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.

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.


Is credibility our best option?

Today I spoke with students about the psychic surgery I witnessed during while in acupuncture school. I was in the front row of a public lecture. It was incredible in many ways:
  • He gave an accurate diagnosis after brushing the body with his hands
  • He proceeded to give the best chiropractic adjustment I've witnessed
  • He mentioned herbs for cancer that are increasingly endangered
  • The theories of organ function he learned from his Aztec grandfather closely paralleled the Chinese teachings in my first year of acupuncture college
  • The patient (apparently a stranger to the practitioner) gave a profound look of appreciation after the session
OK, did I mention the psychic surgery?

The practitioner, Mike Valenzuela, worked in bare shirt sleeves. The patient pulled her shirt up to the chest. He pressed a bare hand through her skin -- up to his knuckles into the liver area, and retrieved what looked like a baseball-sized clotted blood, rather like seaweed. I could see about two-three cups of blood, heard gurgling sounds, and watched him throw the items into a bucket with a splat.

He never advertised himself as a psychic surgeon. It was a fringe benefit. The whole event took place on an Indian Reservation in Northern New Mexico at one of the 12 Pueblos. Had it occurred in Portland, he would have been quickly arrested for practicing medicine without a license.

He supported himself as a car mechanic, and did healings gratis.

Regarding auto mechanics, his grandfather said that if his teachings were true, then they were applicable to any domain. The grandson found that the same theories handed down to him worked on cars as well.

I write this because 'alternative and complementary' health practitioners like myself seek to gain credibility in this amorphous 'system.'

If we can provide 5% improvement --like Prozac did in some of the trials that made it a blockbuster drug-- then we are fitting in.

If we do something incredible though, what then? Would total cures threaten our position?

Patients want the incredible. They don't mind a miracle. Miracles are supposed to happen. Children get that rap every Christmas....

Practitioners, like everyone, don't mind being loved and accepted.

Do we have to be auto mechanics to find that?

...My son just entered motorcycle mechanic school....
in the home state of that Aztec healer, who is now dead (or "transitioned," as his friends say).

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

While travelling in China on a low-budget cruise ship, I saw another incredible healing act with nothing more than human hands and imagination.  There were so many, but this one comes up tonight....

It was by a travelling Buddhist monk, who'd been given up as dead with an incurable disease by his impoverished parents in inner Mongolia. They dropped him off at a monastery as a last-ditch effort. He learned Buddhist qigong and recovered his health.

Every ten years, they send the monks for a year-long sabbatical into the world, to see what they are missing.

(The Amish who lived a bicycle ride from my boyhood home did the same thing for all young men, briefly, to see where their hearts lay. Most returned.)

So here was this monk, getting a close look at the world, making his way by doing healings and readings on the cruise ships.

Our trip was on a budget. The ship was comfortable, but more like a Tri-Met bus. We were delayed for mechanical failure, so we had time. Time is one thing China seems to have a lot more of.

We were nestled into the Yangtze River, prior to its damming. It was much like the Columbia Gorge in the Pacific Northwest, with rugged mountains sculpted by ancient floods, petroglyphs, and local bigfoot/yeti legends.

The monk did his thing. One treatment he gave was to stand about 20 feet away from a patient. He would vigorously crouch and wave his arms, eventually pointing at the patient.
Coins the size of a quarter were placed on acupoints. The monk directed his intention at them, which warmed the coins. When the patient said, "hot!" then the coins were removed. He tapped them on a table, and ash would fall off the coin.

Were he in America, it would be no doubt be televised. Then he'd be decried as either a charlatan or locked up in a lab for study, as a kind of treasure to be watched over. The reaction would be extreme either way.

In China, however, it was a Middle Way. There we were, stuck in a Gorge, getting palm readings and Buddhist external qigong heat treatments by this young monk. The shipworkers were totally unfazed: vaguely interested but not excited by the monk. They did not seem jaded, but what they saw seemed more part of life and nature.

In my experience, more things like this happen in China. It's in the air.

Could it happen here?

One of the patients, Claudia, was from Texas --she could take heat! Just out of acupuncture school, she was curious. "I wanted to see how hot the coins could get," so she didn't tell him when the coins got hot. As a result, blisters welled up at each acupoint, as thick as a little finger. I've got pictures of them.

We can say that magic is everywhere. Personally, though, I've seen more of it within the context of ancient cultures.

May we grow old together, then--and quickly.

10 August 2010

The Inner

Inside. Innerness. Innernicity.

'The answers lie within....'

Why did the Chinese aptly call their cornerstone text of acupuncture the Inner Classic?

Wow--that is different for us. 

Ask someone, like a patient, how their eyes are. They'll bring up data from their doctor, opthamalogist, optometrist --anyone but themselves. Then we have to ask again, "No, how do your eyes feel to you: how do you experience your eyes?"
   Puzzlement is the response. 
   "Do they feel tired, blurry, irritated, burning...." 
   "Oh, well, they feel tired, but that's just because I read a lot."
Or, if they burn, "Doesn't everybody have hayfever?"
We want to be normal, it seems. 

Why do we discount the self, our own perspective, and the entire subjective realm?

"If you can't trust yourself," I tell my students when they look to me for answers, "who else can you trust?
Ken McLeod studied Tibetan Buddhism and quantum physics--both very extensively. One of his strategies for healing the mind in our place and time is simply returning the 'I' in scientific discourse. All meaningful discussion in our culture led to the erasure of the 'I' as some egoic, unreliable and limited perspective. This led to some useful knowledge, but the effect is now so complete, so saturated into daily awareness, that people look outside themselves completely for validation. This creates a situation ripe for exploitation, powerlessness, and "learned helplessness." The latter is the title of a great article on his website. 

The Other Ken--Ken Wilber, referenced in the first blog--attempted the same project: reclaiming the subjective as something meaningful. He studied Tibetan meditation as well, and wrote my students' favorite book of his with his wife as she was dying of cancer. True Grit is its title. 
Acupuncture, as all modalities, is a metaphor for healing. All the needles point in one direction: inside. 

When there is a change, we realize we were just a few needles away from liberation. 

"What drug is on these needles?" surprised patients used to ask me, when feeling acupuncture's effects for the first time. Especially addicts had no idea their own body could whip up such a heady brew on short notice, with such little prompting.
Some attempts to determine how acupuncture works describe it as a 'wounding.' In my experience, this is utterly not so. Acupuncture is simply a medium of communication. A lot of acupuncture, chiropractic and physical therapy these days is like somebody shouting at the body. The target then goes into duck-and-cover mode. There is no 'qi flow' in that! The 'wounding' approach is about the Outer, about overpowering. 
Alternatively, when any practitioner really listens and then engages in a soulful dialogue at an appropriate 'volume,' the inner emerges to meet the outer. We say that yin and yang then unite. This creates life, and life is healing.

09 August 2010

Mental Health

By the time I left Hooper, the in-patient facility, it was ten years after I'd started. I was so nervous getting there the first time, I was exploding in the little Toyota truck on the way in. I didn't know at the time, I was meeting myself in the work there.

By the time I left, my boss (Ed Blackburn) estimated I'd interacted with over 50,000 patients. Acupuncture is based on experience. Those interactions left me a changed man.

The type of patients I'd feared the most I wrote about in the last blog.

The patients who taught me the most were the ones with 'mental health issues,' as we say in our culture.

In our field, we sometimes half-joked about taking a 'mental health day' -- a day off to recoup. We all needed them.

What was stressful about our job?
There was no heavy lifting....
It was a matter of the heart.
Most days, something would break it.

When I started doing acupuncture at Hooper, my heart was weary to see some patients hiding under their beds when it was time for acupuncture. Or in the shower --fully clothed.

"Come out and let's talk about it," I'd say.

All of the patients who hid themselves away during acupuncture had a severe mental health issue.
If you've met someone like that, you know how gentle they are. Our treatments were doing just one thing: blowing them away. They couldn't handle it.

I listened and negotiated with them. I told them to take a break, and then when they were ready, we could try just a few needles.

I went home and looked up more treatment ideas for what they had. The Chinese sources had what we needed. There were protocols for hallucinations, anxiety, 'yang psychosis' (throwing chairs), anger issues --there was plenty to try.

One man who had a particularly hard time with needles was amenable to trying moxa, a heat treatment. We use a compressed herb, mugwort, a relative of sage, formed into something like a huge incense stick that is held over acupoints. A Chinese text recommended moxa on a Small Intestine channel point on the neck (SI 17) for auditory hallucinations. When we did that, he could feel a circle going from his neck to his brain. The voices stopped. It all tickled him.

I learned and tried a lot on these patients. I found I was able to get very good results with psychiatric conditions. This was an area we never studied in school. I often had to wing it. Just finding good protocols was not enough. I found I had a resonance with the psych patients, an understanding. I was puzzled by it.

We were then asked to do acupuncture at a community mental health clinic in on Northeast Alberta street in Portland. To be in a room filled with people with mental health diagnoses, on medications for severe mental health issues --and do acupuncture on them was new. I worked in psychiatric settings: It was my first job after college, a burnout path. But to be their acupuncturist led to a different level of interaction. I was scared, but had no choice but to plunge in.

In feeling into them, I realized that I held a love for these patients that I had for my grandmother. My mother's mother suffered from bouts of psychosis. It was brought out when her husband left for both world wars. Running a farm with five children was a stressor. She was beautiful, a poet, dignified and very quiet.

From that connection, I felt I knew what to do with these patients.  That proved essential, since conventional protocols didn't always work. One point listed in contemporary texts for auditory hallucinations (San Jiao 17) seemed like it ought to work--but never did.
Instead, one day while treating a patient with voices, I got an idea to use a set of three points on the back of the neck. After they worked, I looked them up. One was called Ya Men in Chinese, which may translate to Muteness Door. Acupuncture is bi-directional: this is a well-known point for treating deaf-mutism, but it was the first I'd known of it for silencing an irritating inner voice. The points below it, to my surprise, were called Fu YaMen, or Below Mute Door. From their names, they were meant to go with together, and formed a triangle about an inch apart, with YaMen at the apex.

More commonly, I used a Scalp Acupuncture point for disturbing voices on the auditory center of the brain, just above the tip of the ears (GB 8 & 9). This worked in about 5 minutes, and on every patient. There was not a single time it did not work; I used it hundreds of times. Just this year, I found that ancient Chinese understanding of the brain understood the use of this point to affect the ear in this way.

At the time I was making these discoveries, or re-discoveries, an Aleut medicine woman taught me something. Her name was Share Bear, and she came to Hooper to teach. She came in her traditional apparel from the Aleutian Islands, head held high and carrying a huge walking stick. As we were crossing Martin Luther King Drive, she said, "The real problem, Roger, isn't when people hear voices: It's when they don't hear them at all." Good point!

Whatever happened to that inner voice we once knew and loved?
In contemporary culture, the inner voice was relegated to irrelevance, insanity and untruth in the quest for objectivity. That gave us a certain knowledge, but physicists now tell us there is no such thing as objectivity.  

The Chinese classics never saw a problem with subjectivity. They excelled in building an organized, inter-subjective field. As Wilber points out (see previous blog), this is not 'merely subjective,' but the basis of culture and language.

The acupuncture classics provided an architecture of the soul, poetic writing that was not taken up by later herb classics.

My training in acupuncture emphasized treating the Liver channel, as is common in contemporary Chinese texts and clinics. I was puzzled that so much was going on in the Heart instead --until I read the Chinese classics years later.

Mental-emotional issues are disparaged in our culture. Just the terms are enough to make us run away. For example, when someone is 'mental,' that is a demeaning term. "You're so emotional" is another pejorative remark. Psych and psycho translate as 'whack job.' Not good.

If we are to heal the psyche in our culture and times, we will need to upgrade the language. Chinese is a better place to start. The term for the mental-emotional aspect is called the Jing-Shen, or Essence-Spirit.

It's not just a spiritual thing: that has connotations that can be airy-fairy or highly debatable in our culture. When we first call it Essential, of the Essence as half of it, then we have something real, something substantial and important. Essence-Spirit is a perfect term for what is considered the most refined part of the life of our organs.

To call someone depressed or psychotic isn't real in a scientific sense: there is not objective validation of that reality, unlike diabetes, for example. There are intriguing patterns, but no definitive diagnosis. Psychiatry a matter of convention, of collective subjective definitions and agreements. This does not make mental health issues less real or significant. It can make them our collective responsibility. The Chinese experience in crafting a collective-subjective medicine can teach us how to go about it.

Every day, I am proud to ride my bike to work. More importantly, I love the exhilaration it provides. For a year now, I ride past people laying on the sidewalk, sleeping into the morning by the river or on the bridge. In my car, I could remove myself from them and turn up the radio. On a bike, rain or shine, I'm just feet away from their feet. Jungians  say the homeless are manifestations of my psyche, as is everything. They got that idea from the Buddhists. So, there is part of me: laying on concrete at ten in the morning, face pressed under the metal railing to get as close to the river as possible. Even downtown, there is peace and solace in that river.

They cleared out the mental health hospitals while I worked at Hooper. A yellow schoolbus, rented by the state, would pull up across the street from the homeless shelter on our block called Baloney Joe's. The doors opened up to freedom, cascading patients who'd not been out of an institution for 20 or so years. "Here's your new home," they were told.

Homeless activists made them stop that madness. A more subtle route was found for discharging patients during those rounds of cutbacks. Our neighborhood became a psych ward.

My grandmother's spirit is probably still out there somewhere.

I found my maternal grandmother's Essence-Spirit in those acupuncture clinics. She taught me that there is a lot that we can do for more sane, loving and humane care of the lost among us. The methods in Chinese medicine are simple, effective, safe and teachable. They are needed.