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. 

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.

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.