The Fine Art of Subtle Manipulation

Acupuncture stimulates the embodied spirit to change life process (qi). Manipulating needles conducts movement to unblock vital flow or attract it to emptiness. Acupuncture focuses movement and responsiveness to enhance the potency of specific vital functions. This art stimulates the emergence of healing as a natural expression of the embodied spirit, rather than attempting to control the symptoms or signs that communicate distress.

Of course, individuals want to diminish the intensity and severity of unpleasant symptoms. Many patients seek treatments with proven benefits, often through controlling the expression of pathology, even if the relief they seek is fleeting. Unfortunately, attempts to control pathological expression simply displace the embodied spirit's struggle, rather than resolving it. They elicit rebellion from the embodied spirit which renews the very symptoms or signs one had tried to control. This cycle of short-term control and rebellion reinforces the original pathology by training the embodied spirit to re-create it.

The challenge of understanding the true meaning of symptoms and signs arises from the practitioner's tendency to identify with the individual's personality, rather than with the embodied spirit. The personality projects the individual's point of view onto all experiences. Specifically, most perceive diseases and the symptoms they cause as afflictions. Individuals often just want unpleasant experiences such as symptoms of disease to go away. They aren't willing to learn from them.

The theories of classical and historical Chinese medicine inspire us to slow down that reactivity toward symptoms. Rather than simply attempting to control them, our highest work "sorts out" and resolves their sources (see "Treating Patients with Chronic Disease," Acupuncture Today, Aug. 2006). Can we learn to graciously accept the dao exhibited in the microcosm of each patient's physiology and visualize the embodied spirit's point of view even while interacting with the patient's personality?

The embodied spirit attempts to communicate its distress through symptoms that functionally support its needs. Frequently, symptoms limit the individual's ability to interact in certain ways that allow the embodied spirit to focus on the challenges already manifesting without further blocks presented by difficult input. Symptoms also are the embodied spirit's primary means of communicating the nature of its challenges to the conscious mind. While we have compassion for the suffering personality, accurately discriminating a patient's condition requires that we identify with the embodied spirit.

Listening carefully and consistently to its expression allows practitioners to "sort out" and support its efforts to sustain life by clearly addressing pathogenic causes that block the individual's vitality, rather than suppressing symptomatic expression. On the other hand, even successfully managing the expression of chronic and degenerative conditions condemns one to reinforcing the hold they have on the embodied spirit. Freedom from chronic and degenerative pathologies is available to patients who can disentangle from the habituated patterns of distorted function that support them.

The embodied spirit's attempt to block the penetration of external pathogenic factors leads to various transformations that shift the expression of distress and thereby inform us regarding the status of the individual efforts to sustain his or her life. Rather than simply classifying and controlling the manifestations of distress, if we can accurately sort out responses from causes, we can stimulate patients to engage profound healing.

Enhancing responsiveness (wei qi) stimulates healing by allowing vital process (zhengqi) to flow where it's needed. Often, the embodied spirit then confronts various accumulations and stagnations arising from both external and internal pathogenic factors that it had previously tolerated and moves toward resolution. Asserting control over a perceived affliction inspires rebellion and ultimately leads to exhaustion and collapse. True healing ensues from slowing down the individual's response to blockage and working through factors that impede release.

The invitation to probe and stimulate patients' embodied spirits with acupuncture needles carries with it the responsibility to do so clearly on their behalf. Acupuncture doesn't exert control through this manipulation; it stimulates release of holding patterns that allows intrinsic movement. Placing needles at specific points doesn't simply apply the functions of those points. It doesn't "manipulate" the embodied spirit in the usual sense of control, but rather probes and stimulates movement. We invite patients to heal rather than attempting to control or manipulate symptomatic expression.

The dynamics of needling provides a wonderful model for all our interactions with patients. We must differentiate between "gross" attempts to manipulate behavior by asserting claims concerning prognosis from "subtle" attempts to engage patients to participate in their healing processes. People are understandably interested in outcomes and many are insecure about their potential to experience less severe symptoms. Yet, while a practitioner may have considerable experience treating patients with a particular ailment, no one can predict the willingness of a particular patient with that ailment to engage the healing process.

The most common metric for evaluating health care options is effective short-term control of symptoms. Practitioners and products that can demonstrably satisfy this metric with safe treatments can easily sell them to patients who are ripe for manipulation to consume services and goods. The pervasive focus on "proven" results generally prioritizes attempts to control the expression of distress, rather than the messy work of resolving the sources of an individual's pathology.

We fail patients when we don't address the habituated choices and reactions that distort their intrinsic physiological processes and eventually lead to chronic and degenerative pathologies. Passive forms of health care manipulate patients into dependency. While this may be good economics for providers in the health care industry, does it provide the best public health for society? Although health care is a service often relying on various products provided to people who are struggling with health challenges, our best practitioners work creatively and effectively to obviate the continued need for those goods and services.

Chinese medicine offers us many tools beyond needles for subtly manipulating a patient's embodied spirit. Asking penetrating questions is one of my favorite ways of probing and stimulating a patient's embodied spirit. I need the information gathered through careful questioning and it alters many patients' behavior. They generally pay more attention to their lives. Some are inspired to make notes of how they feel and the quality of various vital functions, so they will be better able to respond at future sessions.

I depend upon careful questioning to discriminate a patient's dynamic struggles. The answer to some specific question concerning the timing or nature of various symptoms often provides the key to clarifying the embodied spirit's story. These penetrating questions seek real differentiations that often lay beyond patients' conscious recollection. Important as that clarification may be, enrolling the patient in paying attention to his or her life is far more important. This engages their yuan (source) qi to realize its role more consciously in creating their lives.

Patients also carry these unanswered questions into their needling sessions. Subtle manipulation of needles during these sessions may guide the embodied spirit to identify habituated drains on the individual's vitality. These realizations often support healing more than any specific intervention. They generally are more effective than enrolling patients in our ideas to support their healing and definitely better than convincing them to acquiesce to our instructions.

The willingness to pay attention to and follow the embodied spirit's gestures to communicate through generating symptoms is the foundation of long-term health. Health is not a consumer good. It's a focus in life; a cultivation of the embodied spirit. Good health grows from the willingness to pay attention to messages from the embodied spirit and make choices carefully to support its vitality.

Many people seem to mistake the nature of the contract between the spirit and the body. While the spirit is contained within the body and activates it, the body is not a slave to the spirit's whims and desires. The "physical" body also is the active embodiment of the individuated spirit, particularly its core or deeply habituated blocks. We can use awareness and rhythmic movements to dredge out habituated blocks that have become somatic and release them with the breath.

A picture is worth a thousand words, except when it comes to musculoskeletal pain (bi syndrome). Multiple research projects using modern imaging technologies to investigate back pain have found very poor correlation between the size and location of lesions and the severity of clinical symptoms. The lesions themselves don't cause pain. The struggle of the patient's embodied spirit with the lesions and (in the case of degenerative lesions) the habitual struggles precipitating the lesions generate pain.

Gross attempts to manipulate symptoms ultimately are doomed. Generally, behavior that acquiesces to instructions rebels. Yet, if we are inspired in all our interactions by the subtle manipulations of acupuncture that stimulate release, we can facilitate profound healing. Our central goal is to focus and encourage the patient's embodied spirit to find ways to support their vitality.