In my experience, the ability to form good relationships with teachers is one of the most essential elements of studying Chinese medicine. Relationships are incredibly important in Chinese society, and those who learn how to cultivate meaningful relationships with a wide variety of teachers invariably acquire an excellent TCM education. This art of building relationships cannot be learned in a textbook, but relationships with our teachers, colleagues, and patients tremendously affect our potential as practitioners. I feel fortunate to have had some great teachers in my studies and travels, and I want to share a few pieces of advice from various teachers that have been helpful to me.
The Spine of the Pulse
In Taiwan, I had the honor of studying with an excellent doctor named Feng Ye. Feng Ye is one of the most inspiring doctors that I have ever encountered in terms of his intelligence and comprehensive knowledge. Feng Ye and Nigel Wiseman were partners on many projects, and they formed a truly powerhouse team. Feng Ye is an incredibly experienced clinician and scholar who could solve any of the medical research problems, and Wiseman’s linguistic abilities could solve any problem of translation and transmission. Together they wrote the Practical Dictionary of Chinese Medicine, which was the product of 10 years of unprecedented research. Feng Ye was also the unsung hero of Paradigm Publications’ monumental Shang Han Lun, where his expertise guided the text selection, explanations, and clinical commentary. He played an important role in selecting source texts and solving challenging questions in our text Concise Chinese Materia Medica, and he was kind enough to bring me into Chang Gung Memorial Hospital in Taiwan for prolonged clinical training.
Feng Ye’s true specialties lie in classical studies, gynecology, cardiology, and internal medicine. He has an amazing memory, which basically allows him to recite most anything verbatim from the Nei Jing, Shang Han Lun, Jin Gui, etc., but the thing that really sets him apart is his ability to think dynamically with sophisticated Chinese medical theory. He is particularly interested in pulse diagnosis, and he was working on historical pulse research for his PhD during our time together.
At the time, Feng Ye was seeing about 3000 patient visits per month, which is obviously a major advantage for a skill that requires extensive repetition and practice. He would always instruct me to feel the “spine of the pulse,” and to use the position where the “spine” was clearly felt to determine the overall depth of the pulse. In addition to determining depth, the spine of the pulse is the place that allows one to feel the global pulse quality with the greatest degree of clarity.
Over time, paying attention to the spine of the pulse has been particularly helpful for my acquisition of pulse diagnosis. As Feng Ye describes it, the spine of the pulse is determined by the following technique: Apply pressure with all three fingers, then gradually press harder to sink to deeper levels. Find the spot where the vessel can be occluded if the middle finger presses just a bit harder than the other two fingers; at this spot, the pulse will slap up against the other two fingers as the middle finger occludes it. Now back off just a bit with the middle finger so that the pulse is no longer occluded. At this spot, you can feel the pulse evenly with all three fingers. This is what Feng Ye would describe as the spine of the pulse, and again he would use this spot to determine its overall depth and quality.
Additionally, on a patient whose pulse you know, a change in the depth of the spine may signify a relative floating or sinking state of their qi at the present time. For example, a patient with relatively weak yang qi may not ever manifest with a truly floating pulse (fu mai) when they experience external contraction, but their pulse’s depth may rise from its norm. As early as the Shang Han Lun, we find evidence that the terms “floating pulse” (fu mai) and a “pulse [that is] floating” (mai fu) were both in use and were regarded to have similar clinical implications. Feng Ye uses this “spine of the pulse” as a natural gauge for the depth of a person’s normal pulse, so he pays attention to deviations from it.
I was fortunate to study with several good doctors in the acupuncture department at Chang Gung, and it would take many a blog to recount the various things that I saw there. However, I would like to share two distinct tips from Dr. Chen Yu-Sheng that have been really useful for me.
The first regarded the holding of the needle. Dr. Chen instructed me to make a triangle around the insertion site by placing my index finger and thumb of my left hand on the skin, along with the middle finger on my right (needling) hand. The center of the triangle is the insertion site, and the thumb and forefinger of the right hand hold the needle handle for insertion and manipulation. This triangle of light pressure diffuses the sensation at the skin’s surface and dramatically increases one’s control of the needling site. I’ve found it to be very helpful, and several of the students at the PCOM clinic that I shared it with found it helpful as well.
Another good exercise for developing needling skill that Dr. Chen shared with me regarded qi sensation. He would have me practice needling and obtaining qi at the superficial level, then at the mid level, and finally at the deep level. In other words, the exercise was to achieve qi sensation at three different layers of depth, paying attention to the differences in the sensation between the levels. Throughout this process, he was adamant that I didn’t lose the qi sensation. So the goal is to feel the qi through the needle superficially, then maintain continuity of that sensation as you sink the needle into the two successive deeper levels. I found that this exercise really helped me to develop sensitivity with the qi sensation.
In Asia, the general trend is to teach little until a student demonstrates dedication and sufficient background knowledge to merit the lesson. In the West, we favor free sharing of information and students show up to class demanding to learn the goods. Obviously, education suffers a bit at both extremes of the spectrum, from the traditional martial arts style school of hard knocks to the Western style of just showing up and paying tuition. In any culture, most teachers love to teach and most students love to learn, and the ability to form a relationship and come together is where the true magic of Chinese medical education lies. I hope that somewhere on the cybersphere there are people who can benefit from my experiences, and I hope that thousands of others will pursue new information and share it for the benefit of others. Medicine is an art of humanity, and we can benefit thousands of suffering individuals by sharing our experiences.