A message from Paul Karsten, one of the SIEAM founders.
Medical education has the tendency to become theoretical, technical, conceptual and rational. Fortunately having to apply these mental constructs to patient care often transforms them into the experience of practice, but there can still be a separation of the philosophy behind a medical practice and the reality of how that medicine is practiced. In East Asian medicine one of the fundamental concepts is that of Qi. Often translated as vital energy it is viewed by many in both eastern and western medical and research communities as a philosophical concept that has little direct experiential basis.
The SIOM perspective on this has been that discovering the personal experiential basis of Qi is critical to the development of effective assessment, diagnosis and treatment. This Qi experience then allows for a more sensitive and intuitive tuning in to the energetic imbalances that occur in human illness, and thus assist in more refined and specific care for each individual patient. Training patients to become more aware of Qi flow through breathing, movement and meditative exercises also assist in empowering patients in ways that deepen their own personal balance and health.
How does a school provide training for students to bridge the gap from intellectual to experiential understanding of a so-called concept? East Asian medical education is particularly well suited for this task. The focusing practices in Asia such as tai chi, qi gong, and meditation techniques can be incorporated into the training. These provide embodied experiences of Qi. Techniques in subtle palpation and assessment of the physical body lead to increased sensitivity of vibrational sensations that have historically in Chinese textual sources been associated with Qi. Treatment of patients with the practices of pulse taking, channel palpation, and needling or bodywork techniques that require sensitive awareness of patient responses and internal states of qi lead to heightened personal experience with Qi. Engaging qi in therapeutic encounters such as acupuncture provide awareness of how feeling this state can impact the quality of treatment. Ultimately the student practitioner becomes more and more comfortable with both sides of clinical practice - the analytical, objective, rational component, and the energetic, subjective, intuitive component. Integrating these two distinctly different skill sets leads to an approach to patient care that is transformative in its results.
To give an example of this in practice: A conceptual only approach to acupuncture practice would be to start with a diagnosis that leads to a specific set of points already established for that particular diagnosis - thus for Spleen Qi Xu the set of points established might be UB20, St36, and Ren12. Then these points are located by particular anatomical landmarks and measurements that are standardized in the acupuncture textbooks as to where to locate them and how to needle them. Needles are then inserted and a timer is set for a prescribed amount of time after which the needles are withdrawn and the treatment is complete. In the simplest version of this approach all patients with the same diagnosis receive the same points located as exactly as possible given the anatomical standard and treated for the prescribed amount of time.
Now consider an approach that more thoroughly combines the conceptual with the experiential. Let's say we start with the same diagnosis and the practitioner is also trained and aware of the standardized point combinations and locations for the treatment of this condition. But in addition the practitioner utilizes palpation to assess the energetic dynamic of the channels and through this experiential sensation of qi discovers points that are the most out of balance with that individual. These points could be the same as the standard, or they could be located close to the points in the standard set, but not where the "anatomically" correct point would be. Or they might by different points all together on different aspects of the body. Then the points chosen by these palpatory methods are needled in a unique fashion depending on the sensation and energetics felt at each point and with each needle insertion. Needle technique involves engaging with qi in both the practitioner and the patient. The length of treatment is then based on the changes felt at the point, or experienced more systemically by the patient and/or practitioner.
This example demonstrates a clinical practice where the intellectual standards of practice inform patient care, but do not dictate actual practice. The practitioner's training in the direct experience of Qi and the assessment and treatment skills associated with this experience provide an awareness of the "energetic moment" that can touch the patient condition at a level rarely reachable from an approach that only uses standardized objective care.
It is maybe clear that in writing this essay the English language provides more challenge to describe the Qi side of things without it sounding particularly "wu wu". The structure of the language itself makes it difficult to describe the full breadth of the experience of Qi without it starting to sound quasi religious or spiritual. This has caused a form of professional shyness in our field when speaking about Qi. For example, if you look at the standards and language of ACAOM, the accrediting body for acupuncture programs, there is almost complete silence in the literature regarding training or practice with Qi as a competency of acupuncturists. Many in our profession believe that for acupuncture to be accepted and to thrive in this country we need to become more "medicalized" and “standardized” and drop descriptions of Qi all together.
Our view is that this direction would be a great disservice to our patients and the future of medicine in this country. SIEAM is committed to a training that incorporates at different levels the opportunity for students to experience various aspects of qi, and to understand its variations intellectually. It is this intellectual/experiential combination of educational methods that we have found produces graduates with the capacity to approach each patient as a unique individual receiving specific individual care that is appropriate in the moment for that person's condition. This approach to training couples objective outcomes and assessments with subjective experiences that resist an analytical approach to training and rely on more personal daily practice and self discovery to hone individual skills. Thus the training itself reflects the challenge of providing a well-rounded education in a higher education environment that stresses objective measurable outcomes and rational linear thinking, when much of what we do as practitioners goes beyond this way of interacting with patients.