Palpation as Practice: Part I
Learning to palpate is a lot like learning to meditate. The two skills are similar enough that the road signs commonly used to navigate the meditation landscape are also useful on the path to palpatory competency. I want to talk about palpation from this perspective. We should be clear at the beginning that they are different things, although there is most probably some cross over benefit in practicing both meditation and palpatory awareness. Most importantly you don’t have to be in a deep meditative state to palpate effectively.
Perhaps the most significant commonality between meditation, palpation and for that matter, medicine is that they are all practices. At the beginning, the expectation is not so much that we will be good at these disciplines as that we know how to practice them. They are skills that are cultivated over time. At least in terms of meditation and palpation, we don’t really know the limit to what it is possible for us to experience.
In learning to meditate, sooner or later we will have a fleeting experience of open awareness. At this point, we can’t really say anything about it. Even acknowledging that it is happening, “hey, look at that, my mind is quiet,” is enough to derail the experience. The early stages of cultivating any form of palpatory awareness can be very much like this as well. It too, may be very fleeting, and just as you think you’ve caught it, it may be gone. Even once you are consistently feeling something, the experience will initially be pre-verbal. It is new and vague enough we have no words for it. Nevertheless, the process of progressively fine-grained articulation builds from this fundamental binary apprehension. I feel something or I don’t.
After a while perception stabilizes, and we start to be able to look around. As we more consciously experience our experience, we are increasingly able to say things about what we are experiencing. In meditation we may simply witness the moment- to-moment play of our emotions. A common observation for palpators at a similar stage is “well definitely I feel something, but is that me or my patient?” In more general terms, we might ask whether this input is self or other. Meditators spend a lot of time on the cushion trying to break down the bounds of self and other, just as we are cultivating a capacity to appreciate qi beyond the perimeter of our own skin. Yet, in both cases, no matter how effectively we extend our perception into our environment, we cannot really function without simultaneously being able to distinguish between what is outside and what is inside.
Mindfulness meditation practices concern themselves with an examination of our internal environment and our responses to external stimuli of one sort or another.
In learning any new palpatory technique, it similarly helpful to identify that phenomena in oneself. If you know what it feels like in your own body, it is easier to identify it someone else. It is also easier to tell whether that palpatory information is coming from you or your patient. For instance, what does your own yang rhythm feel like? Knowing that will help you to differentiate it from your patient’s yang rhythm. You can also palpate an inanimate object. If you find that the treatment table has a yang rhythm then you either have a very special treatment table or you are feeling your own qi?” All this can take some time and experimentation to sort out for oneself. The good news is that the difficulty in distinguishing between self and other fades with experience and generally becomes less of an issue with every new palpation technique you learn.
Meditation is about learning how our mind in particular works and in using that insight to exert some productive control over that process. Although we all share a human nervous system, each of us is wired a little differently. No one’s palpatory antenna is without a few unique bends and kinks. Learning the quirks of our particular apparatus is an essential part of learning to appreciate qi. For instance, is one hand more sensitive than the other when listening to the yang rhythm or doing channel listening? Does it help cross-reference your findings by switching hands? Which hand is best for manual thermal evaluation and which for local listening. Our own acute or chronic injuries may influence the accuracy of our listening. Even problems in our ankle may influence how we stand, subtly influencing the way our hands receive information.
Some days we may be able to sustain our attention and awareness on the cushion better than others. Its best not to label our meditation sessions as good or bad, we just practice. Just as it is counterproductive to beat yourself up when you catch your mind wandering, it is also unhelpful to fret over the fact that you’re not feeling anything. Just move on and keep practicing.
Most experienced clinicians will acknowledge that their palpatory capacities vary from day to day, and even over the course of a single day. In meditation, pulse diagnosis, yang rhythm or general listening, our baseline competencies generally improve as we gain experience. We gradually get to the point where our palpatory input is clinically useful even on our off days. Some days we may be more confident in our local listening than in our channel listening. At other times the opposite may be true. We simply do our best to make use of whatever information we can glean at any given moment. Our receptivity is inherently variable for reasons including but by no means limited to our own competency. Sometimes our patients are just not communicating with us on a particular palpatory wavelength. Cultivating our comfort in working with whatever information we have is a skill in itself. A key to all of this is to try with just the right amount of effort. If we don’t try seriously enough or often enough, we will never learn the skill. Yet working too hard will just as surely subvert the learning process.
Once we are reasonably confident that we are feeling something, and that what we are feeling is coming from the patient and not ourselves, the issue is no longer whether we can feel qi but what specifically we should be filtering for.
We will pick up this thread in a subsequent blog.