Hold Space, Move Qi

getting specific about my job

Art by A. Cohen

This post is a summary of a class I taught on Saturday to our second year students.¹ It happened to be Valentine’s Day, which was entirely appropriate because I really love this topic.

As I mentioned before, we strongly believe that there’s no one right way to practice acupuncture, and so it’s important for students to figure out what’s right for them — to develop their own (highly personalized, probably idiosyncratic) approach. To support that process, we have classes where faculty and supervisors present their individual approaches to acupunking. This post is about how I do it.

Or rather, did it — a caveat is that I haven’t worked regular shifts in the clinic since December 2015. (Yes, I miss it.) Punking is a lot like riding a bike, though, so I can still describe how I do it, and the basic aspects that I’ll never forget are actually pretty applicable for our second year students. At this point in their internships, they’ve all done somewhere between 120 and 200 treatments — they’re way past the “don’t fall off your rolling stool” phase but they’re still focused on fundamentals.

It’s important to me to be clear about what my job is, to define it for myself. I think everybody should do that — it’s an exercise in sovereignty and self-care — but I’ve had some extra incentives, thanks to all the acupuncturists who define my work as devaluing, diluting, dumbing down, and debasing the acupuncture profession.

Which is definitely not what I’m doing in clinic.

My job in clinic is to hold space and move qi.

Hold Space

We talk about this a lot in second year, and by this point in the program all the interns are pretty good at being present, attentive, and non-judgemental. A less obvious dimension of holding space, though, is being organized. You need to come to clinic feeling organized within yourself — physically, mentally, and emotionally. Physically organized means things like wearing clothes that have enough pockets and allow you to move freely, as well as arriving early enough to turn the heat on and look over your charts; emotionally organized means being centered and not preoccupied with your life outside of clinic; and mentally organized is what I’m going to talk about.

For me, being mentally organized for clinic means I have a way to proceed with each treatment that I’m confident about. I’ve chosen my clinical strategy and I’m sticking to it. I don’t want to get scattered or derailed; I want my work to have consistency. This includes being clear about what I do within the treatment time vs. what I might do outside the treatment time. Community acupuncture is defined by brief interactions coupled with long resting times. Community acupuncture is all about limited windows — but that’s okay because you can do very effective treatments in limited windows.

If I feel like I need more information than what I can get in my time with a patient, I might do things like: schedule a phone conversation with them after my shift; ask them to keep a symptom log so I can look for patterns; research other treatment strategies besides my go-to approach; or consult with other punks. That’s all outside of my limited window, though.

Inside my limited window, I aim to move qi.

Move Qi

Moving qi² is something I do with my hands and with my attention — not with my left brain, and (mostly) not with my words. (I try to move qi when I write, too, but that’s a whole different thing. There’s not room for a lot of words in clinic.) My Jingei teacher, Yoshi Ikeda, said that practicing acupuncture is about using your heart, your hands and your head, in that order.

In order to move qi effectively for my patient, I need to identify where the qi is stuck.

First, I listen to what they tell me. Where qi is stuck often comes up in the context of their chief complaint. If they say, my elbow hurts, that’s a good start. If they say, I’m stressed and anxious, I might ask them, is there anywhere in your body that you feel that particularly? And they might answer, I feel it in my shoulders, or my neck — or they might not be able to identify where they feel it. That’s no problem, I have other ways of pursuing the question. I try to take in their body language and any nonverbal communication, including if they don’t really want to talk to me at all. Which isn’t a problem; in community acupuncture we don’t need to interrogate people.

Second, I apply my own clinical lens, which is Jingei. In Jingei, the idea is there’s one channel in every person where the qi is most stuck, and if you can get it moving there, you’ll benefit the entire person. All the qi in the body is connected, so it’s just a matter of knocking over the first domino. Your goal is to catalyze and support an upward spiral for your patient. See also:

So you want to identify that first domino. You can do that through pulse diagnosis — but pulse diagnosis is highly subjective so it’s also good to have other ways, like palpation or observing how the patient holds their body. Eventually your intuition starts to kick in about where the stuckness is, though that takes practice.

Apology to non-acupuncturist readers: the next few paragraphs are kind of technical.

When I say “channel” what I’m thinking of is not just one of the twelve primary channels, but one of the big six: Tai Yang, Yang Ming, Shao Yang, Tai Yin, Shao Yin and Jue Yin, because that’s how the system of Jingei is organized. If someone says, my elbow hurts, and they’re pointing to the Triple Warmer area, I think, okay — Hand Shao Yang. But qi isn’t separate, so I’m thinking about the Foot Shao Yang channel too, or the Gallbladder. And I’m also thinking about the Yin pair of those channels — Jue Yin, meaning Pericardium and Liver. All of those channels are good places to knock over the first domino.

A treatment doesn’t feel complete to me without needling the source point and the he-sea point on what I think of as the most affected channel; I always want to do those points. If for some reason I can’t get to them, though — say I can’t access TW 10 and TW 4 on my patient with elbow pain because they’re wearing satin opera gloves and don’t want to take them off (don’t scoff, it could happen! That’s not even close to the weirdest scenario you’ll encounter in a community clinic) — maybe I can swap in GB 34 and GB 40. I’m still able to address the Shao Yang channel that way.

I have confidence in source points, so my treatments always include source points. For someone with elbow pain on the TW channel, I’d also probably needle Liver 3 and Pericardium 7, and of course Large Intestine 4 because why wouldn’t I needle Large Intestine 4, especially proximally, way up into Ling Ku where the bones of the hand image the elbow?³ Whoops, I’m getting ahead of myself.

Jingei uses the concept of root and branch, with the most affected channel being the root and the symptoms being the branch. Once I’ve addressed the root by needling source points and he-se points, I think about addressing symptoms, which I might do via Balance Method (see above, Ling Ku imaging the elbow). This gets into a bigger conversation about local vs. distal points that we had in class, which I probably can’t fit into this post. I do sometimes do local points, though I’m cautious about it — because local points can exacerbate pain — so I have a whole routine around making that decision, like if someone has a headache I’ll touch my fingertip to Yin Tang and ask them “Better or worse?” and then repeat with all the likely points on the head: Stomach 8, Tai Yang, Bladder 7, etc. In my experience, local points for headaches have about a 50-50 chance of going either way, so I always check. If they say “better”, I needle the point; if they say “worse”, I go distal.

My goal is to collaborate with my patient, to collaborate with their body, and a good way to do that is to look for the path of least resistance. When I’m sitting next to someone in a recliner, I notice: what part of the patient’s body is the most accessible to me? Especially, is their body sort of offering me something, like is their knee angled toward me? It’s almost like divination. Where does the body want to start with the treatment? That’s another way to choose points to address symptoms.

I asked the class: once you’ve needled the points you’ve chosen, how can you tell that qi has moved? We discussed how sometimes you can just feel a treatment land:

You put the needles in and you just know that you connected. The patient feels it too. If it were a sound, it would be a bass reverberation: a thump and a deep echo. You can almost feel it coming up through the floor; I bet a dog could hear it. It’s not about being heavy-handed; you can make a treatment land with a gentle needling technique and very few needles.

You can also look for signs: the patient stops talking mid-sentence because they’re so relaxed; their body loosens and opens up; the atmosphere in the room shifts. The most visible indicator of course is people falling asleep. One sign I always look for is how I feel when I’m done with the treatment. Do I feel warm, energized, lighter? It feels good to move qi. This principle goes double for the shift as a whole. A punk should feel good at the end of a busy shift — tired but not drained, with a quiet mind. If you don’t feel good, if you feel drained, depleted, and your mind is racing, something’s wrong, you’re not moving qi.

When I think about what I do at work, I think about how moving qi is something that you can only do in the present moment. You’re meeting your patient exactly where they are — not a past version of them, or a future version, or an ideal version, just where they are right now. A good acupuncture treatment requires getting into the present with someone and staying there, which helps them to get into the present too — that’s where healing happens. When you do it over and over, it’s called accompaniment. And it’s the best job in the world.

1. Last week I also testified for HB 202, a bill to reform acupuncture licensing in Utah that had a committee hearing last Thursday. I was expecting to write about that, but in terms of what I use this Substack for, developing teaching materials takes precedence. If you’ve heard scandalous rumors that I testified against NCBAHM in a public hearing, though, they’re true! I’ll try to get to that next week.

Thanks to JJ of Cohort 11 for suggesting the title for this post.

2. I keep trying to write a post about qi. Maybe it will happen this year? If people ask me, what is qi, I recommend the book A Brief History of Qi by Yu Huan Zhang and Ken Rose.

3. Assuming I don’t have to contend with opera gloves, I’d probably do the treatment in a circuit, like: R arm TW 10 and TW 4, palpating down the channel in between, plus Ling Ku and maybe even a high TW 3 because again, the bones of the hand image the crook of an elbow there; R leg LV 3, LV 8 (and maybe palpate around SP 9, just because I like SP 9); L leg GB 34, GB 40, maybe palpate down the GB channel too; L arm PC 3, PC 7.