The authors review aspects of what has been termed ‘reflective practice’ and go on to identify its themes within acupuncture traditions. They cite hua (transformation) as our point of origin for education, medicine and spiritual practice; they examine the nature of engaged awareness and the path of the heart; they explore the concept of reflection itself and its role at the core of Daoist alchemy; they develop the notion of acupuncture traditions forming a body of knowledge rather than mere intellectual knowing, and explore the challenges inherent in working from somatic knowledge. They conclude by revisiting reflective practice in the light of Scheid and Bensky’s work on yi - signification, or intent - (published in EJOM Vol. 2 No. 6; Winter 1998/99), and argue for a wide interpretation of reflective practice within acupuncture traditions that honours their roots and diversity and embraces bodywork and the cultivation of inner stillness as much as it does intellectual knowledge.
Keywords nei guan the inner gaze, reflective practice, hua transformation, engaged awareness, somatic knowing, yi signification, Daoist alchemy
'Teachers open the door, but you must enter by yourself.' Chinese proverb
Reflective Practice Reflective practice is assuming greater importance in the education of acupuncturists, and will probably be one of the strands of the Continuing Professional Development (CPD) which will increasingly be expected of practitioners. Oriental medicine has always recognised that the personal qualities of the practitioner are of crucial importance in the healing process, and our traditions offer many approaches to the development of these qualities. This article attempts an initial exploration of some of these themes, pointing towards areas which could be developed fruitfully as we work to improve the education and development of practitioners.
Contemporary discussions on reflective practice recognise that many different kinds of professional work share common characteristics, such as the need to deal with unique and complex situations or cases. These unique situations contain ambiguities and unresolvable elements which require the practitioner to make difficult professional judgements about what is the best way to proceed in a particular case. Being concerned with what is best, these are fundamentally moral decisions. The ability to make these professional judgements is a quality which grows through a gradual and multi-faceted developmental process (Fish & Coles, 1998).
It follows that the continuous process of development of both students and practitioners concerns much more than the learning of facts and theories (propositional knowledge). Practitioners also need to develop their knowledge of how to do things, ranging from explaining a diagnosis to a patient, to needle technique, to the writing of case histories. This has been named ‘process knowledge’ (Eraut, 1994). In addition, it is important for practitioners to recognise that they carry with them many pre-existing ideas, values, and assumptions (their ‘personal theory’), some of which they are conscious of, others less so. This personal knowledge will influence the judgements practitioners make and so it is important to attempt to bring it into conscious awareness.
As practitioners learn they add to their repertoire of personal theory and develop their own style of practice. This is a complex process where the practitioner not only carries their existing personal theory and learned theory into practice, but also uses the experience of practice to develop new theory. However, it is also easy for personal theory to become routine and unquestioned and this can lead to habitual ways of approaching practice that are less able to deal well with a full range of clinical scenarios. As a result, practitioners need to explore, question and refresh their own personal theory within the structures of their discipline. Furthermore, professional judgement tends not to be recognised when it is working well, and this can lead to an undervaluing of the practitioner’s role. This presents a challenge to practitioners to learn how to unearth and articulate the judgements they make so that they can be better understood by both their peers and their patients (Fish & Coles, 1998).
These considerations, which are only briefly summarised here, lead to questions about how these forms of knowledge and judgement can be cultivated. The concept of reflective practice has emerged as a widely favoured response to these questions (Schon, 1983). Reflective practice can be seen as a set of methods which are designed to enable practitioners to reflect deeply on what they do, in order to:
explore and articulate the ways in which they work, learn and make decisions
question their own personal theories and judgements
stimulate the generation of new theory from the experience of practice, and
enable practitioners to stay true to their values.
The aim of all this is to improve practice, and:
‘to treat it more holistically, to work to understand its complexities, and to look carefully at one’s actions and theories as one works and, subsequently, to challenge them with ideas from other perspectives, and to seek to improve and refine practice and its underlying theory’ (Fish & Coles, 1998).
These arguments find many echoes in the literature springing from the long history of Chinese medicine, and by exploring these discussions within our own traditions we may be able to relate such contemporary concerns to the wisdom of our lineages, and hopefully generate some new insights along the way.
As Chinese medicine finds a new expression in the West, it will inevitably be re-interpreted upon the basis of native paradigms. The incorporation of reflective practice into the education and continuing development of acupuncturists is one example of this process. There are certainly strong arguments for the value of developing practitioners’ ability to reflect on their practice. However, there may also be dangers here. It is important that such processes do not close the doors on threads of development that are the lifeblood of the traditions themselves. We would want to resist a process of homogenisation, whereby as acupuncturists we could increasingly lose our distinctive features. Furthermore, those who use reflective practice in professional education recognise that it can easily become a superficial ritual rather than an integral part of being a competent practitioner. Students may ‘go through the motions’ and produce reflective assignments which say the things they believe are expected of them, without ever truly engaging in what Krishnamurti called ‘thinking from our bones’.
A further problem is that the reflective process can become a very intellectual one. This is ironic given that the origins of reflective practice lie in attempts to focus attention on the world of practice. We would suggest that truly useful reflection involves the ability to disengage the thinking mind in order both to connect with a wider perspective, and to connect with our own bodies and feelings.
We would argue that there are elements of our own traditions which may help us to avoid some of these dangers and enable us to incorporate reflective practice as a natural part of our medicine. Universally valid approaches cross borders and are largely perennial, and the ethic of reflective practice can at one level be seen as an aspect of the human function of cognition and therefore generic to all cultures and times. Its expression will draw on the particular cultural components of any tradition, and we can choose to embrace the expression of reflective practice from within the dynamism of the Chinese medical tradition itself.
Medicine as Transformation The recent resurgence of interest in the placebo effect, now renamed as ‘non-specific effects’, reflects a growing awareness in the contemporary West of the role in the healing process of factors such as the interaction between patient and practitioner. This of course has been recognised in our tradition for centuries in the sense that a person’s movement towards health is not something that can be tracked totally within a linear causal framework. There are a potentially infinite number of variables that affect a patient, and, as in quantum mechanics, the very act of observing a system changes that very same system. Thus the practitioner is inextricably involved in the healing process. This, then, places practitioner development at the heart of Chinese medicine, which includes a constant attention to the vitality of one’s own personal theory. A uniting thread with such concerns is that of transformation, both because the healing process itself involves transformation from a state of imbalance to one of balance, and also because the development of the practitioner involves a process of transformation.
The Chinese character for hua transformation expresses this common ground, not only for the patient and the practitioner, but also for the teacher and the spiritual initiate. The etymology of hua is that of a human, standing upright, undergoing change, with change itself showing a person tumbling head over heels. Wieger explains this as ‘to change, to convert men by teaching them’ (Wieger, 1915). He goes on to describe a key derivative of this character as being hua flowers, the evolution of plants. From this, we might consider hua as involving a wide range of action involving the transformation, education, evolution, and flowering of men and women. This thread will have a different emphasis depending upon whether one approaches it from a predominantly Confucian or Taoist perspective. The former will generally be more concerned with cultivating correct behaviour and the latter with spiritual transformation.
A more acute focus on transformation within the traditions occurs within Daoist alchemy. Daoist alchemy is a rich synthesis of traditions within Chinese history that has had an ongoing and reciprocal relationship with Chinese medicine. Its essential concern is the refinement and transformation of the san bao, the three treasures, a transmutation that guides the evolution and unfolding of the zhen ren, the authentic, sacred human. Such a goal is variously understood as encompassing a range of different permutations from achieving immortality to realising and embodying one’s true inner nature. Its scope is vast, but it would be useful to highlight a few of its distinguishing features here.
Daoist alchemy employs an abundance of complex, contradictory and multi-layered images and symbols so as to catalyse the mind to go beyond itself. In a similar way to western alchemists seeking the philosopher’s stone, gold or the Grail, adepts of Daoist alchemy sought as the highest goal the evolution of our fundamental natures in order to realise their inherent divinity, embodied as xian (spirit immortals). This was less an ascension above what materialists might call matter, but more a transformation through immersion and refinement.
Alchemy is commonly understood within the West as a superstitious precursor to chemistry. Certainly, as mainstream scientific approaches became more reductionist and materialist, western alchemy largely sank into the rich ocean of symbols that underpins much of our art and literature. Chinese culture has tended to be more intrinsically holistic than western culture and this is reflected both in its medicine and in its alchemy. It comprises particular aspects as wei dan (outer alchemy), which has underpinned the development of chemistry and pharmacology, and as nei dan (inner alchemy), which has involved the refinement of the self. Alchemy is essentially a process of refinement and the transformation of substance, whether it is lead to gold or jing to shen. Inner, or Daoist alchemy is therefore concerned with the vital substances that we know as jing, qi and shen, and with the five elements:
‘In inner alchemy, the first stage of the work leads from jing to qi, the second from qi to shen, and the third from shen to the Tao or to emptiness. In every instance a basic definition is repeated: the alchemist is not dealing with ordinary jing, qi and shen. In every stage the basic materials used by the alchemist are refined; they are changed from ordinary materials to something special and subtle.’ (Robinet, 1989).
‘The five internal organs are inns for the conditioned five elements, not the gardens of virtues of the primal five elements.’ (Liu Yiming quoted in Jarrett 1998).
So Daoist alchemy involves the refinement and transformation of the habitual or conditioned five elements and the ordinary vital substances into the primal elements of virtue and the subtle substances. This process is a paradoxical journey towards rediscovery of what has always been there. The catalyst for this transformative reaction and the first step on this journey, is the initial movement toward self examination - the inner gaze.
Nei Guan - The Inner Gaze Each of the world’s major religions and spiritual traditions offers its own approaches to meditation and contemplation. For those practitioners who are religious or who have a spiritual practice, their process of development will often involve them in exploration of these aspects of their own tradition. For those who do not consider themselves religious, meditative approaches can be seen as a way of deepening awareness of processes which would otherwise remain unnoticed. It is possible to draw on any of the world’s diverse traditions for contemplation and meditation techniques, although we would caution against a consumerist or imperialist approach that dishonours or disempowers the source teachings. Of course, many students and practitioners of Chinese medicine are drawn to approaches which share the same cultural background as their medical tradition, and Buddhism and Daoism are key spiritual traditions that contribute to that cultural background.
It is within this context that the catalyst of Daoist alchemy, nei guan the inner gaze, has relevance for the acupuncturist. The term ‘reflective practice’ carries many echoes within Daoist traditions. Reflection holds images of an internal meditation as well as active re-presentation of external sense stimuli (as a mirror). Both internal meditation and the mirroring of experience arise within Daoist practices of engaging the inner landscape of the body, a vista which consists as much of the meridians and acupuncture points as it does the divinities and geographical features of the mythological world. Schipper (1982) describes the entrance to this kingdom:
‘One obtains the inner vision by looking within, by turning the pupils to the inside and keeping the eyes half closed to let in light from the outside. The eyes not only relay light from the sun and moon, but are also considered to add their own luminous energy, so as to become themselves the sun and moon of the inner universe. These sources of light are to be directed toward the centre, the head between the eyebrows. In the centre, there is a third source of light, identified with the Pole Star (the third eye), which acts like a mirror and reflects the light of the eyes and directs it within.’
The inner gaze and the mirror itself are not just the practice of a tourist within the inner landscape, it allows the adept to engage in revealing the true nature of things, or as Larre and Rochat de la Vallée (1995) put it ‘the forces that lie behind the perceived universe’. This is a process comparable to Buddhist Vippassana insight meditation (see Kohn 1989). In addition, the inner gaze is used in Daoism to enable the transformation of the adept’s qi field to that of a xian immortal, involving the evolution of jing to shen through the transactions of qi that is also the lightening and refining of the qi itself. Schipper (1982) distinguishes between these two uses of the inner gaze, and goes on to say:
‘Inner vision is called in Taoism: “the returned view (fan-kuang)”; the light is reflected, the mirror reverses the flow of energies. The ‘old things’ have progressed in time and thus achieved a transcendent power; the reflection of the mirror effects a return towards their original identity. In the same way, the inner-directed look allows us to discover our original and essential self, our true form. Mirrors show the reverse side of the original and fundamental image of the universe which, through an involution toward the origin of things, we are supposed to perceive by looking through the mirror.’
Daoist alchemy’s turning of the gaze inward allows one to perceive the universe as represented within one’s own body. There are important implications here for practitioners as their bodies then become diagnostic antennae for external scenarios (e.g. patients’ patterns). This is an important emphasis from our tradition, and we will explore it further, later, in the discussion of embodied knowing. This is something that takes a great deal of work, not least in familiarising one self with the native terrain of one’s own natural filters of pathology and habitual character which could taint any clarity of inner sight if not attended to. In addition, we would suggest that such impressions should always be backed up with other diagnostic information. This is an example of how we, as acupuncturists, need to be aware of the ways in which our own past experiences can affect our perception. Such awareness is one of the aims of reflective practice.
The examination of one’s own filters of perception that cloud a clarity of view contributes towards the inner stillness that is characterised by a path with heart.
The Art of the Heart
‘The great end of learning is nothing else but to seek for the lost heart.’ Mencius
In order to reflect in ways that challenge our own assumptions and help us to develop, we need clarity of awareness. This is aided by meditative practices such as the cultivation of the inner gaze. The aim is to promote one’s own development and to deepen one’s understanding, but all these reflective ways of working are motivated by the desire to improve practice and to work better for our patients. We are therefore talking about the development of awareness which enables us to engage better with the world of practice. Fitter1 has coined the term ‘developing engaged awareness’ to describe this process.
The classical texts on Chinese medicine abound with statements about the importance of engaged awareness in the work of practitioners. Drawing on these texts, Jarrett writes:
‘The sage’s power (ling) to awaken the highest in others is derived from his/her internal alignment with heaven and his/her establishment of ming. . . . . When the will of man (zhi) is perfectly aligned with the will of heaven (ming) then the human becomes a conduit for the authentic qi (zhen qi) of heaven and earth. . . . . Taking the sage to be the healer, the concept of ling holds special import for those engaged in the practice of Chinese medicine. The practitioner of the “internal tradition” does not make things happen in his/her patients. Rather, he/she creates the appropriate context for change through every nuance of interaction with the patient. . . . . This approach de-emphasises acupuncture as a technology and places the emphasis of spiritual development and “upright” (zhen) behaviour on the practitioner’ (Jarrett, 1992).
Similarly, Scheid and Bensky (1998) argue that ‘for many leading physicians in the history of Chinese medicine, their ability to help their patients, their movement toward healing power, was located in or derived from yi’ where they describe yi as ‘a process of self-cultivation rather than mere knowledge creation . . .[which] can be fed by . . . poetry and calligraphy, by biomedical knowledge and by meditative contemplation . . . [and which is] a social process guided by and rooted in tradition’.
These ideas about self-cultivation and the central importance of the practitioner’s own engaged awareness are found in the earliest Chinese medical classics. For example, Larre and Rochat de la Vallée (1995) discuss the inner meaning of chapter eight of the Huang Di Nei Jing Ling Shu. This is the chapter which famously begins ‘for every needling, the method is above all not to miss the rooting in the spirits’. Larre and Rochat de la Vallée (1995) interpret ‘the spirits’ as referring to the forces that lie behind the perceived universe, and also to aspects of being human, such as will and intention. How can the practitioner be sure not to miss ‘the rooting in the spirits?’ This seems to require an attunement to ‘the forces that lie behind the perceived universe’ and the development of the personal qualities of the practitioner. It is clear that the Chinese classical tradition considers deep inner stillness and reflection as key ways of cultivating this attunement and developing these qualities in the person.
Similarly, chapter 9 of the Huang Di Nei Jing Ling Shu expresses the internal focus of acupuncture as needing to ‘close windows and shut doors’. Larre and Rochat de la Vallée (1990) comment on this at the levels of both practitioner and patient:
‘At the level of the practitioner, to close windows and shut doors means to close your orifices in order to keep your essences and qi at work inside, and not to use up your essences and qi in exchange with the exterior. So you perceive reality in the inner world, with inner taste, inner hearing, inner seeing. You use your vitality to perceive your inner reality and to make the unity of your own life.
For the treatment room, to close windows and shut doors means that you need a room calm and quiet enough for concentration, so that you can stimulate the possibility of the relationship and unity between your spirits and your patient’s spirits.’
Considering the meaning of ‘perceiving your inner reality and making unity of your own life,’ Xunzi, a Confucian philosopher of the 3rd century BC, wrote in chapter 21 of the Jie Bi:
‘How can a person know the Dao? By the heart. How can the heart know? By emptiness, the pure attention that unifies being and quietude. The heart is never without treasure, yet it is called empty. The heart is never completely filled, yet it is called unified. The heart is never without movement, yet it is called quiet. Man lives and possesses knowledge; he knows, and through knowledge possesses will (zhi). Will is storing of precious treasure. However, the heart is called empty, for emptiness has nothing to do with impressions already gathered, but with what is going to be received. The heart is alive, and it possesses knowledge; it knows, and from knowing makes distinctions. To make distinctions is to know all parts of the whole at once. At rest, the heart dreams; in calmness it behaves naturally; when in action it makes plans. For this reason the heart is never without some movement; but it is called quiet. This quietude is there because dreams do not disarrange the consciousness.’ (in Larre and Rochat de la Vallée, 1995)
Larre and Rochat de la Vallée (1995) comment thus on this passage:
‘Calm and quietude, the Art of the Heart, are not the denial of the movements and reactions that make up life. On the contrary, the Art of the Heart is an analysis of these movements and reactions. It is the temperance that distances anger and outbursts. It is the perpetual re-establishment of a balanced mode of qi and blood, flesh and bone, feelings and thought.
The heart’s grandeur is the pure and clear perception of true consciousness. Thus can the heart take on the burden of beings.’
This commentary draws together several important themes for practitioners. Calm and quietude are important qualities to cultivate in oneself, enabling emotional balance and creating the inner space to allow reflection on the ‘movements and reactions’ we experience in our body-mind-spirit as we live and as we practise. Many acupuncturists will attest to the value of meditative practice as enriching and deepening their work in a variety of ways. In addition, these passages remind us of the importance of ‘making distinctions’, of the analysis of the movements and reactions that make up life, and of the study of the self.
A similar dynamic is expressed by the Japanese master Dogen Zenji:
‘To study the Way is to study the Self. To study the Self is to forget the Self. To forget the Self is to be enlightened by all things. To be enlightened by all things is to remove the barrier between Self and Other.’ (in Dass and Gorman, 1985)
Dogen Zenji reminds us here that one aspect of the cultivation of inner quietude is the quieting of the voice of the ego, enabling us to remember that we are fundamentally not separate from the world but rather inextricably part of it. He emphasises both the value of reflection, studying the self, and also the importance of rooting that reflection in meditative awareness, ‘forgetting the Self’.
Making Distinctions The Chinese medical tradition includes a large body of works known in modern China as yi de writings (Scheid & Bensky, 1998). This term is generally translated as ‘medical ethics’, although the works are varied and actually relate to the ‘character of medicine’ as a whole. One much discussed statement from this body of works says that ‘medicine is yi’. Many famous doctors in Chinese history, such as Sun Simiao and Zhu Danxi, have written about this, and the central importance of yi in the development of the practitioner has been explored in depth in this journal by Scheid & Bensky (1998) as part of their endeavour to develop a normative account of Chinese medicine. This was a seminal piece, and we refer readers to it for greater depth. We present below our own summary and interpretation of some of the key arguments.
Yi can be translated as intention, ideas or intelligence. Scheid and Bensky (1998) discuss classical sources which support several of these translations, for example a Han dynasty passage in which yi ‘seems to refer to that which the physician desires and consciously conceives of, that which he wills, but also that which comes about through a kind of focusing of consciousness’. This is the basis of translating yi as intention. Similarly, Graham defines yi as the image rather than the concept of a thing, and the movement to action with which one responds to it. This points to a pre-verbal and pre-action quality, which is suggested by the word ‘intention’. Scheid and Bensky (1998) argue for yi to be translated as ‘signification’. Signification means the act of giving something a special meaning, which can be at least partially communicated and which manifests itself in action. It is used by Scheid and Bensky (1998) to describe:
‘the ability to enter into the totality of a clinical situation, view it from different angles simultaneously, match it with ideas already present in the mind, compare and contrast them, weigh up different possibilities for action and then, and only then, do exactly what is appropriate.’
Thus yi is a form of intelligence which ‘comes from knowing and . . . manifests in doing’ but which ‘goes beyond representational knowledge’. As Zhuangzi wrote ‘words are the means to get the idea (yi) where you want it, catch on to the idea and you forget the words’. The Tang physician Xu Yinzong said: ‘medicine is yi; it is in one’s thoughts and deliberations . . . That which is understood by yi cannot be disseminated by mouth . . .’ (in Scheid & Bensky, 1998).
Scheid and Bensky (1998), referring to the discussion of yi in the Yi Jing (the Book of Changes, ‘I Ching’ in the Wade-Giles transliteration), write that ‘yi . . . . is that whereby one searches out profundity and studies the all encompassing to arrive at complete understanding . . . . It is a process with its own trajectory or natural flow that follows a path or dao by the exploration of subtle resonances and the weighing of imponderables which result in complete and penetrating insight into the totality of a situation’.
Although there are aspects of these discussions on the nature of medicine and yi which are particular to the Chinese tradition, there are also aspects which resonate with the discussions in the West about the nature of professional knowledge. Key writers such as Eraut (1994) and Schon (1983) have discussed the complex nature of professional knowledge and professional judgement and how they involve ‘the exploration of subtle resonances and the weighing of imponderables’ in ways which are difficult to ‘disseminate by mouth’. These writers have gone on to discuss ways in which professionals can develop these sort of skills, both during their initial professional education and in the rest of their professional life. This leads to the discussion of reflective ways of working. Reflection is seen as a tool which enables professionals to explore the aspects of practice which are beyond propositional knowledge and technical skills, and the ways in which practitioners deal with unique and complex situations. It is recognised that aspects of practice are difficult to verbalise, and that some aspects may always remain mysterious (Fish & Coles, 1998). This certainly seems to relate to aspects of the discussion of yi:
‘The healing power which flows from signification [yi] . . . is grounded in an understanding which involves thinking and deliberating . . . this knowledge is context specific, personal and not readily communicable’ (Scheid & Bensky, 1998).
Many of the colleges accredited by the British Acupuncture Accreditation Board draw upon some of the techniques which have been developed in the West to encourage habits of reflective practice. These can be seen as ways of encouraging students to ‘analyse the movements and reactions that make up life’, to develop their abilities to ‘explore subtle resonances’ and to ‘weigh imponderables’, and to find ways of articulating their professional judgements so that these can be shared with colleagues and with a wider public. By rooting these techniques in the concepts and language of our own tradition we can integrate them into our wider understanding of our medicine, and we can combine them with other traditional ideas of self-cultivation.
A further way to relate these ideas from the modern West and the classical East comes from the work of Kolb (1984) who has developed a theoretical description of the nature of learning, which can be briefly summarised in the cycle in Diagram A.
Kolb argues that a learning process begins at one part of the cycle and then moves around it. Thus, one might start with an experience in practice, then reflect on that experience, then relate it to theory and in the process derive new insights, which one would then take back to try out in practice. Or one might start with a theoretical idea, work out how to apply it, try it out in practice, and then reflect upon how that went in order to modify the theory. (Incidentally, both of these processes are clearly evident in the history of the development of Chinese medicine.)
Kolb and Fry (1975) also suggest that each individual tends to be stronger at one part of the cycle than at another. Some of us are naturally reflective, others are natural theorisers or application-developers, and others gain most from hands-on experience. For learners, it is helpful to identify one’s natural style and then to work on the other three stages of the cycle in order to round out one’s learning process.
Interestingly, it is possible to map Kolb’s cycle on to the five elements. This is not so surprising when one considers that Kolb drew on the work of Carl Jung in developing his model, and Jung had a keen interest in Eastern thought in general and the Yi Jing in particular. (see Diagram B)
Interestingly, once we have mapped Kolb’s cycle onto the five elements, we can see that Earth is missing. In the cosmological cycle of the five elements, Earth is placed at the centre of the diagram, reflecting its role of mediating between the other four elements (See Diagram C). Since yi is linked to the Spleen and to Earth, one could expand Kolb’s cycle by adding yi as the central quality mediating between Kolb’s four phases of learning. Such a placement has particular relevance when one considers the virtue of Earth, interpreted by Kaptchuk2 as the ‘consciousness of possibilities’.
This addition may provide us with some further insights into the ways in which we move from one phase of learning to another. In particular, it reminds us of the important pre-verbal aspects of much of our awareness. Signification is the act of entering into the totality of a situation and giving it meanings which manifest in action, which is a good description of the quality which connects the different phases of Kolb’s cycle. This seems to be another example of the benefits of applying the wisdom of our tradition to contemporary educational concepts.
Such is the perennial structure of learning portrayed by theories of reflection, Daoist alchemy and yi (signification). All three are experiential in their orientation, but Daoist alchemy particularly shows a substantial difference in its approach. We said earlier that ‘Daoist alchemy’s turning of the gaze inward allows one to perceive the universe as represented within one’s own body’. It is this focus on the body as anchor and arena that distinguishes Daoist alchemy’s contribution to the wider context of reflective practice in contemporary acupuncture traditions.
Embodied Knowing In her review of styles of knowing within contemporary Chinese medicine in China, Hsu (2000) talks about embodied knowledge and somatic modes of attention as being the primary way in which such practitioners know what they know. From clinical experience, this means more than the use of our senses to palpate, hear, see, smell, etc. It extends to being able to discern the texture of the qi field of the patient (and therefore discern their internal climatic landscape). We have touched on this previously in our discussion of the inner gaze, which is one of Daoism’s methods of developing such embodied awareness. Discerning the patient’s qi field means for example feeling the damp energetically rather than mentally ticking off boxes that indicate it. It can extend to being sensitive to deeper rhythms that could be called second sight, but is merely the development of bodily knowing to levels that we don’t even acknowledge let alone devote equal attention to compared with that we give to intellectual knowing. Hoff (1982) refers to an aspect of such knowing when speaking of wu wei:
‘Using wu wei, you go by circumstance and listen to your own intuition. ‘This isn’t the best time to do this. I’d better go that way.’ Like that. When you do that sort of thing, people may say you have a Sixth Sense or something. All it really is, though, is being Sensitive to Circumstances. That’s natural. It’s only strange when you don’t listen.’ (Hoff, 1982).
This relates back to the discussion of yi. Scheid and Bensky (1998) note that ‘in the pre-Han texts such as the Guanzi, [yi] involves the meditation-like bodily practice of intending, whereby one opens oneself to the universal flow of qi so as to acquire a luminous awareness of the world’. Similarly, in the internal arts such as tai chi, yi refers to the ‘bodily practice of intending’ to make a particular movement, before one begins to move.
The Chinese tradition is not strictly somatic, it is just that we need this weighting at this stage and context of its development because of the intellectual imbalance of our native western culture (a weighting which is increasingly finding its way back to mainland China). Arwyn Dreamwalker expresses this distinction within traditions as the difference between ‘a body of knowledge’ and ‘a book of knowledge’3. As contemporary western acupuncturists we have a choice as to which star we follow. As diagnosticians and healers with a vast diversity of perspective, we will have our own particular vantage points on the rebalancing required for the profession, with the application of that rebalancing being our own embodiment of the traditions.
Alchemy and Assessment We have seen that the dynamics of reflective practice are similar to those of Daoist alchemy, shining the mirror of reflection so as to refine the basic nature of the professional or adept. We have also seen that the landscape of Daoist alchemy involves not just an intellectual transformation, but also a physical and spiritual one. This has implications for the implementation of reflective practice within acupuncture traditions in that the composition of reflective practice is not limited to reflective journals, reflective writing and clinic notes. For us, reflective practice extends to, and perhaps needs to be based upon, the body itself and particularly the ongoing development of our vital substances and elemental balance.
If we are engaged in reflective practice from a somatic base, then the fruits of reflective practice are not only essays, CPD forms or certificates, they are the refinement of the body of the practitioners themselves, in their ability to diagnose and in the quality of their own san bao (three treasures). Essentially, reflective practice comprises the refinement of the san bao of the practitioner. So digging one’s allotment or practising qi gong may need to earn just as many CPD points as reading a text if we are to honour the vibrancy of our traditions and support good practice.
Of course, in our contemporary context this raises the question of how one might assess the learning and development resulting from such activities. We could ask students and practitioners to reflect upon their development using methods from contemporary educational practice, such as reflective essays, critical incident analysis, and presentations to peers. But we could ask them in their reflections not only to address their developing personal theory, their exploration of their underlying assumptions, and their articulation of their professional judgement, but also to address their development in terms of yi, the san bao, and the five elements.
Reflective practice as understood by Daoist traditions also has implications in the regulation and accreditation of acupuncture. The landscape of our traditions is in fact the body, our vital substances and zang fu, our elements and officials. The tools of our traditions are the internal gaze, qi gong and bodywork. For us to truly integrate authentic reflective practice into contemporary practice we need to guide ourselves as practitioners into reflecting on the condition of our jing, qi and shen, and our elements. This is something that most of us already do, but it will have particular implications if, in the future, mainstream healthcare attempts to integrate acupuncture within its existing structures, which are open to question in terms of their ability to support the health of their workers. Any healthcare manager designing best practice services might consider setting benchmarks of good practice that are not merely form based but also take account of the importance of cultivating engaged awareness based in the body and of getting enough good air, food and water to sufficiently refresh the qi of the practitioner. As our profession guides such services into being we may consider that to practise a complete and optimal version of acupuncture, there are some bottom lines in terms of working conditions for the practitioner to ensure the health and safety of the patient. This may seem a rather unlikely possibility in our current political context, but it is, nevertheless, a valid argument. Making this case could be one of the most important contributions we can make to the other healthcare professions.
In conclusion, we would recommend that as we welcome reflective practice into acupuncture education, we should seek to express it with the stuff of our own traditions. This would give to reflective practice a welcome emphasis on the transformation of the practitioner, the development of clarity of awareness and embodied knowing, and the cultivation of the healing power which grows from yi. As we cultivate the inner gaze, we refine our intent, and so are able to better help our patients.
(Diagrams, Illustrations, Bibliography and References for this article are printed in the hard copy of The European Journal of Oriental Medicine Vol. 3 No. 5; Summer 2001.)
Richard Blackwell Richard Blackwell has been in practice for twenty years. He has studied acupuncture and Chinese herbalism extensively at post-registration level. His current MSc dissertation concerns approaches to the treatment of multiple sclerosis by acuuncture. He is Principal of the Northern College of Acupuncture and a past President of the Register of Chinese Herbal Medicine.
Paul Hougham Paul Hougham graduated from the College of Traditional Acupuncture after a background including philosophy and mental healthcare. He has since practised acupuncture in mental health and holistic addition centres as well as in private practice. Paul teaches at the School of Five Element Acupuncture in London and at the Northern College of Acupuncture in York.