Revisiting off-the-body sensing in Engaging Vitality
By Dan Bensky
One of the core techniques taught in Engaging Vitality - Manual Thermal Evaluation (MTE) - is extremely useful in understanding the general and regional state of the body, finding useful acupuncture points, and assessing the effectiveness of needling. MTE has been developed by the osteopath Jean-Pierre Barral over the last 50+ years.1 In 1970, he felt a sensation of heat over a patient’s chest while gesturing with his hand while asking her to change position. It turned out that he felt this heat over a scar from breast surgery. After several similar experiences, he began to earnestly pay attention to these phenomena and realized that it was easier to feel what he considered thermal flow with his hand near, but not in contact with, the patient’s body.2 From this he developed an entire approach to using off-the-body sensing for a variety of issues, most prominently for gaining information on specific areas of dysfunction. Further information on this can be found in his book Manual Thermal Evaluation or in workshops from a variety of sources, especially from the Barral Institute.
History in Engaging Vitality
While a student at the Michigan State University College of Osteopathic Medicine, I was a research assistant for John Upledger, when Jean-Pierre came to visit him in 1981. Jean-Pierre was also scheduled to visit a state-of-the-art thermography installation just outside of Detroit. At that time, thermography was a possible competitor to diagnostic imaging approaches such as CT scans and MRI, and Jean-Pierre wanted to compare his hands with the machine. One of the issues with thermography is that in order to get any results, the room in which the scan takes place has to be controlled not only for temperature, but also for other environmental aspects, such as air flow, as drafts lead to variations in findings. Setting up the subject (in this case my wife, Lilian) took quite a while. After comparing Jean-Pierre’s findings with those of the thermograph, it was clear that the areas that he found with his hand correlated with those found by the machine.
I next saw Jean-Pierre in 1986 when I was a student in his first visceral class in the United States, which took place in the Washington, DC area. In this and in subsequent classes, Manual Thermal Evaluation was introduced as an integral part of the diagnostic practice of visceral manipulation . In the early 1990’s, Jean-Pierre worked with some electronic engineers in France to develop a hand-held thermoscan and I purchased one and used it for many years, primarily as a training tool. For the thermoscan to work, it had to be held approximately 10cm from the surface of bare skin. I would first screen the area with my hand and then compare my findings to what the thermoscan revealed.
A few interesting things transpired with this training. First and foremost, it was clear that what the hand felt was related to a change in temperature and that the hand did not distinguish whether the area was hotter or colder. This was totally in agreement with Jean-Pierre’s teachings, but nevertheless somewhat surprising to me. Secondly, occasionally I would quite clearly feel something that would not show up on the thermoscan and, rarely vice-versa. At the time, I attributed this to a lack of skill on my part. Also, it became obvious to me that while the thermoscan required bare skin in order to obtain results, the hand sensed changes even when the patient was clothed (although doing this technique does become harder with more and thicker layers of clothing).
Starting in the mid-1990’s, I taught occasional workshops on what I called “Expanding Palpatory Awareness in Oriental Medicine,” one of the precursors to what later became known as Engaging Vitality, and manual thermal was a part of the skills taught. Although there are many parameters that can be discerned using this technique, the original focus was on point location. As I gained more experience with the technique, patients, and integrating these findings into a TEAM framework, I saw how we could correlate the height of what I recognized as a thermal layer with normal activity – that is the qi - in that part of the body. We will get into more detail about these issues below.
Changing Terminology for Engaging Vitality
In the early part of this century, Chip also started teaching classes that incorporated various aspects of osteopathically based palpation, at one point calling his work the “Learning Hand.” Around 2010 we started teaching together and soon applied the moniker “Engaging Vitality” to this work. With increasing experience in teaching these techniques and thinking a bit more deeply about what we hoped to accomplish, it became clear that we needed to “de-osteopathicize” our terminology, or more specifically, to “TEAMify” it. This process accomplished a few goals: it saved us from going into some background that was irrelevant for practitioners of TEAM, it made it easier for those practitioners to use these techniques and integrate the findings into their practices, and in some ways, it made these techniques our own. Thus, we rebranded the CRI as the “yang rhythm” and the mid-tide as the “yin tide.”
While Chip and I talked about rebranding in relation to MTE, we never got around to doing it. The various problems with this term, especially in the context of EV, became so apparent in recent online workshops, that I realized something had to be done. In these workshops we ended up discussing irrelevant and unnecessary issues with how the technique could be applied, and we found that the technique remained baffling to some participants. These problems were directly related to the usage of a term that does not work well in the context of TEAM.
I believe that the main issues here are:
• While there is definitely a connection between what we are feeling and thermal changes, it is clear that what we are feeling are not simply thermal changes, because it is easily palpable through clothes and also because this technique does not help us decide if a specific area is hot or cold. Areas that “light up” using this technique can be helped both by needling and moxibustion. Which will get the best result is determined by information from other sources, not by what one feels with this technique.
• Many people experience this “thermal” signal in a variety of ways which have no relation to the sensation of heat or cold. Personally, I feel a sense of pressure and Chip felt a buzzing sensation.
• Given the above, we don’t really have a satisfactory scientific explanation for the ‘manual thermal’ experience. Actually, we don’t need one. What we need is a description that fits nicely into the overall framework of TEAM.
Qi Signal Assessment
I was able to dig up some correspondence about this issue between Chip and myself from 2015 and then recently started an online discussion with the main EV team.3 Together we came up with what I think is a very satisfactory term : Qi Signal Assessment (QSA). There are a lot of reasons that this term works for me, among them:
• It relates to both the actual sensation [some sort of signal coming off the body that is appreciated by different people in different ways] and what we think it means [information about the activity of the qi in that area].
• It is a signal from the qi broadcasting from the body, not the qi itself. This reinforces the importance of keeping our hand parallel to the surface we are assessing and at a useful height. It also allows us to better utilize such things as the spike that occurs after needling, as this is a sign that the point has been activated, not that qi is flowing out of the body through the needle. When the spike disappears, the signal has stopped, and the needle is done with its work.
• If it represents a signal from the body about the state of the qi, rather than some aspect heat output, our use of the height of the edge of the layer makes more sense.
I am sharing this with you so that you won’t be confused [or at least be less confused] when you see the use of the term QSA in the context of EV publications and teaching. I also wanted to share some of the process that we’ve gone through as we approached this issue. As always, the core aspect of EV is a constant checking, re-evaluation, and adjustment in our interactions, whether that be with patients, with our teachings, or whatever. Even when the checking is overdue - as here in terms of QSA or, in clinic when you’ve neglected to check things after needling - it is always useful to check and recalibrate.
1. Jean-Pierre Barral, Manual Thermal Diagnosis (Seattle: Eastland Press, 1996), which is an excellent source for a basic understanding of this approach. Note that the original name for this book was Manual Thermal Diagnosis. I was one of the translators of the English edition.
2. Ibid., 3.
3. These are Rayén Anton, Ferdinand Beck, Kailey Brennan, Marguerite Dinkins, Felix de Haas, Manuel Rodriguez, Bart Wintjes, and Velia Wortman.