Published in the North American Journal of Medicine Vol. 20 No. 59, November 2013
The further knowledge advances, the nearer we come to the unfathomable.
Johann Wolfgang von Goethe
In science it is a service of the highest merit to seek out those fragmentary truths attained by the ancients, and to develop them further.
Johann Wolfgang von Goethe
Singular and particular detail is the foundation of the sublime.
William Blake
What is the universal? The single case.
What is the particular? Millions of cases.
Johann Wolfgang von Goethe
Most people (including practitioners) think of the exquisitely careful palpation characteristic of Japanese Meridian Therapy (JMT) as simply a skill or a technique, but it can be so much more than that. It can be a doorway into an entirely different experience of the world around us. I want to tell a story about ten minutes that changed how I look at acupuncture and, really, how I look at the nature of reality. It involves palpation, the theme for this issue of NAJOM, and exceedingly gentle needling. A good outcome was achieved for a patient—a dear old friend in whose home I was a guest—but much more important from my perspective is that the monster of logical positivism and scientific materialism was gravely wounded. I began to BELIEVE that I needed another worldview, one that included what many would call magic, but which was not really magic in the sense that we see in fantasy movies. This magic was real magic.
It was late 2004 and I was in the midst of a year off—I called it my walkabout. I had crisscrossed the US and Canada a few times. At the moment I was in Jupiter, Florida staying with an old friend from my days living in Miami Beach. He was a Vietnam vet who had been exposed to Agent Orange numerous times. In recent months he had experienced recurring pain in his lower left abdomen that extended down to his left testicle. He wondered if it was related to the chemical exposure in Vietnam. I woke up one morning on his couch hearing him call out in pain for help. He was rolled to the edge of his bed ready to vomit into the waste paper basket. His pain was a 9-10/10. He was crunched up in a fetal position with agony written in every feature of his face. His only health care was the VA Hospital, and they had a long waiting list (he was already on the list), and in any event he said they had no ER. He knew he needed help but did not want to go to a hospital due to the cost—such is life in the US, the wealthiest country in the world. His pain had been significant in the past but had never reached this level. I asked him if he wanted me to try some acupuncture, and he gave me his permission.
I took his pulse and felt it was a clear LR sho (LR and KD positions weak). I carefully palpated his abdomen so as not to increase his discomfort. In the lower left quadrant was an easily palpated mass the size of a kiwi fruit. It was hard and had irregular margins, and clearly from his feedback it was the source of the problem. I really worried that it was cancer but said nothing. The rest of the abdomen revealed nothing as noteworthy as this finding. I palpated right LR-8, as I wanted to treat the healthier side. After a close inspection of the general LR-8 area I found a small but notable area of deficiency. I performed Dr. Shudo-style insertion and twirling for a few minutes. As I recall the needle might have been at a 1mm depth, perhaps a little less. I was so focused on the needling I did not really notice that my friend’s pain seemingly had stopped. After this one needle I rechecked the pulse and found a very good change that encouraged me. I again palpated the abdomen, and that is when my world (and worldview) was rocked. The entire “kiwi” was gone, and I mean 100% gone with no evidence that it had ever been there—and my friend’s pain was also 100% gone. In fact the area where the lump had been now felt quite deficient, so deficient in fact that I did some superficial surface twirling of the needle there to tonify it and followed with a little moxa. How could that be I wondered? Just a moment or two before there had been an ugly mass of tissue. Where had it gone? Can something so material and so hard and of such size simply disappear? Not in my world up that point it couldn’t. The material reality I lived in did not behave that way.
For weeks afterwards I was reeling inside. Earlier in my life I had been a mathematician and had also studied logic in college. And, more importantly, I had lived almost 50 years in the “material world” with all the rules that I thought went with it. It just did not seem believable that such a hard, dense lump of tissue of that size could disappear so dramatically and so quickly from one gentle needle, barely inserted, so far away down the opposite leg. And yet I had to believe it because I had lived it. I could not deny it. What else in this world, I wondered, am I confused about? Obviously I had made some assumptions about material reality and how it worked that were just not true. Clearly there were systems at play in the body that I did not know how to think about. This process of questioning and opening to new possibilities continues to this day. I feel like this one treatment that lasted all of ten minutes initiated me into the world of real acupuncture.
I have written in previous articles about the concept that Buckminster Fuller called morewithlessing. This he defined as ”doing ever more with ever less”. He also called this ephemeralization. This LR-8 case was such a clear example of morewithlessing at work. I began to look around in my life for other areas to apply this in. I would observe parents giving their children long, stern lectures in public and maybe even spanking them, and I had to wonder about a different way. Why not try a kind word, delivered simply from the heart instead of from a place of anger and rejection? Perhaps what the children really needed to hear was that they were loved and appreciated? Maybe my patients also needed less advice from me, and more genuine acceptance. At times a simple question, offered as one might offer a gift, might be what they needed to turn their lives in a new direction—a question for which I had no preconceived answer. An example might be: What might your life look like if you were to let go of the fear you talk about?
I still regularly chat on the phone with this LR-8 buddy of mine. He has moved to North Carolina now. I always ask if that pain ever came back. It never did, not to the abdomen, not to the testicle. Fascinating. I think the gods gifted this one to me, and I am not joking when I say that. I needed a shocking experience to really catapult me out of the death grip of scientific materialism and to open to magic—again, I say magic, for lack of a better word. Perhaps a point of clarification is necessary when I speak in such negative terms about scientific materialism. I do recognize the many advances that the sort of science that has generally been practiced in the last century has brought; it is the exclusive reliance on the horribly constricted worldview of scientific materialism that I needed to be freed from. Science itself as a genuinely open-minded inquiry into the unknown is not at issue here.
The Korean Zen monk Seung Sahn coined a phrase “don’t know mind” that I come back to now as my resting place. I am comfortable, and even comforted, holding this attitude of not knowing. Not knowing what? Primarily not knowing the nature of this universe I inhabit. That one little ten-minute experience showed me I had to let go of the attitude most of the modern world holds about what is possible, about the nature of things, about healing, about time, and about matter itself.
Before I started my study of meridian therapy in early 1999 I don’t think I had ever really palpated an abdomen, not in the entire three years of my TCM training—and if I did and don’t now recall it, I had no way to make any sense of what I felt. I thank my lucky stars that in my disenchantment with TCM I did not simply abandon acupuncture altogether, that I somehow managed to find my way up the highway to Seattle to study with the teachers there in their Japanese certificate program. With my TCM training alone I do not think I would have been able to help my friend with his abdominal and testicular pain, at least not to the extent that I did. I doubt I would have even known there was a mass there.
This might sound to many readers like a bit of a stretch; they are perhaps reading this and thinking: “Of course you would have palpated the abdomen.” I have worked as a clinical supervisor at two colleges now for quite a few years, and I can tell you that it is indeed quite possible for those in TCM to ignore palpation entirely. I remember one elderly woman who had come to the college clinic over 30 times for low back pain treatment before she came on to my shift. In that whole time (I read through her entire chart out of curiosity.) no one had ever even looked at her abdomen, let alone palpated it; they had simply put her prone on the table and had treated points on her back and distal points like BL-40 and 58. If they had inspected the abdomen, they would have known where their treatments would have been better focused. She had had a series of botched abdominal surgeries some years before. This was nowhere noted in her chart—not in 30+ visits with multiple supervisors! The abdomen itself looked like the worst kind of battlefield butchery perversion of surgery. I could not imagine what had gone on there. She was thin and frail, but the tissue of the abdomen was like a concrete sidewalk; it was nothing but horrid scar tissue. Ten or so treatments later with lots of local moxa and non-insertive SRI, and she was mostly free of pain. I relate this story to make the point emphatically that it is clearly possible in other styles to miss the sort of palpatory findings that in meridian therapy are absolutely crucial to treatment.
I close with an expression of gratitude for the teachers who have taken me under their wings to help me along the way. Without them and this gentle palpatory style of practice I would have left my career in Traditional East Asian Medicine long ago. It is hard to find the words to express how thankful I am.
Bob Quinn is an Associate Professor in the School of Classical Chinese Medicine at NCNM in Portland, Oregon. He also serves as Associate Dean for Clinics. He teaches Meridian Therapy and Sotai and supervises in the clinic. He also hosts a Shonishin Club and a Sotai Club at the college and encourages NAJOM readers at other schools to consider this more informal way of helping students develop their clinical skills.