JOURNAL OF CHINESE MEDICINE NUMBER 17 JANUARY 1985

Acupuncture in the West –

a discussion between Ted Kaptchuk, Giovanni Maciocia, Felicity Moir and
Peter Deadman.
The following article is a new departure for the Journal. It is the transcript of a
discussion held in London between Ted Kaptchuk, who interrupted his hard labours
working on a book for a BBC series on medicine, Giovanni Maciocia, Felicity Moir and
Peter Deadman. We have edited the discussion as little as possible so it rambles around
a bit. Left out are the many times we collapsed in laughter.

Ted: I'll start of f with a controversial thing. When the Foundation in San Francisco invited
top Chinese practitioners of acupuncture from the Shanghai Institute of TCM to teach a
seminar in Florida in English, people brought in some of their most difficult patients to
these great Chinese doctors. I was told by most of the people who brought patients that
many of them got worse after treatment. The point this raises for me is not that they
weren’t great acupuncturists, but I think that they had no sensitivity to who a patient is in
20th century post-scarcity, high technology society and what their needs are, what their
constitutions are, what their personhood is about. They applied techniques and methods
adapted from traditional Chinese medical ideas that have been modified through
historical circumstances, and applied them as if a person in San Francisco is the same as
one who wall<s into the out-patients department of the Shanghai Institute of TCM. It was
a really vivid example for me of the fact that you can't just go to China and imitate what
they're doing, and I think that's important because it's taken me at least five years to
detoxify myself from seeing patients the way Chinese see patients - a very painful process.
I realised I wasn't paying attention to what my patients were saying to me, I wasn't
hearing what they needed and I was putting a matrix of concerns that are the concerns
Chinese have about illness and health, onto a culturally and historically different kind of
patient, as if we were saying that medicine is not historical and cultural - not a living
process of change. \lot only is the medicine of say the Nei Jing different from the
medicine of the Tang dynasty, or from the Song dynasty, but the patients are different. For
us to go around thinking that the best acupuncture point in a certain kind of clinical
situation the Chinese describe is the best acupuncture point for our patients is ludicrous.
Our patients' needs are different, and in fact our patients are different. We live differently,
we eat differently, we think differently, we work differently and our Qi and blood is
different. I really believe that and its taken me many many years of being pushed against
a wall by my patients, and having to say, what haven't I been sensitive to, and what
haven't I been paying attention to, and there was no Chinese book I could look it up in.

Peter: Do you think it's just that Chinese medicine lacks a dimension for Western patients,
but that what is in Chinese medicine still applies to Western patients, i.e. people still have
those syndromes?

Ted: I think Chinese medicine is a great reservoir. I think it's an attitude towards illness
and health. I think how one works out that attitude depends on historical, cultural and
emotional circumstances and even disease circumstances of the particular milieu we are
practising in. We know that the diseases in the Ming dynasty were different from the Han
dynasty. We know that Chinese medicine had to totally turn around and do different

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things in every historical period because the illnesses - even in Western bio-medical terms
- were different. Scarlet fever didn't exist in the Tang dynasty and it appeared by late
Ming and they had to write different books about it. The illnesses our patients bring us are
different - where the disruption or cleavage of the Yin and Yang is. What the acupuncture
points are for - I don't think we can only rely on what the Chinese tell us.

Giovanni: I think you over-emphasise the differences rather than the similarities. You say
our Western patients eat differently, work differently. I don't think they're that different, I
mean the basic facts of life are the same - people eat, they eat the wrong things, they eat in
the wrong way, they have emotional problems. The basic causes of disease are the same
all over the world. I'm saying this also from my own experience. I can think of many
many patients in whom I can't see any basic difference from Chinese people. Of course
we're culturally different and we develop our own experience of the points, but I still
think we shouldn't over emphasise the differences. Just to give you an example. It's very
common to say that Chinese patients are different, they like being needled, know exactly
about needle sensation, the difference between pain and deqi and so on, but I can tell you
that 60 or 70 per cent of Western patients can do that in just the same way.

Peter: I've just been treating in Norway for three days and I suddenly realised on the
second day that Norwegian patients aren't the same as English patients. They're much
more like Chinese patients. I have this feeling - it's not original - that the ability to receive
acupuncture in a healthy way, to distinguish deqi and not be overwhelmed by pain is a
reflection of the spirit, the Shen. If someone has a strong spirit they have a good distance
between themselves and their physical sensation and they can say, "it's like this, or like
that," but if the spirit is very weak, the sensation invades them, they feel it endangers
them directly.

Ted: Right they don't have a wise observer.

Peter: I felt in China and also in Norway, that people are intrinsically psychologically,
emotionally, physically healthier even when they're ill, so needling on them is much
easier. The other side is that I felt in China, correct or not, that even when Chinese patients
were ill -because certain aspects of their way of life were simpler and, you might disagree,
that their society despite lots of problems is psychologically healthier. that if you could
cure the main problem in a patient they then became well. Someone would come in with a
problem and you'd treat them and they'd get better, and the problem having gone they'd
be well and would reflect that wellness by being really grateful, because you'd cleared
their problem. A lot of patients here, when you clear the main problem, there's a whole
host of other problems waiting offstage to take centre-stage. It's a common experience for
the patient to come back and you say "how are you?" and they say "I don't know, not too
good," and you say "how's the stomach?" and they say "oh that's fine but ..."

Ted: Yes I think your observation's really right and it happens all the time and I think it's
because the acupuncture that we're using is for the clinical situation that's happening in
China, and if we develop an acupuncture that's for the clinical situation in our industrial
world we would get the same kind of great results, because the problems that our patients
bring are different. I don't think Chinese patients are healthier psychologically, I think
they're different psychologically. They don't have a certain kind of depth because the
culture's into face-saving and really influenced by Confucian ethics, and you don't try to

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rock the boat, but their acupuncture is designed for that kind of patient and we have to
develop an acupuncture for the patients that we have and go right to the problem. I don't
think we have a language yet for those kinds of problems. We need to know the point to
affect the Qi and blood of the kind of patient that has a whole host of problems in the
background, and with one needle get rid of them.
Everyone has a whole host of problems - no-one has only one problem, but in China the
dialogue between practitioner and patient is such that when they present the problem the
practitioner responds directly on target, and one needle will actually resolve many many
problems apart from the simple one that's being discussed. Our problem is that we're
aiming with our patients where the Chinese tell us to aim. The Chinese shorthand for
discussing illness is in their terms and of ten takes less account of dissatisfaction with
work, difficulties with home life, etc. There's no such thing as an illness that's not
connected to a whole host of problems. We have to develop a shorthand in our terms. I
think we can resolve all this host of problems by acupuncture. I think there's an
acupuncture point for these seemingly complex problems, and if we use the theories of
Ying Yang and 5 Elements to approach this we'd get interesting results. Different than the
Chinese get.

Peter: Two things. Chinese people also have the same difficulties at work and difficulties
at home, and secondly what is the scope of acupuncture?

Ted: Yes but the question is, does anyone go to a doctor because of those feelings in
China? That's not part of the discourse that's allowable in the doctor-patient relationship.
It's part of what people go to doctors for in our post-industrial societies. We don't have a
form and a dialogue, a way of investigating the illnesses of our culture that are really
different. I agree I may be overemphasising this. I think the real problem is to relate to the
particularities of our culture. Acupuncture changes the way the Qi and blood manifest
and unfold in the body, and that manifestation relates to everything in people's lives, and
though acupuncture can't necessarily change people's problems at home, it can change the
way the Qi and blood deal with it.

Giovanni: Why should it? If acupuncture could do that it would be the universal panacea
- it could cure anything. We have to really decide the scope of acupuncture.

Ted: Yes but what I'm saying is that the Chinese definition of the scope is incorrect, and
why am I saying so? Because they change the scope every 500 years. And another reason
is that in Japan and Korea it's used very differently, and I believe that the full force of
acupuncture's power will come out in the West. We'll have more ability to investigate its
full scope. I feel if you can change the person's Qi they'll be more able to deal with marital
problems, occupational problems, family and spiritual and behavioural and psychological
problems.

Giovanni: Just by virtue of the acupuncture?

Ted: I didn't say cure, I said deal differently. Acupuncture's ability to change the Qi can
deal with that level of reality, and the reason I know it is that when we look at the old
acupuncture books we see what symptoms the points treat - all kinds of symptoms that
Chinese acupuncturists don't talk about, like LU-3 for feeling sad all the time and wanting
to cry. I never heard anyone in China be treated for that, but I know it's in the

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acupuncture books, or KlD-4 for feeling you no longer want to live. Someone thought it
worked that way. And I'll tell you another thing - if it's not in the books it doesn't matter
to me, because my patients tell me this when I'm treating them for 'simple' things. For
example I had a patient who told me "yes my knee is much better thanks, and I can also
eat in restaurants that have windows now". The person had been afraid to eat in a
restaurant that had windows. I was using a KID point for the knee and when I looked it
up in an old book sure enough it had a lot of weird fears indicated for it. For us to let
ourselves be defined by the limits the Chinese have set, because of the limits they have to
have, I think will not let us develop the full potential of acupuncture.

Giovanni: I'm not saying we should be defined by those limits but that we shouldn't over-
emphasise the differences. For instance you tall<ed about the Shanghai doctors going to
San Francisco and all the patients getting worse. I can tell you definitely that when the
Nanjing doctors came here all the patients they treated got better. A lot of my patients
whom I saw after those treatments got a lot better. Definitely no one got worse.

Felicity: Do you think it was just that the Shanghai doctors did really strong needle
technique and so they dispersed the Qi?

Ted: Maybe. But I will take back the story - because obviously it's not a good example.

Felicity: I think that many people coming back from China found many patients being
wiped out by treatments because the needle technique was too strong.

Giovanni: My experience was just the opposite. When you choose points according to
weird theories you interfere with the Qi unnecessarily. After going to China my
treatments became more specific, and one of the main differences was that people weren't
coming back saying they felt shattered after treatment. Patients don't say that any more,
because I use less needles, I go more straight to the problem, treat what needs to be
treated and leave it alone. But what you're saying is right - probably the scope of
acupuncture is wider.

Peter: You talk about the actions of points such as LU-3, KID-4. When do you think they
disappeared from the common language of acupuncture and why?

Ted: I don't know I could say accurately. It's real clear that it goes back further than the
People's Republic. It's got to do with bureaucratisation and the disappearance of some of
the more subtle elements of Chinese medicine. I think it's definitely after Sun Si Miao.

Giovanni: It probably also has to do with the general decline of acupuncture. In the Qing
dynasty acupuncture came to be used only for channel problems whereas before,
according to Professor Qiu, it was much more used for internal problems. Acupuncture
had a very low status at that time.

Ted: Yes I agree. Another thing is that people brought many kinds of problems to the
temples and the religious healing ceremonies of China and acupuncturists got left with
simple aches and pains. The more complicated anguish and suffering went to the temple
healers. There was a decline in education of acupuncturists and of people's estimation of

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acupuncturists. That's probably since the Ming dynasty and not unrelated to some
Western influences too.

Peter: I think also there are ideological conflicts. Not so long ago one of the main Western
pollution’s identified by Deng Xiao Ping was 'excessive individualism', and that does
reflect a whole way of thinking. It's not just a communist versus a modern Western
approach, it's more traditional to China - that your place in society was very much seen as
serving your family and more recently the state. This was also much more pronounced in
this country up until fairly recently - the whole educational and cultural process was
much less about fulfilling your own personal destiny, taking care of your own
individuality, but working outwards to society and that's very much changed for us in
modern times and it's not always clear whether its a totally good change.

Ted: It's a different change. We're born after Freud. We all know that we have
introspection that leads us to potentials and possibilities - and also difficulties. I mean I
didn't feel I wanted to live in China -I didn't meet too many people I wanted to go and
have a beer with. I also couldn't talk to doctors. I told one of my teachers I wanted to go to
India and study Ayurvedic medicine and she looked at me with amazement and asked
why anyone would want to study that. You can't have discussions about anything but
their version of Chinese medicine and western medicine. You can't even ask them what
they think about the Japanese or Korean versions of acupuncture - they don't even know
about them. Very few do anyway. It's almost our mission to deal with synthesising all the
traditions of acupuncture in a way that really brings out its full potential. I don't see the
breakthrough for acupuncture happening in the Orient. I see it happening in the West.

Felicity: Do you see anyone in the West who's breaking through?

Ted: I think its going to take a generation or two of acupuncturists. I think someone like
Worsley who's not bound by the restrictions of any Oriental thought has got to some
creative places, but by the fact that he has no roots in the historical experience he has to be
criticised. But to the extent that he has explored in what very clearly is totally unexplored
territory - there's a lot to watch out for - what happens when you use acupuncture in a
totally non-Chinese way - or non-modern Chinese way. His stuff is not unrelated to some
schools that exist in Japan. Most of it he made up totally, but I think it's important still.

Giovanni: You don't think to make this breakthrough it has to have its roots in the
theories of Chinese medicine at all?

Ted: Oh I do totally. I think it has to have its roots in the Nei Jing, in the theories of Yin
and Yang, in everything in the Chinese experience, and the Japanese and the Korean, but I
think the roots have to give sprouts to something that's strictly our own. If we don't do
that we won't be developing acupuncture. I think the cases Peter gave of the patients who
keep bringing back problems, it's to do with the fact that we didn't angle the needle to the
place where their concern is.

Peter: Mind you there may be other reasons. One is, I think, the frequency of treatment. It
felt in China that because treatment was so strong and very direct, with accurate
diagnosis, given frequently, that the application of the medicine led the patient out of the
disease. When acupuncture is applied less frequently and less strongly as it is in many

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cases in the West, because the medicine isn't being applied in the proper way we have to
then rely more on the patient to lead themselves out of the disease, and we have to talk
them along out of it much more. I mean the medicine has to be applied in the proper way
- penicillin doesn't work if you only take one tablet a week. In China we had patients
coming in with very severe asthma who by the end of ten days had had seven treatments -
it would take maybe seven weeks in this country. The process of change is so quick, the
disease is being cured day by day, the patient's whole spirit and being is uplifted because
they really see something happening.

Ted: I'd argue with the word 'proper'. Application of medicine in modern China is not
necessarily proper - it's adapted to be suitable for their needs and historical circumstances.
What's proper for here has to include that we might only be able to see a patient once a
week and that means that we have to apply the stimulus differently and select points
differently. Also you said 'cure the disease', but lots of patients come to us not with
disease but with real experience of disharmony on many levels, and in those situations
what's proper in China may be totally improper here.

Giovanni: You call weekly treatment proper treatment for here, but that's created by
social circumstances. We're in private practice and people can't afford to come more often.
If they could they would come every other day.

Ted: That's a good point. I think it's created by social circumstances in China too.

Giovanni: Yes it is, because it's free and they can afford to come.

Ted: I don't necessarily think more and frequent treatments are better for us in the West. I
mean if you're going to get good results with asthma, the patient you're going to get good
results with, you don't have to give that many treatments to, and the patient who doesn't
get better, it doesn't make much difference how many treatments you do. If someone
conceives that the main thing that's giving them pain is asthma, and if they can breathe
more easily they would be relieved of everything, maybe more frequent treatment is
good. But most of my experience in treating asthmatic patients, or any of my patients, is
that if you ask enough there's other things that are probably more weighty, and if the
needle was directed there you could use fewer treatments. The pain and anguish that
people feel all the time.

Giovanni: There's one thing I think, maybe I'm wrong, that your experience is very
limited to Cambridge intelligentsia. Have you ever treated farmers from lowa, or
Nebraska, or rednecks from Alabama?

Ted: Yes I have. In the hospital I work in.

Giovanni: And are they different from the Cambridge students and intellectuals?

Ted: Yes very different, I have to treat them differently. My clinical experience is quite
wide. I work in a public hospital and we only treat poor people who can't afford to go to
private hospitals. Our priority is ethnic minorities, people who can't afford treatment in
the private sector, the elderly, the disadvantaged and deprived. They're the ones who
taught me more than my Cambridge people. It's a good point though. My experience at

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the hospital is that we get patients that are so sick they've been sent to us by other
hospitals who can't deal with them. I've often felt that the pain these patients were
experiencing was on a deeper level than the meridians, and by moving around the
meridians we were bypassing what was going on with the patients and they weren't
getting better after ten acupuncture treatments. I felt 'hey stop pushing the meridians
around', their level of discomfort is not on the level of the meridians, even though they
experience it on the meridians. Now if someone comes to me who's a truck driver with a
bad shoulder, I would probably treat S.1.-3, L.1.-4 and the shoulder - not because he's a
truck driver but like you said it's a very clear problem. When you treat them there's no
reactions and somehow you experience their intactness. But when someone else comes in
who's been sick for six months or six years, with acute episodes too, that pain is already
deeper than the meridians. My experience has been that I'll treat the meridian a couple of
times but if that doesn't work I'll do something different. We don't treat more often than
twice a week. My opinion is that sometimes people should only get acupuncture once
every other week. So I just don't know what's a proper treatment, what's a correct
treatment, what's the correct selection of points, but I don't feel that by duplicating the
experience we get from modern China we're going to get there. For example the Nei Jing,
for oedema, lists 50 points. It seems like it's saying use them all at once, but its hard for me
to believe. Why do we use bilateral treatments - no book says use bilateral treatments - it
doesn't make any sense to me.

Giovanni: I don't. Many doctors don't in China either. They say you can use certain
needles on the right and on the left to reduce the number of needles.

Ted: The Japanese don't treat bilaterally at all. I mean what's proper? We don't know what
case histories were like a thousand years ago. My feeling is that they were very different
than they are now. The treatments that are now being used in China I think come from the
1930's, with a modification in the last ten years, from that guy Chang Tan An who was the
innovator of modern acupuncture in China. He died in 1958 and was chairman of the
Academy of Medicine of the PRC, and he rebuilt acupuncture after the destruction of the
Guomindang government. He figured out really appropriate ways on his patients - the
best way to do it. But I don't know what's the best way for me.

Felicity: How have you changed your treatments practically then?

Ted: First of all I assume there's no correct treatment for any patient I have. I listen to
what they have to tell me then I somehow try to take everything I know about
acupuncture and Chinese medicine and in some way respond to where their Qi and blood
is at. It usually doesn't take me any place that my teachers went. My teachers would be
flipped out. What my patients are telling me about is not what they would have heard. I
was hearing fear, inability to turn around, inability to pick their heads up. Even though
they came to me with a knee pain for example.

Giovanni: I think one of the main tasks is to re-interpret the syndromes in terms of
Western culture. I feel the Chinese syndromes are in a kind of shorthand - for a certain
disharmony which a Western patient wouldn't
express that way. It's like there is a tacit agreement between the Chinese doctor and the
Chinese patient. The Chinese doctor is saying, "you tell me the symptoms in this way
because I'm used to dealing with them in this way and I know what to do." So we have to

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learn the way the Western patients express the symptoms. The same disharmonies exist in
the West - but the patients don't express them in the same way.

Ted: Yes one of our main tasks is to take everything the patients say and make our
medicine respond to them, not for us to reconstruct the patients. I feel after teaching
acupuncture for a number of years that I've brainwashed people to do what the Chinese
do, and what I think we've got to do is take what the Chinese have learnt in their clinical
experience and reapply it, with the information from the Japanese, the Koreans, the
Vietnamese and the European practitioners, and add our own clinical experience. It's risky
because its much nicer to be able to say the Chinese know, but I believe that if we take the
risk we'll get the rewards of developing acupuncture to a more refined art. I also think it's
going to take a lot of work and a lot of energy.

Peter: There's a few points I'd like to make that I've picked up on from things you've said.
I really enjoy applying differentiation of syndromes because it does work. It fits the
patients and it's a wonderful process sophisticated and really does apply to what people
have. I feel that you can define what's wrong with people in a number of ways - you can
define it in the way the syndromes are expressed, or you can define it more in a
psychological way, but as long as you define it in a way that leads you to treatment, that
will resolve the syndrome on a lot of levels - so you don't have to define it on a
psychological level. You can treat kidney deficiency, liver excess, heart empty fire etc.,
treat it in that way and resolve things on other levels.
The second thing is more ideological. Buddhism says that in conditioned existence all
beings suffer, so of course if you ask, if you dig into the patient's state you will always
find some psychological suffering. It's inevitable because we're not enlightened beings. So
we have to decide first how far is that relevant, and how far is it treatable. Secondly, part
of me says that people can't evolve through their problems and difficulties without the
right kind of effort from themselves to evolve and grow. That can't be supplied by
needles. People cannot solve their basic communication problems with other people, or
their lack of love, or inability to give other people freedom and so on just through the
application of needles.
The third thing is more political. Social and political conditions create very real problems
for people and affect how they are, and those can give rise to disease on the physical and
psychological plane. And in the same way that I feel it's potentially arrogant to say that
we can solve people's deep-seated personality problems that they have to work out
themselves, I don't think one can expect to solve political problems by needling. There's a
limit to any form of medicine, and it's wrong to say this is all our sphere.

Ted: I agree with you. I think there's no way medicine can solve the fundamental issue
that we're all going to die and that we're all on the planet to experience suffering. That's
part of being alive. But what I think acupuncture can do is, by affecting the Qi, make
people more able to deal with the issues that have to deal with being alive. And I know
that for two reasons - from my reading, and more importantly I've watched how my
patients have responded when I've responded to them. Medicine is always going to be
palliative. If all the doctors in the world gathered together to treat one patient, they
couldn't stop them from dying. We shouldn't make our limitation be that we can only
treat the pain that's in the shoulder.

Giovanni: Oh no one's saying that.

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Ted: O.K., but we don't use acupuncture to get rid of pain - we change the Qi and blood
movement. Sometimes in fact the acupuncture will give you more pain because it will
make you look at what's going on. Ultimately when the Qi and blood is harmonised it
doesn't mean you don't experience pain, anguish and suffering, it means that you're a
healthy human being. We really have to get out of the Chinese model that you treat
diseases. I will not treat diseases, I want to treat my patients. By treating I can make my
patients stronger, but I don't think we're going to change the fundamental issues, and
what level you decide to approach a patient is going to be decided by what's going to help
the patient the most.

Peter: I think in the interests of pushing your point you're being unfair because whenever
you refer to the Chinese approach you always say knee pain and shoulder pain which is
only a small part of the field of acupuncture - in China and applying Chinese acupuncture
in the West. It treats a wider range and treats things in a much more sophisticated way,
including emotional problems and including recognition of the spirit - treating the Shen.
And if a patient has a disturbed spirit along with a shoulder pain, we treat it. We all do.
The Chinese usually do too. Because manifestations of disturbance of Shen are manifested
by anxiety or insomnia or fear or dream disturbed sleep and so on. I agree there is a
priority in China to get people back to work and some of these things will be ignored.

Ted: I disagree with you. Shen problems manifest as backaches, knee pains, and weird
smells under the armpits.

Giovanni: I don't agree that every shoulder, knee, back problem has to be related to
everything else. Why? Of course if someone comes to you with shoulder problems, like
Peter said, if you dig deep enough everyone has got emotional problems, problems with
the family, problems at work or with unemployment. You will always find a
psychological problem or a spiritual problem. Why do you have to relate it necessarily to
the shoulder problem? Not all problems are necessarily related, and not all problems are
dealt with at such a deep level.

Ted: I think it's inappropriate to deal at any level the patient doesn't want to deal with.
That's a fundamental line I draw. Our job is to help a patient and to be with a patient. Our
job is to change the Qi and the blood of the patient to help them deal with the problem
they are experiencing. If someone has fallen down and has an injury and wants me to deal
with the fact that the Qi and blood is stuck in the meridians, that's the appropriate place
for me to deal with. Or a gall-bladder inflammation and it's real clear that they want to
deal with that issue, that's what I do. But I also think that we have to remember that we
shouldn't define the issue with our patients because as acupuncturists we tend to define it
as the Chinese do. My clinical experience is that if we leave them alone our patients will
tell US things that are really unbelievable.

Giovanni: The other thing I want to say is why do we have to make a difference between
treating the disease and treating the patient? I don't believe in this difference. If you
analyse the problem as it is on the basis of TCM - make a good diagnosis, and
differentiation and treat it, the person will get better on many levels. I'll give you a good
example. I have a patient, a woman, with a very complicated case, a very intricate
diagnosis. KlD Yin Xu, ST-Yin Xu, LlV-Yang rising, partly Xu partly Shi, very intricate. I

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treated what I found. I didn't go into her life, her psychological problems and so on. But
over the course of a few months she's a changed person on all the other levels that you
were talking about. But these changes have been brought about by a good down to-earth
differentiation of syndromes. This morning I saw her and she said she's a changed person,
her outlook on life is optimistic, she's changed her job, everyone has noticed that she's at
peace with herself. She gets on much better with her husband, she's just blossoming.

Peter: Can I come to you for treatment?

Ted: My response is that it's what I was saying - acupuncture can deal with many levels.
My question to you is what would have happened if she'd come to you with the problems
that you say got resolved on another level. Would you have been able to treat her?

Giovanni: Well the other point I want to make is that there is the danger when you say
that we should respond to Western patients differently - of course we have to, but there is
the danger of pushing very nebulous and unrooted theories. The patient comes to you and
says for example, "I feel depressed at five o'clock in the afternoon," and I say, "oh yes I've
heard this before, that's SJ-16." That's the kind of thing that goes on in the West. I don't
believe that that's an adaptation of acupuncture to the West. That's a nebulous rootless
fantasy based on nothing. That's the danger. I've been through that and I know it.

Ted: I'm not advocating that we do touch-feely acupuncture. I'm not advocating doing the
needle where you feel it's right, unless you're psychic and there are not many around that
are good. But what I'm advocating is being rooted in the experience of China, Japan,
Korea, Vietnam, and I don't know anyone who is in all those traditions, and being rooted
in the sense of what does it mean to treat another human being. Using the principles of
Yin and Yang and the principles of the transformation of energies and the rules of
acupuncture and trying to respond to that. And I guess I would say that at some point,
not now but in many many years, after we're not even on the planet, there's going to be a
declaration of independence of Western acupuncture. I'm not a Buddhist but it's going to
be like when Buddhism went to Tibet. 11 became Tibetan Buddhism, and when it went to
China it became Chinese Buddhism, and to Japan, Japanese Buddhism, and they became
distinct and very very different and suited for different historical, political cultural,
climatic circumstances. But the less information we have about the original sources of
Chinese medicine the worse that declaration of independence will be. The more
information we have, the more together and richer will our experience be after that
declaration of
independence. Its not that we shouldn't continue to learn from the Chinese and learn
more and more from Chinese medical books, Japanese medical books, translate and write
more and more books and increase our exchange with that part of the world, but at the
same time not to thwart our own development.

Peter: I agree, but I feel we should proceed with gradual steps. You gave the example of
Tibetan Buddhism. I've read that the way Buddhism went from India to Tibet was that
Tibetan scholars translated the Dharma from Sanskrit or Pali, I forget, to Tibetan, but at
the same time they trained Indian pandits in Tibetan, and when the texts had been
translated into Tibetan they were handed over and translated back to check they were
absolutely correct and without a single error. From that fantastically firm and correct
foundation they developed the unique form of Tibetan Buddhism. Totally different. Now

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a lot of the stuff that's happened in acupuncture in Europe has been without that
foundation. It might have had aspects of inspiration and clear vision but it's been mixed
up with the most stupid mistakes and a lot of ignorance. I think now things are going
well, but the first step in adapting Chinese medicine to the West is being really true to
what we know of the Chinese tradition and getting it right and then proceeding from
there.

Ted: I don't disagree with you at all. I guess in the States it's different because we didn't
go through as many different fantasy realms because we had such a large Oriental
community. But I have to raise the question, how come Japanese acupuncture is totally
different from Chinese acupuncture, or Korean acupuncture? We have to learn everything
that's going on in all those places. It's going to take years and years and years. I don't
think anyone of us will ever know a fraction of it, but I think that as a collectivity we're
going to be able to synthesise and see things about the potentials of acupuncture that
those traditions, because they're correct and proper, won't be able to look at.

Peter: There is something about modern Chinese acupuncture that you probably see as a
weakness and I can see that it can be a weakness, but is also a great strength, which is its
role as part of state medicine. Because of its accepted position there's a great pragmatism
imposed upon it. It has to work and has to be refined in their terms to be maximumly
effective, because they've got a billion people and scanty health resources and in the
realms where it's considered to be effective it has to work. I don't know much about
Japanese acupuncture but I suspect that wherever acupuncture is being applied outside
that framework, usually privately, it takes on the aspects of being somewhat luxurious.
We treat them if they choose to come to us but if they don't get better they go somewhere
else. We're not having to test out in the same hard way the practicality of our theories.

Ted: But one thing is that modern delivery system is very very new, it's post Mao Tse
Tung. It's communist reform and it's a very good reform. I mean free or very inexpensive
availability of new acupuncture. Before the revolution in China acupuncture was
underdeveloped private sector medicine, and in China now they're developing a new
form.

Peter: There's one thing going back a bit that I'd like to discuss. You said you don't want
to treat diseases. I don't think Chinese medicine treats diseases. I treats syndromes, and
why I think this is so great is that it occupies the sensible middle ground between treating
diseases irrespective of the patient, and treating the patient as a totally unique individual
irrespective of the disease.

Ted: I think the word 'syndrome' is a very poor translation because it actually means a
configuration for which the correct aetiology has yet to be discovered. Chinese medicine
treats a configuration of energy, it has a label we call it LlV-Fire or whatever. In
acupuncture that's what we treat - configurations of Yin and Yang, Qi and blood. So I
guess you're right. It's a theory of illness, it's not treating an isolatable distinct disease. It's
not treating the whole person either.

Peter: We probably all agree on this but the difference to me is that a disease has walls
around it. It's a box, you have to have certain symptoms that make it definable as that
disease. So if the patient has other things going on it may be a different disease, or maybe

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they just don't fit into any disease box and have to be discarded. Syndromes or patterns
are infinitely flexible. Flexible enough to cover any possible configuration in a patient as
long as it's applied sensitively enough, if we're good enough to apply it sensitively
enough.

Ted: I agree with that.

Giovanni: When you say treat the patient, not the disease, does the disease always get
better?

Ted: I try to treat the patient to help them get where they want to go as fast as possible.
Not all my patients get well, but most do.

Giovanni: You see I don't see the difference between treating the disease and treating the
patient.

Ted: Maybe I was wrong when I said that. If you want to say we treat the configuration of
Qi and blood, maybe that's what we do.. I hate to say this but what I believe is that we
have to develop a more refined differentiation than the Chinese have. Because in fact most
of those configurations are not very old in Chinese history, I mean they certainly don't go
back to the earliest level.

Giovanni: They don't go back to that but they are derived from that.

Ted: I'm not saying we have to abandon the tradition but that maybe we have to begin to
elaborate it differently.

Giovanni: This is like the Stalinists and the revisionists. We want to keep everything the
same.

Peter: I think you're right Ted. To take an example, LU-Qi deficiency, you have !:right
facial pallor, spontaneous sweating, but you also have weak voice. Weak voice is
shorthand for something that we might define quite differently. Someone who's got a
weak, timid voice and doesn't want to speak very much, maybe sitting outside the circle
of people, not being assertive, all those kind of things we would define differently, but
when you understand what it means in the syndrome it's adequate shorthand f or it.

Ted: I treat the LU meridian all the time - totally different from the way the Chinese do.
I'll give you an example with the voice - the whole question of grief which is the emotion
the five elements associates with the lungs. Grief is a perfectly normal reaction to loss and
whatever, but there's a lot of people who are in grief who are not ill in the sense of a
Chinese syndrome. Treating the LU meridian will help. Not being able to breathe in
deeply, that's part of the LU syndrome that the Chinese can't articulate. It may have other
LIJ symptoms but it may only manifest as a fear of talking in a group.

Giovanni: How then do you choose the point out of the eleven points?

Ted: Good question. I look through the old indications and try to find the point that
makes the most sense and use it. My experience is that you can take acupuncture further

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than the Chinese say. It's interesting, when you talked about that patient that got better on
many other levels, why can't we talk about Lung syndromes on any level that corresponds
to reality. Someone who's unemployed - there's several ways of responding. One is to go
out in the streets and pound the pavement, and one is to sit home in a corner and not
move, to weep. You're not going to get someone a job by giving them acupuncture, but
you can help the way they deal with it by treating the syndrome.

Felicity: There's still going to be three million plus people unemployed.

Peter: Yes that's really tricky. What if a patient comes in and they're really angry because
they're unemployed. Maybe that's an appropriate response.

Ted: Then don't treat them. If a patient doesn't want to be treated for something then don't
treat them. I think we bypass the difficulty by helping the person deal with what they
want to deal with, and not make the decision ourselves. If someone's response is
appropriate, then acupuncture will make it more appropriate. Acupuncture on that level
doesn't do bad things. How a person's Qi and blood moves is going to determine how
they respond to unemployment. Everyone has a different response. Acupuncture won't
make you cope but make you more who you are.

Peter: I guess that I agree with most of what you say, but I'm a gradualist about it - I want
to move step by step. I need to define for myself what I feel the limits of medicine are. I
have to recognise there's great variety in medicine. There is acupuncture, there is
psychotherapy. If acupuncture could do it all there'd be no need for pyschotherapy.
Acupuncture does have limits. That's why there's such variety in ways of approaching
people with medicine. We can't expect sticking pins in people to resolve more than we
have a right to expect.

Ted: Who determines our expectations about what's the limits of acupuncture?

Giovanni: I'm not clear about them yet. There are limits. I had a patient who came to me
because she pulled her hair. A very anxious, nervous patient. Whenever she was anxious
she pulled her hair. She was very worried about it. I said I haven't any idea what to do -
how to treat this problem. All l can do is give you a general treatment to calm you down
and then treat it as an addiction - with
points on the ear etc. There was no marked syndrome. She had a few treatments and got a
bit calmer, pulled her hair a bit less the day after treatment, but then it went on as usual.
So I said you'd better go and see someone else - like a psychotherapist. When she went,
you wouldn't believe the stuff that came out from her childhood. Unbelievable. I don't feel
there's any way acupuncture could have dealt with that patient at that level.

Peter: Unless the acupuncturist was also working as a psychotherapist.

Giovanni: Yes but that raises another question. I believe that the qualities of the
acupuncturist and of the psychotherapist are opposite. They cannot be combined in the
same person.

Ted: I would say that by you calming her LlV-Qi she wouldn't have had less problems in
her past, but it would have helped her work in psychotherapy more quickly, with more

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courage and more calmness. I'm not arguing that acupuncture cures everything, but that
treating someone for what they are, what they present to us, we enable them to deal with
the issues that they're on this planet for. That's a heavy statement because if its true its
powerful and if it's not true I'm in trouble.

Giovanni: Treating the patient and not the disease can become a very high-handed and
arrogant attitude. You can get the situation that I've seen many many times that someone
is treated for months, maybe years, and the practitioner thinks he's getting wonderful
results on very deep levels, but they've still got the physical problems they came with.
Sometimes the patient may improve on these deep levels, sometimes the practitioner tries
to convince them they've improved on that level. I also believe in a step-by-step attitude.
We talk about adapting acupuncture to the West. How many books on acupuncture in
English can you count? Just three or four decent ones. How can we begin to make this
adaptation when knowledge of the original is so limited? The declaration of independence
you were talking about has unfortunately already happened. That's precisely the danger.
There are people in Europe who say they are practising European acupuncture, but on no
basic foundation whatsoever.

Ted: That's a very good point. I'm talking about those of us who have had a real
relationship with Chinese acupuncture - at some point declaring independence. I know
that in England people have been trained in schools that worked on the inspiration of
people, not necessarily derived from experience with transmission from the Orient. I'm
sensitive to the fact that's what makes you worried about what I'm saying. The American
schools were primarily opened by Chinese. It's a very different background. I'm reacting
against excessive orthodoxy in my training.

Peter: We were so delighted to discover orthodoxy in acupuncture we still haven't

recovered from the pleasure.

Ted: I think we're all a product of our histories. We need both what you guys have been
saying and what I've been saying in the appropriate Yin Yang balance. I've been scarred
by the tight Chinese approach and you've been scarred by the nebulous fantasist
approach. If there's a difference of opinion it's a difference that's really a complementary
opposite, not antagonistic.

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