Some Questions from Participants in April 3, 2020 Online Study Group
Dan Bensky
Q “Can 8 command points of 8 extraordinary vessels be palpable diagnostic points connected to problem place independent of the 12 regular channels on which these points are located?
For example, if SP4 connects to the problem place but other parts of spleen channel does not, 1) is it possible? 2) if so, does that mean Chong Mai is the channel to treat, not spleen? 3) if so, does its pair channel also tend to be involved?”
A This is an excellent question and reflects the utility of differentiating listening to channels (which we go over in Modules 2 and 3 of our basic course) versus listening to points.
Let me start with a digression into some historical background that should be helpful. In the late 80’s when I started entertaining the possibility that the channels could be “listened to,” I first started by connecting with each channel through it source point. I thought that these would probably be the place where whatever was going on in the channels would be the easiest to feel.
Honestly, I was quite surprised that there was something reproducibly felt by doing this, as I had been taught that the channels were kind of abstracted lines connecting points, which were the real deal. One influence that made me think to look, were materials that had been excavated in the late 70’s from the Mawangdui tomb in Hubei province, some of which were clear precursors to certain chapters of the Inner Classic and in which the channels were clearly primary. In those texts different types of symptoms are described and then cauterization of a channel is recommended - no points are mentioned at all. These texts left a strong impression that the channels were considered a structure, as much as anything can be considered a structure in ancient Chinese medicine. Of course, once we look at the Inner Classic itself with fewer biases, this is clearly true of the channels as described in those texts.
The other influence was the work of Jean-Pierre Barral, who I had been studying with since 1986. He developed the concept of ‘listening,’ which we discuss at length and use quite a bit in the basic modules. A simplified version of this concept is that if you place your hands on a person and allow them to feel what kind of pulls there are in the body from structures that are tight and pull on the rest of the body, you can find out which area of tension is having the biggest effect on the entire body. While there are various types of listening (such as ‘emotional listening’) for which this statement is not entirely true, in general a pull felt while listening with your hand, if it is in full contact with the body, presumes a structure that is tight or not moving well and pulling on the rest of the body.
There were a couple of other unexpected findings. One was that whenever I felt something with a directionality to the sensation or a flow, it always went toward the core of the trunk, that is centripetal never centrifugal. The other thing was the channels moved around a bit, mostly from side to side. Very interesting to me is that the leg yin channels in about a quarter of patients felt as if all the channels were vaguely straight, that is the spleen channel always close to the tibia, the kidney channel most posterior, and the liver channel in the middle. However, the most interesting thing was how difficult it was to transmit how to feel the channels through the source points to students. Whenever I tried to do this in class, it was rare for even ten per cent of the students to have any idea what I was talking about (curiously, I found it quite easier to teach to osteopaths with very little background in acupuncture).
About ten years ago Chip figured out a better way to teach, while working with the students who assisted him in his clinic in Boulder. This is what you have learned, placing our flat fingers over parts of channels with few or little points and getting a sense of whether it is free and unblocked, or blocked up, gunky, empty, etc. From our perspective, after changing over to teaching a “channel-based channel listening” the vast majority of students have at least some idea what channel listening feels like and can use it sometimes in their clinics. A few years ago after we started teaching this skill by learning how to feel which channel is most connected with a problem place, almost all students at least have an experience of what it is like to listen to a channel..
Now to get back to your question. We generally listen to channels in areas with few or no points, because points have their own issues and findings, and most of the time we want to focus on the channel first and the points second. But you have put your finger on one of the times we can use points to check channels, and my experience is exactly as you have described. Let’s say that we have found a PP in the lower right quadrant of the abdomen, perhaps halfway back and not that far from the perineum. It is possible that when we check the channels that go through or connect to this area (spleen, liver, kidney, large intestine, triple burner, etc.) none of them seem to be connected to the PP. Sometimes when you pick a point related to the chòng mài, such as SP-4, you will feel that sense of connection and that this sense is absent when you check the spleen channel as a whole or when you check other spleen points (say SP-3, SP-6, SP-10). This is indeed strong evidence that the chòng mài is involved and this can be somewhat confirmed by needling a chòng mài point and seeing that the PP dissipates (the yang rhythm in general becomes smoother with more amplitude, the pulse improves, the MT layer becomes thicker, etc.).
If you think about it, this is just utilizing the phenomena we access with transient opening from a different perspective. Let’s say that we have the same patient as we described above, but this time her right stomach channel is connected to the PP. Very commonly, using our point localization skills, we will find that the point that is both most connected and unblocks (tōng) the PP is ST-37, the lower uniting point of the large intestine.
When the extraordinary vessels are involved, I think that Engaging Vitality in general (and Chip in particular) would tell you not to rely too much on the command or master points of the imagined set of related vessels. For the former, Chip was very big on expanding the pool of points that relate to the extraordinary vessels. In module 3 you should have been given tables of trajectory and treatment points taken from his book An Exposition on the Eight Extraordinary Vessels.
While observing a of pairing of extraordinary vessels for diagnosis/treatment is common, it is nothing like a rule. There may be reasons why chòng mài problems might be relatively commonly seen with yīn wēi mài issues, but of course that cannot be true all the time. You can use the Manaka or Miyawaki abdominal palpatory techniques to help with this, as well as using point finding and other techniques, but don’t get locked in to them in advance or get freaked out if you find that a given patient has just a chòng mài problem or a chòng mài/dū mài problem.
Q “Local listening with point selection (transient opening), when more than one pull is felt.”
A I’m not sure that I understand the question, but I’ll do my best to explain the process I think that you are asking about. When one feels more than one pull on General Listening or Local Listening (or GL takes you to one place and checking the yang rhythm takes you to another, etc.), the best approach is to not figure it out, but rather test it out. Let’s say that you feel more than one pull [we’ll call them ‘Pull A’ and ‘Pull B’]. First find via MT and other techniques a point that on TO makes that pull go away [we’ll call that ‘Point A’]. Then using the same approaches, find a point that releases the Pull B, that we will call ‘Point B.’. Once you have this, see if Point B can release Pull A or vice versa. The one point that can release both pulls, is the point you should needle first. If you feel three or more pulls, just check two pulls at a time until the point with the biggest positive impact on the system is revealed.
Note there is no reason that there will be “one point to rule them all.” But if you do things in the above order, you will end up getting the biggest positive response from the body with the minimum of needles. In clinic it is useful to also check other parameters (pulse, tongue, MT, etc.) to see the effect of the needling on the system as a whole.
If this wasn’t your question, try again during our study session.
Q “In the past 4 months, especially after the Ba Mai class with Rayén in Amherst, my experience with palpation has changed. Or I should say my awareness has grown. I spent the first 2 years of EV training with no clue what, if anything I was feeling. I was so focused on performing the correct technique, and could not "hear" the sensation that arose inside of me. It's different now. Palpation is an "inside" experience for me now, and much less focused on getting it right, or trying not to do it the wrong way. This shift has been a huge revelation for me. If you feel inclined to say anything about this -- palpation as sensation, verses palpation as "language" you want your brain to translate, I'd appreciate it. ”
A Thanks very much for asking this question, as it shows that we have been teaching things less than optimally. Doing the technique correctly has to include not only the biomechanical [keeping your hands like water, being as relaxed as possible, making contact in a way that does not provoke a response, etc.] but the mental [you are just observing not doing or judging, noting sensations before making any interpretation, etc.]. I guess one way of putting it is that just as your body has to be relaxed, fluid, connecting without provoking a reaction] your mind has to be in a similar state.
I’m not sure that this is true, but the mental state may come to the fore when feeling the fluids, because it is a little less clear what senses we are actually using to experience them. It’s not proprioception or temperature, so we have to be more able, as you state, to “hear” the sensation. One last point, whenever possible “hear” the sensation at the interface between your hand and the body of the patient and not inside yourself, as doing it the latter way can lead to problems for both you and the patient. This is one of Barral’s admonitions — making sure that you always are aware that the patient is the patient and you are you — that I have found very important.
Q “Please talk about the listening for the top of the head. Still the biggest challenge for me!! I don't feel a pull no matter what I do…”
A I believe I see the issue — your don’t really do anything and you certainly shouldn’t try. This in some way connects to the previous question. For GL (listening on the top of the head), you start by placing your patient and yourself in positions where you are both comfortable (and the patient not too stable). You place your relaxed hand over the vertex and sink down until you feel your hand pulled in a specific direction … or you don’t. If you do, then you use geometry to take a guess as to where it is going; if you don’t, then you forget about it and go to the rest of your work. You can ask the patient what they felt to check some of the mechanics - if they felt you pushing their head, you were too intense and forceful; if they felt like your hand was not in contact with their head, your touch was too light. Above all, don’t worry about it and just perform it again at the next opportunity.
There is a wide spectrum in how long it takes people to be able to use GL. If there is a reason for this, I have no idea what it is. I am very confident that if you just keep practicing it with a light mental approach and kindness towards yourself, sooner or later it will be something that you can use.
Q “Could you talk about what you think is going on when we "retain" needles in the body? There are styles of Japanese needling that use contact needling and teishin where you aren't necessarily retaining needles in the body for a period of time. With the EV work, do you think it is possible to get the needed "response" from the body by just doing contact needling, or is retaining needles for a period of time essential in order to effectively do this kind of work?”
A You know in advance what my response to this is going to be — it depends!
To me the issue of needle retention is the same as that of needle depth. Just as inserting the needle to a specific depth will give the biggest positive response at that particular point in that particular patient at that particular time, so will leaving it in for a particular amount of time. That can be from no retention at all to leaving it in for over 30 minutes. We can determine this by using listening to the needle - when listening to a needle (which we do by feeling what happens at the tip of the needle while holding the handle) , if it is the right place, you will feel that sense of connection along the entire channel and even beyond. Once that feeling is gone, you will feel that it takes no force to remove the needle [or if it is in superficially, it will just fall out by itself]. That is the meaning of our instruction to take the needle out when it is done.
My experience with this is that there appears to be no real harm done by leaving most needles in longer than necessary. That is, if a needle should have come out immediately after insertions, but you leave it in 5-10 minutes, it does not adversely affect the treatment. This was a bit of a surprise to me, but perhaps it shouldn’t have been. If you are not stimulating the needle in some way, once the needle/point combination has done its work, the needle is just a thin piece of metal in the body. It’s not doing anything, so it cannot overdo anything. One piece of evidence for this, is that some signs of over-treatment occur if you leave ion-pumping cords on too long. It is something that you can feel clearly if your hands are on the body when it happens. Immediately taking the cords off (but not necessarily removing the needles), will put an end to the signs of over-treatment and no deleterious effects will be noted. Perhaps those of you who use e-stim have similar experiences. This why I always stay in the room when I use ion-pumping cords. At the same time, when I put in needles that are not getting any stimulation, I am not uptight about leaving them in a bit longer than necessary.