6. The inner development of the practitioner
Chapter contents
Introduction35
Why is inner development important?36
Maximising rapport and increasing the efficacy of treatment37
Cultivating virtuosity (linghuo)41
Introduction
Throughout the history of Chinese medicine it has been understood that the individuality of the practitioner has an enormous effect on the efficacy of acupuncture treatment. With its emphasis on treating at the subtlest levels of the person’s qi, it is natural that many practitioners of Five Element Constitutional Acupuncture place a great deal of importance on their internal state.
Wu was the ancient character for a healer or physician. This character depicts a female shaman below a quiver with an arrow and a spear (Weiger, 1965, lesson 82a).
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In the Shang dynasty, the era preceding the time of the Nei Jing, medicine was largely practised by shamans who lived in the community. It was accepted that certain people had the gift to be a shaman or a physician and that this talent was not available to everyone. The Nei Jing, however, ushered in an era where diagnosis was based on more systematic criteria such as yin/yang and the Five Elements. The gifts and skill of the person carrying out the diagnosis and treatment were still considered to be of crucial importance, however. The significance of this expertise is emphasised in the following quotation:
If someone says that an illness that has persisted for a long time cannot be removed his statement is wrong. When someone who is an expert in utilising the needles removes such an illness, it is as if he has pulled out a thorn, as if he has cleansed what is soiled, as if he untied what is knotted, and as if he opened what is blocked. Even though an illness has persisted for a long time, it can likewise be brought to an end. Those who state that such illnesses cannot be cured have not yet acquired the respective skills.
(Ling Shu, Chapter 1)
Sheng ren is the phrase used in the Nei Jing to describe the most accomplished physicians. Weiger translates it a ‘sage’ or ‘wise man’ who ‘listened to and understood the advice given by the sage and thus becomes wise’ (Weiger, 1965, p. 211). Richard Wilhelm says that a sheng ren ‘through his power awakens and develops people’s higher nature’ (Wilhelm, 1951, p. 3).
Inevitably there are differences in how each individual practitioner’s qualities are perceived (see Hsu, 1999, pp. 94–104). In the competitive world of Chinese medicine in China today, doctors who have a busy practice and a good reputation are said to have jingyan. Although usually translated as ‘experience’ the word means much more than that. An experienced but unpopular doctor does not have jingyan. ‘Virtuosity’ (linghuo), which can be found in excellent physicians of any system, is part of what is conveyed by jingyan. Acquiring jingyan is a realistic goal for practitioners and a necessary one if they aspire to attain at least some of the attributes of a sheng ren.
Whether a man goes on living in health, or whether a disease arises; whether it is in the human power to control it, and whether the patient can be cured; whether one is only at the beginning of the study of acupuncture (and moxibustion), or whether one has come to the fullness of it – all depends (on an understanding of the functions of) the twelve-tract network system of yang and yin channels. To the slap-dash practitioner or the tyro [a beginner, a novice] it all seems very easy; only the great physician knows how difficult it really is.
(Ling Shu, Chapter 11; Lu and Needham, 1980, p. 28)
Why is inner development important?
Practitioners cultivate their virtuosity (linghuo) because it enhances their ability to make accurate diagnoses and give effective treatments.
Diagnosis
Signs versus symptoms
When carrying out a diagnosis, a practitioner needs to understand the patient’s signs and symptoms. Diagnosis based on signs is far more difficult to practise than one based on symptoms. A diagnosis based on symptoms can be made from a transcript of a patient’s case history, but it will not help the practitioner to understand subtler aspects of the patient. Diagnosis of the CF is made from observable signs and can only be made by using a combination of sensory acuity and intuition (zhiguan). This allows practitioners to perceive patients’ emotional balance and temperament.
This was described by Chuang Tzu as follows:
The hearing that is only in the ears is one thing. The hearing of the understanding is another. But the hearing of the spirit is not limited to any one faculty, to the ear, or to the mind. Hence it demands the emptiness of all the faculties. And when the faculties are empty, then the whole being listens. There is then a direct grasp of what is right there before you that can never be heard with the ear or understood with the mind.
(translation from Merton, 1970, Chapter 4)
The emphasis on diagnosing the relative imbalance of patients’ emotions requires practitioners to relate to the emotional life of the patient. Practitioners must be able to induce patients to reveal aspects of their inner selves in order to assess the balance of the key five emotions. To do this practitioners must make excellent rapport with their patients.
If a man is brusque in his movements, others will not co-operate. If he is agitated in his words, they awaken no echo in others. If he asks for something without having first established relations, it will not be given to him.
(Confucius; Analects)
The practitioner’s internal state
Practitioners also need to be aware of their own emotions. Because of their own constitutional imbalances and emotional predispositions, practitioners may find it more difficult to experience some emotions than others. This is especially the case if they have emotions that are intense. Some practitioners, for example, are in denial of their own grief or sadness. They therefore do not feel comfortable exploring these areas in someone else. This can result in them having little idea of what really troubles the person. Some practitioners can find it hard to be very sympathetic or difficult to fully recognise the extent of fear in another person. If these limitations are overcome the practitioner’s diagnostic abilities can reach their full potential.
Cultivating awareness
When using this style of acupuncture it is necessary to cultivate an attitude of highly focused awareness in order to make a diagnosis. The practice of Five Element Constitutional Acupuncture becomes sterile and inadequate unless practitioners are constantly vigilant. Practitioners need to listen to the nuances in the voice, observe the facial colour, attempt to discern an odour and perceive emotions arising in the patient. It is this vigilance and awareness that enables the practitioner to make diagnosis a stimulating ongoing process.
If the patient has been separated from his relatives for long and has become worried as a result, then the emotions of worry, fear, joy and anger may undergo irregular changes which could cause an empty deficiency of the five viscera with the blood and qi departing from their usual guarding positions. A physician cannot be regarded as a good one unless he can detect such things in his diagnosis.
(Su Wen, Chapter 76; Lu, 1972,)
Achieving and maintaining this level of awareness is dependent upon the internal condition of the practitioner.
Presence
Another important aspect of diagnosis is the quality of attention the practitioner gives to patients. When practitioners are completely present for their patients they can hear and accept what patients tell them without feeling a need to make their patients change. This special quality enables patients to feel accepted and acknowledged so that they can more easily accept themselves. Over time this allows patients to build trust in the practitioner so that they can open up and reveal parts of themselves they have previously kept hidden. By revealing these parts the practitioner understands and connects to deeper aspects of the patient’s mind and spirit. (For more on making rapport, see Chapter 24, this volume.)
To develop presence the practitioner needs to cultivate a state of focused awareness, coupled with a quality of self-acceptance. Practitioners who strive to accept themselves are likely to also accept whatever arises from their patients. The quality of attention given to the patient by the practitioner helps to develop a deep level of rapport and trust which is of prime importance, not only for diagnosis but also for treatment.
Treatment
In the practice of medicine, rapport is often taken to mean that the practitioner and patient are getting along well and a therapeutic relationship has been established. Practitioners of Five Element Constitutional Acupuncture know that rapport needs to be significantly more than this. The contact between the practitioner and patient potentiates the treatment itself. This in turn evokes change in the patient’s mind and spirit. The degree to which the qi of the practitioner harmonises with that of the patient influences the efficacy of each act of needling.
If two are similar, they will coalesce. If notes correspond they will resonate.
(Chun Qiu Fa Lu, approx. −200; quoted in Needham, 1956, p. 281)
Ideally at the moment of needling, the patient feels relaxed and secure with the practitioner. This enables her or him to be receptive to the change that is being initiated by needling the acupuncture point.
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