Part I: The Spirit of North say but difficult to master”, and he states the

first over-riding principle thus: “Ordinary

American Acupuncture Skills of acupuncture maintain the physical
body”. He clarifies this a few lines later,
stating, “Ordinary techniques guard the
Introduction gates”. Any acupuncturist, it would seem
then, can treat the physical body and
“…I am grieved by not being able to provide extremities (gates, especially from elbows to
for those afflicted with disease” wrists and knees to ankles) that protect
against external invasions that might threaten
- Ling Shu, Scroll One, p. 1
the kingdom within.

“High Skills”, on the other hand, we are

So begins the first line of the Ling Shu
taught, “maintain the spirit” and one must
(“Spiritual Pivot”), the first complete account
learn how to “use spirit to reveal the spirit
of the “way of the needles”. In this classical
and the guest at the door (Ibid).” The
text, the Yellow Emperor, Huang Di, asks his
translator of this modern version of the
court physician, Qi Bo, to elucidate the
“Spiritual Pivot”, Wu Jing- Nuan, clarifies
essentials of acupuncture, of the channels
that “guest” in this context means the
and collaterals and extraordinary vessels, of
“invader” which, he states, “must be honored
their pathways and points, and of the
and shown respect”, lest its power be
needling techniques for assembling the Qi,
underestimated. “Shen”, the term translated
or dispersing it. In this account, we learn of
typically as spirit, refers to the intelligence of
the “Ordinary” and “High Skills” of
existence, the deep knowledge and wisdom
acupuncture.
all living creatures carry within. In the West,
mind-body traditions often articulate a very
Let us follow this first Scroll, where the story
similar concept as “inner wisdom”, the
of acupuncture and the Way of the Needles
knowledge we all carry deep inside which
is first laid down in its entirety.
knows all that we need to know to thrive and
embrace Life fully. In similar fashion, the
Huang Di continues his lament at not being
Chinese language and Chinese medicine also
able to properly care for the sick thus: “I wish
speak of “shen ming”, or spirit clarity.
they did not have to endure the poison of
medicines and the use of stone probes. I
After explaining how to tonify and disperse
prefer to use those fine needles that penetrate
according to the imbalance of the patient,
the channels, harmonize the blood and qi
while attending to the spirit and spirit qi, Qi
energy, manage the currents and
Bo stresses that one will be able to tell
countercurrents, and assemble the exits and
whether the treatment is having a proper
entrances. Please unravel this for future
effect by reading the vital signs of the patient,
generations and enlighten them in the
which indicate that the spirit, and spirit
proper methods so this therapy will not be
clarity, have been prodded to good effect:
destroyed for aeons. See to it that it is easy to
“Look at the patient’s color. Observe the
use, difficult to forget, a classical record […]
eyes. Know how the Qi disperses and returns
Begin with the fundamentals of classical
[…] Listen to the patient’s movement or
acupuncture. I wish to hear of those
stillness. Know his balance and his imbalance
essentials (Ibid).”
(Ibid, p. 4).”
Qi Bo goes on to elucidate the principles for
This refers, I believe, to attending to: the
using these fine needles which “are easy to
patient’s complexion, which should

  1  
normalize to a significant extent after the propagate the needling sensation ( “how the
insertion of the first few distal needles to qi disperses and returns”). At that point, dull
harmonize Yin and Yang, and again when eyes whose color was hard to discern often
the needles are removed, even though the become radiant and full of color, the
complexion may well go through dramatic complexion becomes full of luster and
changes during the treatment, where the 5 normal color returns, the breathing
colors appear, separate and finally blend into (“patient’s movement or stillness”) settles
a more healthy complexion overall; of the the into a deeper, more relaxed state, and an
presence or absence of shen in the eyes and agitated patient quiets down, while a
the return of shen, sparkle, brightness and lethargic patient starts to become more
color, often within the first few needle animated. One could also check the pulses
manipulations ;the reaction to needing, with (radial, carotid) or abdominal findings (hara)
the Qi effect gathering around the tip of the to see if they are more normal, but in fact
needle making it solidly rooted, or once the qi has been reached and the vital
propagating Qi at a distance; the patient’s signs change in this way, there is no need in
speech patterns, breathing and other sounds, my experience for further checking as the
which should grow more calm, quieter, at signs of return of spirit clarity radiate for any
peace as the initial YinYang regulatory practitioner who takes a moment to
treatment is performed (often referred to as mindfully look, listen and hear.
Root treatment); assessment of the patient’s
pulses (carotid compared to radial as well as The story gets a bit complex to follow at this
other arterial pulses) and the points point: ordinary skills seem to be less
themselves, showing excess, deficiency or powerful, less essential than high skills, as
stagnation. they only guard the outer, physical body, and
the “gates” (extremities and the joints,
In their “ practical dictionary” of Chinese especially from wrists to ankles).
medical language, Wiseman and Feng define
“Shen” or spirit in the wider sense as “that This first Scroll lays out the distal, essential
which is said to be present in individuals shu transporting and yuan source points, the
with healthy complexion, bright eyes, erect critical points learned in all classically
bearing, physical agility, and clear, coherent informed and modern TCM teachings, on
speech (p. 550).” the extremities from the fingers to the
elbows, and from the toes to the knees. In
When treating patients in Grand Rounds at this discussion, it would seem that these
the Tri-State College of Acupuncture, I will points, and especially the 12 source points,
often focus, and the ceiling mounted video are Ordinary skills that can cure the diseases
will follow, the changes in the patient when of the viscera when the channels have been
“the qi has been reached”, when spirit clarity injured and their organs have been reached,
is returning to a formerly lusterless skills any acupuncturist must master.
complexion, where the patient’s eyes and
gaze were dull, their breathing, shallow, and Thus we learn that ordinary skills are in fact
point out that this change toward spirit essential skills, of treating the 12 distal shu-
clarity actually often happens within the first transporting and source points of the regular
minutes, even seconds of needling, when meridians when the disease has moved from
mild de Qi has been achieved on initial, the surface to impact on the respective
distal points that were deficient ( causing the viscera.
needling sensation to gather at the tip of the
needle or even sink deeply into the point ), What are these ordinary Skills? Actually,
or stronger de Qi has been elicited to there appear to be four main ones:

  2  
 • Needling techniques (tonification, circulation of Qi and Blood, and release of
dispersal, dredging); excesses, leads, for example, to more normal
• Obtaining the arrival of Qi (de color and texture in scars, or in the ankles,
Qi/Zhi Qi); once brown with stagnation in elderly
• Observing the patient’s vital signs for patients, or to less fibrotic soft tissue, or
evidence of change (in complexion, looser muscles. In my personal experience it
shen returning to eyes, breathing is not enough to treat distal shu-transporting,
improved, circulation of Qi and source, luo and xi-cleft points, to attain such
Blood improved and other signs of changes in locally excess, inflamed or
change, in pulse, etcetera; stagnant areas. In this, I see acupuncture as a
• Pulling out Thorns, Washing away physical medicine akin to tui na, anma,
Stains, Untying knots, Breaching shiatsu, sotai, guasha and stationary and
obstructions. moving cupping.

The first three skills aim to regulate Yin and These obvious local techniques can be used
Yang, with distal points. The last skill seems instead of needles of course, but I have made
to refer to treatment of the patient’s a career of practicing acupuncture only, with
complaint itself, identified by palpation as excellent results in this physical medicine
“thorns”—areas where Qi is stuck; “stains”— domain. I stopped using moxibustion early in
where the color of the skin, capillaries and my private practice, because the first building
veins (the cutaneous regions and minute luo where I worked, and the one where I now
vessels) is abnormal; “Knots”—where work in my own cooperative apartment,
palpation reveals tight, hard indurations in forbade it, as do many buildings in the NYC
fascia and muscle (ashi points, kori, trigger area according to faculty and graduates of the
points, all signs of excess, in the luo vessels college. I also stopped cupping and guasha,
and muscle channels); and “Obstructions” because many of my first elderly Jewish
where one must move Qi through, patients reacted quite negatively to a medical
underneath or around the area, as in professional charging for what they saw as
adhesions, scars, fibrotic tissue, or chronic folk techniques their own mothers used on
ashi points. them, and because of the bruised-like marks
which they found disagreeable. Finally, I quit
The first Scroll therefore emphasizes first doing acupressure and shiatsu early on as
regulating Yin and Yang with distal regular well, because I developed familial arthritis in
meridian points, which should yield my 30s, and massage made my hands ache
improvement in vital signs, and then and grow numb.
attending to thorns, stains, knots and
obstructions, which are local signs of excess, One might say I have worked like the straight
stagnation, blockage. Whether a style prefers chiropractors of the old days who only did
to focus more on distal points or local points chiropractic manipulations, and with
to deal with these excesses, relieve symptoms, excellent results. I am a straight
and address the patient’s specific complaints, acupuncturist.
the first chapter of the Ling Shu includes that
this attention to the patient’s chronic That being said, I encourage students to use
complaints is a part of the Ordinary skills any all AOM modalities they have learned,
acupuncturist should possess. In such depending on the patient and their own
treatment of local areas that are discolored, proclivities.
tight, inflamed, there should be signs of local
improvement. This should be even more the
case after a few treatment, when improved

  3  
These ordinary skills are part of the And how are these “High Skills”, which
curriculum of all North American colleges of control the “moving power and its Way”, the
Acupuncture and Oriental Medicine, Yin and Yang Root of the Kidneys, the
whether TCM, 5 Element, or Meridian prenatal qi and the mingmen fire that
based. They seem to be the common support life, which is “inseparable from its
knowledge, which is tested on North space”, and which “is clear, quiet, and subtle
American national board examinations given (Ibid), the space of the Tantien, achieved?
by the NCCAOM and used by many states as
the basis for licensure upon graduation from Again this first Scroll is full of paradox and
such colleges. Ordinary skills-- common complexity. In order to manifest High Skills,
knowledge--, and yet often referred to in one must follow “the way of acupuncture”
North America as “Root” treatment, a defined, simply, thus: “to tonify hollowness,
designation which one would think would be to disperse fullness, to dredge stasis”. One
reserved for discussion of the “High Skills”. does this, by paying attention to the
movements of the needling: first “slow, then
So then what of these “High Skills” which, quick” which lead to tonification (slow in,
we are taught, “maintain the spirit” and “use fast out to sink the yang qi deeper, to
spirit to reveal the spirit” while attending to yangify), or first “quick, then slow” which
the disease (guest at the door)? lead to dispersal (fast insertion, which elicits
propagation away from the point, done
This theme, of attending to the patient and repeatedly with slow withdrawal to enhance
the patient’s disease with ones heart and the propagation/dispersion, to withdraw the
spirit repeats itself throughout the deep yin, to yinify).
discussions of needling in this classical text.
Thus, immediately after speaking of High
It would therefore seem that a requirement Skills, and of the use of spirit to treat spirit,
for practicing High Skills would be for the Qi Bo proceeds to detail how to tonify and
practitioner to be able to navigate this disperse and dredge with needles, after first
relationship with the patient from a place of eliciting qi. For two pages, we learn of the
spirit clarity her or himself. Chinese nine needles and their use, how deep to
medicine postulates that the heart stores the needle, how to needle distal and local points,
spirit, and so the practitioner must have a defined as “the manipulation and the way of
calm heart, not muddled by the seven the needles”. We learn how to use the
emotions, and focus her or his spirit on that needling hand to “make a vertical insertion”,
of the patient, attending to the deep stressing that “the spirit seems to be at the tip
intelligence and wisdom of existence, and the of the needle”, and finally, again with a calm
will to live and be well that dwells within all heart and mind, to “focus awareness on the
living beings. The change prodded by the patient” so as to read the vital signs for
informed manipulation of the needles, which evidence of therapeutic change, which will
must reach Qi to be effective, portends the come fast.
“onset of a therapeutic effect [which] is faster
than shooting an arrow (Ling Shu, p. 1)”. It appears that High skills are a concept that
Elsewhere this classic text clarifies that once implies practicing Ordinary Skills with
the Qi has been reached and the vital signs of focused attention, mindfully, not distracted
the patient have improved as discussed by anything, with spirit clarity and a mind
above, even though the disease itself will not not disturbed by the 7 emotions.
necessarily show signs of improvement, the
disease will in fact already have lost some of High Skills, based as they are on the spirit
its hold. clarity of the practitioner, would be hard to

  4  
manifest as a beginner, who must learn over “jingluo”, of the channels of acupuncture
time how to remain mindful and focused as and the way of the needles that contrasts
the needling has its, often powerful, effects. starkly with the Traditional Chinese
To do this, like any East Asian art, one must Medicine story.
practice, and focus on the act of needling
itself, looking at the skin, not allowing it to This modern TCM story, constructed only
become bunched up, keeping the needling recently, in the 1960’s to 1970’s, first told in
surface taut like the surface of a drum with English in The Outline of Chinese
the non-needling hand which maintains this Acupuncture, then in Essentials of Chinese
taut surface, while the needling hand is ready Acupuncture and then in its successor
for whatever effects the needling generates, volume, Chinese Acupuncture &
which may reveal a tiger being held by its tail Moxibustion was a story bereft of the jingluo,
as we are told later in this classical text. of discussions of Man between Heaven and
Earth and influenced by the forces of the
High skills therefore seem to refer to focusing Cosmos, with no discussion of Shen or spirit
on the patient, not being distracted by of any significance. The original TCM
anything, keeping ones attention on the skin, approach developed in the 1960s to 1970s in
the flesh, the needle, the point one is the PRC seems to have stripped acupuncture
stimulating, staying attentive for therapeutic of its High Skills, of its shen and of its soul.
changes in the patient’s vital signs.
In the early days in the development of the
To be able to do these needle manipulations North American AOM profession, the
safely and effectively is required, as these founders and key players of the schools at
constitute the common, very ordinary skills that time struggled with what texts should
any practitioner must first master. And this become the foundational, authoritative texts
takes time, and diligent practice. But with for accredited schools, on the basis of which
perseverance, and attention paid to ones own national board and state licensure
development of mindfulness and spirit clarity examinations might be developed. It was
while needling, these Ordinary Skills can clear in those early days that many
become High Skills. practitioners had been more influenced by
European acupuncture traditions, like J.R
The first Scroll ends by addressing the Worsley, Van Buren and Mary Austin’s Five
critique of some people, who “say chronic Element styles, Felix Mann’s texts based on
disease cannot be cured. This is speaking translations of other, meridian-based texts
incorrectly. The skillful acupuncturist can from PRC from the earliest days of TCM,
take hold of the disease in the same way that and French Meridian traditions, and a home-
he pulls out thorns, washes out stains, unties study program offered by the Occidental
knots, or breaches obstructions. Disease, Institute of Oriental Medicine.
although chronic, still can be ended. Those
who say diseases are incurable have not As we founders and teachers of those North
mastered the technique of acupuncture American schools of acupuncture met to
(Ibid).” develop the infrastructure for an AOM
profession (AOM being chosen as the official
The next 80 Scrolls detail how to perform designation, because it recognized that it was
pattern differentiation of the regular “Acupuncture”, first and foremost that had
meridians, the secondary collaterals and the captured the North American public and
extraordinary vessels, with detailed medical imagination, and “Oriental
description of signs and symptoms of each Medicine” to make peace with all East Asian
type of meridian dysfunction, a story of the traditions which felt TCM was just one style,

  5  
while “Oriental” was inclusive of Japanese, And then something interesting started to
Korean, Vietnamese and other East Asian happen in about 1990. Other texts, from
traditions, even if anthropologists at the time other styles of acupuncture that were based
were already replacing “Oriental” with “East on Classical Chinese Acupuncture, started to
Asian”) . We struggled over the disparity emerge, in translation, and written in
between the European influences, some via English by practitioners in North America,
Vietnam through France, which seemed to that told different parts of the way of the
predominate in the schools on the East coast needles from meridian, five phase and other
and in Chicago, and what we soon came to classical perspectives. During this time,
refer to as the California Model of TCM, several texts appeared in English on various
where herbs and acupuncture were required Japanese styles, including the tradition of
in short order as part of State approved classical meridian therapy, as well as on
schools and for licensure. European meridian acupuncture and new
approaches in PRC based on more classical
After much struggle, and owing to the fact approaches. Dr. Yitian Ni’s seminal text
that the main texts in English at the time Navigating the Channels of TCM appeared
from East Asia were TCM texts, and after the at that time, with a foreword that stressed
publication of The Web That Has No that the advent of TCM as the main style in
Weaver which made learning TCM much North America, while good for those wishing
easier for North American students, these to practice Chinese herbology and ZangFu
early pioneers, myself included, achieved a (organ) differential diagnosis and treatment,
compromise where basic TCM foundations proved detrimental to those who wished to
would serve as the basis for accredited learn how to perform a jingluo differential
schools, and national board examinations. At diagnosis of the channels, collaterals and
the same time, the council of AOM colleges extraordinary vessels, specifically, as part of
was adamant, however, owing to the meridian-based acupuncture treatment.
influence and steadfastness of the East Coast
and Midwest schools, that AOM schools And so here we are, in 2011, with several
could teach whatever other styles of new books on the meridians that are very
acupuncture they wished, as long as these different from TCM texts. Yet North
TCM foundations were addressed in the core America colleges must still teach TCM
curriculum. foundations, and national board
examinations, and state licensure
During this period, in North America but examinations, are still based primarily in that
also in Europe which seemed to follow suit a one, modern, Chinese tradition that began
few years behind us, texts rich in more in the late 1950’s, and is already showing
classical styles of practice, especially classical signs of potential demise in PRC, where new,
Chinese acupuncture, disappeared: Royston younger voices are calling for discarding
Low’s Secondary Vessels of Acupuncture, TCM differential diagnosis in favor of
Felix Mann’s Meridians of Acupuncture and biomedical diagnosis, and for a
Chamfrault and Van Nghi’s texts detailing “contemporary medical acupuncture”.
jingluo practice all went out of print. At the
same time, a large number of TCM texts, in There are more English language texts on
translation or by East Asian and Western different styles of acupuncture, especially
English speaking authors, proliferated, meridian-based acupuncture and
making the TCM foundational knowledge acupuncture treatment of pain,
base that much more secure. musculoskeletal and sports injuries, available
in English today than there were texts in
English on TCM acupuncture thirty years

  6  
ago when the compromise to make TCM the examinations, where these common
foundational knowledge base was reached. disorders would be represented in their
proper proportion, thus displacing
What I would like to try to do with this inappropriate internal medicine disorders
Reflective Practicum is to start a movement and their ZangFu patterns, which belong to
for revisiting this biased TCM foundational Oriental Medical (read, Chinese Herbology
knowledge base, thus loosening the hold this and Pharmacology) teachings and tests.
style has held on North American
Acupuncture education, licensure and
practice for 25 years.

I hope to to illuminate the story of a

forgotten path, the Other Acupuncture, that
was based in texts just as authoritative as the
ones that have become TCM primers, texts
which made their way, through a curious and
circuitous route, to England, and to France,
via Vietnam, and to Montreal and the New
York City region, which also existed and were
written by experts in Classical Chinese
Acupuncture from the academies of Chinese
medicine, who were about to be replaced by
State mandated colleges and teachers of
TCM, with a unified, orthodox curriculum
that extinguished the spirit, the power, and
the elegance of Classical Chinese styles.

It may well be that the time has come to

revisit the foundational knowledge base that
has ossified education in acupuncture in
North America, to allow for a more
comprehensive, and effective approach to
treatment that is pragmatic, not orthodox,
and able to adapt to actual clinical reality in
the case of those patients we treat every day.
In such a return to the beginning, we would
do well to insure that our acupuncture
education prepares our students to treat what
they will encounter most frequently in their
North American practices, namely chronic
pain and its associated dysfunction,
musculoskeletal and sports injuries, repetitive
strain and cumulative trauma disorders, as
well as chronic stress, fatigue disorders, and
functional disorders affecting the autonomic,
hormonal, cardio-respiratory, gastrointestinal,
genito-urinary and reproductive systems. We
could then select other authoritative texts to
drive acupuncture education and

  7