As practitioners of the Traditional Art of Acupuncture, each of us will have different strengths and weaknesses, different approaches and favour certain aspects of practice over others. We may all share a common base in that we may have trained in the Chinese TCM System or Worsley's 5 Elements, Kiiko Matsumoto or in Toyohari or Meridian Therapy but unless we are trained in a fixed and relatively rigid clinic setting like a TCM hospital in China or had a long apprenticeship under a particular teacher it is possible we will evolve to practice acupuncture in our own unique and distinctive way.
Not staying true to one method of acupuncture may be seen as a negative thing in the East, but to the Westerner the flexibility has several advantages. It allows for a type of further development and experimentation that would not be possible in a rigid apprenticeship or training. Mark Seems uses the expression “A New American Acupuncture” to describe essentially the development of new systems of Acupuncture that are possible. To the East, you could imagine such expressions being condemned as heresy. I believe this has a great possibility of occurring in a country where innovation and experimentation is a strong driving force.
I have come up with two ways to look at the learning of acupuncture by training in acupuncture systems. One analogy is to look at the continued tradition of orchestras playing classical music by famous composers long-since dead like Mozart, Beethoven or Bach. The compositions of beautiful music by Mozart does not need any further development. It is already complete and any further alteration would only pollute it. At most it requires a subtle interpretation or flavour, which will be given naturally by the composer and the musicians. But fundamentally, the music will remain in its original state. What matters is the talent and accuracy from the musicians to reproduce it. To feel its perfection, it must be played exactly as it was composed. If suddenly an experiential jazz musician was to hijack a section and alter it, it would ruin the piece.
I think this is comparable to the type of acupuncture systems that require strict adherence to its principles, theories and methodology. Such systems are deemed to be complete in their own right and it is considered important to preserve them in their current state and for practitioners to follow their methods accurately without changing. For some, this is the correct way to practice acupuncture. Japanese Toyohari is a system like this although alterations to the system are gradually made.
Then there is the rock and roll approach. For example, a group of boys with a couple of electric guitars and a drum kit form a band together and learn their trade by playing the hits of their favourite singer or some other popular music. Then they reach a fairly good level of ability and gain some success playing covers. In the future, they may continue to play the same cover hits over and over again but never develop further than being an imitation band. On the other hand, they may start to absorb all that they have learnt – all the different styles and musical compositions and then develop their own unique style of music similar to the way the Rolling Stones started out as an American Blues cover band and then added their own youthful British 60’s rock vibe.
This is the way of acupuncture, whereby a person learns one system and practices it but then due to various experiences, interests and creative urges, are compelled to experiment, develop and create something different. The downside to this is that the practitioner is not always able to explain their thought processes or to adequately communicate their method in a way that can be repeated by other people in exactly the same way. Kiiko Matsumoto has a similar method to this although she has found a way to adequately train others in her system. This method is probably the kind of approach that leads to lots of different variations of acupuncture practice – the kind of thinking that existed in pre Communist China and prior to the Meiji restoration in Japan.
So putting that aside, the consideration for practitioners is to ask which approach suits you best and on principle, which do you think is the best way to practice? For me, I know intellectually that following one system rigidly until I attain perfection (i.e. the Mozart approach) is perhaps traditionally the best way. However, in the West this approach is not really possible as the circumstances that enable it to occur do not exist and also there is my own nature - a tendency to creativity and flexibility. Actually, I don’t think there is any one way for an acupuncturist to learn – there is certainly not a right or wrong way. We all have our different journeys. I only think the most important thing is that we respect the art and always continue to improve.
I think it is common for some practitioners to start off learning one system of acupuncture and then over the course of their lifetime, they start to learn other systems. Or they may follow several different practitioners who does things a certain way and change their own practice accordingly. On the other hand, there are some practitioners who only practice the same system they originally trained in, seeking to deepen their understanding and ability in that system. Whatever system or style a practitioner follows, the goal remains the same – to reach a higher level of proficiency.
There are many benefits to staying true to one system of acupuncture. Every system is remotely complex and takes time to learn and then takes even longer to master. The benefit of staying true to one system of acupuncture takes away the temptation to keep looking at the horizon for the next best thing. Otherwise, before you know it, a typical acupuncturist then has ten different trainings in ten different acupuncture systems. ‘Jack of all trades and Master of none’ is an expression which sums up this problem because there is a risk of confusion. When faced with one problem, which solution do you choose? Humans don’t function well when given too many choices.
But then what if the acupuncturist is not happy with the choice of systems available? What if the practitioner is put off with the systematic point prescription approach of TCM? Or the Five Element practitioner tires of going through a long winded consultation process with Jack the builder with a bad back who just wants a quick fix? Or the non-insertive technique of Toyohari where you wonder if you are actually doing anything or the painful looks of patients receiving Tongs Acupuncture. What if you still haven’t found what really satisfies you? I think there are many practitioners in the West who have this feeling.
When I first learnt TCM, there were many things that excited me about the system. I respected my teachers and was impressed at their understanding and ability to explain the theories behind it. I was fascinated by the diagnostic system, which seemed to me amazingly accurate. My biggest problem came with the lack of channel palpation in the system which was something I had a strong personal interest in. When I first had an experience of the Shakajyu Japanese Acupuncture system whilst still studying TCM, it was the palpatory aspect of it that peeked my interest and I knew I was going to have to learn one of the Japanese systems to develop these skills.
For me - to enjoy practising acupuncture, I need to do it in a way that excites me and that feeds my interest so that I can continue to learn every time I practice. I tend to lose interest when I become too systematic in my treatment. However, I know there are other practitioners who feel the opposite and prefer a systematic approach. We all have different interests and biases. I think it is useful to take a look at the kind of acupuncture you enjoy practicing.
I think that finding an acupuncture style or system should have an element of passion around it. Ideally you will experience its power for yourself by having a treatment. If not you should be able to first-hand witness a practitioner of the art help deal successfully with patient’s conditions. It should not just be based on reading or on hearing what others say. You need to see or feel for yourself that there is something in it. It should be the kind of system that not only makes you think “this is it!” but also should convince you that it works by showing you results.
I believe that traditionally acupuncture was a growing and flexible process. There may have been schools around with different methods and approaches. Some families would practice acupuncture passing their teachings and secrets in a linage onto family members or accepted students. Perhaps it was not the most efficient way of developing and training new students but at least it was diverse.
It is only when politics has gotten involved in acupuncture is when we see an end to diversity and an emphasis on standardization. The Government of the People’s Republic of China created the modern TCM system, which swallowed up all the different variations of acupuncture. A similar thing happened in Japan during the Meiji restoration, when the government attempted to severely limit the practice of acupuncture to only Western Medical physicians or Blind people during the drive to modernise the country. Fortunately, this attempt to eradicate acupuncture failed, although sadly they did manage to wipe out the last of the Samurai despite Tom Cruise’s best efforts.
Despite these big changes, there have been many benefits to this cleaning up and standardizing process of acupuncture. The way that acupuncture is taught as a subject with formalized training, clinical modules and qualifications incorporating Western anatomy, pathology and physiology means that it is now taught to a professional standard closer to Western Medical Training. Newly trained practitioners are trained to a set timetable and a set syllabus and only after qualifying can they start working as practitioners. There is also no doubt that there has been a major increase in the number of Acupuncturists Worldwide since TCM has been formulated which means that more people have benefited from receiving treatments in countries that would never have been exposed to acupuncture otherwise.
The biggest disadvantage is that the long apprenticeship under an experienced practitioner is missed out. For some acupuncturists, that is not essential. Some people find it difficult to be under the control of another. I am probably one of those kinds of practitioners. But others would prefer it. Confidence is a big issue facing new practitioners who find they are suddenly thrust out into the world to build their clinics and their skills for the most part by themselves. However, this has been the norm for Western practitioners in the last 30 years, who with the exception of a few months spent in hospitals or clinics in China or Japan have had to gain most of their experience in private practice. It has become one of the first major hurdles to cross and is a necessary step in building a practice in an industry which is predominantly in the private sector. It’s an essential first step for the western practitioner because it encompasses the development of various other skill sets, such as having a good patient centred approach – treating patients with the utmost respect (contrast that to some NHS hospitals and General practitioner) who will continue to get their high salaries paid by the state no matter how inefficient their service or how bad their bedside manner is. Developing your own skill in practice also helps develop business and salesmanship skills. These are very important because they directly impact on your ability to make a living. The following scientific equation demonstrates this:
No patients = have to eat tinned cat food for a while
When you are out learning on your own, there is a constant drive to improve your skills because:
Better skills = better results = Patients come back / More patients = no more cat food
Though in the West we don’t have the traditional apprenticeship model, there are other ways for practitioners to develop their skills. Seminars, workshops occur throughout the year and there are various different systems to learn and many books to pick up ideas from. Without a strict level of guidance to follow, what is likely to happen is that different acupuncturists start to develop their own ideas and treatment protocols based on their own experiences? For example, if something worked, it is logical for a person to repeat it. If it didn’t work, you may try again sometimes with a small variation and if it doesn’t work again, then seek out an alternative approach. However, if you strictly follow one system of acupuncture, you are limited to only using the protocols that it teaches. I don’t believe there is any one system that is able to fix all problems. The answer to a problem may lie elsewhere. For some problems, there may be several different approaches to try out or it may be concluded that this problem will require repeated visits. Either way, there should be a constant process of evaluation going on as you scrutinise what you are doing. For example in a condition that may require a long series of treatments to resolve, there should at least be some minor improvement or good change in some aspect of their health even if it is not in an area directly related to the problem that they came to you with.
Though this process can be painful as it brings us face to face to the possibility that our treatment is not working, I believe it is by this process that we can become more effective practitioners.
And it is this constant desire to improve our skills which takes the Western acupuncturist to look at other systems of acupuncture and learn them. Actually Westerners are in a far better position than Chinese Acupuncturists because we have the choice to change our styles and to learn whereas most Chinese practitioners only have the option of TCM unless they are trained abroad. The benefit is that there are far deeper and sophisticated aspects of TCM that Chinese can learn, which is generally unavailable to Westerners.
There are other advantages to the flexibility of learning different systems. For example, it is my observation that TCM practitioners cannot see the benefit of needling superficially and some hari practitioners have trained themselves to stop needling deeply. But if you read the classic text – the Nanjing, it clearly differentiates between the necessity to needle at different depths for different people.
For example, in the Huangti Nei Ching Ling Shu (Ki Sunu Translation page 86), Huangti asks Chi Po about whether a different treatment method should be used on physical workers compared to those with more relaxed lifestyles. Chi Po answers:
“… if the way of life is different, acupuncture treatment also should be different.
For the treatment of the persons who are sensitive, one should puncture shallowly with the small needle, withdraw rapidly and should not retain the needle in position.
For the treatment of the persons who are insensitive, one should puncture deeply with the large needle, withdraw slowly and retain the needle in position.”
Drawing on my own experience, an insensitive person does not necessarily mean someone who has a fuller body or is a bit obese. Though the muscles are big, they may be very sensitive and feel drained after deep needling. And some thin people who work in office environments with central heating and sitting down a lot are not necessarily sensitive types either. If they are a Liver/Wood types of person with firm muscles and are very springy and active, they may actually be insensitive types. Nethertheless, Some problems require a stronger TCM approach to fix it and feel nothing from hari needling. Other people are in a weak condition and a gentler hari approach is more appropriate for them because TCM can be too draining. These are significant differences in technique which are sometimes passed over.
Overall, if you only needle one way or only use one approach to try to fix all problems, surely there are limitations to this. On the other hand, if you learn from various different systems and different practitioners, there is the possibility you can become a more rounded practitioner. For example, from TCM you can learn stronger techniques like deeper needling techniques and cupping. From Hari, you will develop greater sensitivity with palpation, gentler superficial needling techniques and a more diverse moxabustion usage. From Shakujyu therapy, you can get more experienced with treating the back points. With Five Elements you may be able to develop deeper insights about the make-up of the person in front of you and if you have learnt any kind of massage, your palpation skills may be enhanced ten-fold. All systems will teach you an aspect of skill that can make you a complete practitioner.
But training in different systems is expensive. Not many people have the time, inclination and money to travel to different places and learn whole new systems of acupuncture, so I think this is the value of symposiums, workshops, seminars, informal meeting groups between different practitioners and visits to other practitioners’ clinics either as an observer or as a patient. The motivation expert Brain Tracey recommends you read in your field every day. I think this advice should apply to acupuncturists to continually read up on various acupuncture books, other health related books, journals and other materials every day. Other than from experience with patients, the next best way I find of learning is to be able to watch other practitioners in their clinic and watching their treatment. I have picked up valuable lessons and tools by doing this.
I finish this article by returning to an earlier question I posed: What if you are not satisfied with the system of acupuncture you initially trained in? I think different practitioners may have different answers to this question. For some acupuncturists, the question simply wouldn’t register. You would be met with a blank stare and not be given the answer you were hoping for. Such questions are simply not asked. It is not common practice to question your system. From others, you may be told to have faith and trust in the system and keep practicing diligently for many years and then it will come. This is an answer similar to that sometimes found in some Oriental arts like flower arranging, calligraphy or some martial arts.
From my own Western point of view, my current answer to this question is to respect and honour the systems of acupuncture I have been privileged to learn but also to pay attention to its strengths and shortcomings. Then to practice these systems as best as I can and to gradually improve my skill and abilities. Finally to be open and constantly keep learning new things and approaches from other practitioners, teachers and books – to try out their methods out and adopt them if they are effective. I think it is important not to be judgemental of other practitioners. We all have our different ways, speeds and levels of learning and developing – the same as in life. It is better to share together so that we can help each other become better practitioners.
It is my belief that gradually, each of us makes a personal system of acupuncture that we are happy with – something that gives us the passion to have us working right up to our 60s and beyond, just like the Rolling Stones with their own brand of music. It is a way of acupuncture that incorporates all of our learning, our skills and experiences and some of our own essence. We become what we practice or as the famous acupuncturist Shudo Denmai is reported to have said “Acupuncture is the Acupuncturist”.