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On greeting

a friend
An approach to needle technique

A friend of seclusion arrives at my fence We wave and pardon our lack of decorum A white mane gathered back Patched robe loosely draped Embers of leaves at the end of the night Howl of a gibbon breaking the dawn Sitting on straw mats facing in quilts Language forgotten we nally meet.
Sh W (

)1

By Charles Chace

n Charles Chace has studied Chinese medicine and its literature for over 25 years. He graduated from the New England School of Acupuncture in 1984. He is the author and translator of a variety of books including A Qin Bowei Anthology, translations of the writings of one of the architects of modern Chinese medicine, with Yang Shou-Zhong, a translation of the first textbook of acupuncture from 100 C.E., The Yellow Emperors Systematic Classic of Acupuncture and Moxibustion (Huang Di Zhen Jiu Jia Yi Jing), and with Miki Shima, Channel Divergences, Deeper Pathways of the Web. Charles maintains a clinic in Boulder, Colorado.

S A LONG-TIME STUDENT OF acupuncture, I have had the opportunity to observe and experience the needle technique of many skilled practitioners of the art. Without exception, I have found that those who are the most effective seem to do the least. They simply address the needle to the point, in many cases without even inserting it into the skin, and things begin to happen. I must confess that I am not at all sure what it is they are doing, but I am reasonably condent that their fundamental orientation is rarely based on principles of active qi propogation. Simply put, they are not just zapping their patients with their awesome qi-power. Moreover, whatever the visible method or form these acupuncturists may be using, it is largely a means to an end. The individuals I have had the privilege of studying with have invariably been generous in their willingness to describe the mechanics of

their techniques. In general, they have been very articulate regarding the details of their stance, the positioning of their hands, and the relationship of the needle to the skin. Beyond this the words typically trail off. It is obvious that their method is a form or vessel within which something much more profound is happening and yet it is at this crucial point that their vocabulary for what they are doing falls short. To be sure, the problem may well lie with the listener. It may be that they are speaking in terms I cannot hear. Then again, perhaps what happens beyond the form of a needle technique is something that can only be demonstrated or pointed at, something that each of us must discover for ourselves. Still, Im not convinced that this must necessarily be a wordless teaching. In the course of working on my own needling I have had to develop a personal vocabulary for the experience of what lies on the far side of the mechanics of a needle technique, to verbally dene the ground necessary for me to be effective. It has been immensely helpful to me in so far as it has enhanced the efcacy of my practice and enriched my understanding of the medicine. It may be a language spoken by one, but then again, perhaps its in a dialect that others can understand. One of the most elegant passages I have encountered anywhere in the Nei Jing speaks directly to the relationship between mindset and technique. I have read it again and again over the course of many years and its meaning, or at least an interpretation that is meaningful to me, has slowly but profoundly inuenced my practice. Chapter Nine of the Ling Shu describes the state of being necessary for effective needling.

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Chapter Nine of the Divine Pivot (

In all methods of needling, one must examine the patients form and qi.

If the form and esh have not yet deserted, there is little qi, the pulse is also agitated ( ) and the patient has irascible reversal ( )2, then one must use cross needling so that the scattered [zheng] qi may be retained ( ) and the accumulated [pathogenic] qi may be dispersed.

[The practitioner must] deeply reside in a place of stillness ( ) and divine ( ) the comings and goings of the spirit with ones [sensory] doors and windows shut. The practitioners] ethereal and corporeal souls must not be scattered, his mind must be focused, and his essence qi undivided, and undistracted by human sounds. By concentrating ( ) his essence, he must unify his mind and direct his will entirely toward needling ( ).

means of directing ones attention entirely on needling. In needling from this place we simply wait for the qi to arrive and then stop ( q zh r xi). This is a pivotal point. The author of this passage makes it clear that needling is not about going forth and acquiring the qi. As he denes d q ( ), we simply await the arrival of the qi in a state of attentive and receptive stillness. We are not focusing our qi and attention inward with the intention of then directing it into the patient in the hopes of somehow prodding, goading, or coercing the arrival of their qi. Throughout his Exposition on the Eight Extraordinary Vessels ( q jng b mi ko) (1577), L Sh-Zhn ( ) emphasises the importance of stillness as the basis for activating the extraordinary vessels. His book presumes a deep familiarity with both medicine and alchemy, as well as a capacity to blend the two disciplines. Li is especially fond of quoting the 11th century Daoist adept Zhang Bo-Duan ( ) whose own book on the use of the extraordinary vessels, the Eight Vessel Classic ( B Mi Jng) states:

This is a bit of a paradox because the moment we begin looking for something to happen is when we typically prevent anything from happening.

[In this way, the practitioner may skillfully practice] shallow insertion while retaining the needle, or gentle, supercial insertion so as to successfully transform the patients spirit ( ) and as the qi arrives then one stops ( ).

The restoration of yin and transformation of yang is what facilitates the return to the origin. [By means of] utmost emptiness and utmost quietude those who follow nature will y up and 3 become transcendent. For L Sh-Zhn, any interaction with the extraordinary vessels must be rooted in emptiness. He says nothing to suggest that they can be willed open or manipulated by force. It seems that a ground of stillness is essential to whatever level we are needling. Needling not only requires that we be still within ourselves. Though we must remain attentive, we must not have any agenda about what is going to happen. This is a bit of a paradox because the moment we begin looking for something to happen is when we typically prevent anything from happening. Lacking an agenda, we must trust the bodys intelligence. We are midwives to its own reorganisation, not surgeons seeking to take control and x something. The basis for the sensibility described in the medical texts mentioned above is well developed in an earlier work, the Inward Training ( Ni Y), a text devoted exclusively to internal cultivation that probably predates even the Lao Zi. In simple and elegant verse, the Inward Training speaks directly to the manner in which we should engage the qi. Therefore this qi, Cannot be halted by force,

For males [needle] more deeply [ ] and females more shallowly [ ]. Firmly resisting ( ), dont [let the yang qi] emerge, carefully harbouring ( ), dont [let the pathogenic qi] internalise. This is called obtaining the qi ( ). There is a lot going on here. However we chose to needle, we must rst examine the patients physical form or structure, as well as their qi. This information determines the nature of the technique that will be applied. In needling, we must reside in a place of stillness with our sensory doors and windows shut. This is an allusion to the Daoist cultivation discipline known as returning the senses ( fn guan, translated by Cleary as turning the light around): a conscious exclusion of the sensory input from our external environment. In practice, however, the return of the senses is more often interpreted simply as the inward direction of ones attention as opposed to the active exclusion of external stimuli. It is a

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We need only be still, and introduce the needle, a tangible expression and extension of that stillness, and the patients system will reorganise itself around it. Once we have identied the precise place for that to happen, there is little to do but greet the qi and marvel at its intelligence. Nothing could be simpler and yet few things are more difcult.

Yet it can be secured by virtuosity. Cannot be summoned by speech Yet it can be welcomed by awareness. Reverently hold on to it and do not lose it. 4 This is called developing virtuosity. The principle of welcoming the qi in a state of quiescent awareness is almost the antithesis of obtaining it, of dragging it kicking and screaming to the point. Perhaps more than any other, the sensibility suggested in this passage has transformed my practice. Its not the word welcome that I keep in my head so much as a feeling of welcoming that I store in my belly, and it is the core of my approach 5 to needling. We need only be still, and introduce the needle, a tangible expression and extension of that stillness, and the patients system will reorganise itself around it. Once we have identied the precise place for that to happen, there is little to do but greet the qi and marvel at its intelligence. Nothing could be simpler and yet few things are more difcult. For me anyway, its hard to do nothing. It is harder yet to become still and to continue paying attention when there is quite literally nothing to do. I think that what the Ling Shu is describing here is a potent expression of effortless action ( w wi ). We must rst discern the disposition of a situation, the specic propensity ( sh) our patient has toward health or disease. This allows us to position ourselves in the optimal place. Effective inuence arises from providing a pivot of stillness here. The rest takes care of itself. The thing that took me so long to understand about this approach is that we have to really show up It does not work to stick the needle in and then get on with thinking about the formula that needs to be written, or what is for dinner. We have to be willing to stand there and attend to whatever is or is not happening. This is especially hard when there is indeed nothing happening, and yet that is precisely when, if we are able to maintain our awareness, useful things begin to occur. Even when we just put the needles in and exit the room, leaving the rest to the patient, we must remain present enough to greet the qi with every insertion. The real trick for us as clinicians is retaining some seed of this stillness as we move around the table and on through the course of a busy practice day. In this regard an acupuncture treatment is more akin to taijiquan, than it is to shikantaza or sitting meditation. When we are still enough to attentively welcome the arrival of qi, we enter into a conversation with the patient. Their system knows more about itself than we could ever hope to and it begins to talk to us. We do not presume to tell the patients qi what to do; we are simply providing it with an axis or hinge around which it can sort itself out. We ourselves quite literally become a divine pivot ( lng sh). Chapter Nine tells us that once we have

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welcomed the arrival of qi we should then stop . Perhaps this literally means we should remove the needle. Perhaps it is simply a way of emphasising that the most important part of the process has already been accomplished. Whatever further needling we may choose to perform is merely an expression of this pivot. If we are listening, after a while the patient will begin to tell us what is next, not just from changes in their pulse or abdomen, but from the totality of their qi. Yet even in our attentive stillness, we must take care not to listen too hard, to get too interested. We should not try and peer into the patients channels as if we were looking up their skirts. This is almost invariably irritating, even if patients are not consciously aware of it themselves. We end up assessing an irritation that we have created ourselves: some funk in a patients Liver channel, maybe, that weve actually put there. By patiently remaining rooted within ourselves the channels will talk to us. Our passage from the Ling Shu begins by telling us that we must consider both the form and the qi when needling. It is worth remembering that it is speaking in both general and specic terms. The specic technique it refers to is cross needling ( mao c), a method used for relatively supercial musculoskeletal problems affecting the network vessels. Yet, the state of being it describes is clearly a prerequisite for needling at aspects of form, qi and spirit. We must therefore have some idea of what facet of the channel system we need to contact as this will have some bearing on the depth of needle insertion. After all, we have to be in the right place to properly welcome the arrival of qi. In my experience this has little to do with the actual depth of the needle. In practice, the depth of needle insertion varies from practitioner to practitioner and from patient to patient. I routinely mobilise the motility of the Lungs and other viscera with an insertion of less than 2mm and often with simple contact needling. This is not an expression of the magnicence of my own awesome qi power. It is simply a matter of bringing ones contact, through the needle, into conversation with the level or tissue of interest. To be sure, it requires a familiarity with the channel system and some basic anatomy but if I can learn to do it, nearly anyone can learn it. The Inward Training also speaks to the question of the form of ones needle technique. Its passages have helped me to better understand the focus of many of my teachers on the mechanics of a given technique. Form matters. Proper alignment is, of course, connected to the internal environment necessary for effective action. One cannot do an end run around the physical form and still hope to get to the essence of the matter. I have learned that the hard way, having tried and failed to do just that. According to the Inward Training:

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If you can be aligned and be tranquil, Only then you can be stable. With a stable mind at your core, With the eyes and ears acute and clear, And with the four limbs rm and xed, You can thereby make a lodging place for the essence. This essence; it is the essence of the qi. When your body is not aligned, The virtuosity ( ) will not come When you are not tranquil within Your mind will not be well ordered. Align your body, assist the virtuosity, Then it will gradually come on its own. This passage describes the nature of the alignment, though not its specic form. For me, this is not about needling from some xed quasi-martial pose. In its essence, I understand the Inward Trainings counsel on alignment as an encouragement towards a harmonious integration of body, mind and qi. Depending on the individual, that can look like a lot of different things, but it should be comfortable and relaxed. The way in which alignment promotes tranquillity is that it should provide a physical basis for us to ground ourselves. Regardless of how salutary the position is supposed to be, it is useless if it is not comfortable. Otherwise, we will never become still enough to welcome anything. Some of the worst needling I have ever done was when one of my teachers in Japan insisted I adopt a horse stance to accommodate a particularly low treatment table. The experience was all the more poignant in that I had just spent the previous year carefully working on my needling posture with the help of almost obsessive adjustments in the height of my expensive electric treatment table. There were no such tables at that training in Japan and I am just not a horse stance kind of guy. So alignment matters but there are no xed rules. Personally, I nd it useful to keep my head up. The needle does not need me to look at it and maintaining an upward but inwardly directed gaze keeps me rooted within myself even as I attend to what is going on underneath my hands. And I try not to slouch. Similarly, the smaller details of any needle technique are still relevant. Closing the hole or leaving it open, needling with the ostensible ow of a channel or against it, inserting with an inhalation or an exhalation all make a difference. But in my experience, these things are not in and of themselves guarantors of efcacy, regardless of how rigorously they are applied. They simply provide an optimal vessel for something deeper to happen. The approach to needling I have described here is consistent with the basic goals of all tonication techniques: an arrival of qi lls a perceived insufciency. What about drainage? To my mind, this perspective begins to blur the distinction between tonication and drainage even as it challenges us to examine our assumptions regarding what such

terms really mean. Are we draining in the sense that we are actively sluicing out a channel pathway or are we draining in the sense that we are providing the body with a means for more effectively redistributing its resources? My personal orientation is toward the latter. To whatever degree we may intentionally facilitate such a redistribution, we are still doing so in a manner that will allow the body to decide for itself precisely how that is going to happen. An ideal way to begin to experience this approach is by working on the musculature, channel sinews and network vessels on the upper back. Pick a knot or tight spot. By any denition, indurations such as these surely represent a localised excess of qi and blood that should be drained. Find some little bit of stillness within yourself and having contacted the tissue at the appropriate level with the needle, attentively welcome the qi. There is no agenda, no goal. You may feel nothing. The less you feel, the more you should root within yourself even as you remain attentive and in the present. At some point the qi will arrive and you will probably feel things start to move. The needle is not actively manipulated. You are merely providing a pivot, an axis for change. The tension in the tissues under your hand will begin to relax. Its not uncommon for the person youre working on to feel large planes of fascia release. You have released a localised blockage of qi. Is that a drainage technique? Depressions and areas of accidity often lie right next to such knots and indurations. Locate one of these and needle it in the same way. Once the qi arrives, you will probably feel the area begin to ll out or become less accid. Is that a tonication technique? It would appear that you have accomplished two different things with the same technique. Admittedly, it takes considerably more practice to effectively use this approach on the primary channels and the extraordinary vessels, but the principles are the same. At this point, distinctions of tonication and drainage begin to lose their meaning. By simply greeting the qi we can sidestep some of the perennial conundrums associated with the ideas of tonication and drainage and to attend to our fundamental goal, which is to balance the qi. I am not suggesting this approach is in any way superior to qi gong-based techniques of active qi propagation. On the contrary, I see them as mirror images, different means to one goal. My predilection merely draws me towards one rather than another. I am cerebral by nature and I like to take charge; ne qualities for an herbalist but not always the best way to practise needling. As a counterpoint to this I have tried to foster an approach to acupuncture based on effortless action. Greeting the qi in a state of tranquil awareness has been an effective means to this end.

Endnotes
1. Translation by Red Pine, The Mountain Poems of Stonehouse, Empty Bowl, 1986. 2. Irascible reversal: a condition of internal qi deciency with an excess pathogen in the vessels, causing agitated movements together with cold hands and feet. 3. Chace, Charles, and Miki Shima, Exposition on the Eight Extraordinary Vessels, A Translation and Commentary, Eastland Press, (2007) 4. Translations from the Inward Training are mine, with reference to Roth, Harold, Original Dao: Inward Training (Nei-yeh) And The Foundations of Taoist Mysticism, Columbia University Press, New York, 1999, and Rickett, W. Allyn, Guanzi, Political, Economic, and Philosophical Essays from Early China, Volume II. Princeton University Press, Princeton New Jersey, 1998. 5. I am indebted to John Chitty, one of my teachers of craniosacral biodynamics, who rst showed me what it meant to welcome the innate intelligence of the body.

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