points and lines

i've written something along these "lines" before... back when i was thinking up what to teach my earlier tuina 2 class (which, to be quite honest, didn't "feel" quite as satisfactory as i'd have liked), i was mulling over the two metaphors defining "acupuncture," "points" (acupoints) and "lines" (channels/meridians). as i am (it is becoming more and more apparent) a devout structuralist, tying these two metaphors into the living flesh, we get "trigger points" and "myofascial continuities."

allow me to tell you how i got onto this structuralist theme. i try my best to address the problems of my patients, many of whom suffered from musculoskeletal complaints. the problem that i always attribute to my foray into first the musculoskeletal, and then the fascial realm, was frozen shoulder. now, frozen shoulder is a deceptively simple problem. you get a locked shoulder, restricted in motion, with a clear pain pattern: often "deep" in the shoulder, radiating down in a slight line just lateral to the biceps muscle... i had analyzed this pain pattern via chinese meridians with little result. by straight "linear" chinese meridian thinking, this sort of frozen shoulder exhibited signs of an obstruction of the lung or large intestine channels (because the pain apparently followed those lines). so, standard treatment would involve utilizing a few local ashi points (tender spots) and a distal point or two.

there are variations on this theme, like whether you use moxibustion, or the dreaded electrostim, but basically that's it.

it was only when i reached a consistent wall (or plateau) that i decided to explore outside the box, if you will. that's when i read about trigger point therapy, as developed by janet travell... on the surface, trigger points resemble what chinese medicine calls "ashi points" (in japanese, kori): tender spots, which, when pressed, often exhibit "twitch responses" and/or a specific pain referral pattern. what was fascinating about travell's work was the extent to which she mapped trigger points, and correlated them with the dysfunction of specific muscles or muscle groups.

for example, the pain referral pattern i encountered in treating frozen shoulder was most likely due, not to any muscles on the front of the shoulder (deltoid, attachments of pectoralis major, minor, etc.) but to dysfunctions of the rotator cuff muscles, which, more often than not, were located on the BACK of the shoulder (the exception being subscapularis, which lay deep within the shoulder joint, on the anterior surface of the scapula). by analyzing patient symptoms via trigger point theory, i was able to more accurately find the REAL active points, and encountered greater success.

... BUT. a pointilist philosophy will only take you so far. discovering trigger points was one thing, but it tended to make me myopic, analyzing problems solely in terms of localized tight (and shortened) muscles. i noticed that at times, there were gross structural problems that possibly contributed to a specific, localized problem; the trouble was, i couldn't connect things in any meaningful way. again, looking to chinese meridian theory provided SOME answers, perhaps in ideal circumstances, but patients NEVER come in with simple problems. i needed a more accurate "linear" system to describe connections across the body.

that's when i discovered thomas myers work, "anatomy trains." interestingly enough, some of his myofascial continuities mimic almost exactly certain chinese meridians. for example, the stomach and urinary bladder meridians and gallbladder meridians. however, his work looked at them as purely structural entities, ignoring the "energetic" emphasis given in chinese thought (maybe a good, maybe a bad thing). also, he added several lines which may have been implied in chinese theory, but which were made much more explicit: the spiral line is key in this regard (fascinating to explore the spiral orientations in nature: dna, tree growth, etc. also fascinating to see how the chinese articulated this, perhaps not explicitly in the meridian system, but: take a look at chen style drawings of the body, particularly when discussing "spiral twining" or "chan si jing").

now that i'm orienting myself as a structuralist, i'm of course attempting to "translate" chinese meridian energetic understandings to suit my techniques. in tcm, we always talk about "energy," and either its lack or excess in any given part of the body. it is often metaphorically expressed as water, and the meridians are like pipes. so we open pipes to let "bad" excess water out, and we open other pipes to fill empty pipes... the trouble i have always had with this metaphor (but didn't dare express it) was: 1) what is this energy that we are talking about??? is it a palpable thing that flows through me!?? [okay, while i do believe in the existence of qi/energy, i just believe our understanding/experience of it is superficial... we NEED to have a way to determine what it is, and how it flows... not just stick a few needles and expect results... cynical!?] 2) given that this energy exists, how does it flow? does it have a directionality? 3) given 1 and 2, how do we influence it via the needles? how do we communicate our intentions via the needles? we speak of tonification/sedation techniques, but how, concretely, do these techniques differ from each other, such that the body can recognize what to do with the signals???

ask most acupuncturists such questions, and they will have to rely upon platitudes... unless you find a rare master who actually knows/sees/feels the flow of energy in a very visceral way...

myself, i am very concrete, simple-minded. i only truly work with what i can feel. and the only thing i am good at feeling is changes in the texture of tissue: knots and such. so naturally, i look at the meridian system in such a way that it justifies my perspective... it all makes sense! instead of thinking about "energy" as a "substance that flows," why not think of "energy" in terms of potential/kinetic energy? when we encounter an "obstruction in the channels," it is not like a hairball clogged in a pipe, but a myofascial unit that fails to either shorten or lengthen appropriately, thus passing inappropriate "tension" (another way of viewing maladaptive/pathological energy) throughout the structure of the body. we "free" excesses via needling techniques that insert into obstructions, and the directionality of the needling technique determines and communicates our intention to "lengthen" in any given direction... it makes sense when considered this way...

i am committed to analyzing people in this way... in a way, i can't help but analyze problems this way. granted, i apply acupuncture in other ways too, in ways i can't understand/justify, the traditional approaches... but oddly enough, i've discovered ways to treat problems that i wouldn't normally consider to be under the aegis of musculoskeletal or myofascial problems... is it an issue of seeing nails everywhere, because i'm a sledgehammer!?

...

...but back to the title of this entry, points and lines. i was thinking about points and lines in more general philosophical ways. lines connect. lines extend. lines represent journeys, the binding of two points. dots/points, on the other hand, represent locuses of significance, cities, for instance.

in our thoughts, memories, points are nexuses of significance. they are what we hold to, like in our "power point" notes... the lines, on the other hand, tend to be overlooked... they are necessary, for they "give meaning" to the points, they establish the links between, so that we can "get from" point a to point b. but the only times we talk about the lines themselves, or anytime we struggle to talk about the line in itself, we are involved in a narrative... a story. a progression. and in this narrative, we must express a change. how does boston become new york? how does the east coast become the west coast?

points are the synchronic, static determinants of identity. they are the things we "point to" and say, "this makes me." lines are the diachronic, historical determinants of identity. the lines are the stories we tell about ourselves, the things that take time both to develop and to delineate; it tells others, "this is how i got here." both necessary, both dependent on each other...