Metaphor in Chinese Medicine: A Patient Narrative

Thomas Hodge
versesthewhale@gmail.com

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     The following tells the story of a patient I met in the last three weeks of my rotation
observing the practicing student interns in our school clinic. I have been a student of
acupuncture and Chinese herbal medicine for two years now; and while I value its Daoist
metaphors of yin and yang, its broad perspective of the human body in relation to heaven and
earth and its various patterns of imbalance, my clinical experience is teaching me that it doesn’t
matter to the patient what metaphor I use to understand and treat their imbalance. It’s not a
cultural or philosophical lost in translation sort of thing. Simply, I don’t need to have the patient
on board with my perspective in order to best facilitate their healing process. More importantly,
I need to understand theirs. How do they articulate their own illness narrative? How do they
make sense of their own body, through sensory language, conceptually or symbolically. These
metaphors change depending on our unique perspectives of the world, the distinctive events in
our own lives as well as for those generations that precede us. Each patient is--and I’ll borrow
from Loren Eisely here--our hidden teacher.

                                                                      ***

      Both of AC’s arms are sleeved to her elbows with tattoos. Classical portraits of sugar
skulls arranged with marigolds and a matching vignette on both arms of birds retreating from the
line made with her cubital crease. There is a day-old skull of a woman on her right medial
forearm. Tufts of peeling dead skin keep lustrous from the medicated emollient she uses to
protect this new work of art so that it heals properly. She, as the new skull is a woman’s portrait,
illustrates the careful accord between the subtle and the gross body. No doubt she was a famous
beauty. The flesh is returned to her, now, as an inky cool halo that masks the boney truth of her.
Imbricate rows of candy dots as marigolds garland the unctuous black waves of hair that flourish
as if rooted from the source of that spirit body. AC tells us that she’s always been fascinated with
the day of the dead imagery, but doesn’t know why. She smiles sleepily and yawns.

     “Busy week?” says Claudia, the student intern I’m shadowing this afternoon. Her fingers are
already at AC’s left radial pulse. I secure her right wrist. AC shrugs uninterested. It is here at
the distal end of the radius that we feel for the state of balance in the body. It’s a lot like
deciphering a morse-code message in the deep end of the pool with a divining rod, but once the
basics have been mastered, recognizing the 28 different pulse qualities is not so impossible. The
Nan Jing or Classic of 81 Difficulties, written in the late Han Dynasty around 220 CE,
established, among other theories of Chinese Medicine, the basis for the modern practice of pulse
diagnosis. Here is where the yin and yang of the body come together, where blood and breath
converge as waves lapping the coast line here at the lateral surface against the radial styloid
process. My skills with the pulse are remedial at best, but AC’s is not my first pulse ever studied.
A normal pulse (if we can ever say such a thing) is leisurely, supple and confident. Its fullest
quality is felt at the middle level with moderate pressure and formidable still with pressure just
off the bone. AC’s pulse is difficult to discern; it bobs at the surface then sinks, thin, forceless
and almost imperceptible at the depths. And there at the depths I feel a quality new to me. It is
as a pearl perceived just beneath the ocean floor. I thought of the princess and the pea, the test of
a princess’s delicate skin. But what queen had laid such a pearl in the bed of her flesh? And
come morning will she too have passed for her endured pain and bruising through the night?

     This is my first time with AC and Claudia’s third visit with her over three weeks. I learn later
that AC joined the navy when she was eighteen and spent seven years there before being
honorably discharged two years ago because of a sudden physical disability. Since the operation
two years ago, she’s suffered from depression and dull low back pain that worsens with long
periods of sitting and is “more noticeable” with stress. I consider again AC’s tattoos, her
preference for the day of the dead imagery. As I am especially sensitive to patterns of repletion
as evinced with the progressive number of tattoos she wears, I wonder to myself if her choice of
imagery isn’t manifesting from a misalignment of spirit and body. But what of the slippery
separateness I touched with the pad of my ring finger? Before I can wonder any further, C asks
me, “do you know about Ed?”

     Ed? I turn to AC for more details. There was no mention of Ed in AC’s file. As
observers in the clinic we are expected to be the intern’s shadow cast askew on the wall--nothing
more. The patient knows us only for the gesture of obeisance with a hand shake at the entry to
the waiting room, a devotee quiet in the temple among the statuary. Claudia helps AC up to the
treatment table. I’m hesitant but finally I ask, “Who’s Ed?”

     AC is quiet. I can see this is hard for her. Is she hiding something? Maybe this is what I
felt in the pulse. She’s holding onto something, perhaps, precipitating heat and a cloying quality;
a stagnation persists. I feel for her left pulse. The constriction I feel at her Liver position
confirms the suspicion.

     “Two years ago...” AC tells us, “I was in the Navy. I loved it. I was good at it. They had
scheduled me for a big promotion.” She’s quiet with her thoughts. “That morning I couldn’t get
out of bed.” oh? “My back was broken.” What? “I Literally could not move...Doctors said
herniated disk. Worst case scenario, so they operated. How do you herniate your disk in your
sleep?”

     “And how did that go?” I ask her.

     “Crappy. Didn’t work.”

     “But you’re walking now, you’re here.” AC is not impressed. She is right though. The
operation didn’t work. Sure, the surgeons had corrected the impingement that crippled her that
morning and kept her from attending the ceremony of her promotion, but it couldn’t tell her why
her body gave out the way that it did. Was this a psycho-emotional disability that precipitated
her severe herniation requiring emergency surgery or was this the result of overwork on a naval
vessel? As far as AC was concerned this had just happened. She chalked it up to her repeated
bouts over the years of unspoiled bad luck. We are her last resort, she tells us. A ship on the
horizon. “My ship has sunk”, she says. “I’m the sole survivor adrift on an inner-tube with a
ET-8022A weighing me down. Do you know what that is?” Claudia and I shake our heads No.
She frowns. “It’s a transmitter that broadcasts the international distress frequency. But it’s
power--and this is where the problem lies--comes from a crank that’s really difficult to turn. You
could break your wrist trying to crank it. I’m sinking fast”, she says.

     It’s still a curiosity how acupuncture actually works. Studies suggest that it regulates the
nervous system. It may alter brain chemistry, changing the release of neurotransmitters and
neurohormones. As well, it is said to affect the central nervous system and involuntary body
functions such as immune reaction, blood pressure, blood flow and body temperature.

     Acupuncture turns a light on or off not unlike a regulating hormone, say, that
communicates with the various systems of the body. An activation of C-Delta fibers and
subsequent release of endorphins. And what of the meridian system itself? It can not be
measured or weighed. None of our modern imaging technologies have been able to capture a
viable image of these theoretical channels of energy flow.

     The authors of the classical texts as the Nan Jing and Nei Jing understood the ‘meridian”
channels by comparing them to the images of water pathways--wells, rapids, brooks, streams,
confluences, marshes and reservoirs. It was their close relationship with the earth and the
seasons regarding agricultural health. Poor water flow meant poor crops and this would
precipitate poor health for the community, nutritionally & economically, etc. Just as these
systems of movement can be obstructed, experience abundance to overflow, so too can they dry
up requiring resource from prepared reservoirs kept from seasons of overabundance. The points
are the most superficial articulation of these pathways where with pressure or needles we can
clear obstruction or dredge from the reservoirs. At this moment I think it’s perfect that AC was
in the navy. She knows water imagery. But what about oceans and deep seas and what about the
monsters that reside in these fathoms?

     Claudia and I lift the end of her t-shirt to expose the lower half of her back.

     “That’s Ed,” Claudia says, pointing. Just lateral to the three inch scar down the midline
of her lower back is another tattoo. This is not a candy skull but the head of a giant octopus. Its
color is port-wine stain that begins level with her left iliac crest. It thrashes its muscled tentacles
over her buttocks to grapple the tendons and nerves of her upper leg. I think of Jules Verne’s
monster from 20,000 leagues below now surfaced here in this young woman’s cutaneous. I
touch the flesh of Ed and feel an autonomous presence in the skin. This is AC’s pain, ascending
from the darkest depths of her. This is the spirit of her suffering. Its intention, AC says in her
own words, is to “wreck [her] ship.”

     Claudia is a harpooner with the needles and Ed is her marine obsession. She is careful
and calculated with the hair-thin needles. Five needles dot AC’s lower back level with the lower
border of the spinous process of her second lumbar vertebrae. From my position it looks like a
line drawn in the sand or a game of battleship. She dares Ed to cross the line. With the two
points at AC’s left side Claudia pierces the head of this giant octopus. Instant kill, I think. AC
reports that already the pain feels softer. Claudia proceeds to both AC’s feet where she pinches
at the depression between her ankle bones and her achilles tendon. I’ve heard of practitioners in
China using a single needle to affect these points. Through and through, they call it. In one side
and out the other. Ouch! Claudia uses two needles at perfect level with one another and deep
enough I assume that the tip of each needle must be touching, a spark between the two, but AC
doesn’t flinch. Claudia continues to both AC’s hands and places a needle in the depression just
proximal to the head of her fifth metacarpal bone on the ulnar border of the hand.

     “Are you comfortable?” asks Claudia. AC mutters through the face rest a drowsy
affirmative, so we leave to the consultation room and let her rest with the needles.

     Claudia knows AC’s story well. “Ed’s taking over her life.” Claudia tells. “With our
needles we’re able to sedate and cage her monster, so to speak. But an octopus can’t be caged
for long. They’re just too smart.”

     “Imaginary or not.”

     “Ah, but that’s just it. In this case the imaginary is just as tangible as the real thing.
She’s given it a name. She’s personified her pain. She says that Ed’s got a good hold of her,”
Claudia pauses, “but I think it’s AC who needs to let go.”

     Our needles can encourage the body to express a pathogen as it does a splinter from
under the skin. But we can’t make her let go of it if she’s not willing. We can’t separate her
mind from her body. We can share our observations with her, but it’s her choice to do so.

     I share with Claudia my Jules Verne reference and she confesses that it was Melville’s
Moby Dick that helped her to understand AC’s relationship with her pain. I ask her if it is Ahab’s
obsession, driven by vengeance, and who was ultimately destroyed in the battle with the whale
that inspires her needle prescription or is it Ishmael, the untrustworthy narrator, who has no
emotional connection with the whale but for an object around which he layers his narrative line
after line, each page sinking deeper than the one before it until finally we rest at the last page
born to the bottom of the ocean.

     Claudia reminds me smiling, “It is Ishmael who survives to tell his story.”

     When we return to the room to remove AC’s needles we find her in a deep sleep and there
she remains until Claudia removes the last needle at which point she rouses as if on cue.

     “Oh, I must have dozed off. We done?”

     “You’re needle free.” says Claudia helping AC to a sitting position. “How do you feel?”
AC torques her torso carefully left then right. She l side to side.

     “Good. My range is better.”

     “How about the pain?” Claudia is at her left radial pulse again and nods approvingly. The
quality of the pulse is the answer.

     “Gone.” AC says, “I think Ed’s asleep.” I think back to my conversation with Claudia.
We’ve sedated and caged her beast and now it sleeps. But how long this time until the giant
octopus wakes up and outsmarts his cage and settles where he’s most comfortable? I move to
AC’s right wrist. Her pulse which was once difficult to discern is now consolidated, with even
force at all levels, yin and yang in amicable communion. I press the tip of my ring finger to just
off the radial bone. The pearl I perceived below the ocean floor is gone but there is something
there, subtle , almost imperceptible like an effervescence rising off of the bone. Is this Ed
asleep? Is this a metaphorical snore surfacing from what fathom of her?

     AC does not reschedule the next week nor do I see her again after this initial visit.
Claudia tells me that AC had been commuting to Albuquerque everyday where she has been
studying biology at the university for the last two semesters. To make things a little easier for
herself she finally moved out of her parents home and got an apartment blocks from the school.
Perhaps, too, a western lens will allow her a sharper focus of the yin and yang processes of her
body. There the infinitesimal minutiae of cellular and atomic relationships can be further
segmented and studied for cause and effect. She will be not unlike the astronomer peering
through the night sky with her lens; a convergence is implied. Through a bifocal lens of east and
western metaphors I marvel at the conundrum of the human body. It is a cascade of biochemical
events as characterized by the actions of our still expanding universe.

 

About the Author

  • Photo of author

    I’ve been studying Chinese Medicine in Santa Fe, NM for two years now, but I've always been
    a student of the humanities with and undergrad in fine arts and an MFA from The School
    of the Art Institute of Chicago. After graduation I remained in Chicago at The School for
    six years where I helped manage their film study collection and restored damaged books
    in the circulating library as well as for The School’s various special collections. I went
    whole weeks with limited human contact. When I realized that I could spend the rest of
    my life there, I knew I needed to change course. The antithesis of no human contact is
    engagement with as many different people as possible, listening to their stories, and
    placing myself at the fulcrum of their narratives. I feel that the study and practice of
    medicine--regardless of the model--is a natural progression of the study of what it is to be
    human. Ideally our different schools and training will not separate us as healthcare
    practitioners but bring us closer together for the benefit of our patients.

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    Published: January 28, 2012