söndag 22 september 2013

Dr Wang Juyi and Channel Theory in Chinese Medicine, part 2

This year, Dr Wang Juyi has worked as a doctor in Chinese medicine for fifty-one years. He became known in the West through the book Applied Channel Theory in Chinese Medicine, written with his apprentice Jason Robertson. Dr Wang is famous for his research into the clinical application of Chinese medicine, his appreciation of the Chinese medical Classics, his system of channel theory and palpation, and his constant wish that his students surpass him in skill through applying these principles. In this second second article we keep looking at Dr Wang´s system and his own historywhich spans half of the 20th century of Chinese medicine and into the 21st. This time, we will look further at his life, his system of palpating channels, and his study of point-pairs in acupuncture.
Dr Wang Juyi graduated with the first university class in Chinese medicine in 1962. His teachers were all trained in older styles of Chinese medicine, among them names that later would become famous in the West too, like master herbalist Qin Bowei and ”Golden Needle” Wang Leting. Dr Wang´s working life has been in the state hospitals in China; he has seen TCM be shaped out of the Classical Chinese Medicine (CCM), been head of the hospital he worked in, editor of Chinese Acupuncture (the Lancet for Chinese medicine) and finally gone into private practice in Beijing, which he still maintains. Today, he is 75, tall, with good energy and a strong, gravelly voice. He takes obvious joy in transmitting his research and knowledge to younger generations.

Graduating with the first university class in 1962

What was that class like?”
  ”Well,” he says, ”a lot of the teachers didn´t have any experience in teaching.
They usually lectured according to the Classics and talked about their clinical
experience too. We were the first university class ever, a brand new idea, so
things were being tried out as we went along. And when new students didn´t
understand, many teachers weren´t interested in helping them.”

We are sitting in his own clinic at his desk with translator and student Jonathan Chang behind him. And behind Jonathan on the wall is the famous quote from legendary doctor and Daoist Sun Simiao of the Tang Dynasty, saying ”The Skilled Acupuncturist treats all patients equally”.
  ”And the class was just as varied,” Dr Wang adds. ”Some of my classmates
were already doctors. Others had just left high-school.”

When the students did clinical observation, often it turned out that what the teacher said in the classroom was not how they worked in clinic. Many students began wondering if the theories were correct or not. ”He gets good results in clinic, but why?” Dr Wang started questioning the gap between the two. He waivered between ”This is good..” and ”...but it doesn´t match the theory...”
   ”I often saw the effectiveness of their treatments,” he continues, in his gravelly voice, ”but I equally often didn´t see the theory that explained what happened. I had this view up until I began practicing myself. By that time, I had huge amounts of information memorized – point-combinations, herbal formulas, old songs of points and their usages – lots of it, but very little use in clinic. It was only later I began to understand how the theory fit with the practice, and by that time I had also started to research channel theory.” And this began his lifelong research into channel theory, channel diagnosis and point-pairs.

A deeper look at Channel Theory

For the first instalment and its overview of the basics, please see http://www.acupractitioner21.blogspot.se/2013/05/interview-with-dr-wang-juyi-on-channel_9265.html. This time we are going to look a bit deeper at Dr Wang´s system for palpating and diagnosing using the meridians, jingluo zhenduan.

Channel theory is, in my view, the basis for all Chinese medicine.” This is something he often says during courses. Then he guides students to some of the comments on this in the Classical texts to back it up (see part 1 of this series).

The foundation of his system is to palpate the meridians. This is done in specific ways, going along the meridian from the starting point (usually fingertips or toes) and ending at the knee or elbow. One reason for this is something called the Five Classified Points, or the Five Transport Points – sets of five points along each meridian who have a very strong and specific effect on the entire system.

Over the decades, Dr Wang has mapped specific pathological changes on the channels and what they indicate in the health of a patient. Each meridian has different indications in different places, depending on what kind of change it is and in which place. Students are also taught to feel for how the physical part of the meridian feels – is it tense, large, weak, or even soft? What´s the skin like? Is it smooth, grainy, is the fascia rough? Are there nodules on the channel? They can be soft, hard, come in different lines or be single. Where are they? Does the skin change anywhere on the meridian, or the temperature?

It is important to do channel differentiation, not just pattern differentiation. Always integrate channel transformation in your enquiries.”
                                                                                         – Dr Wang Juyi in lecture

Part of his channel palpation is five stages:

1) Observation

2) Palpation of blood vessels (including taking the standard pulse)

3) Palpation along channel pathways

4) Pressing

5) Light touching with palm

The Five Tissues and actually going home to a point

These palpation techniques will show which channels are affected, and usually reveal that one or two are the most affected, either towards yin or yang. The practitioner will then integrate the findings on the meridians with the diagnostic information gathered from tongue, pulse, and all the other diagnostics that are part of Chinese medicine.

During the palpation lessons his phrase is, ”You want to iceskate, not tapdance”. This helps students to flow along the channel inwards instead of stop-starting on small parts of it. The iceskating also aids relaxation, as the stop-start will more easily create a tense nervous system in the patient. Each point-location should be based on palpation skills, and each location will be guided by several of the five different tissues:

1) Skin

2) Sinew

3) Muscle

4) Blood (vessels)

5) Bone

The point will always be found in a crevasse.” When Dr Wang started out fresh from university, he followed what he had been taught; anatomical landmarks and images, same as is usually taught in Western acupuncture schools with more or less precision. But over time, he realized that they often didn´t match the actual location of the point. Many points were in slightly different places, and each person had their own size that he had to learn to adapt to. Then he had to find the point, open it, and finally needle. These days he teaches this individuality of physiology very clearly to his students, and have found a large number of point locations that in fact are slightly different than the textbook would try to standardize.

Except for trips and longer periods abroad, Dr Wang has lived in Beijing his entire life, and many of his similes about Chinese medicine are based on the city. ”Finding the correct location is as if you are going to meet a friend at their apartment. Many practitioners use a very general address when they are less specific about where the point is. But there is a big difference between being in the right neighbourhood, on the right street, or actually pressing the doorbell at your friend´s place.”

The Six Levels of Chinese Medicine: healing geography in depth
Daoist practices teach that the deeper in our system we feel, the deeper level of our emotions, mind and psyche we also activate and access. This is one reason why any qigong- or meditation-practice working on this should be taught in careful stages over a long time. Speeding that process up often creates an unstable system in the practitioner, which is one of many reasons to look for a skilled teacher that one can have long-time contact with.

Dr Wang´s treatments are often phrased within the greater framework of something called the Six Levels. The Six Levels give a geography in depth of the body and mind of a patient (and of the practitioner). Each level is linked to two meridian systems at that depth, and their corresponding organs and emotions, and the way they help our internal landscape interact with our external one (you can find a longer blogpost discussing our internal landscape and Dr Wang´s view on the Jueyin-level at http://www.acupractitioner21.blogspot.se/2013/01/classical-chinese-medicine-and-body-as.html).

They Six Levels are written about in the Neijing, the oldest medical textbook, but really reach an apex in the Chinese medical classic called the Shanghan Lun, the Classic of Febrile Disease caused by Cold. The Shanghan Lun was written in the 200´s by legendary doctor Zhang Zhongjing. It charts the progression of how an external factor (an illness, or pressure from our surroundings) goes deeper into our system level by level. The book teaches the concept of bianhua, change, as it moves from one level to the next, and how the physician can stop it, intercept it, block it from moving deeper or help the system expel it.
The first and most external level of the Six is Taiyang, Ultimate Yang, which covers the huge area of the back of our body and includes the meridians of the Bladder and Small Intestine with all their respective organs, functions, and links to our emotions and mind. Then it continues deeper by stages until it reaches Jueyin, Absolute Yin, the deepest yin, the deepest levels of blood and stillness and healing in us, linked to the Liver and Pericardium.

The Shanghan Lun part I and II

The Shanghan Lun is primarily focused on herbal medicine. It´s writings have
given rise to one of the main herbal traditions of Chinese medicine – Shanghanpai.
During the Tang dynasty, legendary doctor and Daoist Sun Simiao also utilised
the system using acupuncture instead of herbs. In the Shanghan Lun, Zhang
Zhongjing wrote down diagnostics and treatments not only for each level, but
was also very detailed information about how far the illness has moved within
that level itself.

Clause 1-4: During the first day of febrile disease caused by Cold, the syndrome is at the Taiyang Channel. If the pulse is quiet, the syndrome is not transmitting into the next channel. When the patient is restless and nauseated, and the pulse is speedy and mighty, then the syndrome is transmitting.”
                                    – Shanghan Lun, Zhang Zhongjing, New World Press
2007, transl. Luo Xiwen

The original Shanghan Lun was split up and the second part is now called the Jingguyi Yaolue, Synopsis of Prescriptions of the Golden Chamber. One of the most well-known teachers in the West on Shanghan Lun, Dr Arnaud Versluys, adds that the original Shanghan Lun was meant to begin with external factors affecting us, while the second part of the book, before they got separated, was intended to cover internal conditions that affect us, thus giving a complete overview.

One should carefully protect one´s Body Resistance and avoid the attack of climatic pathogenic factors. Otherwise, channels and collaterals will be violated and health endangered. In case pathogenic factors have invaded the channels and collaterals, medical treatment should be given in time to stop the transmission of pathogenic factors into the viscera and bowels.”
                               – Jingui Yaolue, Synopsis of Prescriptions of the Golden
Chamber, Zhang Zhongjing, transl. Luo Xiwen, New World Press 2007

The Six Levels help us understand how problems and illnesses can begin at different levels in us, and how they can progress to become worse the deeper they go. For a practitioner, it should help us understand how to find at what level the patient´s problem is, and how to treat that and gently allow the system to open instead of trying to attack deeply into it to fix ”the problem”we perceive being there.
If you only rely on experiential points handed down to you, or tricks of the trade, you don´t understand why something works or not."
                                                                                  Dr Wang Juyi in lecture

Point-pairs: the synergy of simplicity

You can read a definiton of point-pairs in the box above, but in short, it´s the art and science of how one point interacts with another. A point-pair should create a synergy larger than the two points alone. Dr Wang has made it one of his areas of research, and systematically tried them out over half a century. He also worked in the state hospitals, which meant that a calm day was 50 patients, and some days he had a 100 – patients and treatments enough to slowly and patiently try things out, systemize them and catalogue them. In the West, a busy acupuncture clinic might have 30 or 40 patients a week.

Point-pairs have been used in Chinese medicine since antiquity. Dr Wang tried out the classical ones and the ones handed down in his family and from other older doctors. Some gave good clinical results, some not that much. He also did continous research on what different points did, and what different meridians were most effective for.

For example, his usage of the Heart meridian and the Pericardium meridian. In some Chinese medical schools, the Heart meridian is not used due to old custom. ”It took me a long time, but eventually I learned to separate the effects of points on the HT and PC meridians. I found out that the points on the PC meridian treats the cardiac muscle better, and emotional issues, while the HT works better for regulating or improving the conductivity of the heart, the endocardium and the valves. It took me decades to get this understanding in clinic, and to prove it clinically too.”

A point-pair example: visiting the Tai Yin level

In the book, Dr Wang collects many of the point-pairs he has tried in depth. But if you train for him he also goes through uncountable other ones that are less general and more focused on specific treatments. He usually says that using point-pairs increases the treatment effect while helping the practitioner to keep track of which points were actually successful in that treatment. And, very importantly, the fewer the points used, the easier it is for the patient´s system to listen to the information they are trying to give to body and mind. Using lots of points will be like standing in the middle of a train-station with 20 people screaming at the patient over the background noise. We looked at this in the previous instalment, but to quote Dr Wang,Don´t make the mistake that using more acupuncture points is better. It is quite harmful to the body.

We are going to take one example here to illustrate the concept of point-pairs.

SP9+LU5, Yinlingquan+Chize

This is point 9 on the Spleen channel, near the knee, combined with point 5 on the Lung channel, on the elbow crease. They share specific characteristics within their respective meridian, being so called hexue, he-sea points or uniting points. Their general effect is to treat counterflow and regulate organ qi transformation. It is here that the channel qi dives inwards toward the organs themselves. Hexue are placed around the elbows and knees.

There is a longer section on this pair in Dr Wang´s book, since it is very useful and treats a broad range of conditions. It is a primary pair for regulating and treating the Tai Yin (Ultimate Yin) level of the Six Levels, which covers the Spleen and Lung and sets a rythm in the body. To write on all the effects of this pair would demand a separate article, but some of the conditions it helps with are general oedema, psoriasis, gynecological issues and grief, it helps stabilize the heart rythm, tonify qi, build houtianqi – post-birth qi – and increase the general quality of fluids in the body.

Using this pair will also create a general resetting of the qihua, the qi transformation in the Tai Yin level, and help regulate the ascending/descending movement of the lung while giving a stimulation of the movement of clear qi upward from the spleen. One of Dr Wang´s senior students, US-based Yefim Gamgoneishvili, used this pair so much for a while and with such great success that Dr Wang started referring to him as ”SP9 LU5”! In the third part of this series we talk to Yefim in an interview I did in Beijing in the spring of 2013, and he will describe his experiences using Dr Wang´s system for fifteen years here in the West.

Dr Wang uses the SP9+LU5 pair as a yin-version of the very well known Four Gates, Siguan, (LI4+LIV3), and he often uses it as a general treatment for many patients before becoming more specific in treating their condition. A very important factor is that it sets a rythm in the body again, something even more crucial here in the West where people have such a stressed and erratic lifestyle.

The future of Chinese medical training

Oh. Right. Well, before our class,” says Dr Wang, ”there were two different kinds of training in Chinese medicine in China. There were smaller schools, where courses usually lasted 3-5 years, and pre-liberation we also had live-in apprentices. Often people learned from their family first – in the educated middle classes, many had studied Chinese medicine on their own or in the family, so knowledge was handed on.” The live-in apprentices started at 14-15. The arrangement was that they didn´t pay, but worked for their teacher and got food, lodging, and knowledge back.

In his book on the Shanghan Lun used with acupuncture, Classical Chinese Medicine-practitioner and Daoist Jeffrey Yuen adds that there was another version, mentorship, where the person gave their life savings to a master and then took them on as an apprentice.

Once the universities began, though,”, says Dr Wang, ”there were still apprenticeships and continued education classes outside, but less than before.”
  ”Do you think the current system works, compared to the old one?”
  ”Fairly well,” he nods, slowly. ”I don´t completely agree with it, though.
There are too differing levels among the teachers in the courses. I hope
that the training system will be improved. One thing that I am involved
with is to do this, where we want the courses for basic education, but then
a system of apprenticeship with a master on the side.”

Two courses with Dr Wang will be held in Dublin this year, again arranged by Cyril Bonnard. One course will be on the basics of Dr Wang´s system, the other more advanced for those with previous experience. Courses begin on the 14th of June and clinic days have been arranged to add more depth. If you are interested, you can find more information at www.equilibreacupuncture.ie.

Daniel Skyle © 2013. Daniel Skyle is a student of Dr Wang Juyi. He has trained in Daoism, chinese medicine, qigong and the internal martial arts for more than twenty years. He currently has two clinics in Sweden where he works with Classical Chinese Medicine, acupuncture, and acupuncture for aid-work. His blog, with the previous instalment of this article, can be found at www.acupractitioner21.blogspot.se. He will soon publish the first book on Daoism in Swedish, Daoism - the Tradition of Change: shamen, mountain hermits and meditation masters, which will come out in English in 2014. It contains a chapter on Chinese medicine and Daoist medicine, and is the first in a series of books on Daoism as a living tradition, with interviews with Daoist practitioners in China today. Next is a book of essays on spirituality and spiritual practice, including material from Classical Chinese Medicine. His books can be pre-ordered through acu@smallchange.se

The term ”point-pairs” refers to two points often used together in an acupuncture treament. Each pair can be thought of as having a specific effect on qi transformation which, when properly chosen, helps to transform a pathodynamic in a way that might be likened to turning a key in a lock. Point pairs should not be thought of in the context of treating a particular symptom or even disease, but should always be considered in the context of their effects on the physiological system as a whole. This is a very important point. When considering the information below, the practitioner should always keep in mind that these pairs are understood as having specific effects on the qi transformation of the channel system. They are not used to ”treat headache” or even for basic TCM functions such as ”resolving dampness”. Each pair has a specific effect on the qi transformation of one or more of the six channels, as described in earlier chapters.”
                                    - Extract from Applied Channel Theory in Chinese
Medicine – Wang Juyi´s lectures on Channel Therapeutics, by Dr Wang
and Jason Robertson, Eastland Press 2008