The medicine of east Asia is based on a science that does not hold itself separate from the phenomenon that it seeks to understand our medicine did not grow out of Petri dish, experimentation, or double blind studies. It arose from observing nature and our part in it. East Asian medicine. From the examination of debt structures, but rather from living systems with their complex mutually entangled interactions. Welcome to qiological. I'm Michael max, the host of this podcast that goes in depth on issues, pertinent to practitioners and students. Of east Asian medicine, dialogue and discussion have always been elemental to Chinese and other east Asian medicines. Listen into these conversations with experienced practitioners that go deep into how this ancient medicine is alive and unfolding in the modern clinic. Welcome back to geological. My guest today is Willmar's will has been a shining figure in our profession for a long time. He is the past president of. In Austin. He was president there from 2005 to 2015. He is a frequent contributor to the dialogue. Of our profession. He writes for acupuncture today. He does regular articles for American acupuncturist. He's the author of neoclassic post-diagnosis and also the author of transformation, treating trauma with acupuncture and herbs, which is actually the subject of our conversation today. He has a deep background in post-diagnosis. Which would be a great subject for another podcast. Uh, in addition to all that, he's a musician, he's an astrologer, he's a writer. And I'm so delighted to have you here today on qiological to talk about helping our patients recover from trauma using, uh, the wonderful methods of Chinese medicine and acupuncture. Welcome to

qiological. I thank you, Michael. Thanks for having me here.

I'm psyched about this.

That's great.

Yeah. That's always fun. I'm always curious to know what were some of the influences that got people. Sort of started in the direction that they're going, that they went and, and, and took them to certain things. And what I'm curious about since today, the subject is treating trauma with acupuncture and Chinese medicine. What is it that drew you to treating trauma with these methods? What, what was the initial stuff that drew you and, and what were some of the influences that you first found that kept you going on this.

Oh, well, my practice began in 1980 and I was using some forms of, uh, acupressure, Jin shin DOE form of active pressure, which was influenced in part by Vail Helmerich now, right? Yeah. It's kind of far out. Yeah. Uh, in particularly the breathing and the issues around the diaphragm. And so. So there's a lot of breathing techniques that are used. And as a matter of background, of course, feel home. Rick was the, one of the major disciples of Freud as was young and, uh, some lesser known people, such as Otto, Ron, who was essentially the godfather of the whole rebirthing movement. So woven into all of this as these, these tools for process that cathartic release. Um, using breathing techniques and so forth, but what happens in the acupuncture clinic is that oftentimes during the process of case intake or, uh, working with the patient on the table, they'll come to a cathartic release. And it's my opinion that, that the field itself, at the level of entry-level education needs to develop better content around the management of cathartic release.

I've seen this in my clinic and it's often unexpected, but sometimes a few well-placed needles indeed will bring really brings something up in a patient and they're not at all prepared for it. And they're not sure what to do with it. And, and certainly as practitioners, if we don't have any background with this, then there's not a space to hold it here.

That's right. And so of course, Reich influenced, uh, uh, a whole host of movements, including what's called Neo Reich in which I did a few years of, uh, in the early eighties, as well as the rebirthing movement, which I did a few years of in my, my oldest daughter was born, um, using those techniques in the early eighties. Now they'll home Reich influenced heavily my book transforming. But to go a little bit further. I subsequently studied with a Leon hammer. Who's a psychiatrist practicing Chinese medicine, and I spent seven years, um, under Leon, uh co-teaching with him, the work of, uh, John HF Shen who I had shared patients with since of the mid eighties, I found myself in a committee. Uh, enjoyed seeing Dr. ShaoYin on the east coast and when they were on the west coast, they would oftentimes come to see me. And I, I managed to see many of the formulas that Dr. Shin used in the course of his care. And, um, and so understanding the nature of the problems that each of these patients was undergoing. I was able to, um, put together a real living sounds of a master at his craft.

Right. And, and through the process of actually doing work with these people, not just like a student observing, but actually co-treating in

a sense co-treating and, um, although we never dialogued, I saw all, I saw the formulas that he was providing through them. Yeah.

Well, w we know that watching and seeing another practitioner formulas is a type

of dialogue. That's absolutely good point. Very, very good point. Yeah. So, uh, so this, uh, this work, uh, has been a rather constant thread for me. And I just like to point out that, um, that Reich's approach to management of cathartic release was to focus top-down. So if there's armoring and furrowing of the brows during a cathartic release, that would be his first place to look, to bring the patient's awareness, to degenerate a softening and a clearing. And then the next would be the ocular surface. And making sure that the eyes are soft and that there's a clear gaze, uh, while the cathartic release is taking place. And this is not an easy task to be done, but his basic principle was that those upper zones should be cleared before going like say straight to the diaphragm, which is how I learned it. Intention DOE or, or, uh, and then, and then the pelvis would be of course the Le the last, uh, because of significant forms of psychosocial. Armoring that take place in. In the reproductive track, but this was, so this was, uh, an approach to the problem, which was very different than what I experienced in my training, which was generally, uh, an attempt to placate or soften the eruptive emotional content. And then I'd like to say that, um, um, one of the very big messages that I bring to the table is. If during the intake, the person is going through some form of a release or getting into contact with deep and difficult, uh, shadow material in their history. That is the time to be taking the pulse that the pulse should not be, uh, an abstracted moment, which is taking place. Oh, I've, I've done my history and now we'll do my physical exam, which is how medicine is taught in general. So this is a very different process where we want to understand what the physiology is communicating about, that individual's experience in order to construct a formula, which is, um, most tightly conforming to that moment of the experience. Rather than their compensated state, which is when they get it all back together and we take the pulse then, and that's a, that's a different set of biological signals rising up at moment. That's a whole

different situation. There's a glimpse that you can get. If you'll take the pulse, when they're in contact with. Th that deeper emotion that's erupting out. Exactly. That's totally makes sense. I mean, I, of course I was trained the way that all of us were trained and you know, but just now as we're having this conversation here and you say that it, it just lands like a ton of bricks, it's like, well, yeah, that would be useful information. And the difference between a pulse in, in a moment of emotion and a pulse in a compensated state will probably also give you some ideas about. Uh, about what those relationships are between those different parts in the

patient. That's correct. And, um, and as, and if it's done regularly enough, one can begin to identify patterns of response to experience. And especially if one's Paul's vocabulary has expanded to that of say the eight extraordinary vessels. As in addition to the conventional 27 or 27, 28 qualities of a leash. Right.

Wow. So a lot to tap into, without even hardly talking to people, if you really want to just work at that

level, it can bypass the narrative. Yes. Bypass the narrative. But the narrative is important for understanding what these signals are, but I find the signals to be, um, very reliable.

Okay. This early study that you've done with Rick has his quote and the pulse diagnosis is really what got you started.

Yes, I w well, in 1980 is when I started really focusing in on the pulse and I did so throughout the eighties, uh, primarily, uh, paying attention to Japanese practitioners. And then it's in 91 that I met. Leon had. And dove more deeply into the Bing family current as Dr. Shannon hammer represented. There's an Eastland press, a book called currents of Chinese medicine, uh, which addresses anthropological and historical sources of the ding family. Current.

Yeah. That is. Uh, fantastic book. Yeah. Yeah. And, and, you know, for our listeners, if you're not familiar with it, it, it gives a glimpse at some history of Chinese medicine that you're not going to otherwise get. And, and in some ways really informs today's practice because so much of that, uh, Mancha clan, so to speak their methods got transmitted through a number of different schools that, that come down to us today.

That's right. They influenced the development of, uh, uh, many mung hub practitioners influenced the development of Beijing. You see them university of course, which was, you know, the hub of PCM thought, contemporary heat, TCM thought.

Yeah. And Dr. Wong long whose book I translated his master's project was the Manchow doctors.

Yeah, I did not know that about him. That is awesome to know. Yeah.

Yeah. It was pretty interesting. We took a trip there to Monka at one point, I want to switch this. I want to move this along a little bit. Kind of change the direction a little bit, because I've got lots of questions here. Okay, great. And. You know, we've got, well, we've got a certain amount of time. Not that I want to be in a hurry, you know, with Western medicine. And this is just, this is something we all know. So it almost goes without saying there's, there's a really a complete split between mind and body. One of the great benefits of Chinese medicine is that is a unity that really was never broken. And. W one of the aspects of Chinese medicine that we all learned something about in Chinese medicine school, but it, at least when I was in Chinese medicine school, I'd say it was an introduction, but it was really not satisfying. It, it gave me some things to think about over the years as I've developed a practice. And that is how eats of each of the organs contains a spirit, right? The juror and the, in the kidney. And the hood and the liver and that sort of thing. I'm curious to know how you use each of these human aspects of the organs in your work with

trauma. I see. Uh, okay. Okay. That's uh, let's see how to approach this question. It's a big question. Yeah. So I think for starters, in, in transformation, uh, treating trauma with acupuncture and herbs, Uh, which was really a spinoff from my work on the classical pulse diagnosis and a current to my publication. Uh, Leasher gen pulse study is an illustrated guide that was with people's medical publishing house. And then, then this book came into, uh, received sufficient attention to get publications. And it was my first publication formally with my own publishing house, 33 publishing,

by the way, everybody we will have on the show notes page, there, any of the materials that we talk about we'll have links to it. So, um, there'll be clickable links, just go to the show notes page and you can get information on, on Will's work and books and that sort of thing.

Okay. So in there I'm dealing with the problem of self. Yeah, who are we as, uh, contemporaries, um, uh, uh, uh, identifying ourselves as human beings, making contribution to society. And, uh, and then in comparison, of course, with that conversation was in fina as closely as like approximate. And, um, it appears to me that the conception is an odd form of dualism between a unity field consciousness. ShaoYin uh, versus a fractal plated holograph of fractal holographics, state of being whereby the five Shen take residence within these Oregons. And, um, so that, uh, so that the ShaoYin is both a reference to a singular state of consciousness, but also a reference to these, uh, aspects of soul and. Uh, there are a number of approaches that I'm using for each of these, with juror and the kid name, of course, and the hone on the liver and the fin and the heart and the Paul and the, in the lung and the E and the spleen. And so I suppose the first job we have is reconstructing these ideas into something that's meaning for, uh, for us today in our clinics. So in my work, I have absolutely no need to precisely reproduced. Knowledges as closely as they were in the Han dynasty, because it's from my point of view, not actually possible, but rather I have to take these ideas as I can grasp them and utilize them in the clinic. And if it makes a difference, that's my goal. And so I've found these methods to make a difference in the course of my practice. And so this is a method. Of inquiry of scientific inquiry, which derives from the worldview of one constructivism, that we're always building the knowledges that we have to, uh, the idea of a, uh, a social moment, a recursive blending of interactions between the practitioner and the patient or the practitioner and the student. Knowledge gets distributed and test it out in what is called a participatory worldview. So this discipline is, um, at once a hermeneutics or a study of the text, but also a blending of family lineage, knowledges, but also that which is of a practical, real results oriented approach. And the clinic. So if I look at the, um, at the juror, well, this is, this is the will that I'm going to expand that knowledge. If I'm looking into the left proximal position, which is the location of the kidney, uh, yen, which is where I'm going to focus my attention or the problems with the juror. There are a host of approaches that can be used one, uh, method. Uh, that I use is called the compass. What I call the compass it's addressed in the Han dynasty lore of, uh, both the funky and aging. Also also the difficult classic, the yellow emperor's classic difficult classic, both address, uh, directional rotations of the finger upon a point in order to understand what's taking place. And of course these directions are derived ultimately from. Sean and Joe dynasty processes of ritual and actually had nothing to do with medicine, but had to do with order of the universe, as it is perspectively driven from the post. And it gaze down upon the planet and looking to the left for the, the east, which is the wood in the south, which was fire and the west, which was metal and the north, which is water. And then the center, which is earth. And this is true for each and every position. Uh, so that's one way to understand, um, how the juror's activating. So, uh, very specifically. I will, uh, if a patient comes in, let's say I'll give an example of a borderline patient who swings radically from a physical presentation of symptoms to psychosocial presentation of symptoms. Often from visit to visit. It may be a series of visits before the swing takes place. So when, uh, when the emphasis of symptoms or when the center of pathology is more. Psycho social sphere. We'll just go straight to this gen position that is the heart physician left distal position and perform the compass there for this person. Almost always the proximal sector will be more full. This is the zone of water, so that we go down to the kidney position and we look there and we, uh, do the role in all five directions, which Dr. ShaoYin also spoke of, but on the contrary, Assigning the five transformative agents, I guess another way to train. Translate these, these terms that any regards. So we go there and usually for this person it's more full and the fire sector, uh, the distal aspect of the proximal physician. And there, uh, this takes us directly to a point because the, the position gives us the channel upon which we focus. Right? So we're in the kidney position or the location of juror, which is in the kidney. And we're looking at the kidney channel. I address. And then we, uh, approach, uh, oh, the Firepoint on that channel and by, uh, even just touching kidney to where the fire point or, uh, needling that Firepoint, that pulse will even out instantly the state of the individual regulates. So it's a very direct method for psychosocial purposes of using a single needle. And, um, the stimulation of that point could be a needle, could be moxibustion could be tuning forks pressure. It doesn't make much difference what the tool or the application, the actual physical agent applied to the point is inconsequential to really. The point that's that's, uh, focused upon. So that's, uh, that's one technique. There are very many approaches to this problem of spirit or disturbances of spirit and each of their sectors or disturbances at the soul level. We can say, we're looking at this, this tenurable and folding of self back disorder. It was the real pathway here. We're trying to understand how we can bring a person into contact with source and that as they gain that access capacity to transform the material that they're working within the course of their life and to manage. Packets and to also reach a level of resolution at the relationship of self with source. So it becomes in part also what might be contemporary terms of an existential, uh, set of problems and the, what the COMPAS method brings to the table is a point of view in pulse diagnosis. Transcendent to the individual's location in time and space rather do is from an absolute location of time and space. The relationship of the Pollstar to the planet as performed in rituals of the ho John, Sean, and Jo dynasty. And then the way that those directions show up, say in chapter four of the major thing and, or various various chapters of the non-judging,

you know, this. Seems like it could be really, really helpful for a practitioner if they could dial in this kind of sensing of the pulse. And the reason that I say that is, I know at least in my own practice when working with people, there's, there's the very physical things going on. There's the psycho emotive or cycles a psycho-social for that matter issues going on. And it can be really easy to kind of get lost. It's like, I mean, they're there for help. And if it's just a physical level thing, I mean, sometimes it's so great just to have a physical level issue that really is just looking for some sort of resolve on a physical level, because in some ways that's easy and it's not particularly difficult to orient to, but when we get into these other aspects of self and being an unfolding as a practitioner, it can be easy to get lost. And. Having something sensate, something palpatory, something that we can go back to and go and get direct information from down to the point of, oh, this pulse suggests this point, touch this point. Ooh,

pulse different. If once, uh, w one is able to approach the matter by setting aside any sense of disbelief. That, which I can, how paid, uh, pulls me through all of the noise that's taking place during the course of case taking.

So if you can sort of see through the disbelief, this is, so this is an issue that comes up. I think for a lot of us in our practices about number one, learning to feel with our hands learning to. Uh, pay attention to things that we're usually not used to paying attention to. And then, and then once we actually start to get information at often very subtle levels, I mean, palpating, the pulses is a subtle art. How do we, how do we work through this thing of being able to feel something? And sometimes I feel things in the pulse and I go, well, that's an interesting point. I mean, I've got pulses that I've made up my own names for, because it feels like something that, that I've never been taught before. It's like, oh, they are, oh yeah. There's that, there's that feeling? And I'll feel certain things on occasion. It's like, oh yeah, there's that? And I have to like figure it out. But back to my main, my main question here, how do we know that we're actually feeling something and being guided about it and. How do we separate that from, well, this is a really subtle thing and it's so easy to make things up. Oh, I think they've got this issue. And so we find that in the pulse or we find it in a point, how do we know when we're getting information and when we're just kind of making stuff up, it's, it's

a real problem. And part of it comes from how post-diagnosis has been situated since the 1950 is when. When the Chinese government brought all these practitioners from around the country and tried to perform positivist science of proving, um, and having repetition. And there was all kinds of problems with respect to, uh, inter-rater reliability between these high level practitioners. Well, first of all, we have to look at technique is, are the people using the same technique? And, um, and I did a presentation for, uh, international Chinese companies. Last year in Arizona. And I did a brief study of pictures on the web of people taking pulses and virtually all of them have radical errors and they're each done performed in such different ways that, uh, until we solve the fundamental problem of the assumption that we're using the same technique, each time we take the pulse or when we compare our findings with the. There's, uh, there are other problems that have to do with the nature of the lore, uh, and this, uh, these problems are addressed in, uh, leaser Jen's Paul studies illustrated guide in that book. I touch upon it briefly. There are, uh, very, very problematic assumptions taking place with the use of the term choppy or rough, the silver. Pulse, uh, also, uh, the gin, my, the type holes, both, both of these have, uh, are a mess in the literature. And so when a person uses the term and I'm talking about high level family level, uh, transmission, uh, about these, uh, pulses without naming any particular family trends, um, drawing from a large pool here, uh, but not a single one of them has. Uh, solved these problems. And, and it just goes to the, the, the real issue within the field. But the problem of say taking the compass bosses is one you've got to set. First of all, there is no conversation in the core literature, let's say the 27 28 qualities of leisure gen, which is really probably derived of mansions of the moon as a, as a pneumonic for learning and not really. Taxonomic structuring for pulse diagnostic systems in general. Um, Leon hammer went very far in giving us probably the best taxonomic arrangement of rhythm and rate that we can that is currently available. And I use that one. So that's just an example of, of some of the problems, but the issue is that until you're shown in person, It's not possible to, uh, perceive many of these things. So what happens is then, and as a result of those studies in China is that they, they took the materials and reduce their presence in the, in the, uh, state approved educational system. And then the, the pro knowledge product of coming out of China use the pulse as a way of confirming what people already thought. So what happens is in that moment is that the pulse begins trailing this set of preconceived beliefs about what's taking place in a person. And this is the source of the problem that you're describing in my view. And that problem being that, uh, it's easy for people to kind of imagine what it is that they're feeling or just make what they're feeling because the pulse is just being used to confirm what people already think about the case,

as opposed to going a little is not the right word, but going without assumptions and just seeing what's there in the pulse and seeing what it has to say

first. Right, which would be closer to the stylings of BN, Trey, whose ostensible author of the non DJing. So this business of rolling in four directions, there's not a single address in, uh, in Leasher Jen's lexicon of distortions of the radial artery, um, outside of its past. This was my doctoral work. Uh, but for my Dom and for my PhD, the focus on different ways of seeing distortions in the trajectory of the radial artery. So the shin hammer or the, uh, the mung hug being family current, as it shows up with Shannon and hammer, as some particular artifacts of practice that discuss distortions in the trajectory of the radial or. Notably if, if the middle position is extending towards the tendon on both sides, which is two different observations, of course, in the COMPAS model, we're talking about changing perspective, but the pulse is completely driven by my question. So this Paul's diagnosis is the fundamental approach that I used for assessing the level of Shannon, each one of these positions. And of course their story guides needed, which of these gen. Take into account, and then I'm going to look at contemporary life and how it folds in. So we count him out in circles on this, but the patterns of distortion can, depending on my question, have different interpretations. So if I have a slipperiness and a radial distortion in the heart position or the left distal pulses, The son that position, uh, in the Shen hammer tradition is suggestive of when slippery, uh, uh, mitral valve prolapse. Well, one of the problems I ran into is that it didn't always, and then they didn't have a conversation for when it showed up on the right side. So this was what caused me to go back to the classical lore of the Han dynasty to understand the answers to these questions. So in fact, we find in the, my Jane, the pulse classic of one shoe, It was a, an archive as to I'm. Sure. Well know that it's responsible for the impart reconstruction of the Shanghai online that anyway, long's personal work was around the Paul's classic. And in chapter 10 of the Paul's class accused addressing both the S six division model and then the sixth division model it's assigned to the divisions of topographical. Presentation the Taiyang shaoyang Yangming JueYin ShaoYin TaiYin and then, but also the eight extraordinary vessels. And he gives us our first I'll start tickling presentation of how to assess the eight extraordinary vessels. So, but the yin way and young way vessels, both have distortions outside the trajectory of the radial artery. And it is one of the more reliable. Uh, teaching methods. So I often deal with these spatially oriented methods when I'm teaching first, because it's more palpable it's once one has shown, if I just keep rotating my finger without pushing the vessel out of the way a radial and the distal position, I can make any number of presentations. Such as that would, is affecting fire. Uh, maybe there's a mitral valve prolapse, or it could be a Taiyang or if given appropriate confirmation, there could be a young way pulse. And these are each dependent upon the frame of reference from which I'm making the question. If my question is which of the compass directions is it? So, so as says, the map is not the. So all we're dealing with through these pulse diagnostic methods and the ma the competence method, which I shared with you, uh, and the listeners is a map, or it rather is an abstraction that we lay over the physical events that are presenting themselves. Now, in terms of subtleties, what I go for when I'm teaching our big cities. Undeniable signals that everyone in the room goes. Yep. Yep, yep. Yep. Unless they've got severe neurological damage or played good part until their fingers bleed like Stevie Ray Vaughan and you know, they kind of callous thing will interfere with the finger's ability to how a pay. So there are physical psychosocial attributes that prepare an individual for the purposes of both diagnosis

so you, you go for the bigger, easier thing. To palpate when first learning these particular methods, what are some of

those? Okay. So the compass would be one, the ability to roll. If I've got my finger in, in that, in the bed of the radius and that radial artery is down there in that bed where it should be. I I'll roll out over the bone and it's, it can no longer be palpated, but if I roll out over the bone and I can still feel that pulse that's, that's something that's very. Very consistent or in the eight extraordinary vessels, let's say, uh, which of the positions is largest. If the distal positions largest and my fingers hit it first, I've got a young child pulse, or if the middle it's a dye mine in the proximal it's Jen child. So those are, those are super easy. Those aren't, yeah,

those

would be easier. Yeah. They palpated. They already palpated every day of their life as a practitioner. So this is not new information. It's. Reorganizing what we see. And then the next process of course, is to dive deeper into the, the various qualities. And I try to unpack it in terms of contemporary physiology as well, so that the Western mind can see it a little differently and that I find to be, be very, very helpful, but there's another message that comes up from the mung HUD thing as Shannon hammer represents. And that's that there is a tolerance for ambiguity and there's a tolerance for paradox and, um, and which is, are critical skills for the physician. And I use physician here, uh, because practitioners of Chinese medicine are physicians and, and I know that various legal jurisdictions, oftentimes, uh, certain classes of providers. Gain social closure on certain terms, like say here where, where I live. Part-time in Texas, there it's against the law to use the term

physician. You can't even call yourself a Docker. In fact, even if your patients call you a doctor, you're supposed to correct them. I mean, there's, yeah, there's

all that, uh, the earned doctorate can be used as long as it doesn't misinform the public and Creek caused them to think for some reason that you're a medical doctor, but the term physician is protected for medical doctors. I see is the, is the point. Whereas in Florida, of course, physician is part of their licensing act. But as far as. All practitioners of this medicine and our physicians, because we were dealing with, um, certainly a greater dimensionality than the physical

it's interesting to me is, uh, what we would usually think of, you know, w when, when you say physician, most people, of course think medical doctor. And within that paradigm, within the Western medicine paradigm, a tolerance for ambiguity and paradox. I think they'd probably have very little tolerance, in fact, ambiguity and paradox. They're doing their best not to have that, right. We want the right evidence-based answer. And yet for the station medicine practitioners, and especially as we're working with patients with more than just, you know, their physicality, that tolerance for ambiguity and paradox, I think becomes very, very important. You know, the longer we're in clinic, the more we see. Tons of ambiguity and paradox show up. Have you got any thoughts? Have you have any thoughts, especially maybe for people that are students or beginning practitioners who want the answer and want to fix the problem? How do we cozy up a bit to ambiguity and paradox? You know, I mean, they're actually our friends, they're not the.

Let's see, I think, I think we're engaging into something that might be a little bit, two separate problems, which is that urge and need to fix something. And they, and it goes along commensurate with that is the issue of identifying with our clinical outcomes. Right. Let's

start with that. That sounds good.

Yeah. My student, I try to encourage my students not to identify with their clinical clinical outcomes and, but rather to study as hard as they can to get as good as they can at their correct. Without judging themselves or identifying with, oh, this person got better and I'm great. And then, oh, I failed here and now I'm, I'm just the worst. I'm just the worst. And this is not a helpful stance to take with oneself. Uh, this harsh, critical judgment upon one's self in terms of clinical outcomes and identifying with them, but rather the, the steady focus upon coming as fluent. As possible at, on acupuncture front, all the channel systems, the five element points, all these features are the warp and woof of good practice. And that gets sidestepped often times in a verbally focused program of TCM where the points are learned in terms of their functions, such as, uh, uh, draining damp, Pete moving blood. And along those lines say spleen 10 for moving blood. I've never seen it. I, you know, I'll do some wet cupping on the back if I want to move blood and that's going to give me some very real results regarding moving, moving blood were explained 10. Oftentimes not. So anyway, that's just an aside. So that's this, this issue of identification of with clinical outcomes. It's who I am is who I am as a practitioner. And I do the absolute best I can. Some people I can help. Some people not helping them just accept

is fair. Yeah. Which, which is not to say we don't care or we're lax and our work. Exactly.

Right.

Exactly. There's this interesting little neutral place in between on a good day. At least for me on a good day, I can sit in this neutral place and someone comes in and they've had a great experience and it's like, well, that's not. And they could come in. I've had a terrible experience and I'll go, huh? Okay. Well now what, and to be able to stay in that kind of neutral space of not getting all puffed up because, oh look, they had a good result and not getting too deflated because they

didn't have a good result. That's right. So we do the best we possibly can refining and honing our craft and serving the people that we serve that in the end. They are who they are and we are who we are. And so that was, that was the one let's see. Now that was woven together. We were parsing that out from another question,

right. About the tolerance for ambiguity and paradox.

Okay. So returning to that issue, let's take, for example, uh, we've discerned a problem at the level of the one. And, uh, and let's say that that problem's exhibiting itself in terms of disturbed dream con. What I will do is ask the person to unfurl that very experienced of the dream. Either directly with me as narrative, where they can do it internally to themselves, if they're not comfortable with discussing the material of the dream. And during that whole time, I'm taking a left also the lift middle position, and I'll be looking at what's taking place in the F in the depths. Of course, Nanjing, we have five devs. Thing family, current more, three depths. And then we have two depths with respect to, uh, many European styles and Japanese stylings of practice rooted in Nanjing. But in any regard, I'm looking at all the qualities that are coming up. So if there's forceful over time, different expressions will present themselves. I just record those expressions and I allow all of them to be present. So if I've got signals for Xs and I've got signals for deficiency or got signals for hot and signals for. Then I'm going to just allow the signals to be recorded and they will receive due attention. And of course the formula construction. So for instance, let's say it's full and it's forceful that you press in and there's no route. Well, good heavens there's a deficiency underlying this excess. So I'm absolutely okay. Using something like Kwon cheer, stragglers to, uh, address, uh, the acquisition of root in the left middle position, which is something that. Typically do, and a host of pre TCM practitioners around Beijing also do similar types of strategies. Um, but then at the same time, I'm going to add some medicinal switch address, whatever the access presentations might so fully confident that if I've got both sides, Hot and cold, I will dress both. And this is essentially the harmonizing strategy, but, but moving away from the polarized spot of it's gotta be this or that.

It's usually not just, I mean, on occasion, someone comes in and it is simply, or this or that. I'm often surprised when that shows up. It's like, okay, what have I missed? Yeah. Yeah. It's kind of rare back to this thing for a moment of, um, and, and are maybe beating this today. But this thing about, we want our patients to get better. We want to help them in the best way that we can help them and patients come in because they have symptoms and they're looking to get those symptoms resolved. And a lot of times we will judge our work and certainly our patients will judge our work based on what happens with their symptoms and in certain situations. You know, getting rid of a symptom might be the right thing to do, but sometimes the symptom is an important messenger. And if you shut that symptom up without getting the message, not only have you kicked the can further down the road, but in some ways that's injurious to our patients as they go along a trajectory, that's going to cause them further problems. Have you got any ideas or guidelines or things to think about for being able to suss out when and how to follow that messenger back to the source. And when it's actually just, you know, oh, it's just back pain. Cause they, you know, lifted a couch, you know, six of them, they were moving. Um, and we just, we just need to get rid of the back pain. Right? How do you know when it's a messenger and when it's just a problem to be taken care of? Right?

Some, some times the sign has no meaning or the symptom has no particular meaning in the life of the individual. You know, like, I'm not sure how I know that, but, but let's, let's say that I approach the problem from a perspective of patient centered care is that material which receives as dressed in the clinic is determined by the patient. And so I don't go digging for psychosocial material, but people oftentimes come with that as they're presenting. I'm always interested in where is the center? That's the question that if, if I, you see it's, this whole conversation is inquiry-driven in the clinic. If I make an observation and the pulse, I'm not going to make an assumption that that's true without further inquiry as a tool of confirmation. So similarly, if I begin to see that there's something of significance in the person's. And it's directly related to the problem. I'm very circumspect about giving revelation of that observation to the patient, because I want to be sensitive to what a situation, which I call clinical ecology, which is the preparedness of the patient to receive our communications and our treatments and their capacity to be the receiver of such.

Because so often they're not ready for that. Partly. That's why this symptom is there. It's a placeholder, it's a way to sort of keep them engaged at a certain point that they might be ready to, uh, to hear that, see it live into it,

whatever. Yes. Yes. And so with the pulse and my conversation with my learners is always, if you, if you have found the second. There is no laugh this minute as they're grabbing the door handle. Oh, by the way, I forgot to mention, then that following statement is already encompassed in the treatment if it's, if you've hit the center. And so one of the ways that we do it is, and I'm not saying that we don't do appropriate reflection on our treatments and treatment strategy. Outcomes. What I'm thinking is that we don't identify with it. It is a different place that we situate ourselves when we do a critical assessment of what's unfolded and that critical assessment should be taking place with both successful and unsuccessful cases from a neutral stance. I think it's one that's what you're hitting upon here is I think one of those things that really does come with experience, and so the question would be maybe, well, how do we get the junior level? Uh, tuned in to that level of, of perception earlier than what it would take for a person to even in practice say 30 or 50 years. And I've thought about this a lot. I thought about it when I was at USC school of medical education. And I also thought about it in my PhD work, but mostly, mostly at USC. And it's a, it's a one thing that the case is probably. The research method, which is best suited for the transfer of expert knowledge to, if we, this is what a, a method of, of research, I, I call recursive systems analysis. And in this method, an expert is videotape. While they're doing their work. Let's say they're doing an intake and prescribing a formula. Then that expert is videotaped while they watch the videotape and discuss their thoughts and impressions at each stage along the process of the clinical interview. And this could even take place on an, on an, uh, an another iteration, but it's recursive in that they are observing themselves on the video and then that videotape is observed. And then if, so it could be done again. And that would be once you hit that stage, then it's of course diminishing returns, but that's, uh, actually was determined to be in expert systems. Say seasoned practitioners, like say, um, emergency response teams or, or firefighters. You have a level of intuition that comes from experience. And so these experienced practitioners would share their stories. And this became the tool by which the junior learners actually acquired the skills most quickly.

Right. So there would be able to watch the. Seasoned practitioner do what they do. Cause that's just the thing they do. And then you get to hear the experienced practitioner describing what's behind what they

were doing. Correct. And doing their own critical self analysis as the case is unfolding before them, while they watch the video

tape. Is anybody teaching acupuncture with.

Not that I know of. And I published this proposed research method in, I think it was in 99, so it's been this long and I haven't, but of course I've had a few things on a few other things, rolling up, doing courses and books and running a school and practice my practice as well. Yeah. Yeah. Always plenty

of stuff to do. Will I recognize that we're coming up toward the end of our time here and. I've I've so enjoyed this conversation. It actually leaves me thirsting for a bit more, but, but for the time being, we're going to have to wind this down. Any closing thoughts that you'd like to share with our listeners?

Well, uh, well, I'm, I'm so grateful to, um, have a moment with you and have a conversation about these things that I think are are meaningful. Uh, this is a really great time to. Reorient our intentions about our relationship to the work and, uh, and come to a place of solidarity with the discipline by which we approached.

Great. Well, thanks again so much for taking the time to be on qiological

today.