Putting the

Classics in the Clinic

Putting theTraditional

Back into TCM

presented by:Andrew

Nugent-Head

The Core Concepts of Being Traditional

• All is relative• We must free ourselves of self importance• We must grasp our insignificance• What is true for the macro is true for the micro• We must recognize patterns large and small

• Can you balance knowing you are irrelevant yet being dedicated toyour path?

• Can you follow the Way knowing the Way does not care?

Classics in the ClinicPutting the Traditional Back in TCM

Qi is the Measure of the Flow of the Way• The enlightened seek to move in harmony with the flow

• The proof of success is in choosing smoothness over friction

• This requires a concept of stewardship, or 'intentional living'

• Qi is the source of all things:太虛無形,氣之本體;其聚其散,變化之客形爾

• (Su Wen) The Entirety of the Human, It is Qi and Blood⼈之所有者，氣與⾎耳


The Description of Qi is Yin and Yang• We must reframe our modern understanding of Yin and Yang to that of ourtraditional medical ancestors

• They are not separate entities• They are not proper nouns• They are not nouns• They are more like adjectives• They are used to describe different aspects of something• It is more accurate to say 'Yinnish' and 'Yangish' and not Yin and Yang


What is the challenge to the Modern Practitioner?

The challenge for the modern practitioner is not simply to return towhat are today being marketed as classical formulas and treatmentswritten by our medical ancestors and taught to us in classes.

The real challenge is developing the classical perspective so that alltreatments and formulas we give are classical in nature whether theyappear in a classical text or not.


To Be Traditional, We Must Reframe Yin and Yang• We must reframe our modern understanding of Yin and Yang to that of ourtraditional medical ancestors

• They are not separate entities• They are not proper nouns• They are not nouns• They are more like adjectives• They are used to describe different aspects of something• It is more accurate to say 'Yinnish' and 'Yangish' and not Yin and Yang


What Traditional Shouldn't Be

• We should not believe that traditional only means following what issaid in the classic books that have survived to today• The number of classical books that did not survive history areuncounted• There is so much more to the medicine we practice than what is inthe books which have survived• To limit our practice to fixed formulas and strategies is to be the'frog in the well'• Develop a classical perspective from the books that survived so thatall treatments given are classical whether recorded in a book or not


The Metaphor of Understanding Yin and Yang

• Originally, the character for Yin was a pictograph of the shady sideof a mountain

• Originally, the character of Yang was a pictograph of the sunny sideof a mountain

• Remembering this helps us grasp they are aspects of something, notactually a something themselves

• Remembering their origins helps us see their relativity, not to eachother, but to us


Everything is Relative

• The Huai Nan Zi shows us that while something may be fixed, howwe feel about it is relative

• Whether a Qi is Yin or Yang is relative

• Whether that Yin or Yang Qi is helpful or hurtful to us is relative

• Relativity is not just to us, but to us at different times of the year,different times of our lives, different times of our health

• Upright and Pernicious are not fixed, but relative to the person


Returning to Our Definition of Traditional• The style of practice of Chinese medicine known as TCM in the West isnot what that style is called in China

• In China, the traditional practice of Chinese medicine is not practiced inthe manner we call TCM in the West

• China has both Traditional Chinese Medicine (TCM) and Modern ChineseMedicine (MCM) methodologies of practice. MCM is what is taught in theschools and practiced in the hospitals we misunderstand as TCM.

• I learned and practice traditional Chinese medicine in China, I am apractitioner of what the Chinese refer to as傳統中醫, or TCM


Other Misunderstandings and Mistranslations in English• Acupuncture does not mean the same thing in Chinese as the Chinese termwe have mistranslated as acupuncture

• Acupuncture would be translated as凖刺, or Zhun Ci in Chinese, not針灸Zhen Jiu

• 針灸 Zhen Jiu does not translate into Acupuncture in English, but into'Needles and Cautery'

• Think about how the term Acupuncture narrows our practice, whereasNeedles and Cautery is much broader



There is not One Needle for One Application despite there being so manydifferent needles. Fortunately, being a traditional practitioner is not definedby how many different types of needles we know how to use!

What Makes a Practitioner a TCM Practitioner• They are dedicated to relieving suffering

• They make use of the experience in the classics to guide what they do

• They make use of the experience in the classics to no what not to do

• They absorb experience of the classics like a foundation to stand upon, notas a doctrine to be weighed down by

• A TCM practitioner absorbs the knowledge from the past, giving themconfidence to safely try new things and create new solutions when patientsdo not get better or the usual tools are not at hand


What a Traditional Practitioner is Trying to Do in the Clinic

The traditional practitioner knows what they are trying to do never

changes no matter whether they are using herbs, needles, burning

methods, bodywork, or patient advice: the TCM practitioner always

remembers they are manipulating Qi. This is because every different

thing we see is simply a different manifestation of Qi and is not

separate from the patient's Qi.


The Steps to Manipulating Qi in the Clinic

• The practitioner must learn to perceive the world as our medicalancestors did

• The practitioner must grasp that all is relative not just intellectually,but physically through commitment to Daoyin of one kind or another

• The practitioner must learn to affect the patient's Qi not justgenerally, but specifically through their treatment methods of herbs,bodywork, acupuncture, and advice


Flow of Qi: the Billiard Ball Analogy• Qi flowing smoothly through a person is like a billiard ball moving smoothly from bank to bank on a billiard table

• Illness is when the ball hits the correct bank, but too harshly, sending it off sequentially on wrong bank after wrong bank from that moment forward

• Illness is when the ball hits the correct bank, but too weakly, sending it off sequentially on wrong bank after wrong bank from that moment forward

• Illness is when the ball hits the correct bank, but at the wrong angle, sending it off sequentially on wrong bank after wrong bank from that moment forward


As a Practitioner, We Must Remember That• We are attempting to manipulate the Qi of our patients

• We are attempting to manipulate how patients perceive their Qi

• We are attempting to manipulate their Qi from a state in which the patient can feel disharmony and/or we can recognize disharmony to one that moves smoothly

• We are attempting to manipulate their Qi so they no longer feel dis-ease and we no longer know what to manipulate within them because we no longer recognize any disharmonies


We are Manipulating QiEtymology of Manipulate:PIE root *man- (2) "hand") + root of plere "to fill" (from PIE root *pele-(1) "to fill"). Sense of "skillful handling of objects" is attested by 1826; extended 1828 to "handling or managing of persons," especially to one's own advantage.

More Simply Put:Manus, from the Latin, meaning Hand. Plere, from the Latin, to fill. We are using our hands to to do something with what is implied as being in our hands. Thus, the skill of needling is completely dependent on the skill of our hands.


https://www.etymonline.com/word/*man-%3Fref=etymonline_crossreference

https://www.etymonline.com/word/*pele-%3Fref=etymonline_crossreference

Choosing a Location to Manipulate Qi• Finding and choosing a point to work on is simply finding a place where we can obtain the greatest result at the easiest place to manipulate Qi of the patient for that condition

• We can often achieve the same results manipulating Qi at a specific area of the body regardless of what channel we are actually needling on

• This important truth can be learned deeply by study of the 六⼗六⽳ 66 Points, also known as the Antique Points in the west.


Reviewing What We Know So Far• That everything is one Qi

• Our job is to manipulate the Qi back into harmony for the patient• We must tangibly understand this Qi through Daoyin, or internal cultivation practices

• We must use touch to understand the changes of Qi in our patients

• We must have techniques to manipulate it the way we want instead of simply stimulating it and hoping for the correct outcome

• We must must combine the best technique with the best location to be the most effective possible in manipulating the Qi of our patient


Understanding Yangish QiWe might define Yangish Upright Qi as:

• movement which helps the human, not too much and not too little;• warmth which helps the human, not too much and not too little;• vitality which helps the human, not too much and not too little.

We might define a Deficiency of Yangish Upright Qi as:• too little movement, inhibiting the human's ability to function optimally;• too little warmth, inhibiting the human's ability to function optimally;• too little vitality, inhibiting the human's ability to function optimally.

We might define Yangish Pathogenic Qi as:• too much movement, depleting the human;• too much warmth, depleting the human;• too much vitality, depleting the human.


Understanding Yinnish QiWe might define Yinnish Upright Qi as:

• stillness which helps the human, not too much and not too little;• coolness which helps the human, not too much and not too little;• restfulness which helps the human, not too much and not too little;

We might define a Deficiency of Yinnish Upright Qi as:• too little stillness, depleting the human • too little coolness, depleting the human• too little restfulness, depleting the human

We might define Yinnish Pathogenic Qi as:• too much stillness, inhibiting the human's ability to function optimally;• too much coolness, inhibiting the human's ability to function optimally;• too much restfullness, inhibiting the human's ability to function optimally.


It is All Relative

Whether the Qi is Yin or Yang, is just right, too much, or too little has

nothing to do with the Qi itself, but with the human experiencing it.

Everything is completely relative as well as subjective, which is the

foundation of traditional Chinese thinking.


It is All Relative1. The Six Qis are necessary for life, though different lives prefer them in different strengths;2. When one or more are too much for a human, they are called Excessive;3. If that Excessive Qi is damaging the human, it is called Pernicious to that human. Pernicious Wind, Cold, Heat, Damp, Dryness, Fire.4. That Qi's influence is defined as Pernicious if:

• It is so Excessive that it affects the human's Upright Qi's ability to function;• The human's Upright Qi's are weak, thus easily aggravated or hindered by the one or

more of the Six Qis even when they are not Excessive to others;5. The human's Qi is called Upright Qi when it is beneficial to their health;6. Should the Upright Qi be either overfilled or depleted (有餘不⾜), what was beneficial to health now becomes detrimental and is called Pernicious Qi; 7. Which means Upright and Pernicious are not real things, but how we perceive the presence and influence of the Six Qi's on us as good or bad to us.


Traditional Perspective Medicine in Clinical Application

Case Examples(time permitting)


Clinical Application: Heart Failure in an Aging Patient

• Age or illness depletes the Upright Yang Qi so it is too weak to engage its functions of moving, warming, or vitalizing fully. We diagnose Upright Yang Qi Deficiency

• As the Upright Yang lessens, its space is filled in passively by Yin Qi aspects such as fluid retention

• At a certain point, the passive building of Yin Qi starts to actively damage the Yang Qi. At this point, we diagnose Pernicious Yin Qi instead of weakened Upright Yang Qi


Clinical Application: Heart Failure in an Aging Patient

Supine• Open constriction in the chest so there is more space for the heart• Drop the diaphragm so there is more space for the lungs and heart

Prone• Soften the heart through its closest point: the Shu Point• Soften other back Shu Points based on palpation• Steady the heart via Tongli HT05


Clinical Application: Systemic Dermatitis in a Patient• Yang Qi grows in excess of its moving and warming functions until it becomes Pernicious to the person. We diagnose Pernicious Heat and/or Fire

• The Pernicious Yang Qi damages the Upright Yin Qi through time and mistreatment. We diagnose Upright Yin Deficiency with Pernicious Yang Heat

• The depletion of Upright Yin leads to an unchecked and unslowedPernicious Heat which spreads throughout the body

• Attacking the Pernicious Heat we see at this point damages the depleted Upright Yin and worsens the condition. We must realize the acute treatment at this moment is nourishing Yin, not purging Heat


Clinical Application: Systemic Dermatitis in a Patient

Relieve Immediate Suffering to Benefit the Spirit

Classic Stop Itch Protocol• Opposite Feng Chi LI11 and Feng Shi GB31• Why Opposite?• Making it a Four Gates Variation• To Retain or not Retain?• Consider Bleeding First or Last if in Flare State with Matching Pulse



Strategy to Treat the ConditionHerbs:

• sweet and cold natured herbs first• bitter cold natured herbs later if at all

Physical Treatment:• Open Lungs to Benefit the Skin• Soften the Liver to Flow the Qi• Treat Intestines to Benefit the Lungs• Calm the Spirit to Settle the Blood



First Protocol to Treat the Condition

Supine:• Palpate Zhongfu/Yunmen LU01-02 as well as intercostals across

to sternum for Ashi spots, then treat.• Treat Qimen LR14, follow intercostal to side and treat if obvious Ashi found.• Treat Zhongwan/Jianli CV11-12, then Tianshu/Daheng ST25-SP15, possibly Shuidao ST28• Settle with Four Gates Variation plus Baihui DU20


Putting It All Together: Seminar in Review

• Embrace the idea that we are in service to others, not ourselves

• Our Dao, or Way to be in service is using Traditional Chinese Medicine

• Learn the perspective of the ancients to understand our medical ancestors

• The classics help us understand how to see the illness, with examples of

what to do and not to do

• The classics are not rulebooks to follow, but foundations to grow from

• This guides how we see the Qi of the patient in diagnosis

• This guides how we manipulate the Qi of the patient in treatment


Final Advice Given to Me Which I Share with You

study tradition

to gain freedom


要學習傳統為達到自由

• Need more understanding of classical theory and diagnosis?Classical Theory in Clinical Practice: pathology & physiology

• Need more understanding of acupuncture & bodywork?Nine Essential Needling TechniquesTangible Acupuncture for Internal Medicine, for Orthopedic InjuriesChinese Bodywork for Clinical Practice

• Need more understanding of herbs?Classical Herbalist and other herbal programs, articles & videos


Where to Go from Here: Learning Resources

• Need more in person training?Clinical observation in our teaching clinic in Asheville, NC

Seminars around the world

Official Study Groups mentored by Senior Practitioners

Senior Practitioners teaching seminars as well



• Online Learning: watch in depth training courses at home:Visit association-for-traditional-studies.teachable.com

• Observing in Our Teaching Clinic in Asheville, North CarolinaVisit: alternativeclinic.org and click on Clinical Training

• In Person and Livestream Seminars:Visit traditionalstudies.org and click on In Person Seminars

• Interested in hosting a seminar? Visit: traditionalstudies.org, click Programs

Follow us on facebook: facebook.com/traditionalstudies



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