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Where do we draw the line?

In previous articles The Yellow Emperor’s New Clothes part 1 and part 2 we discussed problematic aspects of the acupuncture point CV1 including, ethical questions, practitioner-patient relationship and definition of the treatment environment that would best contribute to healing processes.


The reason for the necessity of this discussion is of course the location of the point which demands that the patient reveal themselves in an extremely intimate and potentially vulnerable fashion.

However, the discussion focusing on this particular acupuncture point is just a small part of a much broader discussion.


First, its location on the perineum between the genitalia and the anus is rather radical, but the discussion should include a larger group of points which are located in intimate parts of the body.

Second, this should be part of a broad discussion on the nature and essence of Chinese medicine and its place in the therapeutic texture of the modern world.


I would like to raise a few points for thought in relation to this:


Chinese medicine developed a concept of body image based on principles of modesty.


The modesty of the body characterized the traditional Chinese society, which generally abstained from revealing the genitalia, and was particularly unfavourable when it came to revealing any part of the female body.

In traditional illustrations of acupuncture points, there is no specific illustration of the points in intimate regions, just a general indication of the genital region which is covered by a piece of clothing. The following illustration of the Ren Mai is a representative example:

image taken from https://wellcomecollection.org/
Woodcut illustration from an edition of 1537, image taken from https://wellcomecollection.org/

Were these points actually used for acupuncture treatments? We do not have this information. In contrast to the abundance of literary resources on herbal medicine, the traditional literature of acupuncture is rather sparse. Particularly lacking is the literary genre of case studies which would describe the clinical use of acupuncture in practice. The existing pre-modern literature is theoretical, consisting of descriptions of point locations and listing general functions. There is no way to verify in what way these points were actually used in a clinical setting. Aside from needling, there were other ways to activate the points, including meditation, qi gong and dao yin exercises, massage (including self-massage), heating, ointments, poultices and steaming.

In addition, the term “modesty” can also be understood from another perspective, a perspective which in my opinion is essential to grasp the wisdom and power of Chinese medicine. This perspective arises from the difference between the historical development of Chinese medicine and the historical development of Western medicine.


The roots of Western medicine in ancient Greece were driven by a curiosity which can be characterized as voyeuristic, much attention was focused on the details of the naked body and the research of the anatomic structures, including both external as well as internal organs.

The forefathers of Chinese medicine, however, did not take interest in the visual anatomic structures. They focused on the investigation of bodily forces as a continuum or reflection of natural forces. The aspiration to understand the body did not draw from its shape, but rather from imagining the body as a product of the same processes that design the geographical and climatic characteristics of their surrounding environment.

De humani corporis fabrica libri septem / Andreas Vesalius 1555, Images taken from https://wellcomecollection.org/

This difference is embodied in the medical illustrations of both cultures. Compare the famous illustrations of the 16th-century European anatomist Andreas Vesalius (1514-1564) to the typical illustrations in Chinese medical manuscripts, such as those from the Renti Jingmai Tu (人體經脈圖) of the 17th century.

In Vesalius’s illustrations, you will immediately notice the great efforts devoted to the awe-inspiring depictions of the intricate muscle fibers and layers as well as the complexity of the internal organs and structures.



Renti jingmai tu, a manuscript text executed during the Kangxi reign period of the Qing dynasty (1662-1722) Images taken from https://wellcomecollection.org/

However, the Chinese illustrations of the body completely ignore the anatomic structures and concentrate on illustrating the channels on the outer surface of the body. These illustrations have more resemblance to a map than an anatomic depiction; a road map with coordinates in the case of the meridian charts, and a topographic map in the case of the internal organs charts.

This is not coincidental, it reflects the attention that the Chinese medical doctors and scholars devoted to the “modest” forces, the forces that are not visually alluring, the forces that do not have specified form or defined boundaries. These charts are in effect maps that are aimed to guide the physician in navigating the movement of the forces and processes that affect the body.


For me, this is the essence of Chinese medicine, a medicine that respects the modesty of the physical body and concentrates on the cosmic body.


As practitioners in the modern world, we should attempt to benefit from the knowledge and capabilities of modern medicine, but I do not wish to resemble modern medicine. My strength as a Chinese medicine practitioner draws from the ability to have a different perspective for understanding the body. There is a map on the body, a treasure map if you will, that instructs the variety of ways for healing. I believe that if we learn to read it and use it from a traditional Chinese healing perspective, we can help our patients without crossing the boundaries of intimate procedures.


Hila Yaffe studied Chinese and Chinese medicine in Israel, Taipei and Shanghai. She is currently a Masters student in Asian Studies at Tel Aviv University. Since 1998 she has been working in a private clinic, treating a broad range of diseases with acupuncture and herbs. Since 2000 she has been a lecturer at schools for Chinese medicine. She worked for 10 years in the Natural Medicine Research Center at Hadassah Hospital to contribute to a productive base for integrative medicine. In 2017 she established the "Shanghan Lun Center" which aims to provide Chinese medicine practitioners with access to the theoretical and practical knowledge of the Shanghan Lun's text through articles, lectures, workshops and courses. In 2021 she established and currently manages an acupuncture team in the labour ward of Hadassah hospital in Jerusalem.

Hila can be contacted at https://shanghanlun.org.il/


Bibliography:

Kuriyama, Shigehisa, ed. 2001. The Imagination of the Body and the History of Bodily Experience. International symposium, 15. Kyoto: International Research Center for Japanese Studies.

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