Medical Acupuncture
A Journal For Physicians By Physicians

Volume 13 / Number 1
"Aurum Nostrum Non Est Aurum Vulgi"

Psychosomatic Compartmentalization:
The Root Of Qi And Blood Stagnation
Michael T. Greenwood, MB (MD)

ABSTRACT
Stagnation of Qi and Blood is a basic clinical pattern of Traditional Chinese Medicine, but its origin from splits in consciousness is rarely considered clinically significant. This article suggests that the root of stagnation lies in the mind's attempt to control existential anxiety through strategies of energy containment, which give rise to psychosomatic compartmentalization. It is suggested that attention to these strategies is at least as important as any particular acupuncture protocol.

KEY WORDS
Acupuncture, Qi and Blood Stagnation, Chronic Pain, Dissociation, Compartmentalization, Multiple Personality Disorder

INTRODUCTION
To the Western-trained physician, the diagnostic categories of Traditional Chinese Medicine (TCM) can appear mystifying and frequently seem to obfuscate more than clarify. Often, the conditions referred to in TCM appear to be bizarre descriptions of things considered irrelevant in conventional practice. Qi and Blood stagnation/excess/deficiency is a case in point. As physicians, we are confronted regularly with patients who have a mixture of chronic pain, numbness, or parasthesias in association with and overlapping such systemic symptoms as fatigue, frustration, and general malaise. Despite the best of intentions, physicians often have little idea how to categorize such patients energetically since they appear to have the features of Qi and Blood stagnation, deficiency, and excess all at the same time. Such diagnostic confusion does not help formulate a coherent treatment plan. Perhaps such categorizations are not particularly useful. Conceivably, is it possible that these energetic diagnoses are reflective of something more fundamental in consciousness that, if understood, would provide a more integrated basis for approaching chronic problems?

What Is Stagnation?
Definitions of stagnation can be found in any acupuncture text. Kaptchuk defines Qi stagnation as a pattern of excess that occurs when the smooth flow of Qi is stuck in an organ or meridian.1 The primarysymptoms are pain, soreness, or distension, which characteristically change in severity and location. Conversely, Kaptchuk defines Blood stagnation as an excess Blood pattern characterized by a fixed and stabbing pain; it is essentially a deeper disharmony that may be preceded by stagnant Qi (Table 1).

Jarrett adds a metaphysical view, indicating that Qi stagnation occurs when an individual meets a life situation so challenging that the Qi cannot flow smoothly around it. Similarly, he points out that stagnant Blood can arise when some trauma has occurred that is too painful to assimilate.2 He adds that Blood stasis can present as lost memory of painful events or difficulties with trust and intimacy, together with feelings of betrayal. According to both authors, pain is due to some kind of stagnation, while weakness is due to deficient Qi and numbness to deficient Blood.

It appears that these various TCM diagnoses arise from deeper archetypal forces in consciousness. Particularly, they may be the direct result of the way in which the ego manages its existential anxiety. In a previous article, I discussed how a number of splits arise in the psyche as a result of the process of individuation.3 Summarily, a primary existential split arises during ego construction and leads to a sense of alienation, which is experienced by most people as a background anxiety or "existential anxiety." This anxiety tends to feed on itself to produce further splits, which have been classified as the life/death, mind/body, and persona/shadow.4 Yet another split, the love/sex split, has been discussed by some authors as a separate entity although it might equally be understood as a subcategory of the mind/body and persona/shadow splits.5

Shifting From Pain
If we can accept the basic premise that the ego constructs these psychosomatic splits, we might intuit how the process of splitting could lead to the Qi and Blood stagnation described in TCM. A deeper understanding of the relationship between consciousness and those pathologies might thus evolve. Consider the limited choices the mind has when encountering different experiences and how these choices can lead to trouble. Consciousness, therefore, either moves toward an experience or away from it, either permitting energy flow or blocking it. It accomplishes this feat using the dual strategies of filtering/diversion and containment/dissociation.

STRATEGIES
Filtering and Containment
Filtering/diversion refers to the mind's ability to interfere with the natural flow of original energy through its discriminating function. The mind distinguishes between appropriate and inappropriate energies and permits the flow of only those energies the ego feels are socially acceptable. Unacceptable energies get caught in the filtering mechanism and then get diverted to an energetic dumpsite known in Jungian terms as the shadow. An analogy might be the quality control function of an assembly line worker who lets good products flow through while rejecting inferior or damaged articles. If a significant percentage of the flow is diverted, then a backlog develops on the main energetic route (stagnation), while concurrently, the diverted energy becomes a disposal problem.

Filtering is achieved through tightening the muscles in an area where an unacceptable energy is felt most intensely. For example, an individual will tighten the jaw, shoulders, or stomach muscles to control anger, tighten the chest to avoid sadness or grief, tighten the lower back to contain fear, or tighten the pelvis to control sexual energy.

Containment/dissociation refers to how the mind disposes of such diverted energy. To the ego, unacceptable energies will always remain unacceptable; hence, diverted energies are usually not permitted to return to the general overall flow. Consequently, all diverted energy must be disposed of. Containment refers to the process of dumpsite construction, and dissociation refers to the mechanism of ignoring the fact that the dumpsite is there.

Filtering/Diversion and Stagnant Qi
While filtering and Qi stagnation may appear synonymous, there is a difference. One gives rise to the other; while filtering/diversion is an ego strategy, stagnation is the experiential consequence of the strategy and not the strategy itself. The therapeutic significance of this is that if we wish to ease stagnation, perhaps it would be prudent to pay more attention to the mental strategy behind the stagnation than to the stagnation itself.

In TCM, the Wood sector (Liver and Gallbladder) is the aspect of consciousness that discriminates between things, e.g., this and that, good and bad, or here and there. It is this process of discrimination and classification that is said to bring apparent order out of chaos; the appearance of 10,000 things out of the chaotic unity of the Tao.6 Thus, through observation, we create our reality in the very process of naming it. In TCM, the Liver is said to control the smooth flow of Qi precisely; it is the Liver's discriminating function that is responsible for constructing reality in the first place. The discriminating mind must not forget the ultimate unity of all things, or else the process of discrimination is not rooted in wholeness. It is this oversight that actually obstructs the smooth flow of Qi and leads to stagnation.

The Western scientific tradition is an expression of the process of naming and categorizing. We observe and classify and consider that to be science. Ironically, it is a kind of science that has forgotten the essential wholeness that lies in the background. A society built on the premise of reductionism and endless classification sooner or later loses the ability to allow the smooth flow of Qi. It is interesting to consider that this loss of smooth flow is occurring in a country in which Wood energy is almost a national characteristic. The creativity, competitiveness, and youthful vigor abundant in the United States, together with the country's high levels of violence, point to a strong Wood component in the collective consciousness. Thus, it is probably no coincidence that in North America, one of the most common TCM diagnoses is stagnation of Liver Qi.

Containment/Dissociation
How consciousness deals with filtered/diverted energy is of prime importance in the manifestation of material pathology. The fundamental technique is simple. Unacceptable energy is dumped somewhere in the body's energy field, and then the ego tries to ignore the existence of the dumpsite. It can do this for a long time quite successfully, until the dumpsite gets so full it overflows or the site location impinges on consciousness in some other way such as pain. The process of dumping in a confined site can be termed containment, while the ignoring of the stench coming from the dumpsite can be termed dissociation. Containment is an energy management strategy while dissociation is a distraction technique; their combination leads to the development of cordoned-off areas in the psyche-soma in which there is compromised flow of Qi and Blood. Clinically, this appears like Blood stagnation. However, the symptoms from such a blocked area will be more than just the classic fixed stabbing pain of Blood stagnation; included will be both pain emanating from the contained and stagnant Qi and also a paradoxical parasthesia or numbness emanating from the dissociation.

It is increasingly evident that chronic pain and illnesses are dissociative phenomena.7 Contrary to popular thought, dissociation is not a rare or unusual phenomenon occurring in people who have been severely traumatized. Rather, it is a universal phenomenon, one with which everyone is familiar. For example, most people have experienced injuring themselves while engaged in physical activity such as contact sports without feeling any pain. During intense physical activity, the mind dissociates from the body; first, to focus on the larger strategy and second, to permit the body to be pushed beyond its usual limits. When an injury occurs at such times, there is generally little pain until later, when consciousness slowly returns. Therefore, in the acute situation, dissociation permits the execution of extraordinary feats that in some situations might be crucial to survival.

In chronic illness, a strategy of dissociation generally produces a less favorable outcome. Dissociation begins with a simple avoidance maneuver such as favoring an injured extremity that involves a physical adaptation. This adaptation in turn leads to increased stresses on other areas of the body. Eventually, other parts may become foci of pain which in turn will lead to more favoring. Thus, the whole body can become involved in a process of increasing dissociation until the entire physiology begins to break down. Since avoidance behavior is universal, dissociation and containment are typical insofar as they represent the common strategy of the collective.

Compartmentalization
Containment and dissociation are two aspects of a strategic continuum, usually found together in varying combinations of inseparability. If we block feelings somewhere and then dissociate from the blocked area, we have effectively compartmentalized that part, forming what might be called a psychosomatic cyst. The part may then be "sacrificed" for the ego to maintain its sense of identity. More commonly, no specific part is sacrificed but rather the entire body becomes the depository for rejected energy, leading to a systemic pathology.

Although tragic, localization and sacrifice are interesting clinically. An example is trauma patients who will frequently contain and dissociate from an injured extremity. One such patient electrocuted her hand in a live light-switch socket and although she appeared to have a functioning arm, she refused to use it. Closer examination revealed the telltale signs of Blood stagnation. During acupuncture bodywork, the arm would shake violently but the patient would visibly dissociate.

Another range of compartmentalization is the multiple personality disorder, or dissociative identity disorder. In multiple personality disorder, whole personality gestalts become compartmentalized; different personalities, containing different aspects of blocked energies, exist as separate personas within a single body. The different personalities can have different physiological correlates such as different handwriting styles, drug responses, visual acuity, or even symptoms.8 Long recognized is that people skilled at dissociation are more likely to have experienced severe childhood trauma.9 Such people may have little body awareness, unrecognized multiple personality disorder, or other marked psychic disturbance. Since they are not fully present in their bodies, these people tend to be accident-prone and/or develop illnesses that resist conventional intervention. Such people have difficulty with the healing process, which demands they be present and aware.

Three different varieties of compartmentalization are depicted in Figures 1-3: 2 extreme situations, and 1 depicting the more common overlap situation. The importance of compartmentalization lies in realizing the complementarity of 2 apparently unrelated conditions, multiple personality disorder and regional pain syndromes, better understood energetically as psychic and somatic cysts. This insight suggests a common origin of many chronic pain conditions and at the same time, provides an explanation of how Qi and Blood stagnation arises first as potentials in consciousness.

In Figure 1, the diverted energy is siphoned off into a somatic cyst, which may present as a regional pain syndrome. In this scenario, the somatic compartment may exhibit features of Blood stagnation, while the rest of the body may appear relatively normal or exhibit some milder containment phenomena. Here, the contained energies are separated from the main personality in space.

In Figure 2, the original energy is scattered and diverted into 1 or more psychic cysts, which may present as multiple personality disorder. Each psychic cyst expresses a subpersonality and will exhibit different degrees of containment. Frequently, the subpersonalities will carry most of the body/mind's emotional pain, while the main personality will present with some somatic complaint such as headaches, dyspnea, or depression. The presence of amnesia or time lapses suggests that multiple personality disorder may be involved. Here, the compartmentalization occurs mostly in time.

In Figure 3, the contained and dissociated energies interpenetrate the main persona so that all the various energetic structures overlap, resulting in a complex pattern of psychosomatic cyst formation (persona/shadow overlap) and varying degrees of Qi and Blood stagnation. This is the most common scenario but, ironically, the most difficult to grasp because it involves the conceptual leap that one can be simultaneously present, contained, and dissociated all within the same physical space. It is possible because the body's energy field is a complex interference pattern of waves and troughs, all of which overlap.10 There is no particular compulsion for a contained/dissociated psychosomatic cyst to be located in a discrete area of space/time, although that is possible. Indeed, the classic multiple personality and/or dissociated limb is rare in comparison to the number of people presenting with interpenetrating stagnation. The image of interpenetrating circles, known as a mandorla, is a motif common to a variety of disciplines ranging from Christianity to Jungian analysis. It has been interpreted as reflecting the challenge of bringing the persona and shadow together to form a greater whole.11

In Figure 4, Blood stagnation arises as the result of a compartmentalization/dissociation strategy instituted by an alienated ego as it gets increasingly separated from a center of authentic or original energy. The overlapping of compartments leads to the appearance of systemic stagnation of Qi and Blood; compartments are separated from the energetic center in both time and space. Purely spatial separation presents as somatic cyst formation and somatic sacrifice (regional pain), while purely temporal separation presents as psychic cyst formation and psychic sacrifice (multiple personality disorder). In the more common presentations, an interpenetration of both axes leads to overlapping of compartmentalized psychosomatic fields in what appears to be a sizable combination. Such individuals will exhibit personality variability (i.e., inconsistent behavior), but with continuity of memory between personas. They will also have incomplete somatic compartments so that even if their pain is relatively localized, there will be evidence of Blood stagnation systemically.

The division of psyche and soma is ultimately an artificial contrivance; multiple personality disorder and regional pain syndromes are different expressions of the same disorder: separation from a center of authentic energy or separation from the Tao. The truth of this statement often will be found during acupuncture treatments. For example, exploration of a somatic pain compartment with acupuncture may expose a psychic cyst; there can be an eruption of emotional material that can mimic the appearance of a subpersonality if intense enough. When such material is brought to consciousness and integrated, the original somatic pain can disappear, confirming the energetic equivalence of psyche and soma. Commonly, the nature of the energy contained in a psychosomatic compartment is predicated on reaction patterns based in constitutional typing, and is not intense enough to generate a personality gestalt. It may be difficult to differentiate signs/ symptoms of Blood Stagnation/Compartmentalization.

Blood stagnation presents as fixed and stabbing pain with or without lumps. In chronic pain syndromes, interpenetration of contained energy and dissociated compartments lead to the paradoxical symptoms of pain and numbness simultaneously, which may be confusing if the origin is not fully appreciated. In cases of extreme separation, a patient may not permit the touching of a painful/numb area. The act of touching calls awareness back to a dissociated area; thus, these patients often refuse light touch until they understand the necessity for reversing their conscious stance.

Examination reveals compromised microcirculation, with blanching and slow capillary return after pressure. Due to sluggish Blood movement, the skin temperature may be cool or even cold, and the skin turgor thin or boggy. When this perpetuates in an extremity, the area in question may display the hyperalgesia, allodynia, and hyperpathia triad,
characteristic of reflex sympathetic dystrophy. Or, a deteriorating neurological condition will develop such as multiple sclerosis. An examination of such patients often reveals the typical features of Blood stagnation in the affected extremities.

Pharmaceuticals
When symptoms merge through the containment/dissociation barriers, patients will generally request drugs or consider more drastic interventions such as surgery. In this way, conventional medicine then is propelled into the process of containment/dissociation, and physicians become unwitting extensions of their patients' primary ego strategies. Indeed, many drugs are designed to mimic the functions of containment and dissociation. Examples are drugs that contain antidepressants (such as amitriptyline), and drugs that dissociate include opiates and anxiolytics.

The fact that antidepressants are often effective against chronic pain does not have a coherent biological explanation. As physicians, we often interpret this finding to imply that patients with chronic pain are actually depressed, while somatizing their depression. However, since breakthrough pain pushes people to look for increased containment, there is a simple energetic explanation. Indeed, people taking antidepressants often report that their feelings are better contained, they are less emotionally labile, and more balanced.

With opiates, pain often will be registered in the usual way, but it does not irritate. The experience has been described as dissociative bliss. Ever since Pert discovered the opiate receptor in 1972, research has focused on how to use and improve upon the body's own endogenous morphine.12 Her research has implied a direct correlation between "thoughts" and "neuropeptides." In other words, thoughts create molecules that are the material equivalent of the thought, i.e., a particular thought creating a particular neuropeptide. Thus, the endorphins, the body's endogenous morphine-like molecules, are actually the neuropeptides that represent and carry out the thought of dissociation.

Dissociative bliss has often been interpreted as positive, and researchers hope to find a drug that will produce a blissful state without inducing dependence. Similarly, much of acupuncture pain research has focused on the production of endorphins.13 But if endorphin production reflects the strategy of dissociation, then making more endorphins will only exacerbate the problem. It has been shown that in rat models of reflex sympathetic dystrophy, the opiate receptors are maximally utilized.14 Thus, in this particular form of chronic pain, the body's endorphin output is already maximized, implying that the individual is already maximally dissociated. If pain is going to break through a state of maximum dissociation, perhaps it is time to try a different approach.

Anxiolytics dissociate patients from feeling existential anxiety, which possibly explains why anxiolytics are considered so addicting. The anxiety continues to accumulate, but the patient does not feel it. Any attempt to discontinue the drug leads to anxiety, which is often interpreted as withdrawal and blamed on the drug. In reality, the patient is feeling anxiety again, but more intensely.

Acupuncture
Perhaps it should now be clear that using a particular point to move stagnation in a particular meridian is not effective in the presence of largely unconscious archetypal forces operating in the opposite direction. The key point is that any acupuncture approach aimed to mobilize stagnant Qi and Blood will likely be more successful if attention is paid to the contributing factors. Since these factors lie in consciousness itself, improvement is more likely if the underlying ego strategies are brought to the surface and examined. The treatment focus for all these conditions might be summarized as decontainment, reassociation, and integration.

Stagnant Qi
Stagnation of Qi is generally easier to work with, particularly if it is of relatively recent onset. Since the energy diversion has not progressed to dissociation, there is no lack of awareness in the patient. Often, patients may actually be more present. The pain itself may produce heightened awareness in the absence of painkillers. In this early situation, almost any theoretical approach will be successful. In recent trauma, focusing on the tendinomuscular meridians is effective. For pain of longer duration, a linear N-N+1 input into the zone of involvement is a reliable first choice: front (Yang Ming-Tai Yin), side (Shao Yang-Jue Yin), or back (Tai Yang-Shao Yin), plus local points.

A typical example would be low back pain treated with KI 3 (Taixi), BL 62 (Shenmai) and 40 (Yixi), SI 3 (Houxi), HT 7 (Shenmen), and local points such as BL 23 (Shenshu).

Stagnant Blood/Dissociation
Treatment of stagnant Blood is a more difficult problem. Some speculate that Blood is thicker than Qi and therefore, harder to move. However, there may be a more definitive way of understanding the problem. If Blood stagnation points to dissociation, then there is little chance of effecting a change unless the individual reverses the strategy of dissociation. It is difficult to see how reassociation can be engendered without the individual consciously deciding to return to areas previously dissociated. This can be challenging because it often involves an excruciating exacerbation of symptoms which can prevent further progress. Furthermore, skilled "dissociators" tend to have weaker egos than average, perhaps because they have learned to cope by escaping reality. If they seriously try to heal their various splits, their fragile egos can easily become overwhelmed by the intensity of the material contained in their psychosomatic cysts. When this happens, patients may get frightened and within a short time, will retreat back to the safety of dissociation. All this can make healing for dissociators slow, protracted, and with setbacks. Often, the most they achieve is a stalemate, in which they are more present than before but retain enough symptoms to feel ill.

The Role of Intention
In a previous article, I discussed the concept of intention and its role in acupuncture treatment.15 To summarize, patients must intend to move toward their pain rather than away from it if they want to get better. Reassociation proceeds much more quickly if intention can be clarified at the start of treatment. Without such a willingness on the patient's part to reawaken the area in question, treatment becomes more and more frustrating as the patient resists the increasing awareness engendered by acupuncture treatments.

Working through this difficulty can be challenging. A good strategy is to warn the patient that if treatment is successful, there may be a paradoxical increase in pain, and that should it occur, the patient should resist the urge to abandon treatment and/or take analgesics. If patients are already taking containment/dissociating medications, then they need to understand that this in itself is a demonstration of inappropriate intent and is only going to delay the healing process. An unwillingness to consider the negative impact of medication indicates that intent is unlikely to shift (at times, it might be reasonable to dismiss such a patient early rather than risk getting involved in a protracted tug-of-war) [Table 2].

As with Qi stagnation, a sound, basic approach is the N-N+1 circuit on the affected zone, with local points at the margins of the somatic cyst. The intent is to open energy flow into and out of the painful area. Often, preparing the points with moxa prior to needling can be helpful. A second approach is through the use of the extraordinary meridians, again with local Ah Shi points, at the margin of the affected zone. The Chong Mo, the Sea of Blood, is always a consistent Curious Meridian to invoke, using points such as SP 4 (Gongsun), PC 6 (Neiguan), and ST 30 (Qichong). The lighter energetic equilibrations are less likely to be effective in initial work with Blood stagnation but can be used later when there is a good understanding of the principle of intent. Specific points for Blood stagnation can be used as an adjunct, such as BL 17 (Geshu), SP 6 (Sanyinjiao), SP 10 (Xuehai), or SP 8 (Diji).

Frequently, in long-standing cases, intending a gradual softening is likely to be more effective than attempting progress too quickly. The use of a multifrequency infrared lamp can be beneficial. Gentle massage, acupressure, and cupping are all complementary and can be effective ways of bringing blood and circulation to areas of stagnation. Seemingly, with long-standing deep-seated Blood stagnation, the gentler the intervention the better, perhaps giving the appearance of doing little, if anything. An example is forceless spontaneous release, a form of Yin Tuina, shown to be helpful in Parkinson's disease and occasionally leading to recovery.16 Hands-on work can sometimes be effective at exposing the emotional body; clinicians and patients need to be prepared for emotional release as a cyst is opened up.

CASE STUDIES
Traumatic Compartmentalization
Opening a dissociated area can be much like physically incising an abscess. Contained memories, traumas, and feelings can burst forth in an overwhelming way. The following are similar cases with different outcomes:

Patient 1 was a 45-year-old woman who developed a frozen right shoulder shortly after what appeared to be a work-related minor strain lifting a heavy item. When she presented, there had been little improvement in 3 years. The patient held her arm across her chest, refused to use it for even minor things, and complained that it hurt with minimal movement. She exhibited a hopeless resignation, but expressed resentment toward the Workers' Compensation Board and her physicians for mismanaging her case.

Examination revealed all the features of Blood stagnation/dissociation in the affected arm. Treatment involved clarifying intent, opening a Shao Yang-Jue Yin circuit, using local points at the containment barrier, and gentle massage.

During an acupuncture-bodywork session, the patient entered "the void" and spent several minutes violently hitting a pillow with her injured arm.17 Later, she revealed that she had imagined punishing her abusive ex-husband. After emerging from the altered state, the patient was astonished to realize that she had been using the purported frozen arm/shoulder.

Patient 2 was a 28-year-old man who injured his left knee in a sawmill accident. As with patient 1, his actual physical injury appeared relatively minor, but 2 negative arthroscopies and 3 years later, he was still in pain. The extremity showed all the signs of Blood stagnation. The patient appeared unconcerned about his disability. He reported that he never allowed himself to get angry, and would not allow anger under any circumstances; he reported losing control in the past. In this case, the injury provided a solution to several problems simultaneously. By containing the Wood energy in the leg and then dissociating from the leg, the patient created a disease that provided an acceptable solution to the problem of his rage, an acceptable idea of himself as a victim of circumstance, and an income from disability insurance. As of this writing, the patient remains in severe disability.

Dysmenorrhea
Patient 3 was a 25-year-old woman with dysmenorrhea and perineal pain. She had attended various pain clinics, including a vulvodynia clinic, with no improvement. Her pulse was choppy and there were dark red spots on the sides of her tongue. The lower Jiao was cold compared with the middle and upper, while above the neck, she was hot. She was interested in alternative approaches and embraced the idea of intent early. The patient alluded to having an emotionally sterile upbringing, in which sexual matters were considered negatively and never discussed. She disclosed dreams with sexually suggestive imagery.

Treatment involved a Chong Mo input and clear intent: SP 4 (Gongsun), PC 6 (Neiguan) with moxa, ST 30 (Qichong), CV 3 (Zhongji), and CV 4 (Guanyuan). With this, the patient began to allow the pelvic movement which had always shamed her. Within a short time, she experienced heat and tingling moving up the Du Mo, suggesting Kundalini awakening. After this simple experience, her dysmenorrhea and vulvodynia disappeared for the first time in years. The improvement was temporary, initially, but with perseverance and home dynamic meditation, she eventually became pain-free.3

Patient 4 was a 44-year-old woman with multiple sclerosis who understood personal growth and alternative medicine. Over several years, she had progressed out of a wheelchair to walking with canes. Although her disease had regressed, she nonetheless pursued avenues to reverse her disease. The patient's legs were cool and showed the typical blanching of Blood stagnation. Her pulse was robust, indicating she had potential energy. The patient was willing to consider that she might be dissociating and was eager to reverse her intention once the concept was explained. In a "safe" environment, she displayed an amazing energy and actually kicked me with much strength, while mouthing obscenities. The power in her legs was demonstrated.

CONCLUSION
Despite common beliefs about illness, we actually have more input into our illnesses than we conceivably believe. As physicians, we may intuit our patients' responsibility but avoid bringing it to their attention for fear of provoking denial. In reality, illnesses rarely arise without reason. More often, people are not so much victims of circumstance as they are unconscious participants, actively bringing on their difficulties through attitudes and behaviors that are actively self-destructive. Moreover, there is a generally steady progression of energetic imbalances that patients ignore, preceding the materialization of pathology.

That many chronically ill patients often feel victimized speaks directly to the issue of alienation, the existential split that indicates the primary separation from the Tao. Perhaps the ultimate root of illness, it needs to be made conscious if we are ever to solve the conundrum that illness presents. Once the origin of illness is brought to awareness, then the patient has a choice to shift attitudes and envision the results. Occasionally when this is done, an apparently untreatable illness will resolve.

The stagnation we see in our patients is a stagnation of their consciousness, a belief in their separateness from other things. However, in the final analysis, the idea of separateness is false. Too see the false as false is simply way out of the trap. Acupuncture is a tool for awakening such awareness; the skill of using the tool lies with the practitioner.

REFERENCES
1. Kaptchuk TJ. The Web that Has No Weaver: Understanding Chinese Medicine. New York: Congdon & Weed Inc; 1983:203-205.
2. Jarrett LS. Nourishing Destiny: The Inner Tradition of Chinese Medicine. Stockbridge, Mass: Spirit Path Press; 1998:305-308
3. Greenwook MT. Splits in western consciousness from an acupuncture perspective. Medical Acupuncture. 1999:11(2):11-16
4. Wilbur K. The Spectrum of Consciousness. Wheaton, Ill: Quest Books; 1977:94
5. Stein R. Incest and Human Love. Dallas, Tex: Spring Publishing Inc; 1973:41-47
6. Jarrett L. Constitutional type and the internal tradition of Chinese Medicine - Part 2.. Am J Acupuncture. 1993;21:141-158
7. Hunter ME. Making Peace With Chronic Pain: A Whole-Life Stategy. New York, NY: Brunner/Mazel Inc; 1996:4-6
8. Fraser GA, Raine D. Focusing on multiple personality disorder. Can J Diagnosis. 1993:56-79
9. Kluft RP. An update on multiple personality disorder. Hosp community Psychiatry. 1987;38:363-373
10. Rubik B. can western science provide a foundation for acupuncture? AAMA Rev. 1993;5(1):15-27
11. Johnson RA. Owning Your Own Shadow: Understanding the Dark Side of the Psyche. New York, NY: Harper Collins; 1991:97-118
12. Pert C. Molecules of Emotion: The Science of Mind-Body Medicine. New York, NY: Touchstone; 1997:55-66, 77.
13. Pomeranz B, Stux G. Acupuncture: Textbook and Atlas. New York, NY: Springer-Verlag; 1987:1-34
14. Bennett G. RSD research breakthroughs. In Proceedings of the RSDSA 2nd National Conference; September 5-7, 1997.
15. Greeenwood MT. Acupuncture and intention: needling without needles. Medical Acupuncture. 1999; 11(1):17-23
16. Walton-Hadlock J. Recovery From Parkinson's Disease: A Practitioner's Handbook. 5th ed. Santa Cruz, Calif: Parkinson's Recovery Project; 2000:157-218
17. Greenwood MT. Braving the Void: Journeys into Healing. Seattle, Wash: Gordon Soules Book Publishers Ltd;1997

AUTHOR INFORMATION
Dr Michael Greenwood is the Medical Director of the Victoria Pain Clinic, a residential facility in Victoria, British Columbia, Canada. Dr Greenwood specializes in working with chronic pain and illness patients, and in developing techniques integrating the body, mind, and spirit. He has authored the books Paradox and Healing, and Braving the Void.

Michael T. Greenwood, MB (MD), BChir, CCFP, CAFCI, FRSA
365 Hector Rd, RR#3
Victoria, British Columbia V8X 3X1 Canada
Phone/Fax: 250-595-1486 E-mail: michaeltgreenwood@home.com
Graphics were designed by Dr Greenwood's son, Richard Greenwood.

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