ST 25-24, SP 15 GI distress, abdominal pain
ST 26-30 Lower abdominal pain
ST 13-16 mental and emotional disorders (with ST 40 for mania, obsessiveness,
mental agitation)

KATA 11: TAIYIN OR YANGMING TENDINOMUSCULAR MERIDIAN

DYSFUNCTION
(NOTE: For local ashi/trigger points, see appropriate wei level TrPs in master APM
Acupuncture Jingluo System Chart and Travell and Simons).

TAIYIN: Myofascial pain and dysfunction in the flexor pollucis longus; forearm
flexors; brachioradialis; biceps; brachialis; pectoralis major clavicular; inner soleus;
vastus medialis, lower external oblique.

YANGMING: Myofascial pain and dysfunction in the foot muscles on dorsum of the
foot; tibialis anterior and extensor digitorum longus; rectus femoris; rectus
abdominus; pectoralis major sternal division; SCM and anterior scalenes; masseter;
frontalis.

TREATMENT

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Distal:
Jing well points: SP 1, LU 11, ST 45, LI 1; LI 4/LIV 3 (four gates); distal tender points
along the muscle channel

Local:
Tender local ashi, trigger points along these tendinomuscular meridian pathways.
See Wei level Yangming Zone from Master APM Jingluo Systems Chart and Travell
and Simons for local ashi and trigger points. Note that in addressing the LU
TM meridian, one should check HT and PER TM meridians as well for areas
affected, and that all three arm yin TM meridians converge on the chest and
hypochondriac regions and affect the yin aspect of the upper extremities. When
treating the SP TM meridian one should likewise check LIV and KID TM meridians,
and that all three yin leg TM meridians converge on the pubic region, and affect the
yin aspect of the lower extremities and inner thigh. For the LI TM meridian always
also check SI and TH TM meridians, and for the ST TM meridian, always check the
BL and GB TM meridians.

KATA 12: ‘DIAPHRAGMATIC CONSTRICTION’/CHONG MAI MIDDLE

HEATER BRANCH DYSFUNCTION/ STOMACH/SPLEEN (INVADED BY
LIVER)

NOTE: One will also encounter Taiyin-Yangming System chronic disorders presenting
as ‘Pelvic Collapse’ or ‘Cardiac Alarm’ where one would open jing level with ren and
yinchiaomai at LU7 and Kid 6: and perform three leg Yin treatment of the lower
heater for ‘pelvic collapse’; or triple heater regulatory treatment for Kidney-Lung
disharmony in ‘cardiac alarm’. Conversely one might encounter a case of
diaphragmatic constriction in the Jueyin/Shaoyang System and focus on local reactive
points from LIV and GB regular meridians and MU points.

• Abdominal Pain and discomfort in hypochondriac region/RUQ abdominal

pain

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 • Constipation
• Diarrhea
• IBS
• Anxiety/stress
• Chronic fatigue
• Anger issues with gastric distress
Pre-class assignment/readings:
APM, pp. 109-112
Perform APM assessment for this pattern.

TREATMENT:
YinYang Regulation:
Jing:
Sp 4/Per 6 (chong mai/yinweimai)
Ying:
Liv 3, LI4; CV 10-13; Liv 14 right for constrained Liver Qi;
St. 36, 37, 39; Sp. 6

Re-stimulate St 36-39: ideally there should be stomach noises

resulting; Treatment of Patient Complaint:
St 44-43 for reflux, nervous stomach, where tender, with strong TCM
dispersal (bring down St. Fire);

Local:
CV 12, 6, 4 where tender; ST 25-24 where tender; Kid 15-16 where
tender (for Stomach-Spleen dysfunction due to Liver Invading).
(St Fire “Mu” points): rectus abdominus from ST 29-ST 19 level:
needle shallow transverse toward midline with gentle thrusting into
kori until needle gets stuck; then apply stuck needle technique with
needling hand only, or compress rectus to bunch muscle up against
linea alba and look for mild de qi response; once de qi is obtained,
twirl into the direction that resulted in de qi, slightly downward and
transverse. Propagation will often span several inches, and sometimes
a trigger point release will occur if lifting/thrusting dominated over
twirling, resulting potentially in a big snapping release. This occurs
most readily at attachments over ribs, at and above St 19 level

  299  
 (commonly constrained in reflux patients) especially on the left; for
xu-li needle St 18 on the left if it is much more tender than on the
right/ especially if this releases heat in chest/neck/face (may release a
lot of heat; needle as mu points, over rib oblique; be ready to re-
stimulate St 44).

NOTE: Patients with xu-li are often very tight in their chest and neck
muscles and this treatment might begin to release Stomach Heat and
Liver wind (benign neurological fasciculations). First the teeth will be
clenched tight as they try to stop their teeth from chattering. They
need to relax their jaw, which you can encourage by gently holding
ST 5-6 area and asking them to relax into your fingers. Then whole
body shaking may begin to occur, and possibly also a flush over their
chest, neck and even face (ST Heat release). If this begins, stop
needling but DO NOT REMOVE NEEDLES. Call over a supervisor
while one team member has patient-peer breath abdominally, to
begin to relax. When the supervisor arrives commence with Focusing,
having peer-patient relax into their bodily-felt sense. Ask patient to
feel where the emotional agitation is located, and to describe what
that feels like (aloud or just to oneself). Once they have a HANDLE on
where and what the sensation FEELS LIKE IN THEIR BODY, ask if they
can remove this sensation from that location, by putting it “on a shelf”
a few feet away, or better yet by placing it quite a distance away, “on
a boat”, “in a building”, somewhere that it can be safely CONTAINED.
Then ask if they feel they want to continue with the treatment, by
lying there with mylar for 10 minutes or so, explaining that the
shaking they are experiencing is a release and OK as long as they are
OK with going through it, and that the release might get stronger,
causing the mylar to “rattle”. If appropriate, I often muse that this is a
mini “exorcism” and ask if they have seen the movie, in a humorous
and upbeat voice. I stress that I have seen these releases before and
that they will be fine. I also clarify that the needles can be slowly
removed, but that this might make the release more agitated and
might not be the best treatment. Either way reassure the peer-patient
that one of you will remain during the whole time until needles are
out and they are feeling fine. People who react like this once may be

  300  
 prone to any time a volatile area in their holding pattern is tapped
into, or just if they are more tense than usual. If there is a big
emotional event(s) behind this volatility, these emotional issues may
resurface and the person might need to review these issues with a
psychotherapist before continuing with more acupuncture or other
forms of bodywork. The constant release of nonverbal CONTENT
might have to be verbalized in a Talk Therapy before it is safe for the
person to keep releasing somatically. Psychotherapists are also
trained to look for and recognize signs of serious psychological
deterioration, including suicidal ideation. It is extremely important not
to take on such patients as a new practitioner. Refer them out to
practitioners who have known experience in this area.
NOTE: French Medical Acupuncture texts and Yitian Ni’s Navigating
the Channels warn that xu-li pain can be a precursor to heart
conditions. Any patient with new signs of heartburn or chest
discomfort who is not under the care of a physician for these
symptoms should be referred back to their PCP. Patients with reflux,
heartburn and IBS need to learn what foods to avoid and reflux
patients might do well raising the head of their bed 6” to avoid acid
backup at night while sleeping.

KATA 13: YANG MING ZONE DYSFUNCTION

A] YANGMING FACIAL AND JAW REGION PAIN

• Facial pain (TMJ, bruxism)
• Headache (Atypical)
• Neck pain
• Anxiety/stress
Pre-class Assignment/Readings:
MP&D, Vol I, chapters 42 and 8.
Perform APM Myofascial Assessment

TREATMENT
YinYang Regulation (Jing/Ying):

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 Sp 4/Per 6; GB 41/TH 5 Infinity Treatment; Liver 3/LI4-Four Gates; St
25 and CV 10—12 where tight;
Treatment of Patient Complaint (Wei Level):
Distal:
St 37 (“fullness of upper region”) strong TCM dispersal; Local:
Subclavius trigger point (St. 13); needled obliquely toward shoulder
with tip of needle angled at clavicle into kori; then stuck needle
technique with one hand focusing on fascial tug with heel of hand and
needle; or slow small pecking toward clavicle until sensation
propagates toward shoulder, into shoulder blade, into the back or
neck. When releasing needle, ensure it is positioned OVER the
clavicle, or pull shallow oblique;
St 12, gentle insertion into kori over bone, then stuck needle fascial tugging
technique-- sensation will often spread to upper chest region (platsyma TrP
referral) When releasing needle, be sure it is positioned OVER clavicle, not
underneath it, or pull shallow oblique;
SCM trigger points where tender at level of LI 18 or higher (to avoid brachial plexus
which would cause electric shock sensation propagating far); needle shallow wei
level,oblique; go back and attempt most tender points with APM trigger point
release to fasciculate with supervisor present; or needle LI 18 slowly twirling gently
into belly of SCM
Masseter trigger points near St 5 and St 6; TCM first, slowly into belly of muscle
technique first, followed by APM trigger point release to fasciculate if reactive;
St 7 TCM dispersal technique as per CAM (some practitioners would just do this
local point strongly until propagating qi spreads throughout jaw and neck).

NOTE: this same treatment may add TH 3 and 5, strong stimulation and TH 16, 17
and anmian TCM technique to propagate toward ear and GB8 area (temporalis
trigger points), for tinnitus.
NOTE: If patient has popping or grinding when you feel inside their ear with your
little finger as they open/close jaw, this might be sign of serious dental malocclusion
or serious TMJ disease or dysfunction. Patient should be referred to their dentist
for evaluation/referral to TMJ dental specialist.

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B] YANGMING CHEST AND ABDOMINAL PAIN
• Same treatment as above except add trigger point release of sternal division
of pectoralis major near ST 13-18;
• LU1-SP 20 area clavicular division of pectoralis major and TrP of pectoralis
minor;
• Rectus abdominus and psoas.

C] YANGMING THIGH AND LOWER LEG PAIN

• Same treatment as above except add trigger point release of rectus femoris,
tibialis anterior and extensor digitorum longus.

KATA 14: APM /TCM INTEGRATED TREATMENT OF SINUSES &

ALLERGIES
• Chronic sinus discomfort, pain, sinus headache
• Upper respiratory allergies (to pollen, grass, hayfever, animals, molds
etcetera)
Pre-class Assignment/Readings:
APM, pp. 119-120. Perform APM Assessment

TREATMENT
YinYang Regulation (Jing/Ying):
Kid 6/Lu 7; LI 4; Sp 5; St 36; Sp. 6; CV 4 and 6; CV 12; Lu 1-2; Kid 15.5,
Kid 27 Symtpomatic/Wei Level:
Bl. 2, special location/needle technique (gently gather up frontalis
muscle without creating a vertical wrinkle and place tube firmly, as
skin here is oily and slippery, into frontalis muscle at the middle of the
eyebrow (NEVER needle underneath the eyebrow or bruising might
well occur). DO NOT PINCH with left hand, just keep frontalis muscle
gathered away from bone. Tap in firmly, remove tube without letting
go of non-needling hand, and without pinching frontalis muscle, slide

  303  
 blue handled #3 Serein 1” needle one half the way, 1⁄2”, into the
muscle and let go of both hands.
St. 2, special location/needle technique (pull down cheek muscle
firmly with non-needling hand. Place tube at tender point well below
textbook St 2 angled downward. Remove tube and hold handle of
blue #3 Serein needle against eyebrow, being careful to avoid the
needle at Bl 2 if already needled. With a firm grasp on the needle and
pushing slightly into cheek muscle, let go rapidly with non-needling
hand WITHOUT budging with needling hand, which stays against
eyebrow/bone. The needle will be inserted by the rapid elastic snap-
back of the cheek muscle and fascia.
LI 20 (strong TCM de qi stimulation like “Afrin up nose/tearing”);
Scalp point on GV line for face/head (Zhu)=Du 24

KATA 15: APM/TCM INTEGRATED TENDINOMUSCULAR MERIDIAN

TREATMENT OF JOINT PAIN (ONE TO THREE TM MERIDIANS PER
PAIN AREA OR TRIGGER POINT REFERRAL PATTERN OR JOINT
PROBLEMS)
• Pain and discomfort
• Anxiety/stress
• Myofascial pain syndrome, arthritis pain, rheumatic pain, tendonitis, etcetera
• Chronic fatigue with muscle pain
• Fibromyalgia
Pre-class Assignment/Readings:
Dr. Ni on tendinomuscular meridian needling.
Use Reaves open book for areas of TM meridian dysfunction.
Perform APM Myofascial Assessment.

TREATMENT:

Distal:
4 gates strong stim; strong “big” yang distal points per area; jing-well points; luo
points if their pain target area is involved

Local:

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Ashi and trigger points, wei-level stimulation or APM fasciculation technique per
patient’s deqi tolerance; or TCM Bi syndrome needling techniques (straight into
ashi pt , or add surrounding [above, below, to right and left, angled at 45 degrees
toward ashi point, all wei level)

SEE WHITFIELD REAVES FOR DETAILED JOINT TREATMENTS

A] APM/TCM TREATMENT FOR KNEE PAIN AND DYSFUNCTION:

• Myofascial Pain Syndromes

• Arthritis of the knee, DJD
• Tendon-Ligament Strains/ Sprains;
• Tendonitis
• Lower Extremity (knee) pain
Pre-class Assignment/ Readings:
MP&D, Vol II, chapter 14; Acu Handbook, pp. 121-174
Perform APM Myofascial Assessment

TREATMENT
YinYang Regulation (Ying): Sp. 6, Liver 3, LI4;
Distal:
ST, 36, GB 34, Liver 7, Sp 9, where tender - dispersal technique (St 36
can be tibialis anterior TrP and GB 34, peroneus longus TrP with APM
trigger point release technique); LI 11 (elbow for knee) strong
dispersal, or actual elbow area tender points that “match” location of
knee points- dispersal TCM technique;
Wei Level/Local:
Vastus medialis TrP (near Sp 10); APM trigger point release if
reactive;
Or TCM technique in to belly and/or surrounding; Vastus Lateralis TrP
(near GB 32); same technique as for vastus medialis); add GB 31
TCM strong dispersal for iliotibial band if tight; GB 33 if lateral
ligament problems or if tender, oblique into kori over bone;
Eyes of knees, with knees on big bolster to open up the eyes, at an
angle up and in with two needle tips almost converging – twirl in

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 slowly until spreading de qi sensation; continue stimulation as per
patient’s de qi tolerance by just twirling rapidly once needle has
elicited de qi response, without lifting and thrusting; sensation should
spread under patella;
Extra Point at top center of kneecap (heding), for patellar tendon;
needle into kori and twirl rapidly with minor lifting or thrusting;
sensation should spread under patella;

Note: Patients with primary fatigue and muscle pain should have been checked for
low thyroid. Their pain may disappear totally when low thyroid is treated with
medication, naturopathy or TCM herbology. Patients with primary anxiety/stress
who come for musculoskeletal release may react emotionally to any release and
treatment should proceed cautiously so as not to agitate patient further. True
fibromyalgia patients may not tolerate strong needling, especially locally, and
shallow oblique wei level needling should be done first, adding stronger stimulation
to de qi tolerance.

B] APM/TCM TENDINO-MUSCULAR MERIDIAN TREATMENT OF ELBOW,

WRIST, ANKLE REGIONS
Students will perform myofascial assessment, and treatment of common foot, hand
and elbow pain for muscle, tendon and bone-bi syndromes following Whitefield
Reave’s protocols for sport’s injuries.
Pre-class Assignment/Readings:
Acu Handbook, pp. 75-99 (FOOT PAIN); pp. 217-226 (HAND PAIN/Carpal Tunnel
Syndrome); pp. 227-247 (ELBOW PAIN).

KATA 16: YANGMING/TAIYIN DYSFUNCTION (BI and WEI SYNROME

(RSI; TOS; RADICULOPATHY)
• Myofascial and neurological neck pain, numbness, discomfort
• Thoracic outlet syndrome-like pain
• Repetitive strain injury
• Cervical radiculopathy
• Frontal headache

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 • Atypical facial pain
• Trigeminal neuralgia-like pain
Pre-class Assignment/ Readings:
APM, pp. 128-130;
MP&D, Vol I, chapters 7, 28, 29, 34 and 42. Acu Handbook, pp. 217-226
Perform APM Myofascial Assessment

TREATMENT

YinYang Regulation (Ying):

4 Gates (Liv 3/LI 4); ST. 25 to ground Upper heater points;

Treatment of Patient Complaint(Wei):

Distal:
St 37 and/or St38 where tender, strong dispersal technique; LI 10 area, strong
dispersal technique; LI 2& 4 dispersal TCM technique; Lu 7 (luo of Lung for carpal
tunnel, wrist and palm symptoms) AS FLEXOR POLLICUS LONGUS TRIGGER
POINT—slow into tender point until mild de qi reponse; then careful pecking APM
trigger point release technique.

Local:
Brachioradialis(Lu 3-4 area) MP&D, chapter 34;
Coracobrachialis MP&D, chapter 29;
Anterior deltoid MP&D, chapter 28;
Clavicular aspect of pectoralis major (Lu 1-Sp 20) MP&D, chapter 42;
Subclavius (St. 13 slowly into muscle after moving the trigger point onto the clavicle
and needling it at the clavicle, NEVER UNDER THE CLAVICLE—then pull back to
surface and leave shallow and ensure that it is not sucking back into the muscle;
SCM (near LI 18) MP&D, chapter 7;

APM trigger point release technique to fasciculate on any reactive trigger points
according to peer-patient’s de qi tolerance level; or TCM into belly and/or
surrounding; or wei level shallow but rooted technique.

NOTE: in the presence of radiculopathy the same cautions as for spinal stenosis
above pertain, and if any needling at multifidi level or along nerve pathways

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provokes poker-like hot reactions stop the local needling and stay distal or treat
analogous areas or opposite side; consider referring patient to KM style where
local non-needling treatment like diode chains and rings, magnets etcetera may be
tried. In the presence of recalcitrant problems, and especially if there is muscular
weakness and atrophy involved refer the patient to her or his PCP to see about
consulting with a neurologist for EMG and other nerve conduction studies to rule
out serious radicular or other nerve entrapments or neuromuscular disease (wei
syndrome). Also consider referring the patient to a senior AOM herbal practitioner
if patient refuses or receives little or no benefit from biomedical treatment.

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C. APM ACUPUNCTURE CLINICAL
READINESS/PREPARATION FOR PRACTICE

Students versed in the above 17 KATAS, who have passed the Year II final APM oral
practical are ready to practice APM Style in a team in the community clinics, and
wirth focused practice in the final clinical year, will be in a position to encoiunter the
10,000 things with APM Style when they graduate, as well as integrate that style
with other AOM, CAM and mainstream treatments for best patient-centered care.

 Chronic visceral agitation (stress and functional disorders of the viscera and
symptomatic relief of visceral disease)—see Four Patterns of Stress,
Visceral Agitation, Fatigue Chart;
 Regular Meridian/Circuit dysfunction(other ZangFu disorders and functional
complaints and symptomatic relief of visceral disease) – See Circuit Chart;
 Acute, or single muscle, or joint musculoskeletal disorders of the tendino-
muscuar meridians(muscle channels) integrating in Travell’s myofascial
physical examination and needling release strategies—See Travell for muscle
and tendo attachment trigger points;
 Zone patterns (with chronic neuro-muscular symptoms and associated
circuit symptoms of the paired Zang)—see Zone chart in the back of
Acupuncture Physical Medicine and as revised in this book.

Based on differentiation into one of these four meridan sub-systems (extraordinary

vessels; regular meridians; tendino-muscular merdians; cutaneous regions) one can
focus on the point selections and treatment stretgeies and techniques approporiate
to that sub-system, and the comprehensive Zone/Circuit protocol allows one to
‘image’ and perform treatment at all three levels addressing all three sets of
complaints in the same treatment plan/series of treatments.

Once these katas have been internalized, and techniques have been honed, and with
a commitment to lifelong learning from ones patients, an APM practitioner can
shape and transform these kata endlessly to meet the actual contingencies of the
clinical situation as it unfolds. By establishing a franmewor of wei, ying ans jing level

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treatment options, for such complex and chrionic disorders, one could recommend
and perform or refer out for other AOM ways of treating a level or levels, and also
integrate in other CAM or mainstream medical care as follows:

WEI LEVEL OPTIONS

APM tendino-muscular and zone treatment
AOM Bodywork (Anma, Tuina, Shiatsu)
TCM Muscle, Tendon, Ligament, Bone Bi AcupunctureTreatments
TCM External and Internal Herbal treatment
Yin Style Ba Gua Acupuncture for Orthopedics and Rehabilitation Medicine
KM Treatment of structural dysfunction and pain
Cupping, Guasha, Moxibustion
Daoyin practice of physical self-cultivation
Yoga
Western Bodywork
Physical and Occupational Therapy
Osteopathy
Chiropractic
Rolfing
Feldenkrais
Homeopathy
Mind-body and bodymind therapies
Biomedical Treatment including surgery
Other

YING LEVEL OPTIONS

APM circuit and patterns of fatigue treatment
TCM Acupuncture
TCM Herbal Medicine
Japanese Kampo
Yin Style Ba Gua Internal Medicine Treatment
KM Treatment of constitution, Organs, patient functional complaints
5 Element Acupuncture
AOM dietary treatment
CAM and western nutritional treatment
Nutraceutical treatment

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Homeopathy
Mind-body and bodymind therapies
Daoyin practice of physical and mental self-cultivation
Yoga meditation, breathwork, mental self-cultivation
Biomedical Treatment including surgery

JING LEVEL

APM Acupuncture (ying and jing stratgeies)

KM Acupuncture
5 Element Acupuncture
Qi Gong/Daoyin Cultivation of the Mind-and-Heart
Yoga Cutlivation of Mind and Heart
Mind-body and bodymind therapies
Western counseling, psychotherapy
Psychiatry

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APPENDICES:

1. Etiology and Pathology in APM

2. APM Physical Assessment

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1. Etiology and Pathology in APM

Yin tends toward deficiency/ yang tends toward excess:

This fundamental principle of APM style treatment, based on Shudo Denmei’s
understanding of this etiological phenomenon from an acupuncture perspective,
suggests that organ functions weaken, become deficient in their ability to work
optimally, over time.
All things being equal, APM presumes that every person has an underlying zangfu
target area that would weaken over time merely due to the effects of aging,
perhaps serving as the final cause of death in someone who “dies of old age”.
Target zangfu functions can become disrupted much earlier than aging would have
exacted its toll, due to trauma (physical or emotional), unabated stress (from
physical overwork to emotional overload), or excessive or debilitating lifestyle
issues (dietary, sleep, use of alcohol, drugs, nicotine, caring for sick loved ones,
etcetera). While acupuncture can help with the effects of a disabling lifestyle,
people in such situations often need some other sort of counseling, from
psychotherapy to dietary therapy to legal counsel, which are beyond the scope of
the following discussion.
Based on the understanding that yin tends toward deficiency means that zangfu
functions become dysfunctional over time or due to the above etiological factors,
and that these yin functions are root imbalances, APM root treatment consists in
determining which set of zangfu functions are deficient (read: dysfunctional).
APM also posits that yang tends toward excess means that the meridians, and
especially the yang tendinomuscular and cutaneous regions, become constricted
and constrained over time or due to the above etiological factors, and that any
person who presents with a root zangfu imbalance may also at the same time have
a blockage in the tendinomuscular meridians or one of the three yang zones,
namely Taiyang, Shaoyang or Yangming. The symptomatic tendinomuscular
meridian(s) or zone will often explain the pain and discomfort that brings the patient
in for acupuncture treatment, and release of this myofascial holding pattern will
resolve their complaint, especially in musculoskeletal pain complaints.
Patients with primarily root, zangfu disorders without pain as a primary complaint
may have a visceral holding pattern in one or more of the three heaters which can
be discovered upon palpation, and release of this visceral holding pattern will aid in
the overall root treatment, as well as provide often significant relief from

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associated symptoms (gas pains, distention, dyspnea, PMS symptoms, nasal
congestion, etcetera). The somatic contriction found on palpation of reactive mu or
shu points, or hara findings, may entail congestion at the surface stemming from
underlying visceral agitation/irritation: overactive organ functions (visceral
agitation/organ neurosis). Rather than attempt myofascial release in such cases,
APM applies dispersal at the ying level, with propogating needling deep within to
disperse the internal excess.
When the surface excess in such cases of visceral distress are so severe as to
constitute what Wilhelm Reich termed character armor, where the person becomes
a prisoner to a blocked, dysfunctional body that shapes or distorts their overall
personality, strong myofascial release may be indicated, a sort of acupuncture
Rolfing, but this is a very advanced intervention that can only be undertaken if the
patient is ready for such a release, and the practitioner is emotionally up to the
challenge. Such a release may entail shaking, crying fits and other emotional
outbursts that may well leave patient and practitioner emotionally and physically
drained.
YinYang Imbalance:
In APM, YinYang Regulation for chronic functional disorders of the zangfu are
understood and described from a three heaters perspective.
Acute overload, or slow drain of the visceral system from overwork, lack of sleep,
or an onslaught of multiple factors may constitute an extreme stressor that
provokes an adrenal overload or excess, to use Hans Selye’s theory of the “stress
of life”, or even an adrenal collapse. The body’s initial response to such stressors is
in the form of spinal irritation, attacking the CNS and leading to constrictions in
the yang musculature of the back, especially along the spine, in the trapezius,
gluteals and quadratus lumborum. Such a patient will have difficulty falling asleep,
until the adrenals collapse, at which point they will work and play hard all day, only
to drop into bed without undressing, “dead to the world”. If this spinal, CNS
irritation is prolonged, or too severe for the person to withstand, the visceral
reaction to these extreme stressors will shift to the three heaters, effecting
whichever one is most vulnerable in cases of target zangfu weakness, or following
a typical route in many cases from middle heater to lower heater to upper heater,
perhaps in a fashion similar to what Selye termed the General Adapation Syndrome
(GAS), as follows.
When chronic zangfu disorders develop in the middle heater, this will effect the
Liver, Spleen and Stomach functions, entailing a diaphragmatic constriction upon

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palpation: the CV line from CV 10-12 will be tight, as will the Kidney and Stomach
points from Kid. 17-20 and St. 24-19. This is the middle heater segment of
chungmo, from an APM, meridian perspective, and chungmo is the excellent choice
for such middle heater constrained qi disorders, at the jing root level (opened with
Sp 4 and Per 6). Local points along the middle heater pathway of chungmo might
be needled locally as mu points for the middle heater constraint involved, and are
found by palpation for tightness and, or, tenderness (mu-point boogey). Ying level
treatment would entail distal (ying and shu or based on TCM or five element
strategies) points from Liver and Spleen and lower He-Sea points for the digestive
functions (St 36, 37, 39), combined with local reactive points near Liver 14 to GB 24
and St 24-25 and CV 10-12. Liver, Spleen and Stomach TCM patterns of disharmony
will be found in this case, and etiology could be further explained by detailing the
TCM pattern(s) involved.
If diaphragmatic constriction occurs over a long enough period of time, or is
severe enough, or if a person is predisposed to dysfunction in the lower heater,
then this diaphragmatic constriction might lead to Liver invading the Spleen, or
Spleen invaded by the Liver, or Stomach heat disrupting the Spleen, each capable of
weakening the Spleen’s holding functions leading to pelvic collapse, with
congestion in the functions of the lower heater. This will lead to genitourinary and
reproductive complaints, often marked by dampness and damp-heat, or deficient
yang with cold, from a TCM pattern perspective, affecting the Kidneys, Bladder,
and Small Intestine, with constraint in the meridians of daimo, and the lower heater
branches of chungmo (Kid 11-16 and St 30-26) and renmo (Cv1-7).
When the middle heater constriction generates significant heat, this can rise to the
upper heater, disrupting the functions of the Lungs, Heart and Pericardium. Likewise
if the lower heater collapse weakens the Kidneys sufficiently, this will disrupt the
Kidneys autoregulatory relationship with the Heart, Pericardium or Lungs. In either
of these etiological events, the main zangfu patterns will occur in the upper heater,
with what APM terms signs and symptoms of cardiac alarm. This will entail
problems in the Lung’s functions such as asthma and COPD, functional and organ
dysfunctions of the Heart and Pericardium, and emotionally based stress disorders
such as hyperventilation syndrome, anxiety disorder and panic attack.
In brief, root etiology of chronic visceral dysfunction in APM can be understood
and stated in terms of these four primary patterns: spinal irritation, and disorders of
one or more of the three heaters: diaphragmatic constriction in the middle heater
(Liver, Spleen, Stomach functions); pelvic collapse in the lower heater (Kidney,

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Bladder and Small Intestine); cardiac alarm in the upper heater (Lungs, Heart,
Pericardium). The TCM patterns of disharmony in the zangfu functions involved
may serve as further etiological elaboration of the pathologies involved from a
zangfu perspective, but it is sufficient in an APM assessment to limit ones
description to location of constraint in one or more of the three heaters, labeled as
diaphragmatic constriction, pelvic collapse or cardiac alarm. The diagnosis (read:
localization based on signs and symptoms including heat, cold or tightness and
discomfort [constrained qi/stagnant blood] based on manual palpation) would be
listed here as a root imbalance.
The strategies chosen would be at the ying level, and reinforced if one wishes at
the jing level.
Mu points selected by palpation might be further described as local reactive points
along the meridian pathway involved: hence local points along the Kidney and
Stomach pathways from Kid 11 and St 30 to Kid 20 and St 19, namely chungmo;
local points along the pelvic aspect of the Spleen and Liver pathways from Sp. 15-
Sp 21 and Liver 14-GB 24, with constraint at CV 10 and CV 12, for example.
Yang tends toward excess:
The yang, excess part of the etiological discussion in APM is articulated at the wei
level, in terms of myofascial constrictions (Travell’s trigger points), and/or surface
meridian blockages (tendinomuscular and cutaneous region patterns or TCM bi
syndromes) with ashi points (kori in Japanese acupuncture). This will be listed on
the wei, symptomatic level of an intake form, and points will be selected based on
Travell’s trigger point patterns (ie. Infraspinatus selected for its referred pathway to
shoulder), or meridian pathways/ bi syndrome location (ie; ashi points and kori from
SI 10-11).
The symptomatic description (diagnosis/location) at the wei level might be framed
as constrained qi in the scapular aspect of SI tendinomuscular meridian from SI 10-
11, involving the teres minor and infraspinatus muscles. One could go further and
give a detailed description of Travell’s trigger point referral patterns, and an
etiological discussion based on her understanding of perpetuating factors in such
cases, right from Travell’s text; or a classical Chinese description of the meridians
involved, such as tm of the small intestine and bladder, citing texts such as Ni’s
Navigating the Channels. Inclusion in a case study of diagrams of these referred
patterns would be indicated to visually depict the fact that the diagnosis of the
holding pattern at the Wei level is an issue of LOCATION.
The Presence of Disrupted Shen:

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In APM shen disruption may occur in any of the four patterns of visceral agitation,
in any chronic tendinomuscular disorder or any chronic disturbance of a myofascial
zone (the cutaneous regions).
This is due to the concept that where qi is blocked, shen may be blocked and from
the experience in acupuncture where needling of seemingly straightforward
reactive points results in a big emotional release, as if the distressful experience
were blocked in the taught fascia, which Upledgger terms “somato-emotional
release”.
Thus treatment at any of the three levels, wei, ying or jing, may also be treatment at
the shen level, and care must be taken when awakening such a “tiger’s tail, grasped
by the needle as it hangs over the great abyss”(Ling Shu). One must approach such
situations mindfully, stopping for a moment to take a deep breath, observe what
the patient is exhibiting and the feelings this engenders in you, and proceed, with a
supervisor present to help guide you through such complex and emotionally laden
terrains.
For patients who are engaged in spiritual, transformational work of their own, they
might well take treatment at any level as an aid in their spiritual journey. In a student
clinic it would be inappropriate for interns to suggest to the patient that they are
treating the spiritual level however, for this is a joint collaboration between a
practitioner engaged in such a journey, and a patient already thus engaged, or
ready to make such a commitment. This work would be outside the scope of
interns in community clinical situations.
It is appropriate to suggest that acupuncture might calm the spirit, relax the nervous
system and dissipate the stress response and reactivity a patient might be stuck in.
Also, by clearing blockages of Qi and Blood, the overall status of body, mind and
spirit is improved.

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2] APM PHYSICAL ASSESSMENT

APM Pain and Dysfunction History in Line with Travell:

Preliminary Review of Records: (review patient’s initial intake form and any
materials provided by patient before the interview)
 chronology of life events and medical history, either before the first visit or at
that first visit, including medical events and a list of current and recent medications
and supplements, including any that did not work or caused side effects;
 The psychosocial history data should include dates and places of residence,
education, marriages or other significant relationships, children, sports and other
physical activities (with any repetitive physical activities carefully assessed such as
computer or blackberry use, the playing of musical instruments, and sustained
postures at work or play), travel and employment, leisure activities, hobbies, how
they relieve stress, use of tobacco, recreational drugs, problems with weight, body
image, age-related issues;
 The medical history should include childhood, adolescent and adult illnesses,
infections, surgeries or other procedures, accidents, dental procedures or
conditions (including focal infections such as root canals and abscesses),
pregnancies and miscarriages, allergies (airborne, chemical and food) and
vaccinations.
The Patient Interview: (an opportunity to demonstrate that the clinician has a
clinical understanding of the complaint, and to validate the patient’s experience of
pain, discomfort and distress)
 Listen carefully as you encourage the patient to share the actual experience of
illness related to their primary complaint(s). Travell used to reposition the patient
while conducting this initial interview for comfort, and to educate the patient about
better body mechanics. I was interviewed by Travell in this fashion the first time I
met her, while she slipped sponges under my short upper arms to make them meet
the “Kennedy style rocking chair” arms, like the one she designed for the former
president; a butt-lift on my right side, as she noticed a short hemipelvis when
looking at me get into the chair; a small pillow tied loosely to the lumbar area of the
rocker, to support my excessive lumbar curve. By the time she was through, as she

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describes in Volume One (Ibid, p. 105), she asked me if I was comfortable, which
indeed I was, much more than usual when sitting for two hours talking;
 Travell also shares pearls of wisdom and her expertise with verbal rapport to
match the above somatic wizardry, which students would do well to study in detail,
using Travell as a model for such verbal reframing. Travell especially
stressed that when patients state they hurt all over, it is essential to map the actual
pain pattern, which I usually show to patients from Travell’s texts for validation and
to reassure them that what they have is real;
•   Travell also stressed a careful review of diet and food preparation and
eating habits ( food made at home, take-out, fast-food, restaurant setting);
•   Review of the workplace for ergonomic set-up, occupational exposures,
stressors, including how the patient feels about the job;
 The nature and timing of pain: Travell clarified that “most patients with
active TrPs experience intermittent pain that is characteristically aggravated
by specific movements and may be alleviated at least temporarily by a
certain position. [...] “Latent TrPs”, on the other hand, “give no primary pain
clues, and must be identified by postural changes, muscle dysfunction, and
physical examination. As the authors of the second edition of Volume 1
underscore, it is no longer their belief that latent trigger points will
demonstrate the referred pain response when compressed, and the local
twitch response has also been discontinued due to its unreliability in
identifying active or latent TrPs;
 Questions about limited range of motion, which the patient may or may
not be aware of;
 Questions about weakness, which patients are more likely to be aware of
if they limit activities;
 Questions about any other non-pain symptoms, such as changes in sweat
patterns, cold extremities, excessive tearing or nasal secretions, dizziness,
spatial disorientation, vertigo, tinnitus, and disturbed weight perception (Ibid
pp. 109-110);
 A history of depression or sleep disturbance;
 Activation of the pain syndrome: sudden onset is usually easily
remembered,
and the traumatic event clearly identified; gradual onset is more difficult for
many patients to identify, and it is here that Travell stressed the need for

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 good detective work to uncover the repetitive motions that perpetuate such
chronic overload syndromes (Ibid, p. 111).
APM Physical Examination:
It is important to stress that this APM physical examination is done after the
Four AOM Examinations, as the conclusion to the Palpation Examination to
establish the holding pattern in the 3 reguar meridian circuits, the 12 tendino-
muscular meridians, the 4 patterns of fatigue/stress/visceral agitation or the
3 zones(after palpation of pulses, Hara, and mu and shu points), or instead
of these other palpation examinations when the myofascial/Bi-syndrome is
straightforward.
Steps of the Examination:
1] Patient mobility and posture, Travell stresses, should be carefully
observed while walking, sitting and gesticulating during the history and
palpation examination. While she was focused on musculoskeletal
comportment, classical Chinese acupuncture teaches us to observe and
sense the overall way of holding onself containing oneself (or not),
presenting oneself in space with an Other.
2] Neuromuscular Functions should be assessed as follows according to
Travell:

Restricted movement by active or chronic TrPs: Boeve’s identification of relevant

TrPs (Ibid, p. 113). This is consistent with muscle channel palpation for ashi points
performed in the Bao Ci or “leopard spot” needling technique where the
practitioner moves up the muscle channel looking for signs of excess, or places the
painful area in various positions that recreate pain, needling each point in
succession and retesting for pain in each point before moving on;
• Neck ROM (seated patient places chin firmly on the chest, looks straight up
at ceiling, tilts just the head at least 90 degrees sideways to the acromion on
both sides, and places the ear close to the shoulder without cheating
(shrugging);
• Mouth Wrap-around Test for shoulder-girdle muscles (Fig. 18.2, Ibid, p. 489);
• Hand-to-shoulder-blade Test (Fig 22.3, Ibid, p. 557);
• Scalene-cramp Test (Fig 20.4, bid, p. 511);
• NOTE that the “Patient Examination” section in volume one and
corresponding

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 sections in volume two give specific active tests the patient can be asked to
perform while the practitioner records, such as the neck ROM, Mouth Wrap-
around and Scalene-cramp tests above. This section also lists passive tests
for strength and joint play which should only be performed if the AOM
practitioner has been trained in these tests, or the patient should be referred
off to a physical therapist or similar physical medicine specialist for further
examination.
• Referred Myofascial Pain Patterns: drawn by the acupuncturist on blank body
forms (front, back, each side, head, bid pp. 98-99);
• Myotome referrals;
• Dermatographia for excessive histamine release, most commonly according
to Travell
in the muscles of the back of the neck, shoulders and the torso, but less
frequently over the extremities. This is common in patients diagnosed with
fibrositis or fibromyalgia, and they may need an antihistamine according to
Travell (in line with the common description of this condition as being like an
“allergy in the soft tissue”) or phytotherapeutic or neutraceutical regime to
reduce this surface inflammation;

 Panniculosis, now associated very narrowly in rheumatology with a

nodular condition of the skin seen in erythema nodosum, which
Japanese acupuncture describes as “kori” or soft-tissue
indurations/geloses. These are areas where the subcutaneous tissue
has become more gummy, stuck, which breeds surface inflammation.
Travell cites her extensive experience to identify a less discrete or
pathological condition that I have identified repeatedly as well based
on acupuncture soft tissue palpation for three decades. In this more
generic “panniculosis”, as Travell clarifies, “one finds a broad, flat
thickening of the subcutaneous tissue with an increased consistency
that feels granular[…]usually identified by hypersensitivity of the skin
and the resistance of the subcutaneous tissue to ‘skin rolling’ (Ibid, p.
115).” Acupuncturists who palpate carefully find this subcutaneous
thickening frequently at Liver 14 and Gallbladder 24, and those who
perform TrP dry needling frequently find this exact tissue density at
the ischial tuberosity, at Bl. 35, which fasciculate like a trigger point
when the needle is inserted carefully into this gelosis. Compression

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 of these flat “myelogeloses” as the German rheumatological
literature of the 1970’s referred to these findings, against an
underlying rib or bone elicits exquisite tenderness and signs of
inflammation (intense erythema surrounds the point thus palpated or
needled and remains for quite some time). While Travell states that
this sort of subcutaneous tissue finding is not a sign of inflammation,
the acupuncture understanding of a mu point demonstrating a hot
condition would tend to see a sign of heat.

Likewise, the resistance to skin rolling is a commonly described

acupuncture examination technique known as forearm testing, and this
skin rolling technique is used as a treatment in neuromuscular massage
according to the celebrated English osteopath and acupuncturist, Leon
Chaitow, where skin rolling of the subcutaneous stuck fascia “over” a
painful trigger point eliminates the trigger point sensitivity without
touching the muscle. Travell clarifies that this form of “panniculosis” and
increased viscosity is not to be confused with “adiposa dolorosa” or “fat
herniations”. Travell concludes that a series of skin rolling, which can be
accomplished in the manual fashion she recommends or with moving
cupping, can normalize the tissue and make it more responsive to TrP
needling;
• Compression Test (p. 116);
• Passive Muscle Testing: See comment above
• Assessment of Joint Play: See comment above;
• Trigger Point Examination: palpation of suspected TrPs only, based on
the history, the physical examination and the referred pain patterns
checked against Travell’s text BEFORE palpating patient;
• Identification of central and attachment TrPs (Note on Key and Satellite
TrPs: while Travell advocates identifying only the key, and not satellite,
TrPs for injection, the acupuncture Bi-syndrome technique of “bao-ci”
[leopard-spot needling of tender point after tender along a muscle
pathway) of distal points while moving up toward the main ashi point(s)
(“surrounding the dragon”), leads acupuncurists to disinhibit excess TrPs
distally and proximally, especially in chronic obstruction syndromes, thus
needling the referral area, not just the painful area);

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 • Assessment of possible entrapment: suspected entrapment, based on
Travell and Simon’s text descriptions, should be identified and
monitored. Where TrP release produces no improvement in the “aching
pain[…], numbness and tingling, hypoesthesia, and sometimes
hyperesthesia”, nerve entrapment may be relieved “by cold packs on
the neurogenically painful area”, while pain of myofascial origin usually
responds better to heat, and is aggravated by chilling. Pain and
neurogenic signs and symptoms that do not improve with a course of 1-
2 months of TrP and Bi-syndrome treatment should lead the practitioner
to suspect a “wei”syndrome such as a nerve root compression, stenosis,
neuropathy or myopathy and such patients should be referred for
neuromuscular evaluation;
• Careful Review of the Differential Diagnosis Section 11 for each muscle
(which was referred to as “associated trigger points” in the first edition
of Volume 1 and in the only edition thus far of Volume 2) . In the first
edition of both volumes, when differential diagnosis was discussed, this
was usually in Section 7 (“Activation of Trigger Points”) or distributed
unfortunately throughout the chapter, requiring a much closer read. This
section is critical in aiding the acupuncturist in identifying red flags
requiring referral so as not to exacerbate or miss an undiagnosed
condition best treated in other ways.

Serious Lack in Travell

What is not included in Travell, perhaps because she struggled so vigorously to free
physical medicine, as she was coming to see it, from its moorings in psychosomatic
medicine and plant it squarely on the side of the soma, was the interplay
nonetheless between ‘the psyche and the body process’ as Dr. Flanders Dunbar
from Columbia University called it in her groundbreaking Emotions and Bodily
Changes.

APM acupuncture corrects for this lack.

This rigid demarcation of a somatic territory where myofascial pain and

dysfunction would play out free from emotional turmoil, trauma and stress is as
lopsided as the over-emphasis on the side of the psyche Travell fought against,

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where patients with chronic pain would be seen to suffer from a psychosomatic
disorder best treated in psychotherapy.

It is my experience in the vast majority of cases of chronic pain that I treat, where
the patients are also being treated by other physical medicine practitioners
(orthopedists, neuroloigists, osteopaths, physical and occupational therapists and
massage therapists) that the side of the psyche is being totally overlooked in favor
of a narrow physical medical perspective.

There is no reason why any acupuncturist woud make this mistake, if they adhere
to the classical Chinese acupuncture teachings that the main cause of internal
dysfunction and disease are the 7 emotions when they become inhibited or
expressed excessively. Unfortunately, too many North American TCM practitioners
ignore the side of the psyche as well, framing the patient’s problem from a much
more materialist perspective that is dominant in PRC that is aligned with modern
scientific medicine and so looks askance, in fact, at classical theory and practice,
paying it lip service only in this regard.

And unfortunately, too many North American TCM practitioners, especially if they
ractice herbal medicine, see their terrain as ‘internal medicine’ and look down on
any physical medicine approach to acupuncture and Chinese medicine as
tantamount to tuina which they disdain or consider a lowly step-child of TCM.

It is a frequent occurrence for APM practitioners trained at the Tri-State College of

Acupuncture to see patients for chronic pain and dysfunction who were treated by
TCM practitiners to no avail, who clearly had no phsyiocal medicine perspective or
skills.

APM practitioners, on the other hand, who ignore or even disdain getting involved
on the side of the psyche without a network of some mindbody and bodymind
practitioners are selling their patients short on the benefits they couod derive from
a more comprehensive approach.

And so after 25 years of developing an approach to acupuncture as physical

medicine, which it was and always should have remained as Andrew Nugent-Head
shows in his powerfuil ‘tangible Qi’ video and teachings, and knowing that the

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physical medicine training at the college is probably the strongest in North America
and will only get that much more powerful and clinically effective under his ifluence
and training, I am ready to return full force to the bodymind energetic approach I
laid out in Bodymind Energetics in 1987, to bring back acupuncture as a powerful
psychosomatic therapy that, by dint of being a physical medicine, can gain deep
access to the inner reaches of the Mind-and-Heart and prod the bodymind to
actualize its potential by restoring the equilibrium before the feelings are aroused
as Confucius advocated.

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