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After playing for a while in clinic with the new palpation tools that Dan Bensky and Chip Chace have thaught, some new questions, doubts, thoughts arise...
Ferdinand Beck has rised his hand and Dan Bensky has given many juicy responses...
This is an interview born of clinical experience, we hope you find it useful as well!!!
One on one with Dan Bensky Back an forth over issues arising from integrating the palpation skills into clinical acupuncture practice. Interview by Ferdinand Beck.The white dot in the black spot...Ferdinand Beck:The CRI indentifies the most-least/weakest area, but then the MTD looks for a hot spot i.e. a place of increasedactivity, there you needle.Is there a logic which I don’t get, or is it just experience that works? (A similar confusing logic applies intoyohari meridian therapy: on the abdomen and pulse one looks for the weakest, then one chooses thehealthier/stronger side, and finally one looks for a weak point to tonify…) Dan Bensky: I think the common point here is that both of these techniques are focusing on stagnation. It is the stagnation that causes both the lack of movement and a resultant increase in heat. The analogy that seems best to me is that qi, like air, when compressed generally becomes hot.Ferdinand Beck:Yes, that makes sense. Often on local areas for symptom treatment, there is a spike in the MTD, but the surfaceis then rather flaccid on direct touch. These concepts of 虚 vacuous vs. 实 replete probably are not always to betaken in a western-logic physical sense… But what about the listening on the source points you had uspractice? When active then they are open or rather stagnated? I often feel a kind of resonance which I interpretas “this wants to be touched/treated”. I lately use it a lot as an addition to pattern selection or selection of thetreatment side. If I decide to do something but do not get in touch with the decided point, I do not proceed, butcheck again what to do. Seems to work well. Is this the way you use it? Dan Bensky: First, I have a different opinion about the basics here. In the end 虚 xu and 实 shi come down to empty/depleted and full/excessive. Don’t get what is going on mixed up with the manifestation; this is not only true with what we feel. One basic example: heat can come from many, many types of dysfunctions; from deficiency or from excess, from dampness as well as dryness. While all of these may end up generating heat, the best approach to treatment will be different for each one. I don’t work this way. My “gold standard” for point location is that the point that has the biggest response on the organism is the correct point at the right location.Thermal layer: the level and the spikes...Ferdinand Beck:Are there situations where you would needle an area which has a dip in MTD instead of a raise? I remember onecase in London where a student had a lowered hight of the MTD layer on her injured knee, wouldn’t it makesense to work there locally?….Are the height of the layer and the intensity of the point two separate bits of information, or is the peak ofintensity in fact a heightening of the layer?
Dan Bensky: This two questions go together as the height and intensity are two separate bits of information. The height is related to some underlying aspect of the organisms function [I believe closely related to the EAM idea of boththe ying and wei qi, but Im not sure about that]. Usually [except in the case of acute fevers] the closer the height of this layer is to 10 cm, the healthier the person. Therefore it is quite common for the area of greatest restriction to have a lower thermal layer than the rest of the body. As the point of most intense heat is commonly a point that often is related to some problem in the flow, it is often at or near the border where the height of the heat layer comes closer to the body. Just to make it more interesting, it is normal for the point ofmost intense heat not to be at the outer limit of the thermal layer. As an example, the thermal layer may go from around 8cm to 4 cm around GV-7; the most intense heat over GV-7 could be at 2cm over the body, not at the edge of the thermal layer (which is at 4cm).Sticky pointsFerdinand Beck:When finding a point to needle you told us to look for a “sticky” feeling. That works very well. Then you saidthat palpating deeper, one should again look for stickiness in order get a sense of how deep to needle. This I findmore difficult. I do feel some kind of resistance or a general feeling of resonance, not unlike when touching theyuan source points in our exercises.Do you palpate horizontally like when finding the point or do you poke vertically? Could you please describewhat you feel there? Dan Bensky: When you want to see if a point is active [in the scheme presented in the class because it feels as if there is a discrete increase in the heat there] you rub back and forth over it starting with very little force and increasing gradually. The amount of force that ends up making the point the stickiest is usually related to the depth of the points location. That is, if it feels stickiest with minimal pressure, the point will be at the surface; if it feels stickiest with the deepest pressure, the point will be as deep as possible in that area. This is an indication, a guide, not a fact, so you have to still pay attention when you needle. Maybe the word “stickiness” does not work for you; what we feel is that your finger runs into an area of heightened friction so that it takes more force to move it over the point at this level versus other levels.Ferdinand Beck:When “listening” for points, I sometimes found that when pressing a point, the base of the palm is drawn toanother site, sometimes even the other side. With varying the amount of pressure there seemed to be a degreewhere the pull on the palpating hand went neutral. I thought that might be another idea to get an initial sense ofthe insertion depth. I am still trying, do you have experience with this? Dan Bensky: I am not sure I understand this question. If when doing the style of listening your hand is in one place and the palm gets pulled to another place, the second place is probably where you should focus your treatment.Ferdinand Beck:I place my right hand on the sacrum to listen, then place my left index finger on the point where the pull comesfrom. I found that the amount of touch with that left finger on the point makes a difference whether or not thepull is neutralized. If touch on the second place is too light it sometimes does not make much difference, if too hardsometimes the pull changes its direction to the opposite side. I use this to estimate the needling depth, i.e. decide
whether I do a contact or insertive needling. Difficult to tell though how much my expectation plays a role, andto do this my own body posture is twisted plus while I fiddle around with one hand I must listen with theother... If you haven’t noticed this then it’s probably just in my imagination. Dan Bensky: I think I understand. This issue should not have anything to do with depth of needling. It is common for a point not to be inhibited if the pressure over it is too light. If you feel a different place with more pressure, I would think that it means that you are not in the right place and that the second point you feel (“opposite side”) is correct. It is not unusual in the beginning when people try too hard, to end up chasing your own tail. That is whenever you inhibit a point, a new pull is felt and so on and so on. That just means you need to do something else, as the listening is not going to work that day on that patient.All roads lead to RomeFerdinand Beck:You had us touch the source points. I can definitely feel something, and different qualities here and there. Sowhat do you with it? If a channel feels open, would you pick that one for treatment, because it reacts? Or ratherthe other one that needs to be opened? Dan Bensky: There are two different approaches to this. For me, I have found it more useful to choose a point on the channel that I feel stagnant, as the best change that I get is from unlocking/opening it. Chip has the opposite opinion, with what to him are his best results coming from picking a point on the openchannel. While we are feeling the same thing, we do something different with it and this probably has to do with the differences in our own approaches to diagnosis and treatment. Remember that all we are teaching you are palpatory and conceptual tools - you can use them in a variety of ways that will be useful, so you will have to figure out yourselves what you want to do with them.And then...?Ferdinand Beck:Then again the usual problem comes up: how much of this is “real” and how much of my perceptions actuallyonly meet my expectations. In fact I consider this one of my biggest problems in clinic… are there ways to trainthe mind to be objective and not only finding what one expects? Dan Bensky:The best way I know is to have as few expectations as possible and to use a few different ways to check yourself [and time]. Of course, the basic concept of focusing just on sensation first and on interpretation later makes it easier to avoid simply feeling what you want to feel. Thank you Dan Bensky for your inspiring teachings, time and dedication.