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Shape of Qi - By Chip Chace

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  • 1. featureThe Shape of QiEnhancing the vocabulary of contact in acupunctureThe following paper explores the integration of osteopathic palpa- By Charles Chacetory sensibilities into the practice of acupuncture, particularly withregard to pulse diagnosis and the overall assessment of qi. I am not suggesting that we can become better acupuncturists bybecoming osteopaths. On the contrary, my fundamental premise is I n most styles of acupuncture we tend to describe the goal of treatment in terms ofthat we can adapt some of the conceptual maps and sensibilities of harmonising or regulating the qi. When ourcranial osteopathy to our own modality without ever having to patients ask us what acupuncture is supposed to be doing, we generally tell them something to theconcern ourselves with dural restrictions or sphenobasilar lesions. effect that we’re balancing their qi. We may tonify For this reason, I have kept the osteopathic jargon to a bare deficiencies or drain excesses in the service of thisminimum and have focused instead on some of the most general goal but our primary operating premise is thatconcepts of palpation that are most easily adapted to acupuncture. our patient’s ailments will disappear once their qi is balanced. But how do we really know when weThose interested in a more detailed discussion of cranial osteopathy have balanced the qi or had any impact at all?are referred to Franklin Sills’ Craniosacral Biodynamics. In the classical literature, balanced, harmonised This discussion is framed in the context of a specific style of or regulated qi is most often described in termsacupuncture known as Toyohari. Developed by blind practitioners of how it improves the quality of the blood, thein Japan about 50 years ago, Toyohari is a style of meridian therapy lustre of the skin, the quality of the flesh, or the sparkle in the eyes. This is not surprising in that acharacterised by the highly developed palpatory sensitivity of its defining characteristic of qi is that it is primarilypractitioners and its extensive use of contact needling. Because perceived through the things it influences. Indeed,of its emphasis on subtle palpation and the rudimentary nature of the word qi is sometimes translated as influence.its theoretical framework, Toyohari is particularly well suited to the Whether or not we realise we are doing so, we most often talk about the expressions of qi ratherintegration of the palpatory sensibilities described here, making it than the qi itself. We speak of the sensation of aira useful bridge between modalities. Nevertheless, my fundamental moving through our lungs, and in the quality ofassumption is that these sensibilities are relevant to nearly all styles an abdomen, a voice, a pulse. From these signs, weof acupuncture. make inferences regarding the state of the qi and For a more detailed discussion of Toyohari see: www.Toyohari.org/. the impact that we are having on it. Pulse diagnosis is among the most important tools in acupuncture practice for assessing health and disease, and in the Toyohari style, the pulse is considered the prime indicator of the state of the qi at any given moment. To be sure, we palpate the1. Franklin Sills, Craniosacral Biodynamics, abdomen, stroke the channels, listen to the qualityVolume One, Berkeley California, 1. See, for instance, Unschuld, Paul, Medicine in China, A His-North Atlantic Books, 2001. tory of Ideas, Berkeley, University of California Press, 1985. Vol 5–1
  • 2. feature ‘’of the voice, and ask questions throughout the change as opposed to its expressions in the par-course of diagnosis and treatment. Yet when we ticulars of the pulse, abdomen etc.?are tracking the subtle changes that occur at every This paper is an exploration of the premise thatstage of needling, we take the pulse. However the state of a person’s qi at any given moment isimmediate the experience of pulse diagnosis may palpable anywhere on the body and the informationseem, it is important to remember that most of we receive in this manner is of clinical relevance. We take it as a matter ofwhat we are feeling is not the qi. The best we can It is also an attempt to develop a consensual principle that qi is perva-say is that we are feeling the expression of the qi vocabulary for these perceptions as a means of sive throughout the body.through the pulse. In diagnostic assessment, it refining our own skills and communication. It is therefore rather ironicseems that we are always at least one step away We take it as a matter of principle that qi isfrom directly contacting the qi. When we feel a pervasive throughout the body. It is therefore to consider the lengths toweak wrist pulse in the right middle position rather ironic to consider the lengths to which we which we go to abstract itwe may say to ourselves “this person’s Spleen qi go to abstract it into its expressions in the pulse, into its expressions in theis very weak” but all we really know for sure is , tongue and abdomen. We spend most of our pulse, tongue and abdomen.that there is a particularly weak spot on the radial formal training in acupuncture school learning topulse. Everything beyond that is an inference. work with these abstractions and very little time Having recognised that the pulse, tongue, learning to directly engage the qi. Still, many ofabdomen, flesh and skin are secondary expressions us naturally develop some facility for this kindof qi, we are left to wonder if there might be some of assessment simply through years of clinicalmeans of assessing the qi on a more fundamental practice. Yet it is precisely because we are left tolevel. What might that look and feel like? We stumble upon this on our own that we often lackcertainly tend to speak about and interpret the the capacity to communicate our perceptions insensations that we feel in our hands when needling a manner that makes sense to others. Students,as a direct experience of qi. We say that we have especially, are left thinking that what their teachersobtained the qi, or more generally, that we have felt are describing is just another one of those arcaneits arrival. We have the sense that we are tracking experiences that maybe they too will have after achanges in the qi from moment to moment. The few decades of practice. Their problem is not sowords that we use to describe these experiences much that they lack the experience or capacity tobelie a tacit assumption that our experience of qi feel such things; it is that their teachers so oftenin this way is somehow more immediate. lack the words to clearly communicate what they Yet the qi does not only arrive at the point are experiencing. What we as acupuncturistsbeneath the needle. It is readily felt by a pulse lack is a consensual vocabulary of qi: a verbaltaker who knows what to look for beyond the and conceptual map that allows us to more fullymechanics of vascular fluid dynamics. In the engage the terrain that we traverse every time weToyohari system, the arrival of qi is experienced as contact our patients.an energetic wave that is distinct from changes in A number of years ago, I participated in a largethe pulse itself. Toyohari practitioners are carefully Kozato style practice session at a yearly meetingtrained to track the arrival of qi in this manner of Toyohari practitioners in Tokyo. Eight or nineand to provide the person who is needling with blind acupuncturists were crowded around thefeedback on the efficacy of his or her technique. table along with me and a senior instructor. TheThis is an integral component of the so-called instructor was taking one of the patient’s pulsesKozato method of needling practice. and another participant was on the other pulse. The rest of the participants simply placed a handW hen We stop to thInk about It, it is obvious that the qi does not only arrive atan acupuncture point and in the pulse; in practi- somewhere on the patient. The two people on the pulse gave me feedback on my needling technique in a manner consistent with the Kozato method.cal terms, it arrives everywhere at once. Regard- They informed me of the changes I had producedless of what diagnostic parameter we are attuned in the pulse on a moment to moment basis. Whatto, the pulse, abdomen, skin, or flesh, we typi- struck me, however, was that all of those whocally perceive an almost instantaneous change were simply touching the patient gave preciselyin those parameters when we have needled ef- the same feedback at exactly the same moment asfectively. We typically explain this phenomenon the pulse takers.by saying that we have effected an overall change Regardless of how they might have describedin the qi. Is there a means of tracking this overall it themselves, it was evident to me that what they were doing was listening to the qi. It is2. The Kozato method is a cornerstone of the Toyohari style curious that although the Toyohari style hasof practice. It is a systematised approach to honing one’s developed a highly refined terminology anddiagnosis and needle technique that requires at least three conceptual framework for assessing changes inpeople. One person needles, one lies on the table and gives qi as perceived through the pulse, abdomen andfeedback on the quality of the needling, one person tracks thechanges elicited by the needling through the radial pulse. skin, it apparently has absolutely no vocabulary The Lantern 5
  • 3. feature ‘’ for this more immediate assessment of qi, at least notable exceptions, the vocabulary used in this none that has been communicated to sighted paper is already used in Chinese pulse diagnosis practitioners in the West. to one extent or another. All I have done is to My interest in qi palpation has not been limited expand the scope of its application into a realm to the realm of Chinese medicine. Osteopathic for which we have little language, despite the factOne’s sense of the ebb and palpatory sensibilities have been deeply influential that this realm is central to the effective practice offlow of qi in the pulse is a in the development of my own palpatory acupuncture. Even those concepts that are indeedqi phenomenon that is awareness. My experience with clinicians in this new for acupuncturists nevertheless describe field far more skilled than myself has convinced terrain that should not be entirely foreign.expressed through the me that these disciplines have a great deal topulse but is in actuality offer acupuncturists in developing a more fluent The qi shapes the pulsea generalised effect vocabulary of qi palpation. For instance, when Iperceptible anywhere refer to the “qi as a whole” I mean the sum total Chinese medical pulse diagnosis contains the of all different kinds of qi described in Chinese some of the most nuanced vocabulary that wein the body ... medicine and their expressions in the pulse, have for tracking the qi. The Toyohari style in par- tongue, abdomen, channels, spirit in the eyes, ticular has a highly formalised criterion for the etc. From an osteopathic perspective, the qi as a most general attributes of a positive pulse change. whole also encompasses the state of a person’s By and large, effective needling should produce nervous system, fluids, physiological functioning four fundamental changes in both the pulse and and the various tidal flows that are perceptible the qi. There should be a palpable settling, slow- when contacting a patient. The capacity to assess ing, increased suppleness, and integration, both the qi on these levels adds another dimension to during and after needling. These attributes are our appreciation of the overall state of a patient’s not limited to the pulse but are characteristics of being. positive changes in the overall qi that are percepti- An essential premise of the biodynamic ble anywhere on the body. Many Toyohari practi- approach to cranial osteopathy is that for any tioners tend to use a slightly different set of terms meaningful change to occur, a patient’s system but I prefer these because I believe they more ac- must reach a point of quiescent self-regulation curately reflect what we feel in both the pulse and known as neutral. Cranial osteopaths consider the qi as a whole. this state of neutral to be quite literally the ground of healing within the body. This perspective on the Settling dynamics of healing has profound ramifications for the practice of acupuncture and I will have I prefer the word settle to sink because deep pulses more to say about the role of neutral in our should ultimately move upward towards the mid- appreciation of qi later. For now it is sufficient dle depth. Nevertheless, effective needling inevi- to say that neutral is a generalised phenomenon tably elicits some experience of settling or sink- perceptible everywhere in the body. As such, it ing that is perceptible to the person needling and is an excellent benchmark for a system in which the person taking the pulse, even in patients with qi is balanced. The pathologies themselves may deep pulses. I think that the word settling is both not have resolved, but the proper conditions have a more general and a more inclusive term, evoking been established for their resolution. a sense of grounding that is often but not invari- A number of my cranial teachers were very ably characterised by a sinking in the pulse. adept at conceptually mapping the stages and characteristics of the body’s transition to neutral Slowing in the context of teaching students. In studying with them I was struck by how much their We expect that effective needling will speed up descriptions had in common with the pulse the pulses of patients with severe bradycardia, but vocabulary of Chinese medicine. It slowly dawned then pulses in our culture are more often rapid upon me that at their roots both disciplines were than they are slow. The pulse rate will palpably ultimately attending to the same phenomena. slow by anywhere from two to 10 beats a minute. This realisation has allowed me to deepen and Sometimes though, the pulse simply feels less refine my palpatory skills in both realms. rushed after needling without there being an ac- The ideas that follow are not so much an effort to tual change in the rate. The phenomenon of slow- adopt osteopathic techniques or terminology into ing is part of a more generalised sense of relaxa- the practice of acupuncture as attempts to reflect tion in the qi that occurs with effective needling. the overall sensibility or approach to palpation that is characteristic of osteopathy. With a few Suppleness . This statement has been confirmed by Steven Birch and This relaxation does not imply a loss of form or Junko Ida, the two most senior teachers of Toyohari in the West. structure. The pulse should simply become more Vol 5–1
  • 4. featuresupple in that hard, wiry or tense pulses should has already softened, slowed, become more sup-soften, and yet soft and scattered pulses should ple and integrated prior to the moment one re-also become better defined. The radial artery moves the needle.becomes lithe. When experienced in the qi as a One’s sense of the ebb and flow of qi in the pulsewhole, this quality of suppleness feels wonderful- is a qi phenomenon that is expressed throughly fluid while still conveying a sense of structure the pulse but is in actuality a generalised effectand integration. perceptible anywhere in the body. Beginning students of Toyohari spend a great deal of timeIntegration trying to feel this wave of qi in the pulse when it is in fact something that is happening throughIn terms of pulse diagnosis the quality of integra- the pulse. We must filter it out from all the othertion can be seen as a subcategory of the other. The gross physiological input that we are feeling frompulse as a whole is becomes more coherent, and the modulations in the flow of blood through thebetter organised. This is undeniably the most sub- radial artery. It has been my experience that whentle of the qualities discussed thus far but it never- properly attuned, students often find it easier totheless has some very tangible expressions. In the feel this characteristic wave in the qi with a handToyohari style, this sense of integration is often placed anywhere on the body rather than lookingreferred to as consolidation. It is not enough for a for it in the radial pulse.pulse to become stronger; its strength should be This more generalised palpatory awareness ofcontained within well defined boundaries with- qi has the potential for greatly enhancing ourout feeling hard or constrained. appreciation of the overall state of an individual’s When experienced in the qi, the quality of health. It informs our understanding in ways thatintegration is much more easily distinguished go far beyond our assessment of a patient’s pulse,as a distinct characteristic of its own. The qi is abdomen, tongue, etc.often perceived as being segmented or stratified. In pulse diagnosis we tend to compartmentaliseWith effective treatment, we experience a our experience of the pulse. For instance, wehomogenisation and an increased coherence rarely say that a pulse is both a floating ( fu)within the qi. Integration is, in essence, our and a prison ( lao) pulse, yet we routinelyfundamental concern when assessing qi as a describe pulses as wiry and floating on thewhole and the rest of this discussion should be surface and soft, squishy and empty upon deeperunderstood in the context of this quality. palpation. Because our perception of the pulse is It is evident that all of these factors depend so intimately tied with how firmly we are pressing,upon one another and must present together we tend to focus on one characteristic or another.for an optimal change in the pulse and qi. Our When palpating the qi, however, it is much easierfundamental premise is that any therapeutically to feel a subject’s qi all at once in its entirety. Weeffective intervention on the qi will influence the may indeed experience the qi as light and floatingpulse in the manner just described. This is not on top, and strong and hard down deep with notso much a characteristic of the radial pulse as much activity in between. Because it is so muchit is a characteristic of the qi as it is expressed easier to appreciate all of these layers at once, wethroughout the body. As such, it is indeed can more clearly assess the qi as a whole. Theperceptible anywhere in the body. Moreover, range of information that becomes available tonearly everything that can be perceived in the us is highly nuanced, seemingly endless, and wellpulse can be felt in the qi anywhere in the body. beyond the scope of this paper. For now, however, we will focus on those phenomena that occur bothUnfiltered perception in the qi and the pulse, and that lend themselves to description in terms more familiar to pulseTo take this idea a step further, although some diagnosticians. Still, even in its most rudimentarythings are easier to feel in the pulse, many other expression the global quality of the informationthings are often easier to feel in the qi. Some of gained from qi palpation both informs andthese things are immediately relevant to Toyohari complements our other diagnostic tools.practice. For instance, one of the pivotal aspectsof an effective ho (supplementation) technique The perfect touch Ante Babic’sin this style of acupuncture is knowing when to Tips for runningremove the needle, which should occur just be- Before discussing the details of a systemic expe- a successful clinic ...fore the arrival of qi completely peaks. As men- rience of qi, it is worth defining the manner intioned above, the perception of this “qi wave” is which it must be engaged. We spend a lot of time Introducing my new product,not something that is fundamentally vascular in in Toyohari working on our touch. We learn to lo- the ultimate solution for thosenature and this distinction is often difficult for patients who jump up, needles . It is not uncommon for sensitive individuals to be ca-beginning practitioners to distinguish. If the ho and all, to answer their mobile pable of perceiving and tracking just by being present intechnique has been applied properly, the pulse the room. phones: Velcro sheets. The Lantern
  • 5. feature ‘’ cate acupuncture points and to needle in a certain ciated the situation can we then place the infor- way. In contrast to other styles of acupuncture, mation we have gained in the context of whatever our contact becomes almost preternaturally light. treatment style we are working with. In conversing with the qi as a whole it is necessary to attend to more than just the lightness of our Varieties of palpatory experienceIf we approach the qi with touch and we must cultivate a somewhat differentsome preconceived notion set of palpatory skills. Much of the highly nuanced language of pulseof how lightly or firmly we Much of this terrain has been mapped in the diagnosis can be readily adapted to the palpation field of cranial osteopathy. There are three aspects of qi. For instance, one of the easiest pulses forneed to touch the body to to effective contact. First, the contact must have a beginner to feel is a floating pulse. Floating orget the information we are the right pressure or firmness. It may be lighter or buoyant pulses are very common in people wholooking for, then we are not heavier depending on the patient and the practi- are stressed out. It comes as no surprise then thatreally listening. The qi has tioner, but it must feel comfortable to the patient. the qi of people who are stressed also tends to We cannot be too heavy-handed in our touch, but float. By this I mean that we experience their qi asits own agenda for contact. neither can we be too ethereal. In and of itself, a being closer to the surface of their body. In such very light touch often fails to confer enough of a individuals, it may also be difficult to feel their qi presence for the qi to talk to us very deeply and its down “close to the bone”; it is somehow unrooted furtiveness can leave patients with the sense that in the same way that their pulses and their very the practitioner is not really there. Next, our touch being can be. must be soft, water-like and most of all, receptive. Regardless of whether we are supplementing Our hands must soften and melt to receive the qi. or draining, pulses generally become slower and The final and perhaps most evasive aspect of con- suppler when we have needled effectively, and this tact is that we must find the right level of presence is accompanied by an overall sense of settling that that will encourage the qi to speak to us. is palpable even in very deep pulses. The same is Finally, we must show up for the qi in a way that is true of the qi. The settling I am referring to here neither intimidating nor aloof. One of the simplest does not mean that the qi is collapsing and no and most difficult things that we can do as humans longer able to hold itself up. This is the settling of is to be present. Many master acupuncturists qi back to a state of stillness and clarity like the have a very light touch, but what makes their clearing of sediment in a stream. It is the ground contact remarkable, soothing and therapeutic is in which all of the other positive changes occur the sense of compassionate presence their touch and its full expression is described in cranial conveys to the patient. We must make contact osteopathy as “neutral” or “holistic shift” wherein in the same way that a mother cradles her child, all the tissues and physiological functions of the simply holding, letting the qi know that we are body both settle and homogenise. The tissues present, and appreciative, but without judgment, reach a state of harmonic resonance such that questing, or inquiry. If we approach the qi with distinctions between them become meaningless. some preconceived notion of how lightly or firmly The salient characteristic of neutral is an ever- we need to touch the body to get the information deepening dynamic stillness. Everything becomes we are looking for, then we are not really listening. very integrated, undifferentiated, absolutely The qi has its own agenda for contact. quiet, and yet vibrantly alive. It is from this place that the inherent intelligence of the self regulating No agenda mechanisms of the body take over and do whatever needs to be done. In Chinese medicine in general and Toyohari in This is as good a definition of an effective root particular, we are perpetually asking and analys- treatment as one could ask for and acupuncture ing. In the Toyohari system we have only four di- can be a powerful tool in facilitating such a agnostic possibilities for the primary sho or pat- holistic shift. From a Toyohari perspective, every tern, and the secondary pattern is typically even needle, every touch, should improve the pulse; more limited than that. We are forced to cram our from my perspective it should also nudge the perceptual reality in an almost absurdly narrow patient further into neutral. The settling is felt on set of boxes. This requires a fair amount of diag- all levels, and it is not surprising that the patients nostic analysis. Part of the beauty of this system, themselves typically feel as if they are melting into however, is that within this almost ludicrously the treatment table. simple model we then have a remarkable degree When needling, if we do not perceive this settling of freedom to work with directly with the qi. But and homogenisation in the qi, we almost certainly we cannot let ourselves become hamstrung by the will not feel it in the pulse. But when all of the model, and when we draw our attention to the body’s tissues, fluids, flows and functions begin qi as a whole we must at least initially leave our 5. Of course, seasonal factors must also be taken into ac- diagnostic agenda at the door and just listen to count. For instance, we expect the qi to be more superficial what it has to say. Only after we have fully appre- in the summer and deeper in the winter. Vol 5–1
  • 6. featureto speak to us in a single coherent voice, it depth at which the qi is the strongest, just as pulse may each tell us something differentwill tell us what it needs if we know how to we assess the depth of a pulse’s “stomach qi” . about a patient’s condition, so too may thelisten. The sense of systemic integration that After all, is it not the overall state of qi in the qi. These differences will typically becomeis perceptible in the qi when simply touching body that makes a pulse float or sink in the more congruent over the course of treatment,the body informs and enriches the relatively first place? Why shouldn’t this quality be ultimately resolving as the system becomesmechanical experience of a supple, relaxed, palpable in a generalised manner? Another more fully integrated.pulse that we define as perfectly balanced. way of describing this is to define at what level the qi feels the most dense. Lag timeYou say tomato… Stratification The utility of listening to the qi lies in howThe pulse and the qi can tell us similar it enriches information gained by other di-things in different ways. For instance, when Direct palpation of the qi can often give us a agnostic methods. The presentation of thelocating points in practice sessions, even clearer sense of the overall stratification and pulse and the qi when people have been sickrelatively experienced practitioners do occa- integration of the qi. Sometimes a pulse that with a cold for a few days is a simple andsionally run right over them before the eval- appears to be very buoyant will actually be vivid example of this principle. The patient’suator on the pulse can tell them they have the strongest with deep pressure. These dis- pulse may still be floating and his symptomsfound the best point. The pulse responds to tinctions come into sharp relief when direct- may suggest that the pathogen is still in theproper point location in an almost binary ly palpating the qi. We look to the strength exterior. By contrast, one may experiencemanner. The location is either right or it of the pulse to tell us something about the the qi in the interior, or one may feel it onisn’t. By contrast, the sense of sinking and vitality of the qi, and this information is also the surface but accompanied by an odd sen-settling that expresses through the qi tends readily expressed in the qi as a whole. I don’t sation of collapse, like the first flakes of fishto come on a little more gradually, letting generally experience the qi as being fast or food slowly beginning to sink to the bottomus know when the optimal point is com- slow although I do typically get a sense of its of the tank. In these cases, the sinking of theing up, so that we don’t just roll on past. overall activity as distinct from its strength. qi presages the movement of the pathogenThe phenomenon is true for both the pulse into the qi aspect, deeper into the system. Itlocator and the evaluator. Grain just has not yet appeared in the pulse. This is A good measure of how well one useful information for both acupuncturistsunderstands what one is feeling is how The quality of activity also conveys a sense and herbalists. Particularly in the absence ofclearly one can articulate it. This can of coarseness or refinement, a grain. It helps other unambiguous diagnostic indicators, itbe harder than one might expect, even me to think of the qi as having a quality of can be a pivotal factor in deciding on whatwhen one’s perceptions are apparently effervescence, like the bubbles in soda water level to focus one’s therapy.unambiguous. Although it is essential to or champagne. These bubbles might be large We have posited that the qi shapes theremain open to whatever information is and turbulent or fine little pinpricks. They pulse and we therefore expect changescoming through with as little conceptual may feel agitated or languid. I think that the to appear in the qi first. Sometimes thebias as possible, it is often useful to begin by image of bubbles is also apt because bubbles opposite is true and we perceive change firstdescribing that information in ways that are are essentially little packets of empty space in the pulse. Once we do feel something inboth familiar and easy for us to digest. This moving through fluid. This image puts us in the qi, however, it may contain some otheris at least one reason why the first thing we touch with both the fluid qualities of qi and bit of information that is not yet beingdo in pulse diagnosis is to identify whether its essential stillness. So it can be helpful to communicated through the pulse. It is asa pulse is floating or sinking, fast or slow, define the grain of the qi’s effervescence. if that at any given moment, some kinds ofstrong or weak etc. We can use a very similar Of course, we may feel other things as well. information are transmitted through the qicriterion for beginning to talk about the qi. We may feel the coursing of fluids and tides, and at others through the pulse. A dance ofIt has four major qualities; we can assess its and many other things that we cannot even information takes place between them.overall degree of buoyancy; we can assess name, but the four criteria just described are Then again, some details are just easier tothe depth where it feels the strongest or our gateway to our appreciation of the qi. It feel in the pulse. The qi may enhance ourdensest; we can assess its overall strength; is essential to remember, though, we are not appreciation of the big picture, but the pulseand we can assess its grain. diagnosing, merely describing. may still be the means by which we decide The next step after gaining an impression precisely where to put the needle. The pulseBuoyancy of the qi in this way is to compare it with our can tell us that the hardness that we feel in pulse findings. Are they entirely same? If the surface of the qi is focused in the SmallThe buoyancy of the qi is clearly analogous not, what aspects differ? In most cases, you Intestine. We can see how the problem in theto the buoyancy of the pulse. Both pulses will find a substantial congruity between the Small Intestine channel creates a resonanceand qi may be buoyant, sinking, or some- pulse and the qi, but if they were invariably that is palpable throughout the body. Thewhere in between. Both may seem to float the same then it would be redundant to listen two tools complement each other.while still feeling rooted to the bone. Con- to them both. Sometimes one quality willversely, both feel buoyant yet unrooted. be more apparent in the pulse and another . It is worth noting that skilled osteopaths routinely in the qi. For instance, we may experience identify visceral restrictions simply by touching theDepth a layer of turbulence, density, or hardness body, so in this example the qi could in principle be every bit as informative as the pulse in identifying a on one level in the qi and on another in Small Intestine problem. That level of palpatory sen-Aside from this, we should also assess the the pulse. Just as the tongue, abdomen, and sitivity is well beyond the scope of this paper. The Lantern
  • 7. feature ‘’ Some of us will undoubtedly be able to palpate impulse to do that one last needle that confounds currents of qi far deeper and more subtle than I all the masterful work we have done up until that have described here but the concepts I have pre- point. sented comprise the fundamentals of all levels of palpatory awareness. Regardless of how deeply Menage a troisSome sense of irritation or one may be able to plumb the depths of the qi,agitation often appears in any therapeutic change will be characterised The Kozato method of needling practice requiresthe qi before it appears in by an overall settling, slowing, suppleness, and a minimum of three participants. There is a sub- integration on all levels. Whatever qualities of ject lying on a table who is being needled, thethe pulse and it typically buoyancy, stratification, or agitation we may have person doing the needling, and someone whobegins to float. By the time begun with will have homogenised into a sense is taking the pulse and giving feedback on pointsuch changes appear in the of coherence that ultimately facilitates a dynamic location and needle technique. The settling, slow-pulse it may be too late. stillness within the patient. Whichever style of ing, becoming supple and integrating that I haveAttending to this can save acupuncture we may use, this is the definition of described above is unquestionably perceptible in a root treatment. all participants who have been trained to attendus from our impulse to do There are many ways to conceptualise root to it regardless of which position one occupies inthat one last needle that treatments. I like to think of them as establishing the group. The interrelationships between one’sconfounds all the masterful the optimal conditions for whatever will happen experience of palpation, needling and being nee-work we have done up until next. Root treatments are our attempt to make dled were made vividly apparent to me at a recent use of an existing situation, a propensity or Toyohari training (London, September, 2007).that point ... momentum ( shi), and to subtly give it a nudge One of the senior instructors there offered a help- in the right direction. The more skillful we are ful piece of advice for honing one’s point location. at this, the less it seems that we have actually He suggested that we spend some time each day intervened at all. Things follow a spontaneous locating Tai Bai (SP-), attending not just to the course. The branch treatment is effortless, or we sensation in our fingers but to our internal expe- simply allow the innate intelligence of the body to rience, the overall internal sense of wellbeing that sort itself out. Toyohari is a masterful expression occurs when we’d found precisely the correct point of this minimalist approach to ordering the qi. on ourselves. In effect, he encouraged us each to become our own self-contained Kozato group; Getting out of the way subject, point locator and evaluator. We can use the sensations that we experience in ourselves as Once we indeed have the qi heading in the right subjects to amplify and inform the sensation in direction, the most effective thing that we can do our hands as point locators and needlers. may be to just get out of the way. In the end, the This instructor may have been intentionally patient’s body is infinitely smarter than we are vague in describing what we should be feeling and at this point our challenge is not so much because he well understood just how subjective to lead the qi as to follow it. The Toyohari style the palpatory experience can be. On the other can be paradoxical in that with every touch or hand, it has been my experience that when we stroke, every contact, we can shepherd a system carefully examine the palpatory phenomena toward this neutral. Yet, if we persist in attending that occur when we precisely locate a point, we to minutiae in the pulse, we can actually impede discover many of the same qualities that we find the qi’s progress toward its complete expression in the pulse. Of course, we will probably also of coherence and dynamic stillness. experience other sensations that are unique to Listening to the qi can be a helpful tool in each of us, just as each of us almost certainly avoiding this pitfall, particularly in sensitive observes changes in the pulse that are beyond individuals. It is not uncommon to find that the bounds of our consensual vocabulary. Every although subtle, and sometimes not so subtle, nervous system is a unique palpatory apparatus imperfections remain in the pulse, the qi itself has and each practitioner must learn to work with become well integrated, coherent and still. This the tools he or she quite literally has at hand. completeness may not yet have expressed in the Nevertheless, our nervous systems are more alike pulse and indeed in some patients it may never. than not. If this were not so, then humans would In such cases, I trust the qi. I would rather close never agree on anything they experience. It only with a good, if flawed, pulse change and a sense makes sense, then, to look for the commonalities of coherent stillness in the qi, than with a perfect that we share in experiencing qi to begin to pulse and the nagging suspicion that I may have define them. The sense of wellbeing described by overworked the qi. Some sense of irritation or this instructor can be at least roughly framed as agitation often appears in the qi before it appears an experience of settling, slowing, relaxation and in the pulse and it typically begins to float. By the integration. After training acupuncturists of all time such changes appear in the pulse it may be stripes and skill levels in these sensibilities, I am too late. Attending to this can save us from our confident that these qualities constitute a basic10 Vol 5–1
  • 8. featureworking vocabulary for our experience of qi on that occurs in the qi beneath our fingers, we areall levels, as practitioners, patients and teachers. no longer so dependent on feedback from the When people locate acupuncture points on pulse. We know from moment to moment howme in Kozato practice, I will often feel that some well we are maintaining a container for the qi andpoints are particularly buzzy or active. I used we can adjust our technique accordingly.to identify these as the most “alive” or available The addition of a specific qi listening positionpoints, the ones that we should pick for needling, to the Kozato trio utilises thus far untapped re-but pulse takers would often find that some source in our use of the Kozato method in refin-other point produced a superior change in the ing our engagement of the qi. This is presumablypulse. It took me a long time to realise that I was how large group Kozato practice has worked infocusing on a sensory perception that reflected Japan for decades prior to the advent of the nowonly part of the picture. I now find that that my popular “pulse chain.” All I have really addedexperience of settling and slowing is a far more here is a means that allows every participant toreliable indicator of positive changes as expressed communicate more articulately with one anotherthrough the pulse than the more superficial sense and to bring these qi listeners into the conversa-of qi activation alone. tion in a manner that benefits all involved. The same principle holds true when actually The Kozato method is in my opinion amongneedling. The sense of a surge of qi building, the most effective techniques for developing one’sand peaking as we needle is really just a partial acupuncture skills that we have available to usdescription, a yang expression that has a yin today. I have referred to it repeatedly in this papercounterpart in this sense of settling. It is not that because it is a methodology that I am intimatelywe need only focus on the sense of settling, we familiar with. But it is just one of many ways thatmust attend to both. we as a community go about communicating with one another. I believe that the vocabularyInto the abyss presented here is potentially useful for a much wider range of acupuncture styles. Regardless ofThere are many ways in which this principle of how it might be employed, it is just a beginning,attending to both the yin and yang aspects of qi not yet a language, but a rudimentary syntaxexpression plays out when needling. For instance, that allows us to begin voicing more clearly howwhen needling in the Toyohari style, one’s oshide many of us may already engage the qi. The termsmay be too heavy, making the pulse hard, or dif- themselves are less important than the consensualfuse. Of course, our ultimate concern is not with experience that they point to. Once we are ablethe pulse at all. The pulse is merely the vascular speak to one another in ways that we can allexpression of a much more generalised resonance make sense of, we can begin to both broadenin the qi. A heavy oshide expresses itself in the our vocabulary of qi and to further refine ourbody as a whole by compromising the qi’s natu- palpatory sensibilities. nral tendency to ground and settle and generallymakes it float back up. Sometimes the qi seems 8. Although I saw Dr Yoshio Manaka demonstrate a simi-to somehow congeal, becoming sluggish or more lar technique during a training I attended in Boston in theviscous. These qualities are not represented in the late 1980s, In Toyohari circles the “pulse chain” apparentlyqi wave; they are experienced in the level of per- originated in a large scale training practice in the Unitedception that is deeper than that. States. With a large group of people standing around a Just as we look for the pulse to settle, slow and treatment table waiting for something to do, one partici-become suppler in a particular way, the qi too, pant grabbed the pulse of the designated pulse taker, and another took his pulse in turn, allowing all the participantsmust settle in a very specific manner. In Toyohari, to feel pulse changes during needling. This technique hasif one’s oshide is too loose or otherwise imperfect, now become a standard procedure in large Kozato groups. .we say that this makes the qi “leak” This expresses While I concede that this is a convenient means of allow-itself in a pulse that lacks borders or structure ing many people to participate in Kozato practice, and mayeven though it may have slowed and settled. A be helpful at some stage of practice, I believe that it ulti-sloppy oshide also tends to produces a unique mately creates more problems than it solves. It is often dif-sensation within the qi. Although it still sinks, the ficult to distinguish the perturbations in the pulse of one’s neighbor from those of the intended subject. Advocates ofqi can feel as if it is plummeting into an abyss. the pulse chain technique make the valid point that theOur experience of the qi as a whole gives us a clear “old style” qi listening technique described in this paper n charles chace has been a stu-sense that it lacks a container. Like an infant that can be very disruptive for the Kozato subject who must dent of chinese medicine and itsis more at ease when swaddled, the qi requires cope with the influence of so many hands touching them. literature for over 25 years. hesome structure that helps it to most fully define In either case, the problem is one of observer neutrality. graduated from the new englanditself. Once we are able to clearly identify the Regardless of which technique we may prefer, it is essential school of acupuncture in 1984.presence or absence of structure and integration that we keep our own stuff out of the picture to whatever he is the author and translator of degree possible. The problem with the pulse chain method a variety of books and maintains a7. The oshide is the ring made by the thumb and index in this regard is that it is difficult for most of us to presentfingers that holds the needle against the skin. our fellow pulse takers with a truly neutral pulse. clinic in boulder, colorado. The Lantern 11

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