Chip Update #3

Dear Friends, 

Since my last update, I spent 10 days at home under the loving care of Monika, and David Cooks, my dear friend from Bend. Monika is plugging along, trying to maintain whatever normalcy she can in her life when she’s not here just holding me in her arms.

Cooks is some sort of a cross between a superhero and a saint. He’s stayed with me pretty much 24/7, and shepherded me through a bunch a nasty pain crises in addition to managing an unimaginable amount of logistical work. At one point he was my student but he’s become a far better acupuncturist than I ever was, and I’ve been benefitting from those skills on a daily basis as well. Monika and I would be lost with out him.

Roger Briggs is my social director and the other arm of my logistics team. He’s managing a large amount of email that I’m receiving, and coordinating the input I get, which isn’t much. A few other dear friends have been close by, but I’m unable to see many visitors. The pain and nausea characteristic of this disease have been an ongoing challenge. We are constantly adjusting the meds, which work for a day or two but then become virtually ineffective. Nighttime is the most difficult for pain, though the last two nights were considerably better due to a dilaudid pain pump. I only have a few hours each day when I’m lucid enough to read, write, or talk much, so please forgive me for not responding to the many messages that have been sent to me.  

Last weekend brought two midnight visits to urgent care with unmanageable pain. This landed me back to the hospital a few days ago for a new round of pain management strategies. First, we tried a nerve block procedure, but it proved ineffective, probably because the cancer has spread so much. Today I am being transferred to an acute hospice care facility in Longmont. The plan is to stay there a few days until we are confident that the pain meds are working, then to go home. We are not pursuing any heroic, life-­‐extending treatments. My goal is to die well.  

In the time I have left I need to finish my part of a textbook concerning the synthesis of acupuncture and osteopathic palpatory techniques. To do this work, the meds have to be working well enough to help me manage the pain without leaving me incoherent and nodding off.  

A number of my closest colleagues have flown in to provide support for this project. Rayen Anton traveled from Barcelona and is collaborating with me on several chapters. Rayen and I worked together as much as I could manage and made good progress while she was here. Dan Bensky, my longtime friend and coauthor of this book, arrives today and will spend parts of the next four days working with me. After Dan leaves, Kailey Brennan, one of my students from Denver, will coordinate some 2-­‐hour scribing sessions. I need to spend whatever time and energy I can summon to finish this up. 

Last week I had a visit from Miki Shima, an elder brother in the practice of Traditional East Asian Medicine and a very close friend.  About 10 years ago I asked Miki why he had gone back to practicing Shinto, the ancestral religion of Japan. We all love nature, rocks and trees, but do they really have to have a spirit that we must propitiate? He explained that Shinto was really about gratitude. We don’t so much worship rocks and streams as we express our gratitude for the gift of our being part of the universe in whatever way, good or bad. This insight has shaped my own Zen practice ever since.  

It was good to have Miki here to help me further catalyze this practice, because now it is game on.  I offer my sincere gratitude for my 30-­‐year marriage to a magnificent woman; for a lifetime of wandering in the mountains; for the many patients and students I have had the privilege to have worked with; and for the love and support that so many of you have expressed.  

Perhaps most difficult of all I am trying to fully embrace the reality of my situation with gratitude. I want to go beyond just coping with it all, to a place where there is nowhere else I would rather be. My deepest thanks to all of you for helping me to work toward that.  

Love, 
Chip

To see Chip’s earlier Updates go to:   
https://stillwaterhealthboulder.com/charles-site/

Please send all correspondence to:
Iamchipspancreas@gmail.com

Diane Chiang on EV

Diane says . . .

Listening to the body can greatly impact a treatment. I have felt the profound effects, and these experiences have motivated me to persist in practicing the Engaging Vitality palpation techniques.

I received my first experience as a patient. I was being treated in the SIOM student clinic when Marguerite Dinkins, as supervisor, listened to the push-pull of an inserted needle. Marguerite then informed the student practitioner that the needle needed to be inserted 1 more millimeter. The point location was correct but the depth of the needle was not where it needed to be, to fully engage with the channel pathway. After the needle was adjusted, I could instantly feel the channel opening up and my lower abdomen warm up. The correct needle depth opened up what was blocked. Who knew that 1 millimeter would make such a difference?  I imagine this is like getting a new house key made, if the angles and depth of the new key "teeth" are not precise, it is much more difficult getting the door open to get into the house. This was the moment I realized that Engaging Vitality palpatory skills could lead to very powerful and effective treatments.

The second experience I had also left a similarly lasting impression on me. I was in Module 2, Dan Bensky was helping us to further refine our palpatory skills. Our small group needled 2 points on the patient that we found through our Engaging Vitality palpation. The Yang Rhythm (quality of the movement of Qi) had improved and was greater and smoother. Dan then proceeded to needle reliable ST36. To my surprise, the Yang Rhythm changed. The movement of the Qi was no longer big and smooth. I couldn't feel it anymore. The first 2 points had affected positive change but the body was now telling us that ST36 was agitating it. It is one thing to hear Dan and Marguerite tell us to not over treat but to experience it under my own hand and by having the patient's body tell me directly was a very clear and strong message. The patient also reported that although she did not feel the insertion of the needle into ST36, her body did not feel right.

It was very powerful to experience firsthand the profound effects of using Engaging Vitality to guide a treatment, both as a patient and as a practitioner. The empirical successes have encouraged me to keep practicing, to fine tune my techniques and to improve my sense of touch.

Diane Chiang,

SIEAM (Seattle Institute of East Asian Medicine) graduate.

Update #2 from Chip

Dear Friends, September 27, 2018

First and foremost, thank you for your kind and healing communications. There is no way I can respond to all these but please know how much I appreciate the love and support that has been expressed to me.

I left the hospital on Monday Sept 24 and came home. This is a much better environment for me and I have a core team of friends and loved ones taking care of me. The pain is generally under control and the side effects of the opiates are improved but still need work. But I am in good spirits.

One of the many challenges is dealing with all of the communications that are still coming in by email, text, and voice. We have more than 300 people from all over the world on our contact list and it’s very draining for me to process this, so I have a communications team receiving everything and making decisions about when to reply and what I need to see. Please direct all communications to: Iamchipspancreas at gmail.com.

Now that I’m settled in I can begin attending to a few things that I would like to complete in the time I have left. This means that I need space and energy in my life to complete these goals, and sadly I have very little of either. It is a difficult decision to make but with the exception of a few members of my extended family who will be flying in during the next month or so, I will not be receiving visitors. As Monika and I have specific support needs, we will reach out to any of you who may be willing and able to help us out.

Deep thanks for your support.

Love, Chip

Chip’s Saga 2018 September

Chip Chace’s Saga, 2018 September

Greetings friends,
Sorry for taking so long to respond to your missives.
As you may have heard, I’ve had a rather challenging summer culminating in a diagnosis of adenocarcinoma of the pancreas.

Those of you uninterested in the following back-story can skip this bit.
Back in April 2018, I trapped a testicle in my climbing harness and experienced a mild strain injury. The pain persisted and did not seem to improve. In late May, I had a colonoscopy, which was normal. Shortly thereafter, I developed symptoms of gastritis while teaching in Europe. I was unable to consume wine or eat like normal. I experienced persistent gastric upset accompanied by pain radiating between the left flank and both testicles.

I saw my Primary Care Doc at the end of June and we decided to treat for H. Pylori with a berberine-based formula and an iteration of Wen Dan Tang, a Chinese herbal formula. Things improved considerably on this regimen.

I left for Canada on July 8th on a return tip to Baffin Island, while continuing on my gut meds. I flew for two days followed by a one-day boat ride, then a two-day walk, including two sketchy river crossings only to discover that my gear cache had been stolen and that an attempt to solo Mt. Asgard would not be possible.

I made my way back to Boulder by July 20-21. I sought solace in the Wind River range in Wyoming. I’ve been soloing there for the past 40 years and its my home range. Ten miles west of Rollins, I was rear-ended by a semi trailer that was going 40 miles per hour faster than I was. I totaled my Toyota FJ, but was miraculously unscathed otherwise. Monika came up and got me so that I could regroup back in Boulder. I returned to the Winds with a rental car and spent another two weeks climbing. I still had to be very careful about caloric intake and continued on my meds. I did have a 17-hour moment of grace during which I soloed the 1800 west face of Mt. Helen. All the while, I was juggling the gut and testicular discomfort as best as I could.

Upon returning home the upper GI symptoms began to diminish, although the left flank pain persisted, as did the radiating pain into the pelvic floor. I continued working, but was doing very little else. The flank pain became increasingly prevalent and unresponsive to anything that I tried.

I was admitted to Boulder Community Hospital on Saturday 9/8 at midnight with left-sided flank pain that was unresponsive to pain relievers. They ruled out the possibility of a kidney stone via CT scan. This they followed with a CT scan with contrast dye, which identified pancreatic adenocarcinoma and hydronephrosis.

Presumably the tumor or an adjacent lymph node is compressing my left ureter and this is causing the pain.

I continued to have a difficult time with adequate pain control. I received morphine and dilaudid via IV every hour, plus oxycodone every two to three hours and atavan every three hours, which helped with sleep. They also put on a fentanyl patch since I was still getting inadequate pain control. This helped a great deal with the pain. They put in a nephrostomy tube on the left, which helped to decrease pain from the ureter. At some point, I developed intractable hiccoughs, which persisted for 5 days. None of the drugs for this were especially helpful.

I became less responsive to all the pain meds. At some point last night on Friday, 9/14, Monika worked on me while I was in the midst of my barely conscious delirium and this seems have mitigated the hiccoughs significantly but not entirely. The fentanyl made me delirious and I rapidly improved after the removal of the fentanyl patch. By Saturday afternoon, 9/15, I was alert and the pain briefly abated Though by the next day I was again began experiencing nocturnal pain that was off the charts. Two days ago that shifted to nearly severe pain accompanied by intensive wrenching and vomiting fatigue, weakness, and mental fogginess.

The Intensity Scale

Pain is often graded on a scale of 1-10 with 10 being unbearable. For me it’s useful to grade other experiences based on their raw intensity using a similar scale. Uncontrollable vomiting, retching, chills, weakness and muscle twitching may rate a 9 or even a 10 even though actual pain involved. In Baffin last year, I embodied the wild in the midst of a level-10 intensity experience and catalyzed a lasting moment of transformational grace. My death deserves no less than that.

Current Status

My diagnosis is adenocarcinoma of the pancreas and hydronephrosis in the left kidney. There is currently a tube draining that kidney. My biggest medical issue is extreme pain, followed by vomiting, nausea, and mental fogginess. They have not yet staged this extent of the cancer as this requires a PET scan, an outpatient procedure. I still need IV meds for the pain, which requires me to be inpatient. Catch-22. On the other hand, no one is in much of a hurry for me to get the PET scan as all other signs point to significant metastases.

Prognosis is poor. The immediate goal is palliative care - get me home and functional on oral pain meds. Now that I’m marginally lucid, I’ve begun doing Chinese medicine, acupuncture and osteopathy to help me recover whatever strength I can.

Goals

First and foremost, I want my death to be an act of creative transformation, that is to say, I want to die well. I’ve been training for this my entire life and I’m well prepared. I would have preferred to die in the mountains, and that is indeed what Monika and I had envisioned for me. I got this instead. Yet, here is precisely where I want to be. I cry from the raw wonder and intensity of the experience but never because I’m sad or afraid.

I’m grateful for every second of I’ve lived so far and for whatever moments I have left. When I’m writhing in pain I scream thank you. When I’m puking my guts out I retch thank you...and sometimes FUCK!!!!!. I’ve been practicing more or less this way for a long time.

I want to optimize my time with Monika and Djinni.
I also want to nudge my students along as best I can.
If possible, I want to finish up a couple of writing projects,

To achieve these goals, I need to ration my time carefully. We’ve set up this gmail email account: IamChipsPancreas at gmail dot com so that we can keep you updated in a manner that creates the least amount of hassle for everyone.

I’m not seeing visitors just now, but if you want to get together or talk on the phone then please email us back at this email address and we will contact you with information (but DO NOT REPLY ALL because there are about 300 people on this list). That way we can have meaningful conversation with as few interruptions as possible. Please do not just stop by, as virtually every hour of my day is schedule. I know many of you have already expressed interest in getting together. We’re just getting organized here so please write again now if you’re still interested.

A thousand thanks for your love and support Love, Power, Grace and Gratitude to you all.

Chip

Maria Portnaya on EV

Maria says . . .

I have been exposed to Engaging Vitality work for close to a decade, but only now am finding the ability to dive deeper and bring the tools into my practice. In writing this, I want to share my experience and reflection upon the past years and most recent 6 months. 

I remember being introduced to some of the tools from EV back when I was a graduate student at SIEAM (Seattle Institute of East Asian Medicine). The degree to which we as a class were exposed to these methods of assessing the body and Qi was very superficial. I liken it to the foam on top of your latte, learning something briefly and skimming the surface. Exciting yes, but not substantial enough. I think part of fundamental education in East Asian Medicine is to be exposed to many different lines of thought and practices so that we as practitioners can choose what resonates most and follow it deeper. In the course of my own private practice, many things I had learned during SIEAM have taken a back stance and some things have moved more to the foreground. I think unanswered questions and experiences in the clinic really dictate this trajectory for me. It has taken me some time to take action to pursue my curiosity and sign up to take the EV modules as CE courses. After taking the first two modules, I feel more connected to the medicine I practice, more eager to practice the methods and wondering why I have waited this long to arrive here. Learning these seemingly simple methods of examining the body and Qi has opened up a lot of dialogue inside my own experience. In reflection I can honestly say, there is a sense of fresh air when it comes to practicing EV in the clinic. This feeling is renewing me in a way. It allows me to create more space by setting aside the things I think I know, and allow myself to rest in not knowing it all. So far, with the instruction from Marguerite Dinkins and Dan Bensky to drop the ambition and practice I am taking myself past the surface into this study with their help. I cannot be more grateful to the additional practice sessions that Marguerite and Dan lead. During the last practice group I realized how much support these sessions are offering me. I find them to be most valuable and crucial in order to deepen my skills, in order to get immediate feedback, and be charged with energy to continue the dive. With all things that take time to cultivate and develop, having this support from the EV team helps me tremendously. Like roots to a tree. Thank you!

-Maria Portnaya LAc., Ageless Acupuncture LLC



An EV Case from Jennifer Spain in Raleigh, NC.

A few months ago, a friend, who is also an acupuncturist, reached out to me for help with a year-old neck injury.  He had been treating himself with adequate success over the past year, but recently had an unexplainable flare up that involved both the right side of his neck and his right shoulder.  The neck pain was tight and achy—similar to what he had been experiencing for the past year, though more severe, and the shoulder pain was a new, deep squeezing pressure inside the joint capsule. He hadn’t had much luck getting the pain to shift with the treatments he’d been giving himself. 

Upon examination, I found the yang rhythm at his left hip to be lowest, and channel listening guided me to the Urinary Bladder channel. Manual thermal diagnosis on his left leg indicated UB58 to be an active point, and the yang rhythm increased as I applied pressure to that point with my fingertip. His pulse was bilaterally deep, thin, and slippery; and he had very strong bilateral oketsu (blood stasis) signs. This pulse indicated hot fluids stagnating in the lower burner, and specifically to the use of a formula like Polyporus Decoction (zhū líng tāng). I inquired about any urinary symptoms, thirst, or dryness. He replied that he had been having some urinary difficulty, along with dry mouth and lips, and thirst since the onset of the flare up. This was interesting! I had an active bladder point, urinary symptoms, and a pulse that indicated a formula that moves hot, stagnant fluids out of the bladder. The strong oketsu signs also made sense in this context since blood will often heat up and become stagnant when the fluids become hot and stagnant. Additionally, this all seemed to relate very well to pain inside the shoulder joint which is full of synovial fluid, and the well-understood premise that blood stagnation can cause pain. 

Using acupuncture, I treated the left hip with left UB58, treated oketsu with Lv4 bilaterally, and treated the shoulder and neck with right LI11, and left GB41 and TB5. I also gave him Polyporus Decoction (zhū líng tāng) to take for a couple of weeks. Upon follow up, my friend reported that the squeezing pain in the shoulder joint completely resolved after a couple of days, and his neck pain returned to his prior baseline.  The urinary symptoms also completely cleared up, as well as the dryness and thirst.  

    The Engaging Vitality approach is all about listening to the body to see what’s showing up first, and then using Chinese medical theory to understand and make sense of it. There are so many theoretical relationships that this case made tangible for me, that I thought it might be interesting to share it. There is the contralateral relationship between the left hip and the right shoulder, the relationship between the fluids in the bladder and all the fluids in the body, the bladder organ and taiyang bladder channel relationship, and the relationship of interior blood disharmony and exterior pain along the taiyang areas of the body. 

One thing the EV instructors have repeated many times is that it’s more clinically useful to try to be helpful rather than be right. It would have been so easy to have given my friend an acupuncture treatment that used local points in the painful areas to release local stagnation, and then given him a formula like Cinnamon Twig Decoction plus Kudzu (guì zhī jiā gé gēn tāng) that theoretically addresses painful conditions in the neck. That might have seemed more right based on a symptomatic approach to treatment. Actually I found out later that my friend had taken a formula based on that approach with no effect. Polyporus Decoction (zhū líng tāng is actually a perfect fit in this context: it contains Alismatis Rhizoma (zé xiè), Poria (fú líng), and Polyporus (zhū líng) to move congested fluids, Asini Corii Colla (ē jiāo) to address the blood, and Talcum (huá shí) to cool. By listening first to my friend’s body, and then making sense of all the combined diagnostic information from the palpatory findings and the pulse, I was able to administer a treatment that was actually helpful and that also made sense within the context of Chinese medical theory.

Chip on Palpation as Practice

Palpation as Practice: Part I

Learning to palpate is a lot like learning to meditate. The two skills are similar enough that the road signs commonly used to navigate the meditation landscape are also useful on the path to palpatory competency.  I want to talk about palpation from this perspective. We should be clear at the beginning that they are different things, although there is most probably some cross over benefit in practicing both meditation and palpatory awareness. Most importantly you don’t have to be in a deep meditative state to palpate effectively.

Perhaps the most significant commonality between meditation, palpation and for that matter, medicine is that they are all practices. At the beginning, the expectation is not so much that we will be good at these disciplines as that we know how to practice them. They are skills that are cultivated over time. At least in terms of meditation and palpation, we don’t really know the limit to what it is possible for us to experience. 

In learning to meditate, sooner or later we will have a fleeting experience of open awareness. At this point, we can’t really say anything about it. Even acknowledging that it is happening, “hey, look at that, my mind is quiet,” is enough to derail the experience. The early stages of cultivating any form of palpatory awareness can be very much like this as well. It too, may be very fleeting, and just as you think you’ve caught it, it may be gone. Even once you are consistently feeling something, the experience will initially be pre-verbal. It is new and vague enough we have no words for it. Nevertheless, the process of progressively fine-grained articulation builds from this fundamental binary apprehension. I feel something or I don’t. 

After a while perception stabilizes, and we start to be able to look around. As we more consciously experience our experience, we are increasingly able to say things about what we are experiencing. In meditation we may simply witness the moment- to-moment play of our emotions. A common observation for palpators at a similar stage is “well definitely I feel something, but is that me or my patient?”  In more general terms, we might ask whether this input is self or other. Meditators spend a lot of time on the cushion trying to break down the bounds of self and other, just as we are cultivating a capacity to appreciate qi beyond the perimeter of our own skin. Yet, in both cases, no matter how effectively we extend our perception into our environment, we cannot really function without simultaneously being able to distinguish between what is outside and what is inside. 

Mindfulness meditation practices concern themselves with an examination of our internal environment and our responses to external stimuli of one sort or another. 

In learning any new palpatory technique, it similarly helpful to identify that phenomena in oneself. If you know what it feels like in your own body, it is easier to identify it someone else. It is also easier to tell whether that palpatory information is coming from you or your patient. For instance, what does your own yang rhythm feel like? Knowing that will help you to differentiate it from your patient’s yang rhythm.  You can also palpate an inanimate object. If you find that the treatment table has a yang rhythm then you either have a very special treatment table or you are feeling your own qi?” All this can take some time and experimentation to sort out for oneself.  The good news is that the difficulty in distinguishing between self and other fades with experience and generally becomes less of an issue with every new palpation technique you learn. 

Meditation is about learning how our mind in particular works and in using that insight to exert some productive control over that process. Although we all share a human nervous system, each of us is wired a little differently. No one’s palpatory antenna is without a few unique bends and kinks. Learning the quirks of our particular apparatus is an essential part of learning to appreciate qi. For instance, is one hand more sensitive than the other when listening to the yang rhythm or doing channel listening? Does it help cross-reference your findings by switching hands? Which hand is best for manual thermal evaluation and which for local listening. Our own acute or chronic injuries may influence the accuracy of our listening. Even problems in our ankle may influence how we stand, subtly influencing the way our hands receive information.  

Some days we may be able to sustain our attention and awareness on the cushion better than others. Its best not to label our meditation sessions as good or bad, we just practice. Just as it is counterproductive to beat yourself up when you catch your mind wandering, it is also unhelpful to fret over the fact that you’re not feeling anything. Just move on and keep practicing. 

Most experienced clinicians will acknowledge that their palpatory capacities vary from day to day, and even over the course of a single day. In meditation, pulse diagnosis, yang rhythm or general listening, our baseline competencies generally improve as we gain experience. We gradually get to the point where our palpatory input is clinically useful even on our off days. Some days we may be more confident in our local listening than in our channel listening. At other times the opposite may be true. We simply do our best to make use of whatever information we can glean at any given moment. Our receptivity is inherently variable for reasons including but by no means limited to our own competency. Sometimes our patients are just not communicating with us on a particular palpatory wavelength.  Cultivating our comfort in working with whatever information we have is a skill in itself. A key to all of this is to try with just the right amount of effort. If we don’t try seriously enough or often enough, we will never learn the skill. Yet working too hard will just as surely subvert the learning process. 

Once we are reasonably confident that we are feeling something, and that what we are feeling is coming from the patient and not ourselves, the issue is no longer whether we can feel qi but what specifically we should be filtering for. 

We will pick up this thread in a subsequent blog. 

Kailey Brennan on why study EV Part 2

2018 June

“A map is not the territory it represents, but, if correct, it has a similar structure to the territory, which accounts for its usefulness.”

— Alfred Korzybski, Science and Sanity 

 

    In school to study acupuncture and East Asian medicine, we start with the fundamentals. We study East Asian medicine’s understanding of the body. We learn about the pathways of the meridians, the concept of the Qi dynamic, the theory of Yin and Yang, the Daoist understanding of humans and their relationship to nature, as well as some of the cultural, historical, political, philosophical and spiritual ideas that influence and undergird this medicine. 

    If your education was anything like mine, you learned all of the specifics of acupuncture point location. Hours upon hours of memorizing point prescriptions out of the Chinese Acupuncture and Moxibustion textbook (CAM). Shang Han Lun, Jin Gui Yao Luo. The relationship of the five elements. 

    While in school, if we had enough sanity and bandwidth left over, we started studying the other systems that so many of us use and draw from today: Dr. Tan, Master Tung’s Magic Points, Kiiko Matsumoto’s clinical strategies, 5 Element acupuncture, specific auricular protocols, Jeffrey Yuen’s tradition, amongst the many others out there. 

    Practicing in more advanced clinics while still in school, I started to feel quietly unnerved. More times than not, patients did not come in with the sort of clearly defined patterns and diagnoses laid out in our TCM textbooks. Not even close. Sometimes treatments were successful, sometimes they were not, and it was very difficult for me to discern why this was. When a course of treatments didn’t seem to make much of a difference, privately I worried that I had gotten myself into the wrong profession.  Absolutely worst of all I was starting to become secretly blameful towards patients, critical of their lifestyle or questioning their desire to work in the service of healing. I was tasting the makings of burn out and I wasn’t even out of school yet. 

    I could theorize and read up and draw on my understanding of East Asian medicine, sure. I could try different point prescriptions, balancing different meridians, working both local and distal style acupuncture. But I wasn’t sure if I was just telling myself some kind of elaborate, made-up story. People and their bodies are so unique and they present with such diversity. They can’t even begin to be encapsulated and described in all of the textbooks and medical theories and treatment systems in the entire world. Plus, I’m a very tactile person and I needed a grounded, perceptible and detectable way in the clinical encounter to discern if my treatments were having an effect. 

    So much of this is to say, and I’m coming to discover this more and more everyday working with the Engaging Vitality material, that the map is not necessarily the territory when it comes to the practice of East Asian medicine. They are useful and necessary and very helpful, but they can’t completely outline, nail down, and describe every person, condition, and presentation that walks into our clinic. Having a glimpse of this reality in school was terrifying for me. Very gradually through my involvement with the Engaging Vitality work, this has become very interesting and actually almost exciting. 

    Maps are very useful. Navigating through parts of Denver I’m unfamiliar with, I would be in big trouble if I didn’t have the Map function on my iPhone. It even lets me know in real-time which sections of I-70 or I-25 are backed up due to traffic or an accident. It’s an indispensable tool for living in a city, one that I would struggle without in very real and tangible ways. It saves me valuable time and energy each and every day. 

    Similarly, I am very reliant upon my maps in East Asian medicine. Distal style treatments, 5 Element acupuncture, strategies that I’ve picked up on from the Japanese tradition, continuing studies in pulse, tongue, and abdominal diagnosis. The maps I studied in and after acupuncture school and continue to study are incredibly valuable and I utilize them regularly.

    But the human body is so incredible and diverse and mysterious. Textbooks, theories, teachings, protocols, and prescriptions are all very necessary and useful. But from what I have learned and am continuing to learn and discover everyday is that they are only capable of outlining the tip of the iceberg. When a patient comes in to see me for the first time and however many times after, it is so very interesting, compelling, and undeniably useful to try to engage the patient’s own qi in a dialogue and try to understand what the patient’s qi is asking for in that moment, opposed to placing or imposing my map or system or treatment strategy on that patient from the get-go. 

    In the Engaging Vitality work, we orient with this understanding that the human being is a functional unit comprised of body, mind and spirit, and that the body is capable of self-regulating and healing. Many of the ideas come from the osteopathic tradition here in the West, and they in many ways synthesize very agreeably with our understanding of East Asian medicine. In the Engaging Vitality work, we think about using all of the tools we have developed in East Asian medicine - acupuncture, moxibustion, e-stim, and so forth - to work in the service of supporting and encouraging the body’s innate capacity to self-regulate and heal. 

    Part of working in the service of the body’s healing mechanisms is understanding when you’ve given the body more information than it can adequately process in a treatment session. This is commonly referred to as “over-treatment” in the practice of acupuncture. And in Engaging Vitality, we have some very useful, immediate and direct ways of discerning if a patient is nearing over-treatment: the pulse becomes disorganized, the Channels start to feel buzzy, the tongue may develop more defined teethmarks, and the body’s fluids will start to feel like a thick, viscous liquid, like molasses. This is an incredibly valuable tool to have for more reasons than need mentioning. 

    And that doesn’t even begin touch on the usefulness of the Engaging Vitality work. Old injuries, strains, and ailments can lead to tension, constriction, and systemic disharmony in the body. With the Engaging Vitality tools, we can start to actually discover and pick up on this through our palpation skills. You come to learn that acupuncture points and very often channels may not necessarily be in the exact location that they were outlined in the texts. Recently having taken the Visceral Course, I’m starting to cultivate a tactile understanding of why we say that the lungs are responsible for the function of “descending and diffusing” in East Asian medicine. I’m continually discovering why certain acupuncture points are given their very unique, interesting and oftentimes perplexing point functions as outlined in Peter Deadman’s Manual of Acupuncture text. I might have certain preconceptions about what is going on for a patient based on their constitution, presentation, and main complaints, but those preconceptions might be completely vaporized once I start doing an examination.

    The map might not necessarily be the territory, and this is good news for me. Learning the Engaging Vitality tools and mindset has helped me to be curious and interested in the face of ambiguity, complexity and confusion, as opposed to fearful, anxious, or feeling overwhelmingly impotent. It is incredible to think that as practitioners of East Asian medicine practicing with the Engaging Vitality material, in addition to all of the information we can glean from our pulse, tongue, and abdominal findings, there is this ability to receive so much palpatory information from our patient’s bodies and their qi. This information can help us come into dialogue with a patient’s qi, get feedback in the clinical encounter if we are truly working in the service of the body’s innate capacity to move towards healing, and helps us to more elegantly address, while holding a very large and open perspective and an appreciation for the wisdom of the body, the reasons why patients are coming to see us for treatment. Practicing the Engaging Vitality work helps me to more skillfully, attentively, and reverently practice my values and serve my entire reason for getting into East Asian medicine in the first place - to help people and to help people feel better.

Why study EV? by Kailey Brennan

Here is an excerpt of a wonderful letter Kailey sent for EV in 2017, describing what we do. 

Engaging Vitality is a acupuncture and palpation workshop developed and taught by Dan Bensky, Chip Chace, and Marguerite Dinkins. In addition to being longstanding practitioners of Traditional East Asian Medicine, the instructors have extensive training and expertise in osteopathic palpation methods, including visceral manipulation and craniosacral therapy. Engaging Vitality is the product of their many years of deep engagement, study, and practice of these various traditions. 

I believe Engaging Vitality has something very unique and valuable to offer to acupuncturists. Beyond the ability to improve diagnostic skills and and grow in clinical competency, Engaging Vitality teaches a way for the fundamental concepts of East Asian medicine to come to life in our handsIt is also a chance to study with and learn from three very generous and encouraging high level practitioners with a deep respect and appreciation for this incredible medicine we get to practice. And on top of all that, it’s a lot of fun. 

Thank you for taking the time to read this e-mail and I hope to see you in Boulder this fall. 

All the best,

Kailey Brennan L.Ac. Denver, Colorado 

Why study EV by Kailey Brennan

2017-11-20

    I landed in my first Engaging Vitality Module I seminar a month after getting licensed as an acupuncturist. My primary reason for signing up was that I saw it as a chance to develop my palpation skills. I did not come to this profession with a background in any kind of bodywork. Beyond point location and surface anatomy, palpation was not heavily emphasized in my TCM schooling. So I felt deficient in this capacity as an acupuncturist, and I felt that taking a few Engaging Vitality seminars would help me develop my palpation skills, and that this would then translate to becoming a more competent and effective practitioner. I was clueless when it came to the osteopathic tradition, and I really did not give much consideration as to how it was going to be a part of the Engaging Vitality training. I was only focused on developing my palpation skills. 

    In hindsight, I can see that there were a lot of other reasons why I needed a training like this. TCM school left me with a lot of gnawing questions. For me, there was an appreciable disconnect between the theory and practice of acupuncture. In our theory courses we learned about the different manifestations of Qi; Yuan Qi, Ying Qi, Wei Qi, Zhong Qi, and Zheng Qi, amongst others. Were these just theories that provided a scaffolding for how we could think about practicing acupuncture? Or did these different manifestations of Qi actually translate into an appreciable palpatory reality in the clinical encounter? Is Qi actually something we can feel in our patients, through our hands? Or does my “capacity to feel Qi” require honing and developing some kind of nebulous, energetically-based, intuitive capacity in myself? Obviously, I had a lot of questions, and I was not sure if this made me a tenacious, curious student or a cantankerous pain-in-the-butt. Probably a little of both. 

    Suffice to say, I wanted to develop my palpation skills and work through some of my discontent with the practice of acupuncture. I learned the various palpation techniques in Modules I, II, and III. The techniques are not difficult to learn on the surface, but they require a willingness to hang out in a place of “unknowing” and not push an agenda. It is about coming into dialogue with a patient’s Qi. This may sound esoteric, but it’s not meant to be. It’s actually incredibly ordinary. And it was so reassuring to me to learn that the way one gets better at the Engaging Vitality material is by consistently practicing it. It is not about striving harder. It just takes regular, consistent practice. And then something starts to happen. You discover a whole world of information in your hands. 

    Having worked with the Engaging Vitality material for the past year, I now know that Qi is a palpatory reality, we can feel it in our patients, and we can use it to guide us and give us feedback while giving an acupuncture treatment. This has been a priceless discovery and it has made the medicine come alive for me. And not only that, but the real cherry on top is the chance to continue to study with and learn from high level teachers who encourage deep questioning, skepticism, and rigorous debate. From the beginning, I have never felt like I was learning from three completely inscrutable, all-knowing, omniscient teachers. They are real people who are working with this same material on a day-to-day basis in their own clinics. There is a real sense of being able to have a long, continuously fresh, tremendously interesting and ever-evolving journey with this material. Practicing acupuncture this way is anything but boring. For all these reasons and many more, I am so glad that I came into the Engaging Vitality work, and I am so excited to have more people come along for the ride.

Clinical Case #1 by Chip Chace

The Engaging Vitality approach is based  on the idea that enhancing engagement with our patients’ qi enhances clinical efficacy. Part of this comes about from expanding our repertoire of techniques for appreciating the qi while another important aspect is to learn how to weigh and cross-reference this input.  This is central to the diagnostic process whether we are working exclusively with the familiar TEAM methods of tongue, pulse, abdomen, and symptoms, or incorporating a broader range of assessment methods. 

I have used the following case in a few Module IV trainings to illustrate the application of the listening to the fluids in Chinese herbal prescribing. Here, fluid-body palpation worked for me as a sort of diagnostic tiebreaker. I think the case works pretty well on that level. In the course of presenting the case again, however, it recently struck me that it also exemplifies the more general process by which we creatively apply and cross-reference a variety of diagnostic input. The case may actually be more informative in this regard, as it speaks to the challenges of dealing with vague, ambiguous, and even irrelevant information. 

IW, a petite, female yoga teacher in her late 40’s experienced what she described as an “asthmatic cough” subsequent to a bout of bronchitis she had contracted after a trip to India three month’s previously. The cough was predominantly dry and unproductive. It was worse in the morning and evening, or when teaching or speaking, and drinking water helped to soothe it. She also complained of a burning, inflamed sensation in her chest. 

Prior to her trip to India, we had briefly worked together in treating some perimenopausal symptoms, addressing them with at least partial success in the context of a liver and kidney deficiency. She now only had night sweats once a week, though she remarked that her recent menstruation was preceded by an outbreak of acne. She was also prone to joint pain. IW mentioned that she had been very busy since her return from India made a point of reminding me that she was very sensitive to stimulants. 

General Listening localized to her posterior left diaphragm with a confidence level of +++ out of ++++ . Her tongue was slightly red and dry (+++),  and her pulse was rapid and fine  (++++). Pulmonary auscultation revealed clear but slightly tight lungs (++++). I was confident that her yang rhythm felt unremarkable (+++).  Here I had a fairly high confidence level in my palpatory findings. 

IW’s dry cough, burning sensation in her chest, dry tongue, and fine rapid pulse suggested a straightforward though fairly entrenched case of dry heat in the lungs. I didn’t think that there was sufficient evidence to consider her background liver and kidney pattern a significant factor in her present situation. My plan was to drain deficiency heat/fire with bitter and sweet flavors, secondarily moisten the lungs, and downbear the lung qi to stop cough. I gave her 3 packets of the following prescription. 

  • Mori Cortex (sāng bái pí) 15
  • Lycii Cortex (dì gǔ pí)
  • Anemarrhenae Rhizoma (zhī mǔ) 12 
  • Lilii Bulbus (bǎi hé)
  • Trichosanthis Pericarpium (guā lóu pí)  6
  • Stemonae Radix (bǎi bù) 9
  • Armeniacae Semen (xìng rén) 9
  • dry fried Scutellariae Radix (huáng qín) 4.5
  • Glycyrrhizae Radix (gān cǎo) 6

She was instructed to sip 1 ½ cups of this in decoction over the course of each day. 

IW e-mailed me 6 days later and reported that she was 60% improved after taking the first packet of the prescription and 75% improved after taking all three packets over the course of 6 days. Although she was happy with her rapid response, she now complained of mild jaw pain she described as “TMJ” (temporomandibular joint syndrome). Unable to actually see her, as I was in Europe at the time, I had to rely on her short written report. The most likely pathodynamic involved in the jaw discomfort seemed to be a counterflow of yang, though I was unsure precisely where it was coming from or why it was happening. I asked her to take another 2 packets of the same prescription with the addition of 12 grams of Ostreae Concha (mǔ lì) to more aggressively downbear this counterflow. 

IW returned for an office visit 4 days later and reported that her lungs were now 90% improved. She mentioned that she had experienced a tight cough and a slight tightness in her chest for one day though this was now gone. Thinking that this might be a sign of constrained qi I asked her about her moods but she reported that if anything, she was less irritable than usual. On the other hand, Spring had sprung and her usual seasonal allergies were bothering her. IW’s eustacian tubes felt blocked and there was no change in her jaw discomfort.

IW’s lungs were clear upon auscultation with no sign of the tightness I had heard previously (++++). Her pulse when sitting was soft (+++) and possibly slippery (+). When prone, her pulse was wiry on the left, esp. in guan and proximal positions (++++). Her tongue was significantly better overall, but I could imagine that there might be a hint of blueness in the center (+). Her yang rhythm was again unremarkable but again, I could imagine that there was a slight restriction in the cranium (+)

None of this suggested a definitive course of action. Was her jaw pain actually linked to her seasonal allergies, an external pathogenic factor complicating a pre-existing condition? Her pulse when sitting suggested the presence of dampness and possibly phlegm, presumably attributable to the allergies, though the pulse was clearly not superficial. Was there a deeper counterflow phenomena at play arising from her underlying liver and kidney yin deficiency? It was certainly possible to read her prone pulse presentation in this way. Yet it was equally plausible that her wiry pulse reflected an element of qi constraint. Moreover, she complained of no tightness in her chest, no irritability and her tongue only “possibly” (+) blue. The restriction in the yang rhythm in her head, if it was there at all, did not contribute to a differential diagnosis.  Did I need to nourish her fluids at a deeper level, relieve constraint, or perhaps even open the exterior and clear her sensorium?  Some other diagnostic criteria was needed, so I listened to her fluids. 

Based on the prominence of the left guan and proximal pulse findings, I needled left Ki 2 and right Liv 8, the side determined by channel listening and the points themselves determined by manual thermal evaluation. Since her current chief complaint were in her head, and though vague, her cranium was the most prominent listening post, I found GV 23 using manual thermal evaluation and also needled that. This settled her system sufficiently to allow me to listen to her fluid body. 

I could imagine that fluids felt somewhat dry (+) . More significant, however, was a slight but clear tightness on the outside(+++). This suggested a significant element of superficial constraint, though I remained unconvinced that an exterior pathogen was anything more that an adjunctive concern. I decided to continue clearing deficiency heat and moistening the lungs but to more directly open the chest and relieve constraint there. In retrospect, perhaps she could have done with a little more lung diffusion from the very start. Because her pulse as a little soft I included an adjunctive component for awaken the spleen and opening the sensorium, if only to mitigate the potentially cloying nature of the sweet moistening flavors. 

  • Anemarrhenae Rhizoma (zhī mǔ) 9
  • Glehniae/Adenophorae Radix (shā shēn) 9
  • Platycodi Radix (jié gěng)
  • Curcumae Radix (yù jīn) 4.5 
  •       Acori tatarinowii Rhizoma (shí chāng pǔ) 3

IW took 1 packet of this preparation in decoction over two days and all of her symptoms disappeared. 

Vague and ambiguous information is often all we have to work with. Dan, Marguerite and I typically use some form of confidence level scale to help us weigh the influence of of each diagnostic parameter. Here, I used a scale of 1+ to 4+. Of course, any bit of information can have multiple meanings. Here, even the most unambiguous aspects of the pulse image could plausibly have been interpreted in a few very different ways.  Cross referencing those possible pulse interpretations with the tongue, auscultation and patient history helped to narrow the differential diagnosis though not sufficiently to make a definitive diagnosis.  Although listening to the fluids was the diagnostic tie-breaker even this metric was somewhat ambiguous. The fluids did “perhaps” (+) feel a bit dry, but I was more confident (+++) that they felt tight and that distinction was the difference that made the difference, leading to an effective course of action. 

As we are learning the Engaging Vitality palpatory techniques, our findings will almost certainly feel vague and ambiguous, particularly when compared with diagnostic parameters we may be more familiar with such as the pulse and tongue. This is even more the case, if we gravitate towards a particular style of diagnosis or treatment where a particular finding yields an “if X then treat Y” answer. More often than not, however, the diagnostic process is characterized by some degree of ambiguity, regardless of the system we may be orienting to. When applied carefully and critically, low confidence findings can nevertheless help to clarify these situations and guide us to effective clinical outcomes.

 

Connecting to the Whole: The Role of Tong in the Engagement of Qi by Chip Chace & Dan Bensky

Here is an excerpt from an article in The Lantern Dan and Chip wrote about the Chinese concept of tong and its relation to East Asian medicine.
Now published 2018 Feb. Available for $5AU
To Order from The Lantern Volume: XV, Issue: 1, 2018
For more information, go to www.thelantern.com.au

[O]penness, denotes in this context our translation of tong 通. For us, tong is the fundamental thing that acupuncture accomplishes. As we will demonstrate in this essay, we understand tong as far more than a synonym for moving the qi. We are not in any way proposing an orientation to practice based on drainage as opposed to tonification. Tong is a principle that lies even deeper than the elementary ideas of excess and deficiency, tonification and drainage. If the system is tong, a great many of the issues regarding when and where to tonify and drain become moot. This is because once the body is tong it can fully utilize its inherent capacity for self regulation.

To us, tong is a synonym for one aspect the body’s own self-healing abilities, that is for health. As A.T. Still, the founder of osteopathy put it, “To find health should be the object of the doctor. Anyone can find disease.” A tong body knows better than any physician how best to rid itself of a surplus or pathogenic qi, and to replenish regions of insufficiency. A crucial aspect of our job as physicians is simply to help the human system express its inherent tong-ness. This article explores the concept of tong and how it can be applied to the practice of medicine.