06 March 2011

It All Starts in High School

It's a Friday in March, the weather is winter cold but the sun is out and spring is coming.  I'm standing before a group of high school students from the metro Portland area who are all interested in careers in natural medicine at NCNM. 

In China, acupuncturists are trained right out of high school. Their colleges integrate western and some eastern medicine throughout. There are systemic problems, such as Chinese medicine being subsumed by Western medicine.  Another is that few graduates in mainland China actually enter their field (since the state prohibits private practices which they consider to be in competition with state run clinics). Still, there are impressive institutions of Chinese medicine that are based on size alone--meaning they are massive structures with tens of thousands of students.  One example is a university where I studied in Nanjing.  For most traditional students, after practicing for 20 years, then you've got a student who becomes teacher.

American high schools have their problems too. Once pathbreaking institutions, they are now seen as outmoded, evidenced by high dropout rates--up to 40% locally.

On Friday, we had a 7:30 meeting--in the morning. It was a rousing discussion on bridging ancient Chinese with Greek medicines (and Phenomenology for good measure).  I was reminded about the high schoolers awaiting me. Power point this time? Maybe just for wallpaper. I thought of sharing an impressive story about the patient getting surgery with only acupuncture anesthesia--something with flash to get them engaged. I remember being pretty glazed over in high school: I was wrong this time.

The youths were dressed up. Men in restrained dark suits with the gravitas of Obama. Their elbows were on the table, leaning forward. There were about 45 of these students in our old brick building, originally an elementary school from 1902.

I began the talk with my own despair of when I was in high school and of not knowing what my career path would be. I wanted to be like my old grandfather Roger, a surgeon in a mining town who trained at Johns Hopkins and served as a surgeon at the European front during World War I.

My math skills plummeted with the stress of entering an all-boys, competitive private school. I gave up ever wanting to practice medicine, or anything to do with math.  I went on to speak to the group about the career aptitude tests I endured in the 70s, with little gears that turned so that they would know if I could be an engineer (and get a real job).   The results, for me, were to work with people not machines. Yet there continued to be omnipresent social pressure to learn 'hard' science (math, engineering & medicine) in order to survive in the "new" economy -- which was plummeting in its own unique way even back then.  

Lights didn't go on in the audience but the students were listening. I told them my flashy acupuncture story about the patient getting breast surgery of 54 stitches (including cauterization) with acupuncture as the sole anesthesia.  They seemed unfazed. I felt a little out of my league and scrambled to find connection.

At this point, I showed the students a picture of an old Chinese man playing a Qin, a stringed instrument on his lap (in the middle of our powerpoint slides). He played it to treat patients. We talked about the importance of music, and how the Chinese often used it not just to sound good, but for healing.  Finally I struck a chord.   In high school, for so many students, music is everything.

Questions started to fly. A hand flew up like an uncertain bird taking flight.  The question was a tentative young woman asking how long a student would have to study to become a healer.  I answered and the students became more bold--asking about a variety of issues--

"Who wants a treatment?" I interjected. Half the group raised their hands. I couldn't pick one, so I just put a chair and invited the first one to get there. After a polite pause, a young man took measured steps to the chair.

Here are some teaching tips with high school students: In past years, I tried ear and scalp acupuncture. The treatments wind up being too strong and needles often had to be removed. I find I can treat patients who are about 14 and older with needles in clinic but group events have a stronger level of Qi and response. Youth are more open.

So I offered ear seeds for the first time to this group of high schoolers. I thought it wouldn't be compelling enough for them but the results were perfect.

On the brave young man who offered himself up to be treated, we found a tender point on his knee, and applied black radish seeds to corresponding points on his ear.   I pressed on the acupressure pellets and he slid down a little lower in his chair.  He reported his knee pain was gone in moments.

We did a second demo on a young woman with chronic shoulder pain.  The group volunteered her: they knew her story, and were delighted when she smiled with clear relief.  I was moved by their collective concern for one of their own.

Then we did qigong. Here's another tip for reaching high school students.  I've done qigong over the years with this age group. They are very open, and get a little blown away with powerful or deep forms very quickly. It makes them giggle a little. Likewise, a very showy or expressive form, like something with shaking can make them feel awkward. This time, I just had them stretch up, and then wash Qi as 'bioenergy' with their hands through their body. Nobody cracked up, giggled or felt overwhelmed. It was a first.

The young man came up afterwards, full of questions.  "When can I start studying this? How long does it take? This really moved me," he said, "I want to do it --now!"

I knew the feeling of excitement and finding one's calling.  The light in his eyes was similar to when I met my first bodywork teacher.  After two weeks in his class,  I saw my career. There was a glow of recognition.

Later that Friday afternoon, I was treating patients in the second floor of our magnificent new NCNM Clinic. I saw the high school students in the parking lot. The same young man took their picture with a video camera.  I could see his face, the soul and heart of yearning as he looked at the building before leaving.

The sun at that point was setting in the western sky and cast a white hazy glow through the high clouds.  I wanted to open the window, to wave and call out one last time, but the students had walked beyond calling distance.  They were on their way back to their lives.  I had to wonder, would they return one day?

18 October 2010

Research on Addiction, Spirituality & Acupuncture

This is a response to a student paper on a research article using acupuncture to treat nicotine withdrawal--

The issue is very timely. Smoking does seem to be on the rise locally, though i've not seen statistics on it.
German research documented the carcinogenic effects of tobacco in 1935, before the chemical additives were used in manufacturing cigarettes. I mention it to patients who feel their smoking is OK, since they smoke 'natural' tobacco. Another point is that the active ingredient is identified in the death process caused by smoking, which knocks 13 years off a life.

Smoking is being promoted by the Chinese government, according to Dr Zwickey of our research department, since it generates revenue.

The problem with numerous studies are manifold. It gets into the heart of the problem with researching addictionology, and how research is missing the spiritual or inner dimension in healthcare.

First, how are patients recruited? This is seldom mentioned. Often though, in conventional trials, an ad is run and patients get paid.

Ever pay anyone to get off alcohol?

Could that ever work?

In acupuncture, the Nei Jing/Inner Classic of acupuncture says healing comes from within. Nowhere is this more clear than treating addictions. When the addict is ready to change, they will endure anything. If they are not ready, nothing changes.

This could be why studies on AA and 12-step programs--our main tool in addictionology--fail in RCTs. If we view a spiritual movement like Recovery as if it were a drug, it doesn't work: Funny!

Ask any worker in the field of addictions if Recovery programs work: They'll ask you, "What else is there?" While not perfect, they are organic, free, widely available, and seem to work. That was my impression, and those of my colleagues in the National Acudetox Association.

Statistics can be illuminating. Prozac got it's start with 5% upticks. 12 and 13 as found in comparing nicotine patches to acupuncture is significant in research. It's not enough for clinicians though.

Government research provided helpful information that most smokers quit on their 5-6th attempt. I tell smokers who fail that it takes multiple attempts (without mentioning a specific number). Some statistics do help us.

It's more the spirit in which they are provided. What we do in acupuncture and addictionolgy is not drug-like. I've yet to see a drug effectively treat chemical dependency. Acupuncture can work better than drugs, in that it has less side effects. But it has an inner aspect that conventional research is not measuring. The reason is that we are often providing an ulterior motive to study participants: cold cash.
The NY Times just had an article on the culture of professional research subjects. There is such a thing. Some make a living doing it.
My experience is that most research projects in Oregon, on the other hand, is with research subjects who possess a great sense of public service for low or no pay.

Qualitative research could assist. Comparing the writing of nicotine patch wearers to acupuncture patients would be something. Combining qualitative with quantitative research is bringing together yin and yang.

Research and all efforts in the field of quitting smoking will help this most difficult process our patients go through, as many of them attest.

15 October 2010

Response to Journalist Query

The excellent question: What is the response of skeptical patients to acupuncture?

In our student clinics, patients are often surprised by the effects. After the first visit, they sometimes wonder whether it was chance, or their imagination, or the Advil they ate many hours ago.

After the second treatment, these doubts clear. 

We welcome skeptics--prefer them to 'true believers,' who are more prone to disappointment if things don't match their expectations. Either way, the effects are noticed.

It takes a skilled practitioner to try different techniques and modalities within the field of acupuncture. About 10-15% of my patients do better with non-needle techniques, such as acupressure or moxa. They are too sensitive for needles, and don't enjoy them as much as these allied modalities. 

When I worked in public health settings, both in and out-patient, we had more than 'skeptics.' There were many patients there for the other public services: not the acupuncture. They would be openly hostile to the process. I found with time ways to reach even the most difficult patient. Often it was a matter of treating a specific pain that would open the door to clinical rapport. Sometimes it was using subtler, less conventional methods such as acupressure or external qigong. 

My finding after several years was that if I had about two weeks with any patient at most, we could find a way to meet their needs using acupuncture-related methods. 

Likewise, the case of the patient undergoing breast reconstruction surgery in Portland in 2004 using acupuncture as the sole means of anesthesia raises questions. This may be beyond what a placebo could reasonably be considered to do. It is also far beyond surprise for both the patient and her healthcare providers. 

11 October 2010

About the Inner Classic

When I went back to acupuncture school for a doctoral program, we were assigned readings from the Inner Classic, our main source text of acupuncture. This 2500 year old book was impenetrable before. My teacher, Dr Li, Yu-tang, asked us simple questions about how a short passage related to our clinical experience.

After struggling with various translations, I found that the one by Wu & Wu was accurate, despite the slightly rough English. To write papers and really get ideas, it was the only one in paperback that made sense. Translations by Tran are excellent and complete in French. They are only now being made into English. They are too expensive for most of my students, but worth it. Henry Lu's new version of the Nei and Nan Jings is exciting and a favorite at my college. However its size and cost puts it out of reach.

For all reliable versions, this roadmap will help. The Nei Jing is seemingly random topics. They may have been intuitively organized at first, but over time the chapter organization was re-created by guesswork. Despite this challenge, the brilliance of this text only grows with age.

The Han dynasty Systematic Classic of Acupuncture/Jia Yi Jing is organized by sections and chapters. There is an excellent translation by Blue Poppy Press that is affordable and clear. However both scholars and students are slow to adopt this book. Some of the ideas are different from the Nei Jing.

Due to the continued popularity of the Nei Jing, this roadmap will help with its biggest problem: the organization.

My hope is that the document of Nei Jing Topics, just posted, will be a kind of open-source software. I encourage others to correct, add to, and distribute this. Please let me know what you find.

When giving classes and talks on acupuncture, people are most excited about this spreadsheet.

Acupuncture is the 'mechanism of action' for Chinese herbs, nutrition, Qigong--all of it. It may lead to a better understanding of homeopathy and all energy medicines. Homeopathy struggles on this very issue: it provides good outcomes in rigorous studies, but the lack of a tenable mechanism limits its current acceptance in some communities. Acupuncture classics also provide the link to the psyche, psychology, soul and internal medicine for many developed manual practices, such as chiropractic and osteopathy. In the latter, very developed and skilled manual methods for manipulating organs have no discussion on what moving an organ means to the mind, psychology or psyche. The acupuncture classics had significant writings on diagnosing organ positions and size, but did not offer treatment. In this age, we can put the two together.

Later writings on Chinese herbs assumed that readers had not just read the Nei Jing, but memorized it --knew it by heart. Herb texts like the Shang Han Lun don't talk much about psychology and the Spirit, perhaps because it was already covered in the Inner Classic.

In TCM programs, it is rare to devote classes to the classics. My teachers in Nanjing were discouraged from spending too much time on it. TCM programs in the US have few, if any classes on these classics. As a result, the doctoral program I was in was surprised by the lack of understanding by practitioners of these texts. We need to start studying them from the beginning, as difficult as it first seems. It is simply a unique language. A text such as by Maciocia can be understood on the first reading, while a translated classic may need three. In college, I found philosphy texts needed six readings for me to start to understand them. The classics were clearer than Hume or Descartes for me. The fact that they are harder than a newspaper seems to dissuade many students.

Knowing classical Chinese is ultimate and necessary. Most of my students will not attain that. We have some students who self-taught themselves Chinese while going through our program. They had enough training from our several teachers with that to take it to completion. Their translations are fearless and unique, in their own voice.

We all need to start somewhere. There are an increasing number of translations in English. Reading them will fire an interest to go further. Not all of us will have the need, interest or capacity for learning classical Chinese. We do what we can. My experience in this field is: you can do a lot with a little.

The Nei Jing is a bold description of the architecture of the soul --Soular Architecture. It can revive medicine's focus on the body as machine. Systems Theory in biology is the other link to rescue us from viewing the body as a mere machine. Between the two, we will see more of the whole picture.

Classical Chinese acupuncture is a gift to the world.

Inner Classic/Nei Jing of Acupuncture: Topics

Wu LW, Wu AQ (trans.).Yellow Emperor's Classic of Internal Medicine. (Wang Bing version) Beijing: China Science & Technology Press. 1997
Annotated notes by Dr. Roger Batchelor (DAOM, LAC) ©10/10/10
Topics in Su Wen/SW & Ling Shu/LS (--pages in parenthesis):
1 Shen SW14, 26-definition (143); LS 32-diet; LS 78
2 Yin-Yang SW 5; LS 40
3 3 Levels SW 20
4 4 Seas LS 33, 36
5 5 Phases SW 50, 51-levels, 69,70, 78
6 6 Stages SW 2,6,16, 21&22-pulses, 31-fever, 35,36, 45, 56, 64, 68-exquisite, 74, 79; LS 72-psych,biotype, 78
7 7 Emotions  (later descriptions after Nei Jing)
8 8 Trigrams / Ba Gua SW 12; LS 77,78
9 9 Pulses SW 20, 27
DX: LS 4
Attitude SW 76, 78; LS 73-perception
Dreams SW17,80 LS 43, 80,
Face SW15, 32, 39, 42; LS 1, 29, 37, 49, 54
Complexion SW13,14,17, 57; LS 10
Forearm SW17, 28; LS 74,75
Pulse: SW10,11,18
Renying-Cunkou SW7; LS 9, 19, 48. [Neck/wrist ratios, later thought to be left/right radial pulses in Pulse Classic/Mai Jing]
5 Phase SW 7,17, 23
Ke cycle SW15
6 Stage SW 21, 22
Death SW 48
Questioning/Sx SW 64, 66; LS 28
Temporality - time sequence SW 36, 39; LS 25
Eye, sclera LS 70, 74, 80
Pediatrics; pregnancy LS 75
DZ: Pain Lumbago-SW 41; LS 26, 53, 71-sites of degeneration
Bi SW 3, 43, 56; LS 6, 13, 27, 46, 49
Diabetes SW 40, 47 (SP D-H); LS 46,47
Heart SW 44; LS 24-attack, 58
Depression LS 22
Mania SW 30, 46, 49,55; LS 22
Headache SW 49; LS 24
Deafness LS 26
Aging, Life Cycles (Development) SW 1, 76, 80-hospice; LS 54
Consumption (exhausion) SW 3,14
Lunar, weather effects SW 26, 63, 69; LS 44, 79
Fever SW 23, LS 31-3, 61
Cough SW 38
Jue SW 45; LS 24
Yin xu SW 62
Ke cycle SW 65, 69
Emotions, Psycho-social SW 8, 21, 24, 39, 67, 77-class, happiness, 79-family roles; LS 5-class, LS 8
Alcohol abuse SW 1, 45-violent(215), 46-hangover; LS 50
Wind LS 49, 58, 77, 79
Edema LS 57
Voice, loss/laryngitis, dysphonia LS 69
Insomnia LS 71, 80
Tumor, cancer LS 81, LS 46 (688)
Pathogen LS 71
Organ size, position- psychology (applications to osteopathy) LS 47 (640)
TX: Plan LS 42-combining; 45-profound
Teaching SW 80; LS 73
Acupuncture: SW 54-9 needles, 61-seasons, contralat-62,63; LS 4-Dao, 60, 77-needles
Skill Levels SW 1
Technique SW16; LS 7-Daoqi, 12-Depth, retention, 67, 73
Clinic SW13; LS 9
Back-shu SW 4, 39; LS 51-moxa
Blood-let SW 24, 35; LS 39
Mental Process SW 25, 26 (143), C2976; LS 73
Neck microsystem SW 32
Contra/caution, prohibitions SW 52-pts.; LS 3, 9, 41, 53-needle phobia, 55, 60,61
Zone tx SW 56
He-pts LS 4, 44
Pediatrics LS 38
TuiNa LS 73
Food SW3; LS 32&37-Shen, 56, 63, 65
Herb SW 23, 75, 37-Ht; LS 71-pinellia/banxia
Attitude, mental health SW 1, 13
Prevention SW 2, 13-psych
Regional influences SW12
Music SW 4; LS 65
Organ: SW9,8-emotion, Position  condition-LS 47, Constitutions-LS 64, Levels-LS 66
HT SW9-primacy; LS 71-Pericardium
SP SW4-spine (25), SW5-formlessness, 29, 47
ST SW5, SW7-larynx,pharynx, 18-Luo, SW 34; LS 68-thought, 80
SJ SW 8, 38; LS 2
Brain SW11-uterus, 81
Uterus SW 11-brain, 33-heart
SI LS 19
Points SW 58, 59, 61-St 36; Sky Windows LS 21
Primary SW 60; LS 2, 5, 16, ST as largest; proportions of Qi/Xue: LS 12
Luo ST Luo-SW 18; SW 34-minor dz, 56, 63; LS 10, 39
Extraordinary: SW 60; LS 17-Qiao
Chong SW 44 (215); LS 38 (664), 64-pathway, 65, 66
Divergent LS 11
Internal LS 10
Sinew / TMM LS 13
Wei [immunology] LS 52, 59-activation pts, 71, 76, 79, 80
Misc. SW 41-lumbago and various special channels

What About Those Studies?

A bright journalist asked me if acupuncture works, considering the studies that find it often doesn't work as well as a toothpick in sham studies. 

Here's one response:

Scientific deliberations take time and care. Research and inquiry functions best when taken across modalities.

Acupuncture is not placebo in that:

  1. Acupuncture works on animals--better than humans: Placebo does not work on animals. There are a quite a few veterinary acupuncturists. I can put you in touch with one, Steve Marsden, if you like. Many are like him: DVMs with secondary degrees in acupuncture, who use this modality extensively in their practice.
  2. There is no such thing as 'sham' acupuncture. There is no real 'control' in acupuncture studies.
    1. Ask any acupuncturist, and they will tell you that all the common shams--toothpicks, fake needles, and sham points--can have significant effects. Some types of acupuncture stimulate the skin without penetration, in effect the toothpick or stage-dagger needle approach.
    2. Likewise, everywhere is a point. We found ear points that the textbook locations led to fast results, while the 'sham' points--only a few millimeters away--simply had slower results noticed by patients: by about 5-10 minutes. I can show you an acupuncture text that includes more points than our beginning textbooks, used with specific purposes, that seem to cover the map. Also, there is experience from Shiatsu that has channels in between the primary ones. This matches patient experiences of pain that sometimes follow these lesser-known pathways (still different from neural ones).
    3. Some control groups are 'wait lists.' This is rarely done, though it matches the reality of chronic care. There are ethical concerns there that limit it as denying healthcare.
    4. Ted Kaptchuk has some articles on PubMed that discuss acupuncture research design and the flaws in conventional controls. However they are pretty dense and wordy articles.
    5. The only real control I've heard of are studies as the VA that apply acupuncture or not during general anesthesia of conventional surgery. However then you are looking at acupuncture in a very unusual circumstance, one which will have limited applications.
    6. Bengston did extensive research that calls into question control groups with energetic interventions, such as acupuncture, homeopathy, and the like. His surprise finding was that if an energetic treatment was applied to rats for cancers, all animals in the building registered an effect. Based on that, we now should go back through all the research to see where the control groups were located relative to one another.
    7. Scientific research on acupuncture is not correlating with clinical reality. Scientists and MDs I mention this to understand it. Conventional RCT research on acupuncture views it as if it were a drug. Instead it is more like surgery, where the issue of controls is also problematic.
  3. Acupuncture and natural medicines are applied holistically, in combination with other therapies. Acupuncture is usually combined with nutrition and lifestyle recommendations, herbs, bodywork, etc. There is a movement to "Whole Systems Research," led by Mikal Aickin, a bio-statistician. This is where treatments are analyzed in whole clinic settings. He sees huge flaws in RCT for natural medicines.
  4. Some see it that we are going about acupuncture research backwards. Hugh MacPherson in the UK came up with this: in drug studies, first we prove the drug is safe, then that it works, and then that it is cost-effective. With acupuncture, looking at safety is done last. Both he and others documented the safety of acupuncture in rigorous reviews. Compare that to aspirin and other drugs. The safety of acupuncture and natural medicines is one of its strongest aspects.
  5. For some conditions, such as chemotherapy-induced nausea, the evidence for acupuncture in RCTs is "overwhelmingly positive," in the view of one MD who now offers it to patients in oncology wards. (It's interesting to me that some of our best outcomes are for this condition, since our main acupuncture classic--the Nei Jing/Inner Classic--focused on the Stomach and digestion as well.)
  6. The research shows that acupuncture doesn't always work, but there are enough rigorous studies that document positive outcomes to say that something is going on here. That intrigues neuro-biologists and others who are focused on the mechanism of acupuncture. One PhD in that field, Richard Hammerschlag, indicates that we are about 2/3 of the way to fully understanding that mechanism. That is enough to inspire some great dialogue across professions that will lead to new discoveries. 
  7. The same meaning applies to patients. Nobody gets excited when Advil works. But if acupuncture works on a patient, they understand themselves, their bodies and their potentials in a new way. Not all of our patients may choose acupuncture, but those that do who find results are teaching others about what is possible. Research at Kaiser that was qualitative found these outcomes in natural medicines: they affected patients' worldviews and sense of self in healthy ways. Pills are not known for this. 
  8. Alternative medicine needs alternative research. Natural medicine will lead to a different research model. Integrative medicine will lead to integrative research --Aickin's Whole Systems Research is leading that. The gap between research and reality needs to be bridged.
  9. Not enough acupuncturists are involved in acupuncture research. Serious practical errors are evident as a result. This makes the treatment interventions flawed to begin with in a striking number of studies.
Bottom line for me:
  • Acupuncture is safe
  • It is cost-effective in both private and public health settings --cheaper than herbs
  • It is highly sought-after by patients
  • There is enough research to "warrant further study," as we say in research-speak, but not enough to be "conclusive."

06 October 2010

What's News?

Yesterday, a group of us from NCNM went to KBOO to tape a show for Sunday morning (830am--you can listen at their webstream at that hour).

We had 4 near-strangers searching for meaning, for 'news,' and this is some of what came up:

Little Portland, Oregon, is the only city on the continent with national-level colleges of every major modality represented: Naturopathic, Chinese Medicine (2), Chiropractic, MD, and Nursing.
This allowed these colleges to collaborate in research comparing outcomes of their respective modalities --nationally funded (through NIH). I participated on a panel that developed acupuncture protocols. These studies take years to make, and the results are still sitting on shelves, waiting to be analyzed and completed. Although the research takes forever, it seems, just getting it off the ground was a boost.

The interviewer, Tom Park, has a great and abiding love for this town. He was excited by the progress in alternative medicine since the 70s, when he first came to Portland and got to know NCNM. It is amazing how far natural therapies have come since when I first started learning them--out of people's homes--in the early 80s. To have real institutions with comparatively vast knowledge and resources at a mind-boggling increase now from then... who could know then it would be this way now?

When we took flower essences and ate brown rice religiously, getting bodywork (--we didn't grow up with that in Ohio) it was with total certainty. We just never guessed it would lead to bricks and mortar, NIH research or real programs. We instinctively knew what we and our friends and patients needed. And we weren't getting it in our families of origin or their doctors --or other institutions, for that matter. Viet Nam changed all of that. I watched my older siblings forge new ways of being, totally cut off from the elders who were drafting them for a war nobody seemed to want. I will never forget what happened at Kent State. Being with Tom, my Elder, reminded me of the power of generational differences. Each one has its most memorable, defining moment.

Portland is ready for a little good news. Homelessness--always growing since the 80s--is more evident: I saw a child sitting on the sidewalk outside the shelter on the Burnside bridge two weeks ago for the first time (the number of homeless families grows and is the least visible aspect of this issue). The Willamette Week--never a Beacon of Hope--this week noted that our county leads the country in illicit drug use.

But one bright light here is medicine: OHSU is our biggest employer. Besides the colleges for the modalities named above (NCNM, Western States Chiropractic, OCOM), there are at least 3 massage schools (Oregon School, East-West, among others), community colleges turning out more LMTs, University of the Pacific with its health programs, and the international Process Work Institute in NW Portland.
Walk around sick in this town, and you are bound to bump into a budding cranial-sacral therapist, homeopathic specialist, or shamanic practitioner (turning out positive outcomes research at Kaiser, no less).

How did this happen? Maybe it was from:
  • The Willamette Valley being termed "the valley of death," according to some urban legends about First People's term for this rich homeland (which I doubt)
  • Enough stubborn flower children getting stuck here in the 70s
  • A lack of pro sports teams to root for
  • The paternalistic healthcare models of timber company towns in the Northwest, leading to relatively more efficient and collective health enterprises in Oregon & Washington
  • Gorgeous beaches and mountains to draw in real healing --and people interested in that

When I lived in Taos, New Mexico, everyone believed in the energy of the land, and that it was most expressed through the dominant mountain. "The mountain decides," was a common refrain. It wasn't just a new age thing. The 'Anglo' population was only one-third.... Whether they were Pueblo Indians, Spanish farmers (first arrived 500 years ago), or retirees from LA, they all spoke the same way on this topic. They saw how recent arrivals were seemingly either welcomed by the land, or shooed away. The land was seen as alive, an independent agent.

Taos Mtn., New Mexico

People's cars starting breaking down in Taos as soon as they invented them in the 1920s, leading to permanent residency for many with no intention of settling in a pin-dot town at 7,000 feet elevation. This led to the establishment of a colony of artists. The painter Georgia O'Keefe, in nearby Abiqiu, was part of that movement:

Red Canna, 1923

As I look at this sometimes-broken, sometimes-healing, always-soulful city named Portland, I wonder how we all got here: Was it Mt. Hood or Tri-met? Some school or the beaches? Where is the energy vortex we owe our draw to? As an acupuncturist, I would like to know the point.

It seems to be growing.

03 October 2010

City Life

This is a response to a student paper. One of my first year students wrote that half the planet now lives in cities as of 2008, according to the UN:

"A good question for your classics teachers is: who were these scholars of ancient Chinese medicine? Cities existed in China for a long time. Scholars were a small subset of the population, male, and--urban? Most were not farmers.

We've got some rough characters like Hua Tuo who were 'close to the land.' He was an amazing Daoist sage-doctor. But most medical scholars were not of his class, literally and figuratively.
Hua Tuo, with herbs

My own experience was growing up suburban, moving out to the country as soon as I could, then moving to the city with children to work in inner city public health clinics.

My finding was that Chinese medicine could bring nature to the city. On lunch breaks when stuck indoors, I could do qigong to feel almost like I was in the woods. The effects of qigong went beyond what I experienced just being in nature, and enhanced my experiences of wilderness as well.

China is experiencing the largest migration in human history as it urbanizes. The findings are that physical health may improve with urbanization, but that psychological health can decline. For example, Chinese longevity increased since 1950--doubled in fact, due to a lot of what you are setting out to learn. However suicide rates are now a big health issue there (#1 in female suicides on the planet).
Another finding is that Chinese medicine can help anything. I worked in an acupuncture clinic in Nanjing that was dedicated to treating depression in young patients. They are losing about one a day from a scenic bridge over the Yangtze river, a bridge that when built was a symbol of national achievement over nature. The results of the acupuncture were encouraging, and I use the methods here on many of my patients.

In the end, it can all be expressed as yin and yang. My perception is that living in the woods both allows and requires the cultivation of light. However urban environments foster the conscious attraction and cultivation of yin, since that is often what's missing (as peace, quiet and inner focus).

In clinical practice, we treat what presents. My finding was that inner city patients often manifested yin deficiency: night sweats, agitation, insomnia, etc.
I thought it was anomalous, until reading in the Inner Classic (Nei Jing), our oldest and best acupuncture classic, that one encounters more yin than yang deficiency, since yin is more delicate.

This is a medicine you can take anywhere...."

15 August 2010


After a century-old apple tree came down in my backyard, there was enough sun to plant a garden. 

The tree was good and its apples won medals in pies. It endured a variety of pruning theories that left it with a combination mullet, crew cut and perm. Eventually the bugs ate enough so that when I could put my arm through it, we knew it was over. 

Sunlight was a new dimension in that back yard, which abutted a ravine off the Willamette River. Years ago, salmon ran in the stream....

I write this for casual gardeners, students with little time, and those who never gardened before. There is nothing like gardening. 

In our valley, in just a few weeks is an ideal time to plant a winter garden. The beauty of the Willamette Valley is that we can garden nearly year-round. In the past, I grew all my vegetables 11 months out of the year on a small plot, and half the fruits for a family of four. 

Recently my wife urged me to plant a raised bed, which I'm now hooked on. A neighbor generously donated his yard to a community garden after his tree big came down (from ill-advised 'professional' pruning). I've not bought any vegetables since spring, even though it's just a 4x8' bed:

I was first influenced by the 'French Intensive' method, which advocates close planting in deeply dug beds. The density makes for a jungle-like canopy that conserves water and gives great yields. The first year is difficult making double-dug planting beds, but well-worth it after that. This year we made double-high raised beds, using untreated thick cedar. We trucked in garden soil for all the beds, also adding compost from my yard. Trucking in dirt may be cheating, but it helps kick start the process --just once. 

I was then taken with 'square foot gardening', which undoes the linear traditional American garden. This link sees it as a way to eradicate hunger. 

Whichever style you use, you can't do it wrong. It's like the vaunted Schools of Acupuncture that way.... From now to mid-September in our region, a winter garden awaits your hands. I like to wait until it is a little cooler, around Labor Day. You can pick up 'six-packs' of organic veggies at food and garden stores. A few go a long way. I've done the raise from seeds with timed lights in the basement on a hot mat with a fan thing, enough to know those six-packs at the store are a real gift. Brassicas family--known for their anti-cancer effects--are perfect: broccoli, kale, possibly brussels sprouts. Choose a variety of lettuces, and in a few weeks, you've got salad.

From seed, beets always work. Their greens are perfect. Garlic can be planted any time of year. I like Elephant Garlic. Take any garlic from the grocery store and plant the cloves tip up, maybe an inch deep. A six inch sprout will overwinter. You can plant more in the spring. The greens and flower are great to eat. 

Kale will go down to 20 degrees. Brussels sprouts taste better after a hard frost or two. I've done cloches and mini-greenhouses, but didn't like them. They gave maybe an extra week or two, but removed me from the plants. 

I'll do the same thing over during Spring break, and then put in a summer garden in May: tomatoes, beans, and squash. I've done corn, but it depletes soil after a year. 

The Hopis grow corn on 2-3 inches or rain a year. They say to talk to the plants like they are people. I'm not there yet. But I do love to come out and see what's come up overnight. 

In our community garden, it's interesting to see the different approaches. My jungle is looking a little ragged now. A young woman named Zoe made large crescents with carrots and beets that are now coming into their own. Her sunflower grows, but mine does not. 
Another neighbor planted brussels sprouts that I just didn't think would be so great in the hot weather, but they are glorious now. 

Slugs and aphids are a sign of the wrong plant for the soil. The problem is not on the leaves: it's the roots. Chinese medicine takes the same view, using more roots in herb formulas than anything. The ancient Chinese saw the human energy system as a plant, with the legs as roots. Aging starts in the roots, it is said. This is why walking, foot reflexology and the like are so helpful. 
If there are bugs, take it out or cut it back. A healthy broccoli or lettuce can give multiple harvests in one season. 

My chickens love the garden greens better than anything. I'll throw a broccoli leaf into a smoothie. The 8 year-old girl I live with will eat broccoli and kale flowers out of a garden like candy, but not many other veggies.   

A garden gets me out, even in the rain. I know my neighbors better because of it. 

A century ago, much of Portland just west of downtown (around what is now I-405) were Chinese veggie gardens. I liked the book Better Gardens the Chinese Way by Peter Chan, but never went for his non-organic options. He made a beautiful garden in Gresham. It turned out my qigong teacher bought his house and garden--which looked so familiar to me. 

Gardens unite us.  

13 August 2010

Group Qi

I was a loner when I started took up acupuncture, still in my 20s.
I chose to live in lonely, out-of-the-way places with just a few close intimates.

After learning, acupuncture, I looked realized I needed to go where people were.
Moving to the city was a shock. I endured and adapted. Now I love cities, groups, people.
The more the merrier!

This is how it happened: It began with my first day at Hooper Center, the public detox I worked in.

I was extremely nervous or 'edgy,' as the Process Work practitioners say when people enter a new field of experience. I didn't want to be there, but the new school I was at said I was the "low man on the totem pole."

Portland's Terwilliger Bike Trail, 2009

Which I later learned is not a bad place to be.

Nobody wanted to go to the detox. I didn't, since I'd worked in front-line social service jobs. They were the kind staffed by young people with good hearts, who feel after six months they are old-timers--with few who last more than a year. Psych wards, nursing homes, special ed facilities.... They each gave me a chance to re-integrate with the 'populations' who were weeded out during my childhood education, taken away somewhere else. Through the work, I found the psychotic to be gentle, the developmentally disabled as joyous, and the elderly to know the cycle of existence as grand seasons and rhythms of life (even while bound to a wheelchair, living in pajamas).

I thought I was done with all that. But no, the State of Oregon said I needed a few more clinic hours. So I went, barely unable to contain myself with the strange burst of energy (that I interpreted as anxiety). I went upstairs, where Patients were cooly playing pool in their pajamas. When it was time to start, they assembled quickly in plastic chairs in a circle on the shiny blue floor. The acupuncturists went like bees to flowers, quickly putting pins in their ears. At a certain point, the energy in the room formed a circle like the Rings of Saturn.
Saturn, associated with Earth (Stomach-Spleen channels)

The group qi field seemed to coalesce, spin, tilt, and then go somewhere. There was peace and some joy. I was hooked. I fell in love, and returned twice a day--once on Saturdays, leaving after ten years.

I'd pull into the parking lot in my little white truck, sometimes exhausted from the drive in, or the family life of raising young children, or starting a practice. But after work, I always felt better, strangely better.

I commuted alone, along with every single other driver on the road. Nose to tail, we formed a serpent entering the city at rush hour. The drive got longer, eventually creeping up to 45 minutes. Just me and NPR, maybe Nina Tottenburg chirping along.

My little practice near my little suburban home focused on individual patients. Sometimes I wanted to pull up the sheet-rock walls so they could all meet each other: I could see the similar patterns among the patients, who thought they were all separate.

Hooper was changing me, though.

Eventually, I brought a bike in the back of my truck. I rode it to the different clinics in town, sometimes three stops a day. It was like bursting a bubble. It felt so alive to ride, even in winter.

After a while, I offered group treatments to my suburban patients. I called it 'Happy Hour:' between 5 and 6 on a weeknight, drop in for a reduced rate treatment in my waiting room with a small group.

Half my patients went for the idea. Many that did said the slight reduction in price was the sole reason they could continue their treatments. I expanded it to three evenings a week.

Everyone seemed to have a great time. Patients instinctively knew who needed the most help, even though they could not read their charts. They would turn with needles in place and give their philosophy of life or some advice to the person who needed it the most.
I even wound up treating 5 generations within one family--one in utero--all in the same room.

I found that I needed to do only about a third of the number of needles on a patient during a group session than a private one. For example, if a patient needed about 12 needles per treatment in a solo treatment, when they switched to a group treatment, then they only needed 4. 

After about 3 months, it became my favorite way to practice. It seemed to take that long for the qi field to gel on some level. It's strange, but other acupuncturists I've talked to notice the same thing with clinic spaces. They seem to need a little time to coalesce, for the qi to saturate the walls and amplify a healing space. It is palpable.

Despite my enthusiasm, some patients just wanted the one-on-one. I could never predict who would: there was not economic or psychological profile I could discern. So I tell my students to offer both types of treatment.

And to let patients talk! If they want quiet, they'll shut their eyes.

We live in a culture where never before have so many people lived, travelled and worked alone.
Not a bad thing perhaps...we'll find out what it does eventually. Some of my suburban patients led monastic existences with great depth. But even monastics had company.

There was one Frenchman who chose to live by himself in a cave for an entire year as an experiment. He got terribly lonely --it wasn't fun. I've treated patients who were punished with solitary confinement in prison: they were never the same. This raises the point: Why do we lock so many people up in jail in this country? And why do we use 'timeouts' of enforced isolation on children as a preferred mode of punishment?

What I learned was: People need people. We are social animals, like birds. We need to talk -- and be heard, and go through rhythms of life together.

Now I live in the city. I try to see how many days I can go without being in a car. I rode a bike to work everyday last year, and love the connection with other cyclists. We nod and smile and murmur to each other, "on your left, thanks." The car drivers meanwhile look either bored or furious --I remember that. I love living in a family, and wait for the children to come back to roost. Although originally shy, I eagerly await the return of my students in the fall. There is so much to talk about, so many rhythms to go through together.