Community Shiatsu?

I was just reading a post on Chinese Medicine Notes about community acupuncture. I think it's a fantastic idea. Acupuncture and Shiatsu are sometimes prohibitively expensive and this stops these great therapies helping people who really need it. As opposed to those who just have a lot of spare cash. I think it's deeply unfair that great therapies and great therapists should be restricted to those who can afford it. The upper middle class. So how, or is it possible to apply this model to Shiatsu?? Any thoughts?

Shiatsu in Action

Here are some images of our teacher Markus demonstrating some Shiatsu to our class and one of me doing seated massage which is based on Shiatsu techniques.

Love and Bad Medicine?

After a colossall amount of time having not put a single post up I have finally felt inspired to do so. The ever inspirational Eric @ Deepest health is back on the scene again and this has pushed me to do some posting.

So many things have happened since last post. First and foremost, I got married Wooo! which was such an overwhelming experience that comes highly recommended! The whole process from humble beginnings, vow writing to the final day was a journey through our intimacy with one another, our connection with family, friends and the world at large and a reevaluating reconnecting and nourishing our connection with each other as well as our spiritual selves and how this whole love thing underpins everything.

So that was that! Also I have been studying for and just finished my Final ever Shiatsu Theory Exam! Wow which was more difficult than expected and not helped by the fact I got quite hungry part the way through and there was no food in site! Anyway, after a couple of days to think about it I keep thinking of questions I've got wrong!! Let's hope I do better with my point location exam coming up, which is a challenge because, essentially there is no easy way to remember Point locations and their functions, just read, repeat, memorise. Still it hasn't stopped me trying, I have made flash cards, recorded the points onto my iPhone, written them out in books and drawn all over other books.

On other matters, my interest in corporations and the role they have in our lives,and in particular healthcare has been reawakened, thanks to a doctors day on our course, the Film The Corporation, the Book Dirty Medicine. Thinking about the issues raised in these made me think of incident that happened to me.Many years ago now, when I got a very sore throat and swollen glands, I wasn't feeling so well, so I went the doc's . The doctor seemed only concerned that I got out of his office as quickly as possible. He took a look at me , asked if I had eaten anything hot, prescribed me a painkiller and anti-inflammatories, got me out of there. After two days I was feeling worse, totally spaced out and unable to eat anything, even slivers of cucumber are too painfull to swallow, so, another visit to the doctors and I am rediagnosed, tonsillitus, that had now gone septic, septic tonsillitus woohooo. I also find out that the two drugs I was presribed shouldn't be taken together, not only did my visit to the first doc's not make me bettter, it made me more ill!
Now this illustrates a few things, not that doctors are bad, on the whole their intentions are good, they mean well. They are just limited, by time, by money and sometimes by the scope of the medicine they opporate within. The other things that it illustrates is where the power is. You feel ill, you go to the doctor. But what if the doctor is pushed around by so many opposing forces and regulations that their intention becomes not what can I do for this person but, how can this person help me meet my targets? Obviously this results in a 'health' system that is fundamentally flawed.
What to do? Well this brings me to the film the Corporation, the way to tackle this problem is the same as the way you deal with corporations. Corporations illustrated in the film are sociopathic monsters only interested in the bottom line. The way to combat them, is local groups, becoming informed of what they do, support local industry and take back what corporations have taken.
How does this apply to medicine, well the big problem in my story was that I was ignorant of what was happening to me. I was dependent on this other to know about that which is fundamentally mine, my health. If I had known what the symptoms were for tonsillitis, if I had been more aware if my health, and finally if I had been aware of other modalities of health care (Chinese Medicine for example)Then I would have been more empowered, I could have have (possibly) prevented the occurrence, or once it had broken I could have self-medicated, or at least known enough to not trust doctor number one's diagnosis.
None of this is to say that allopathic medicine is wrong or bad, it's not. It does great things for an enormous amount of people and here in the UK is under so much bureaucratic and financial strain it is a miracle that it still functions.

The conclusion is that there a lot of options for health care, Allopathic health care in this country at at least, should be reserved for crisis medicine, whilst the strain be taken off an ailing health system by encouraging people to search out different modes of health care, have an emphasis on prevention rather than cure and to empower people to know about themselves and what to do or at least what is most effective when things are not right. Finally a whole being approach to health, nbody, mind and soul is important.

All thse changes require more than placing blame or pushing for structural change. They require a truly integral approach , individuals, groups, institutions, minds, bodies and souls. In short a change of consciousness when it comes to healthcare of which I hope I can play a small role.

Winter and Water, the Five Elements in Action

This month and the one previous always bring home to me the relevance of the Five Elements in everyday life. The Winter is associated with the Water element in five element or five phase theory.

The Water Element is associated with the Kidneys and Bladder, Kidneys being the Yin, Bladder the Yang. These organs and the Water element as a whole are associated with following: the emotion of fear, the colour black or blue, water, floating,the ears, the bones, Winter, the north, a putrid smell, a salty taste, a developmental stage of resting of storing and the 'spirit' of will power amongst others. Some of these things make more sense in a diagnostic/therapeutic setting but what excites me here is the clear correlation between the feel of the Water Element at this time of year and it's expression in human behaviour and it is this that I want to explore in this post.

In particular I would like to focus on the Emotion of fear, the willpower, and the developmental stage of resting or storing and the nature of the Kidneys in Chinese Medicine.

The Kidneys in Chinese Medicine are the Root of Yin and Yang of the whole body, they also store Essence or Jing, the energetic savings account that we are born with which makes them pretty damn important!! How does this relate to Winter and the larger picture of us Humans wandering around in the manifest world?

Well this is where it gets interesting, have you noticed how at this time of year there is a sense of slight rising panic? People dashing around getting the Christmas shopping in, have I got this, have I got that? I wonder how far back this goes how primal this slight sense of panic is. In times past the harvest would have been gathered in and people would have been settling down and slowing down to ride out the winter. In times past if you hadn't got your winter supplies in then this really was a case of life and death and some frantic scurrying to get food and fuel would have been in order. I wonder because we tend to be a little divorced from the turning of the seasons how much the Christmas panic is a manifestation of this lack of contact? As we have no time of gathering in, a seasonal marker that this is the time when everything is in we have safely stored away and we are ready for winter then it flicks an ancient, seasonal panic switch at a very deep level, what if I haven't got everything?, what if there is not enough food?In essence WILL I SURVIVE? This is the embodiment of the Kidneys, survival, primal fight or flight.
The yang aspect of the Water is the Bladder, whose channel runs from the head down either side of the spine, back of the legs, to the out sides of the foot. It is this channel that embodies the reaching forward, the manifestation of the yang aspect of the Kidneys will power in the world. It is also through this channel that things like colds which predominate at this time of year invade the body giving those early symptoms of achy back and neck.
The flip side to this, the healthy relationship to the Water Element and Winter is the ability to rest and be calm, to be rooted and secure, with a fearless resolve and ability to keep going, though the way through the darkness of winter maybe difficult.
The Kidneys being the root of Yin and Yang provide the heat and cooling for the body. Healthy Kidney Energy means that a person his able to stay warm and nourished throughout the winter.

In order to get in touch with the positive aspects of winter, which is often seen as a bleak time, it is important to look to nature, what does nature do? I was reminded if this by the trees outside my window. In winter they have lost their leaves, and the sap has stopped rising, I get a sense of them coming to rest storing the energy in their roots and in the seeds they have dispersed, waiting, waiting for the warmth of spring.

Winter is a time that we can take advantage of the season, store our essence away, snuggle up, look inwards and meditate on our achievements in the year gone and reflect.

A time to eat more nourishing foods, lamb, duck, beans , miso, marmite, turtle beans, kidney beans and a time to explore the more Yin nature of our lives as human beings.

Geek Tastic

I am a total gadget freak and am a bit obsessed with internet/computer technology in particular and I just thought I 'd let you know about an App I have had on my lovely iPhone for a while now. The App is called Points and is basically an Acupunture Point Location and function finder for the iphone. It has all of the Twelve Meridiands plus Extra Points all with nice graphics and a tap to flip interface that has the location, function and actions of the points on the "back". It has been great for me when learning points as I always have it on me and it encourages me to use it 'cos it's all geeky!
A couple of downsides, the interface is not very smooth, when scrolling through point images the pages get 'stuck' in between and then zoom forward too fast. On the point selection interface you have to be careful to line up the meridian letters with the point number in order to get the right thing otherwise you get some other point altogether.

So great ! I shall post links to the requisite place but needless to say you can find it on the app store by searching acupuncture! Hooray!

Markus Grasser's Response to Kyo/Jitsu Debate

Hello! Very Exciting news! I have been sent the full response to the Kyo/Kitsu debate published in the Shiatsu Society news, this was not published due to space restriction, but I am very proud to present it here, in full. It was previously held on Tim Mulvagh's CB Shiatsu site but it is currently down.

Enjoy!!


CLARIFICATION OF ORIENTAL MEDICAL THEORY AND PRACTICE CONTINUED:
FULL AND EMPTY DO NOT EXIST ON THEIR OWN BUT ARE RELATIVE AND INTERRELATED.




Thank you to all of you who responded last autumn to my article. The main criticism to what I wrote seemed to centre around the belief that Kyo and Jitsu are more fluid, flexible, relative and interrelated terms of reference to use when diagnosing compared to ‘fixed’ TCM patterns and concepts such as Full or Empty, ‘which can exist in and of themselves’.

I would like to put my view across that this is a grave misrepresentation of TCM and its terms such as Full and Empty and its use of patterns. I would like to show that just like shiatsu diagnosis and treatment, TCM is vibrant and responsive to subtle changes in the moment and knowing this can deeply enrich our treatments.

As some of the responses to my article related to “TCM” in it’s limited “post cultural revolution version” I will from now on use the terms Chinese or Oriental Medicine (CM/OM) to avoid such confusion.

In the human body, when it is out of balance, Chinese medicine usually diagnoses two or more co-existing patterns. All of the patterns are seen, in their most simple form, as either excess or deficient. In my last article I wrote that these patterns directly correspond in a palpatory, energetic way to the kyo and jitsu qualities found in the relevant meridians.

So if particular pattern combinations reveal themselves to be the most empty and the most full in the person this will also be what we find under our hands in our client’s body. However this does not necessarily mean that these are the two meridians that we treat. What we decide to treat needs to be decided at the moment using our palpatory skills, the other 3 pillars of diagnosis, our intuition, personal style and trial and error. However, when we do select what we feel to be the appropriate, reactive kyo/jitsu combination we will still be able to find that these full and empty qualities mirror the fullness and emptiness of one or more of the CM patterns we have for this person, though it maybe not always be so obvious, especially with a limited understanding of CM and how patterns manifest.

So, I do agree with those who wrote in to the magazine on this point. What I disagree with is the argument that states that the energetic configuration of the patterns do not directly correspond to the tone of the meridians and vice versa (see my summer ‘06 article).They do indeed correspond but this is only the beginning of how we find which are the most relevant meridians to treat.(see future article on Choosing a Treatment Principle) Any CM practitioner worth their salt will choose from amongst an often complex array of pattern information what they think to be the most ready, effective point of intervention.(For some guidelines see Maciocia “The Foundations Of Chinese Medicine” under “Principles of Treatment” and “Ben and Biao” (root and manifestation) especially under multiple roots and manifestations, ch.35)

What I now want to show in this article is how full and empty do not exist on their own in OM but just like kyo and jitsu are relative and interrelated.

When I first began to study shiatsu I too believed that CM was a fixed, clumsy way of diagnosing the living, changeable energy under my hands. I enjoyed feeling how the kyo and jitsu configuration changed not only from week to week but throughout the session under my fingertips. (From reading the responses to my article I think all of us can relate to the excitement of this alive, in-the-moment feeling of giving Shiatsu)

So I started to deepen my understanding of Oriental Medicine because I wanted to understand more about the interrelationships that seemed to reveal themselves so strongly through the various kyo and jitsu findings and how they could change over time.
Inspired by my hands-on shiatsu experience I was not satisfied by the way many “TCM” books oversimplified CM and/or presented patterns in an isolated manner and i knew deeply that there was more to it than it may seem to some at first. Thus i did not give up and searched until I found all that richness I knew from direct touch mirrored in the classical approach.

From studying with various teachers and experienced practitioners as well as more advanced books, it became clear to me that:

a) Not everything fits into a beginners book but deeper understanding of CM can be found in more advanced books.
b) There are many aspects of understanding and practice that may well be even mainstream Oriental Medicine but nevertheless are not necessarily pointed out in books yet are implicit/pointed out in the personal teachings and the practical treatment records of senior practitioners.
c) That Oriental Medicine is much, much more extensive than the simplified “TCM” version we often encounter in the West.

A WORD ABOUT PATTERNS

You do not need to have all the signs and symptoms of a particular pattern to diagnose it as such. Thus different people with the same named pattern may have quite different signs and symptoms. Also you will find many more signs and symptoms that may not be written about in basic textbooks or anywhere else, but nevertheless are expressing the particular energy being impaired.
The most important thing here to me is to see how exactly a particular energy is out of balance in each particular person. The more we can get a direct sense of the energetic current (rather than just looking at the signs) pertaining to the various channels/organs being out of sink the more individual the treatment will be.
Thus, patterns are not fixed, but about how a particular energy (e.g. the upwards rising life asserting energies of the Liver) unfolds or doesn’t unfold (e.g. tight inner thighs and tense diaphragm.).


FULL AND EMPTY ARE RELATIVE AND IN RELATIONSHIP TO EACH OTHER:

It has been suggested in the autumn newsletter that this was not the case and that relativity and interrelatedness actually were the characteristics of Kyo and Jitsu only.
Also it was written that Kyo and Jitsu are based on Yin and Yang implying to me as a reader that Full and Empty were not.
And thirdly that Full and Empty can exist in and of themselves.

But if you study the usage of patterns in Oriental Medicine, you can see that patterns are often paired up to describe very intimate, changeable interrelationships with each other, which reveals the very heart of oriental medicine:
Rather than diagnosing just the single parts of the person it is all about interrelationship.
Full and Empty are based on Yin and Yang and therefore are characterized by the very essence of Yin and Yang which is their relativity and interrelatedness.

This is very clearly described in Giovanni Maciocia’s “Foundations of Chinese Medicine” under “Yin/Yang”.
The same idea is continued under “5 Elements” (i want to point out that the above is the very essence of the 5 elements or more obviously also called the 5 phases. It is their fluidity, changeability, interrelatedness and relativity that are the very hallmarks of this system. This is exactly what the “Shen/Generation”,”Ko/Control” and the “Cosmological” cycles are about. But as this is well explained in many books on the subject i will not go into detail in relation to them !).
And also under: “Yin Organ Interrelationships” as well as “The Transformation of Qi”.

There are many Full/Empty interrelationships that are clearly described in basic textbooks. E.g.:
Kid Yin xu/Liv Yang Rising
Kid Yin xu/Heart Fire
SP Qi xu/Phlegm in the Lungs
Liv Qi Stagnation/Sp Qi xu
Etc., etc…….

This way of understanding patterns is also clearly spelt out in Shudo Denmei’s “Meridian Therapy”(p.30):
“Excess can thus occur……in response to deficiency….(this) is called reactive excess. The concept of deficiency and excess in the framework of the 5 phases is easy to understand using the analogy of a seesaw. When the amount of qi in two phases is equal, the seesaw is level and there is no deficiency or excess…………generally, for every excess in one meridian there is a corresponding deficiency in another.”


DYNAMIC AND CHANGING PATTERNS

In practice the above patterns are often closely interwoven and they can change their relative proportions from week to week and even within a session .
In treatment the most reactive combination of both channels and patterns can also change from one week to another. E.g. the focus in one treatment could be KID Yin Xu and Liver Qi Stagnation (manifesting e.g. as KID kyo and GB jitsu) but can become Kid Yin Xu and Heart Fire in the next (e.g. KID Kyo/ SI Jitsu). This does not necessarily mean that the Liver Qi stagnation has disappeared but only that this week the focus on KID/H maybe more appropriate.

And this will be reflected in what we palpate on a daily basis……

EVEN IN THE MOST JITSU PATTERNS IT IS IMPORTANT TO TONIFY EVEN IF THIS IS NOT NECESSARILY SPELT OUT ALL THE TIME

In terms of Chinese Herbal Medicine it is interesting to see that even a prescription that is indicated for “pure” Liver Qi stagnation without deficiency such as ”Chai Hu Shu Gan San” translated as “Course the Liver decoction” includes a major Blood/Yin tonic in up to twice the dose of the Liver Qi moving “emperor” herb.
To me this clearly shows the applied wisdom of the principle of tonifying whilst dispersing, acknowledging that very Kyo/ Jitsu relationship even in so called “fixed isolated” patterns such as Liver Qi Stagnation. One would never just use purely moving herbs.
So, in many instances even when it is said that the action of a prescription is focused on a certain pattern, the herbs used will actually address other interrelated patterns as well and this includes the relationship of full and empty even if this is not necessarily spelt out. It just is an implied part/art of treatment.
Many, many examples of this principle can be found in action even if you sometimes have to look behind the obvious.


PATTERNS CAN BE VERY SUBTLE WITH DIAGNOSES RELYING ON FINE TUNED PALPATION

For example, with regards to the above point a), in Macioca’s “Practice of Chinese Medicine” he expounds in much more detail relationships he had not even mentioned in his “Foundation of..” For instance, in the relationship of Liver Yang rising to Lu Qi Xu in the treatment of headaches (p.23) He writes that if there is Lung Qi deficiency this will contribute to Liver Yang rising. In terms of the 5 elements this is called “Metal not controlling Wood”. He points out that treatment of the Lungs is indicated even in the absence of other Lu signs and symptoms purely based on the weakness of the Lung pulse. He does not talk about other palpatory findings but I think it would be legitimate to add, from a whole body palpation point of view, the client would reveal Kyo Lu diagnostic areas as well as weak Yu/Bo/Source points and Channel.

I think this is a very important example of how even in the absence of big, obvious signs and symptoms but solely palpatory ones, it is recommended to support the Kyo.
It does not have to be spelt out in every excess pattern that if there is Lu xu, we would tonify the Lu, if Kid Xu, ton the Kid etc…. in Oriental Medicine this is just implied!
This is clearly pointed out in the Japanese Meridian Therapy School. See e.g. Denmei (see above).

OTHER IMPORTANT RELATIONSHIPS

Other examples are abundant e.g. in Macleans “Clinical Handbook Of Internal Medicine”. He also clearly shows the importance of treating the whole person and he also elucidates many more important interrelationships such as:
Kid Yin Xu/Liv Qi Stagnation
Kid Xu/Stagnation of Lu Qi in the chest
Kid Xu/Liv Fire
Sp Qi Xu/ Liv Qi Stagnation
Lu Qi xu/Liv Qi Stagnation
Etc.etc.

However it is important to realize that any number of combinations and proportions of patterns are possible and these are merely the most common relationships. And again as I said in my introduction, though these patterns will embody themselves directly in the meridian system, the choice of patterns/meridians to work, is another ball game.

INDIVIDUALLY CREATED ACUPUNCTURE POINT SELECTIONS WILL ALSO REFLECT THE UNDERSTANDING OF THE INTERRELATEDNESS OF FULL AND EMPTY EVEN IF THIS IS NOT ALWAYS SPELT OUT

As for acupuncture, the common misconception (but unfortunately also often a reality!) about treatment is that only those points suggested under the various patterns are used.
Yet Maciocia writes in his “The Practice Of Chinese Medicine” in appendix I that: “ the art of acupuncture consists in selecting the right points and combining them in a harmonious way. The lists of acupuncture points which have been given for each pattern in this book are not formulae or prescriptions; they merely set out possible points from which to choose. For each treatment, some points have to be selected ……..in a meaningful way.”

And this, as he writes, brings into play the channel system as a whole, “…. balancing yin yang, left right, top bottom, rising and descending qi, arms and legs, channels from different elements”
For example in the treatment of Liver Fire, Kid 6 or SP 6 will commonly be included in basic textbook’s “pointlists” acknowledging that very Wood Excess /Water Deficient relationship, even though some people think that in CM Liver Fire is seen as a pure excess pattern. (p.28 “The Practice of…”) and only treated by clearing Fire.
And again it goes without saying: if the Lungs are Kyo: tonify the Lungs… if the Spleen is Kyo etc…..the point being: this does not have to be included under Liver Fire.



PATTERNS CAN LOOK AS IF THEY CAN EXIST IN AND OF THEMSELVES BUT IN PRACTICE WILL BE TREATED AS RELATIVE AND INTERRELATED

This understanding of the interdependence and interrelationship between patterns is practically used all the time but often only the building blocks are presented in the basic literature, leaving a fragmented impression for many students.
E.g.: in a book certain points and herbs may be listed for a certain pattern, yet it is simply assumed that the experienced practitioner will create a complete and harmonious treatment by addressing the whole energetic imbalance.
A great historical example of somebody who always spelt out the intricate interrelationships of meridians and organs, highlighting that no patterns exists on their own was Li Dong Yuan, the great 12th century chinese doctor, author of the famous “Pi Wei Lun” (Treatise on the Spleen and Stomach).
The whole book is abundant in examples of this and famous for it.
On the subject of Liver Qi Stagnation in the commentary on the text it quotes Li (p.56) as saying “in case of Qi Stagnation, to administer sweet flavoured medicinals”. Bob Flaws, the translator, goes on to explain that ”this is because the Nei –Jing (“Classic of Difficulties”) says that the sweet flavour is relaxing and Qi Stagnation is commonly associated with tension. This line also helps underscore the clinical reality that one rarely sees pure Qi Stagnation as described in undergraduate textbooks. Because of the interrelationship between the Spleen and Liver, supplementing the Spleen in the case of Liver Depression (Qi Stagnation) does not typically cause unwanted side effects but rather renders the coursing of the Liver and rectification of the Qi all the more efficient.”

The chapter that puts it the clearest is Ch.2 of Book Two, where Li Dong Yuan defines Yin Fire, which is a pathogenic upward stirring of the Ministerial/Life Gate Fire. In the commentary on p.82 it says: “ Li identifies five disease mechanisms which can give rise to Yin Fire (….).these are 1) Spleen Qi Vacuity 2) Liver Depression (Qi Stagnation) 3) Damp-Heat 4) Yin-Blood Vacuity and 5) Stirring of Ministerial Fire. Although I must explain these one after the other in a linear fashion, the reader should understand that these five disease mechanisms are all mutually interdependent. This means that any one of these mechanisms can result in the creation of any of the others. Because of this, real-life patients do not typically exhibit only one or another of these five, but rather three ,four or all five at one time.” As I said before, which pattern/meridian combination/s we treat in Shiatsu (or acupuncture and herbs) depends on what is happening in the moment.


TO SUMMARIZE

CM patterns may be described initially by themselves to facilitate an understanding of the various parts just like when we first learn meridians as separate lines in the body. But if we are to benefit from this ancient and time tested tradition, they have to be seen in the context of the whole and thus their fluidity, relativity and interrelationships, the hallmarks of Chinese medicine, become not only more and more understandable to us intellectually, but we can also begin to integrate this knowledge with what we find intuitively and in our direct experience of our clients on the futon.

Markus Grasser MRSS(T),MRCHM

The Future of Shiatsu

I have to say I am worried about the future of Shiatsu. Our only guiding body in the U.K. the Shiatsu Society seems to be floudering, the articles it publishes are short and occasionally uninspiring, there seems to be no space for energetic debate on key issues and its seems unable to drum up the vibrant support it needs. If the Shiatsu Society represents the state of Shiatsu in this country today then it is a therapy that is in danger of not being taken seriously and determined to cut itself from it's strongest roots. Shiatsu IS Oriental Medicine and if we try and convince an already sceptical public otherwise, we are in danger of alienating them and making ourselves look ridiculous! Shiatsu works Qi, it balances disharmony, it balances Yin and Yang, this is what all Oriental Medicine does, sometimes the approach is slightly different and the techniques are very different (needles, herbs, hands) but the foundations and the goal are exactly the same.