A knot may have been tied for long, and yet it can be untied.
A closure may have lasted for long, and yet it can be opened.
If someone says an illness with a long duration cannot be removed, then that is simply an erroneous statement.

—Huang Di Nei Jing Ling Shu

Circulatory tree, arbor vitae of the cerebellum, lead tree or silver amalgam crystals precipitated into a tree that conducts lightning, is it your countenance that traces our destiny for us in the fire-scorched tortoiseshell, or your flash that brings forth from an infinite night that slow change in being in the En panta of language?

—Jacques Lacan, Écrits

Author’s Note

The body of this essay is comprised of five succinct parts:

I. The Warp and Weft of the Speaking Body

II. The Littoral Terrain

III. A Punctuation of Dreams

IV. The Body Without Organs

V. The Clinic of the Real

The style is condensed and aphoristic rather than expository and explanatory. After completing the text, I decided to add an overture to contextualize my theoretical moves in historical and conceptual terms.

My method is discursive and rhetorical—to write the shared discourse of acupuncture and psychoanalysis, and read their inscriptions to each other.

Some readers may prefer to dive headfirst into the body of the text only to return to the overture for afterthoughts; others may prefer a preface before entering the ambiance of the text.

This being said, I stake no claims. My only wager is a structure of inverted forms, suitable for efficacy.

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Free Associations for a Floating World

From Meridian Therapy to Meridian Analysis

Historical Antecedents

Acupuncture and psychoanalysis are subjects rarely spoken in the same breath. Their histories are vastly different in scope and locus—but I hope to show that their similarity is not across a frontier but through a neighboring landscape. That is, acupuncture and psychoanalysis are distinct languages with common roots in unconscious scripts.

If acupuncture and psychoanalysis can be read as functional articulations of unconscious structures, then it is the consequence of a communicable discourse already embedded at the root. Does discourse have a rhizomatic structure? Are acupuncture and psychoanalysis lateral developments, with anterior methodologies and radial diagnoses? If we follow this line of inquiry, we will be led to a concordance, rather than a synthesis.

We see the first intimations of a convergence between acupuncture and psychoanalysis in the early-to-mid-twentieth century, when both fields were experiencing a renaissance along parallel lines. But these lines of development only met in anticipation of a nexus.

In the early-twentieth century, Japan was facing the influence of modernization in relation to traditional acupuncture—centuries of practice were being revised in the arbitrary image of the West, as Shudō Denmei recounts:

In 1918 the government commission on acupuncture education compiled the so-called ‘revised acupuncture points,’ which became the standard for licensure. The revised acupuncture points bore no resemblance to the traditional meridians and points, but were arbitrarily arranged according to a grid system superimposed over the surface of the body.1

In reaction to this Westernizing trend, a group of Japanese acupuncturists began to advocate for a return to the classical source-texts of acupuncture, where they could retrace the anatomy of their medicine. Following the efforts of Yanagiya Sorei, the neoclassical movement known as keiraku chiryō, or “meridian therapy” was born.

The meridian therapy movement not only returned to the classics of acupuncture but also to a classical period in the history of Japanese acupuncture.2 Yanagiya championed the “traditional approach to acupuncture and moxibustion” and “contended that the information in the classics was valuable but not infallible. He believed that all classical approaches had to be examined with a critical eye, put into practice, and discussed among practitioners before their worth could be determined”.3

By the 1930s, Yanagiya had founded a school dedicated to his motto, “Study the classics!”. Practitioners of meridian therapy took to the Classic of Difficulties as rigorously as Lacan took to The Interpretation of Dreams. And they each carefully deciphered and codified a system of practice “that had never before been so clearly defined”.4

Meridian therapy reached Europe in the mid-1950s, when Yanagiya traveled to France at the invitation of the French International Society of Acupuncture and Moxibustion. Yanagiya’s arrival follows a fertile landscape in French acupuncture and psychoanalysis: Soulié de Morant had published the first Western compendium on acupuncture, L’Acuponcture chinoise, and Lacan had formalized his return to Freud in the seminar.

Meridian therapy develops along a similar longitude as Lacanian psychoanalysis. The closest historical parallel between them is a loop of influence between France and China via Soulié de Morant, a French diplomat to China who not only spoke Chinese but also learned acupuncture from Chinese masters. As Eckman notes, “I think we can say that contemporary traditional acupuncture in the West, whatever that is, started with George Soulié de Morant in 1927 in France”.5 In this sense, the history of acupuncture in France has an earlier inception than Lacan’s psychoanalytic school. But by the 1960s, both movements were in full swing.

Soulié de Morant’s magnum opus, L’Acuponcture chinoise, was published from 1939 to 1941, but the complete text was published posthumously in 1957. L’Acuponcture chinoise is a remarkable text in the history of acupuncture. Soulié de Morant not only translates classical Chinese and Japanese texts, he collects a diversity of East Asian traditions—Chinese, Japanese, Vietnamese, and Korean—in a single place. His condensation of East Asian styles makes legible a pluralism intrinsic to the tradition of acupuncture, collating their ethic amidst a new cultural intersection.

Soulié de Morant treated prominent Parisian artists and intellectuals, including Maurice Ravel, Atonin Artaud, Jean Cocteau, Wassily Kandinsky, and Marie Bonaparte.6 Soulié de Morant’s collaborative relationship with Bonaparte is especially notable, since it marks what may be the sole historical convergence between acupuncture and psychoanalysis. Marie Bonaparte was not only the grandniece of Napoleon, she was an ardent follower of Freud, and helped establish Freudian psychoanalysis in France.

Bonaparte asked Soulié de Morant to translate the Yùxiájì (Memories of the Jade Box), a classical Chinese book on dream omens and their interpretations (ca. 239 BCE). In 1927, Soulié de Morant published his translation of the text alongside Bonaparte’s annotations as Les rêves étudiés par les Chinois in Revue française de psychanalyse—the same year that Freud published The Future of an Illusion and the English edition of The Question of Lay Analysis, and Lacan began his clinical psychiatry training at Sainte-Anne hospital.

Soulié de Morant belongs to a tradition of lay practice that Freud advocated for, a mode of work that moves from the institutional to the avant-garde and from academic discourse to analytic discourse. The question of lay practice that faces psychoanalysis also confronts acupuncture, even while the latter has secured both theoretical standardization and regulatory verification to ensure the limits of its “licensure”.7

Synthetic Precedents

Compared to acupuncture, psychoanalysis appears to be a new discipline, founded on Freud’s articulation of the unconscious. But this does not leave psychoanalysis without its antecedents in antiquity. Yanagiya’s “return to the classics” and Lacan’s “return to Freud” are Renaissance movements that revolutionized their respective fields through a retrograde motion. They each find new beginnings for their field at a point of origin, and thus precipitate a future direction. Lacan not only traces psychoanalysis to its founding moment in Freud but to the liberal arts of the Middle Ages—“the series going from astronomy to dialectic by way of arithmetic, geometry, music, and grammar”—that “foreground what might be called a fundamental relation to human proportion”.8

Human proportion is a constitutional ratio and a spatiotemporal complex. By citing the liberal arts, Lacan is suggesting that psychoanalysis concerns itself with constitutional structures. He elaborates:

At the present time, psychoanalysis is perhaps the only discipline comparable to those liberal arts, inasmuch as it preserves something of this proportional relation of man to himself—an internal relation, closed on itself, inexhaustible, cyclical, and implied pre-eminently in the use of speech.

It is in this respect that analytic experience is not definitively objectifiable. It always implies within itself the emergence of a truth that cannot be said, since what constitutes truth is speech, and then you would have in some way to say speech itself which is exactly what cannot be said in its function as speech.9

If the unconscious is a structure that is structured like a language, then it is constituted in proportions unique to the speaking body. As Lacan says, “Language is what constitutes xing, nature”.10 In the context of Chinese medicine, xinghas the connotation of “constitutional nature”. Lacan makes the link between language and constitution clear when he analyzes the Chinese character yan, which “means nothing other than language, but like all terms in Chinese, it can also be employed as a verb. Thus, it can mean both ‘speech’, and ‘what speaks.’ What does it speak? That would, in this case, be what follows—namely, xing, nature . . .”.11

The Freudian map of the unconscious is a topography of the psyche as a structure of signifying associations. The meridian anatomy of the Chinese is a topography of the psyche, written across the signifying terrain of the body. What happens to medicine and psychoanalysis when we take the unconscious as a psychosomatic constitution? If we cannot objectify the proportions of the psyche and soma, then what remains is a ratio of articulation, measured for the moment of its puncture. Thus, acupuncture apportions the body as a field of language through which speech functions.

By the 1960s, European practitioners had begun to absorb acupuncture into the milieu of psychosomatic approaches, in a field inaugurated by Georg Groddeck, a German physician and psychoanalyst who influenced Freud’s concept of the id (das Es).12 In 1965, Denis and Joyce Lawson-Wood published Five Elements of Acupuncture and Chinese Massage,13 an early and influential English-language book introducing acupuncture. In a chapter titled “Psychological Considerations”, they raise the question of synthesizing acupuncture with psychoanalysis.

They open their argument by referencing the work of French physician, Roger de la Fuÿe (a student of Soulié de Morant who promoted a synthesis between acupuncture and homeopathy in his treatise, Traité de’acupuncture). De la Fuÿe referred to his approach as “homeosiniatry”, basing it on a combined repertory of acupuncture points and homeopathic remedies.14 Highlighting de la Fuÿe’s approach to clinical synthesis, the authors write:

Doctor de la Fuÿe emphasizes, and we re-iterate and emphasize this also, that a practitioner must be supple in his outlook and not seek at all costs to make any one method triumph over all others. Above everything else the practitioner must have the desire to heal the patient: and, he says, it would be evidence of narrow-mindedness to reject a priori a synthesis of acupuncture and other methods on the grounds that such a synthesis of methods is not in strict accord with the ancient tradition of ‘pure’ acupuncture.15

This admonition applies equally to psychoanalysts: we must not seek the exclusive triumph of the psychoanalytic method for the sake of a “pure” ideal. The only purity of psychoanalysis is the presence of the speaking subject. Any other erection of purity leaves psychoanalysis impotent in the words of its own sanctimony. For Lawson-Wood, the question of modality is secondary to the primacy of the healing act: “The ideal therapist is one whose spirit is pliable enough, and whose knowledge is broad enough for him to use at one and the same time the quintessence of all known reputable methods”.16

From here, the authors mention Groddeck before formulating a link between acupuncture and psychoanalysis in “the treatment of the psyche”: “When we talk about treatment of the psyche we are not thinking in terms of modern Western psychiatry, with use of shock and drugs, but rather in terms of psycho-analysis and systems derived therefrom”.17 This leads them to pose two issues they associate with psychoanalytic treatment:

(a) Psycho-analysis, from the patient’s point of view, can be an expensive way of having the psyche treated; especially as a beneficial outcome is by no means certain.

(b) Whether it is in the end successful or not, psycho-analysis seems inevitably to be accompanied by a great deal of emotional torment and distress.18

It is difficult to know which methods of psychoanalytic practice or thought were familiar to the authors in formulating this critique.19 Regarding expense, the cost of treatment is typically seen in proportion to the frequency of treatment—and, in this realm, psychoanalysis has privileged an intensive format. Freud typically saw patients for analysis six days a week. Today, it is more common for psychoanalysts to see patients on a weekly basis—the same frequency with which patients also see their acupuncturist.

Who is to say which method is a greater source of distress—the scansion of the subject’s speech or the physical puncture of their skin? It is erroneous to locate these subjective experiences in an objective method of treatment. Patients may engage in analytic work for years, but they may also see their acupuncturist for decades. The duration of healing work is less questionable when we re-locate their effect in the logical time of a preventative praxis. But the question remains: how do we arrive at the “success” of any given treatment, regardless of cost and duration?

The authors continue to suggest that acupuncture may provide a more efficient pathway to the treatment of the psyche than psychoanalysis:

It is desirable, therefore, that there should be some alternative and far speedier method of resolving analytical problems. But this does not mean to say that we regard Chinese acupuncture by itself as an alternative to psycho-analysis in all cases; but rather do we intend to convey a judicious use of Chinese acupuncture points can serve as an extremely useful technique for bringing about more rapid results, without torment, and with greater predictability.20

This critique hinges upon a proper understanding of so-called “analytical problems”, or more accurately, symptoms of the unconscious. If we appreciate that such symptoms are necessarily psychic and somatic, then the question of method becomes the substance of a ritual.

In my clinical work, I have observed an equivalent efficiency between psychoanalysis and acupuncture, as well as the inverse. This is to say that the questions of efficiency and “resolution” are irreducible to method, but are rather a question of discernment on the part of the practitioner. It is perhaps less a question of “which” but of “who” and “when” and “what for”. At a specific point in the analytic process, the frame itself functions beyond the question of intervention and within the locus of transference. It is thus within the palpatory grasp of the practitioner’s hand to determine the precise dialectic of their clinic.

Despite their criticism, the authors conclude their thoughts by positing a classical link between acupuncture and psychoanalysis:

If anyone wants classical justification for linking psycho-analysis with acupuncture, we draw attention to the passages in the NEI CHING dealing with interpretation of dreams. Several thousand years before Freud the Chinese recognized that dreams represent a mechanism for symbolic wish-fulfillment.21

The authors are referring to the classical source-text of Chinese medicine, the Huangdi Neijing (Yellow Emperor’s Inner Classic). In chapter seventeen, “Discourse of Vessels and the Subtleties of the Essence”, the text discusses the affective dimension of dreams and correlates them with organs and elements.22 It is true that the topic of dream interpretation precedes Freud by millennia, as the therapeutic significance of dreams has been recognized for thousands of years in Ayurvedic, Tibetan, and Chinese medical texts.

Freud’s contribution is to chart the phenomenon of dreams within the associative network of the patient’s speech. As Lacan points out, “For a dream is not the unconscious but, as Freud tells us, the royal road to it. This confirms that the unconscious proceeds on the basis of metaphorical effects”.23 Lacan proceeds to situate the unconscious as a signifying structure:

Here, however, the path was not simply traced out for us by Freud: he paved the whole road for us with the most sweeping, unvarying, and unmistakable assertions. Read his work, open his texts to any page, and you will rediscover the foundational stonework of this royal road.

If the unconscious can be the object of a kind of reading that has shed light on so many mythical, poetic, religious, and ideological themes, it is not because it provides their genesis with the intermediary link of a sort of “significantness” of nature in man, or even of a more universal signatura rerum that would be at the core of their possible resurgence in each individual. Psychoanalyzable symptoms, whether normal or pathological, can be distinguished not only from diagnostic indices but from all graspable forms of pure expressiveness insofar as they are sustained by a structure that is identical to the structure of language. By this I do not mean a structure that can be situated in some sort of supposedly generalized semiology which can be drawn from its limbo regions, but rather the structure of language as it manifests itself in what I will call “natural languages,” those that are effectively spoken by human groups.24

Psychoanalysis teaches us that the locus of symptoms—whether psychic or somatic—is in the unconscious, and that a “symptom is language from which speech must be delivered”.25 The symptoms of meridian imbalance are thus analyzable symptoms, treatable through a tonification or scansion of signifiers. “It is via speech, of course, that a pathway toward writing is paved”.26 And this is where Lacan locates the double-transcription of xing and ming, what is inscribed by nature and what is what is written—“The shift occurs between xing, nature—such as it is, owing to the effect of language, inscribed in the disjunction between man and woman—and ming, heaven’s decree, this other character . . . meaning “it is written,” the character freedom shrinks from”.27 Xing and ming is the double transcription that codes the fate and ciphers the destiny of the speaking body.

The analysis of a symptom is the punctuating of a text, written across a signifying body. To puncture and to punctuate is to “point out”, to show the punctum that is the navel of the line. Soulié de Morant says, “It would seem that the action of puncturing is very simple and can only be accomplished in one way. However, the word ‘puncture’ has three meanings: the action of puncturing, the excitation produced by the puncture, and the trace produced”.28

These three meanings can be placed into the three registers of the unconscious: the action of puncturing is imaginary; the excitation produced by the puncture is a symbolic effect; and the trace that remains is the letter in the real.

Here, we approach the body ecologic at its littoral zone. As Lacan says, “What constitutes the ground of the littoral is the crossing out of any trace that may been there before”.29 Whether the punctuation of an associative discourse or the puncture of an associative meridian, it is we who must see the “imperceptible trace of . . . the gazelle’s footprint on the rock”.30 We must “listen for what lies beyond discourse” by taking “the path of hearing, not that of auscultating”.31 A riverbed where currents of discourse once ran, now only the inscriptions of a leitmotif left to read in the lituraterre of the speaking body.

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Après-Coup: Sinography as Semanteme

In the language of Asian medicine, we also find signifiers for unconscious structures and processes, for drives and their vicissitudes, for somatic symptoms and their psychic origins. Acupuncture is founded on a symbolic language that describes the functional apparatus as a psychosomatic structure. The symbolic order is a circulation of signifiers that move in a möbius channel of signification. The body does not keep a score but a name of functions that invoke a symbolic law.

Soulié de Morant’s translation of jīng as “meridian” is now in vogue to detest. Some accuse Soulié de Morant of inventingan imaginary meridian paradigm that is alien to the “scientific” basis of Chinese medicine. These claims privilege a scientific materialist reading of acupuncture that aims at its legitimization in the defiles of colonialist medicine. The new trauma is inflicted from within its co-optation. The trouble is an age-old confusion between the imaginary and the symbolic amidst a naïve realism.

Instead of “meridian”, the term “channel” is advocated as standard nomenclature. Instead of a geography of the body, they prefer the imperialism of chemical signals and vascular pathways, an altogether dissected vessel emptied of symbolic notions for the sake of imaginary captures by false prophets of reality. But to read coffee grounds is not to read hieroglyphics. Acupuncture is not a figment of imagination, projected onto a body double—it is a signifying system, as legible as a written language, whose rosetta stone it is our task to palpate and punctuate.

This becomes clear when we give Soulié de Morant’s translation the instance of another glance. He was not only a French diplomat to China but a polymath who learned the Chinese language from the age of eight and studied acupuncture in China during the cholera epidemic. Soulié de Morant was not only versed in acupuncture and linguistics but also in art, literature, music, theater, and history. Why did he choose the term méridien as a translation of jīng?

In the second chapter of L’Acuponcture chinoise, “The Twelve Meridians”, Soulié de Morant defines “meridian” and justifies his translation:

Knowledge of the meridians (jing), or lines of points, is an essential foundation for true acupuncture . . . The meridians give us an understanding of the relationships among the organs and help us to classify and analyze the effects of a point.

. . . The Yi Xue Ru Men explains (I, 1r): “The meridians (jing) are the longitudinal paths.” The ideogram used to describe these lines of points is formed by the elements “string-line-right-winding-work,” the idea being a string connecting a winding alley into a path. From the most ancient times, the term “jing” was used in astronomy for the lines of north-south longitude. It is still used in the countryside for the north-south paths of a field.

The pronunciation jīng has not changed since antiquity. The British transliteration is “ching” while the old French transliteration is “king.” Sometimes the name “jīngluo,” pronounced “keiraku” in Japanese, is used.3233

Chinese is a tonal language and, as such, words convey distinct meanings depending on their intonation. The term jīng, as in jīngluo (“meridian network”), is pronounced in the first tone. At the level of audition, it is thus indistinguishable from the jīng which means “essence”. Although the jīng of meridian and the jīng of essence are pronounced identically, they are written differently. English transliteration misleads us into the illusion of an identical text, since jīng is transliterated the same in both cases. But when we look at the ideographic script of Chinese writing, we see the distinction in plain sight:

• 經 jīng/meridian

• 精 jīng/essence

Let us look closely at the meaning of jīng (meridian). Jīng means “warp”, “longitudinal lines of the Earth”, “pathways of the sun, moon, and stars”, “channel”, “road, footpath”, “principle, law”, and “classical texts”. This polyvalence of meaning makes obvious the signifying nature of the word jīng. In other words, there is no translation that duplicates the meaning of jīng in a one-to-one correspondence; there are only chosen moments in the movement of its signifying chain.

Consider the definitions themselves:

1. As warp, jīng signifies the threads of a loom, a weave or mosaic, a quilted tapestry.

2. As longitudinal lines, jīng signifies a spatial plane of coordinates, angular distance and span, and an invisible (but locatable) topography.

3. As pathways of the sun, moon, and stars, jīng signifies an orbital plane, a celestial ecliptic, and an evanescent appearance.

4. As channel, jīng signifies a hydrological current, a pathway of irrigation, a furrow which conducts a symbolic passage, a groove which traces the sounds of time.

5. As road or footpath, jīng signifies transportation, traversal, and the vector of desire.

6. As principle or law, jīng signifies a symbolic order, a signifying chain, a structure of articulation.

7. As classical text, jīng signifies a timeless treasure, an enduring word, and a written pedagogy.

Soulié de Morant’s use of “méridien” is now evidently logical. The French meridien comes from the Latin meridianum, meaning “noon”, from medius, meaning “midday”. In astronomy, the term “meridian” describes the phenomenon of solar noon—when the Sun is directly overhead, it crosses a longitudinal meridian at its zenith. Is this not the “law of midday-midnight”34 that governs the logical time of meridian flows? The notion of meridian simultaneously signifies a longitudinal line and a point of intersection—a meridian is precisely the crossing-point of space and time.

This brings us to the Japanese translation, keiraku. Kei means “passing through” or “threading”, raku means “connecting” or “net”. The meaning of “passing through” resonates with the notion of “longitude” and “threading” resonates with “warp”. On a secondary level, keiraku means “thread of connection” or “chain of reasoning”. This meaning set brings us closer to the notion of a signifying chain that is both logical and related to itself, or analyzable.

Meridian Analysis

Does this not take us to the zenith where psychoanalysis articulates its field and function? “Analysis” comes from the Greek analuein, meaning “loosen”. What is loosened in analysis if not the very threads that course a signifying chain? The discourse of the body is already written upon its surface in threads of connection that await communication.

Chiryō means “treatment”, “cure”, “therapy”. Taken together, the phrase keiraku chiryō was consistently referred to in English as “meridian therapy” by the Japanese masters who founded this movement. With the phrase, “meridian therapy”, I felt the masters were not only placing themselves within an historical current at the precipice of a century, but in a momentary suspension in which the instant of their glance was set upon antecedents across milled annals of comprehending.

We cannot conclude an anxiety of influence that holds us still in a moment of temporal tension, suspended between classical threads of thought evolved through thousands of times. The future of medicine is neither a syncretic nor integrative but entirely radical. A return to roots still growing in microbiomes.

If what is classical is merely in step with the past, then how are we to ascertain the lagging moment that drags our feet behind the beat? The classification of classical is an assertive logic that attempts substantiation through historical associations in thought but not necessarily through word and deed. The verification of oral transmissions is a false deduction in the locus of its locution. The anxiety of influence is an existential angoisse, caught between the sense of what was and the discordance of where one is. Lineage becomes the spatial lure of associative lore rather than a treasure trove of scriptural transmission.

A claim is no more than an anticipated certainty, made with hesitant hands that needle synthetic threads. The truth is a dialectic across antiquity and culture, where medicine arose as a collective logic. But this collective is nothing but the subject of the individual.

The truth that depends on the rigor of each is a subjective assertion that will stand the tests of time by anticipating its own return. In returning to the classics, medicine receives its own message in an inverted form. The subject who practices is neither technician nor artist but a clinician of transference, where what is exchanged is not reciprocal but transmissible.

We seek not the duplication of the past in acts that bring us closer to nothing more than our own double, who is neither extant nor invisible but always looking back. The glance we catch is exactly our own, even when we hear it in oracular echoes.

What is divined has been heard before, what is seen has seen us first, and what is foretold has thrust itself upon us. What we listen for to hear a diagnosis and see a prognosis is neither a reflection nor a speculation but the anticipated certainty of an outcome. The intervention of medicine is ever in the company of the three times, where an omnidirection of its text is reciting truths still grasping another time.

This leads us to the revolutionary conclusion that what is classical is original, not a grade but an avant-garde. The experimental form of an intervention leaves half-spun threads open for another hand to loom. My response a century later is to move keiraku chiryō toward keiraku bunseki—from meridian therapy to meridian analysis—an intervention at the midpoint where the psyche meets the soma of a speaking being.

By emphasizing meridian therapy, the Japanese masters were resuscitating the classical locus of acupuncture intervention as meridian-based in distinction to the organ-based locus of herbal medicine. The meridian network is the symbolic layer of the body, a cartography not reducible to organic anatomy and physiology.

Psychoanalysis and acupuncture are symbolic interventions at the level of a linguistic field that is constituted as a chain of signification—a legible and palpable discourse. Psychoanalysis and acupuncture are differentiated by the implements of their intervention, but the essence of their logic is similar: listening to diagnose, hearing to punctuate, and seeing to anticipate.

As we move from therapy to analysis in all our interventions, we move through the registers of our respective fields and approach a clinic of the real. The movement of analytic acupuncture is framed at the intersection of two modalities, but the nature of their intersection is a broad spectrum truth that lives freely in every associative anecdote.

Rather than the administration of a therapeutic cure, meridian analysis attends to the discourse of the patient as a free-associative text, where punctuation is placed with acumen, an audible rendering of an unheard oracle. A physical needle puncturing a symbolic structure is an analytic act that takes the unconscious as the logic of its certainty. And there is an arrival of qi, likened to the feeling of a fish taking the bait, a sinking into subcutaneous signifiers at the tip of the signified, a current of junctures that irrigates the ebbs of speech.

Psychoanalysis and acupuncture are not parallel fields, but semblables likened across a discursive structure. Psyche and soma are the fields where the function of acupuncture and psychoanalysis intersect. The nucleus of their circumlocution is the chiastic composition of the unconscious. When we take acupuncture at the letter of its word, we will practice l’acupuncture parlétre—a method for the madness of the speaking subject.

I. The Warp and Weft of the Speaking Body

The Body is Structured Like a Language

The meridians of the body are quilting points in a current of discourse, the nodal points where verbal forms intersect,35 where the signifier and the signified weave a symbolic order of language. The meridians are structured like a language, signified as they are by ideographic names that picture a law and order.

The name of the point is the holy spirit of the signifier; its character is a sinographic dream. The names-of-the-points are the names-of-the-father that encode the physiology with its heavenly qi.

Qi is the mechanism of the transference that powers communication and relatedness, or the very function of discourse as a social link. Qi is the transferential locus of the relatedness between the Umwelt and the Innenwelt, a likeness that yet yields a difference rather than a reciprocity. The meridians thus describe and inscribe the very meaning of our relatedness as a signifying chain of associations.

How is it that the Chinese drew a topography of twelve meridians that mirror a likeness to the twelve rivers of China? Is not language equally a dialectical phenomenon? The body is structured like a gaze, itself a body politic that is its own double. Thus, the body is structured like a landscape.

It is not that the body is natural or unnatural—it is the individual who inhabits it that is imaginary. The body is not merely biological but a bios of logia—an incarnation of words.

The body itself is an environs of existence, a terrain of signifiers sliding across slippery spheres. The body is in a chain of dependent origination that is discursive in nature. The body is a canvas of tattoos, a carving of diacritical marks in symbolic cuts, etchings of permanence on a mortal frame.

Méridien is the synchrony of noon in a diachrony of day. A spatiotemporal complex standing on a mirrored stage. A mediating structure between the imaginary and the real. A tapestry of language woven in a logic of time and a ratio of space.

The meridian has a pulsion that moves in elemental rhythms and elliptical cycles. The message of the meridian is heard in palpable sounds of diagnosis, where the current of discourse beats in meters and ellipses, scansions and excesses, where speaking stagnates in temporal dialectics and spatial lures skip in arrhythmia.

In neurosis, there is a repression of desire, either in obsessional deficiencies or hysterical excesses. The method is to tonify the meridian at the level of desire. The technique is gentle—moxibustion followed by subcutaneous needling. For the neurotic requires a return of the repressed in a symbolic form.

In psychosis, what is foreclosed reappears. The method is to balance the meridian at the surface of its boundary. The technique is non-invasive—moxibustion followed by non-insertive needling. For the psychotic already fears the penetration by structures they foreclosed, long before they could be erected for real.

In perversion, there is a disavowal of desire. The method is to sedate the meridian in the direction of its counterflow. The technique is invasive—cauterization followed by deep needling. For the pervert disavows what is lacking in a reversal of flows.

The presence of the needle initiates an echo in its absence through a symbolic alternation, where the subject hears the tonification of their own message, returned without a sender.

Acupuncture is thus a discursive intervention in the subject, an invocation that punctuates the symptom in a smoke of signifiers, drifting in divergence from a single space.

II. The Littoral Terrain

The Discourse of the Body Might Not Be a Semblance

The littoral is a literal terrain, a continental divide that constitutes the body ecologic. In Chinese medical anatomy, the natural terrain is mapped onto the human body.

The body is not only a living system but a terrain, a topographical locus with valleys and streams, rivers and seas, mounds and mountains. The body is not a system of correspondences but a juncture of semblances.

The human body derives a natural language without being reciprocal. Semblance is a littoral edge, not a reciprocal relation. There, where the meridian bends in the curve of the body is a geōgraphia—a writing of the earth.

Therefore, the terroir of the body is structured like a language—its breath an inspired writing, its blood an inked inscription. From where do we inhale the calligraphic ink and brush of anatomical character?

We palpate the meridians by hand, sliding across a gap of connective tissues, between the littoral and the literal. The points we palpate are skin-deep depressions made in singular strokes, traces of letters in the parting of clouds. There is no belly in the muscle, only a gully in the real.

To needle is to invoke and evoke a punctual dance of rain, an arrival of jouissance. “What is evoked of jouissance on the breaking of a semblant, this is what presents itself in the real as a gullying”.

The needle is a signifier that ensnares the letter in the net of semblance,^[1] a lure of jouissance waiting to be caught. Where jouissance stagnates, the letter has no agency. To puncture is to reinvigorate an imaginary divide, to liberate a signifier in the symbolic order, to penetrate a hole in the real.

A puncture is a form of punctuating, a periodic break in a sentence that structures a communication. Therefore, the act of puncturing constitutes a discourse. For it is the body that speaks, and one only derives jouissance from it when the word of interpretation rains upon it. In the Ling Shu, it is said:

The essence of acupuncture is that the effect comes with the arrival of Qi. The sign of this is like the wind blowing the clouds away. It becomes clear and bright as if looking into the blue sky. This means the purpose of acupuncture has been fulfilled.36

There is no obtaining of jouissance because there is no relation in which or from which it could be obtained. There is only an invocation between Heaven and Earth, a gully where jouissance arrives like a tidal wave, to part the clouds on the shore of the real.

Acupuncture is a discourse of the body, where the needle initiates a littoral link in a brush with jouissance. Therefore, Sugiyama says, “When there is sinking, heaviness, dullness, tightness, and fullness after the needle is inserted, and it feels as if a fish has swallowed the hook, and there is movement which seems sinking at one moment and floating at another, it means the Qi has come.37

Qi arrives in the form of a discourse in the sound of a social link. What then is the discourse of the acupuncturist? And does it resemble the discourse of the analyst?

The acupuncturist diagnoses the meridian in need of puncture by listening to the twelve pulses. Are these pulses not pulsions—radial urgencies, speaking to the ear?

The acupuncturist thus diagnoses by sound, where what is heard is an invocatory pulsion, in the voice of desire. The acupuncturist diagnoses by sight, where a scopic pulsion meets the gaze of the eyes in the chromatic of desire. The acupuncturist diagnoses by smell, where an olfactory bulb is the pulsion of an orifice, an aromatic of demand. The acupuncturist diagnoses by emotion, where the affect of transference is a pulsion of projection devoid of interpretation, mouthed as an edible demand.

An acupuncturist thus listens to hear and see the causative shape of the subject’s demand and desire, to locate an elemental pulsion in a course where clouds of jouissance gather to precipitate an impulse in the circuit of the real.

Acupuncture treatment is nothing more than the arrival of punctuation in the discourse of the speaking body. A talking cure is not necessarily a spoken cure, but it is a cure whose evidence is found in speech.

Therefore, the biggest mistake we can make as acupuncturists is to forgo the speech of our subjects by presuming an epistemological superiority via subtleties, when it is the speaking body of the subject that provides the articulation we wish to punctuate.

Acupuncture is an interlocution, an orthographic incision between language and speech, where every thread rests on the skin of the real. We will know if our treatment has been effective not by what we feel and see, but by what the subject says. Therefore, the acupuncturist and analyst are both punctuators of a discourse that may not be a semblance.

The role of the acupuncturist and analyst is to help the subject meet the mark, wherever their transcription is presently amiss. In doing so, the subject’s symptom is translated to a sinthome, where the knots and weaves of meridians and points become the warp and weft of aesthetic ecstasy.

III. A Punctuation of Dreams

A Physiology of Interpretation is an Anatomy of Destiny

The meridian network is a physiology of dreams, ciphered in anatomical lines of destiny.

The intersection of function and form is legible as nodal points in a signifying chain, a meshwork where desire grows up its fruiting body in myofascial forms of communication.

The navel of the dream is the abdomen of the body, where the tangle of dream-thoughts reaches unknown depths, unfurling uncharted territory in a remembered course of desire.

Diagnosis is an analysis of the surface, a palpation of the body at the radius of its pulsion and the umbilicus of function. Qi and blood are the psychical forces that determine the syntax and semantics of the dream.

When qi stagnates under an open sky, its vapor condenses to a cumulus of meaning, threatening to flood. Where blood stagnates, it distorts the essence of the message in knotted determinations. When qi is perverse, it displaces the signifier of its communication, leaving only defiles in its wake. When qi and blood combine in stasis, the dream is overdetermined—fated at the nucleus of repression, where only associations can free its predictive strangle.

What is distorted in the vessels condenses in the meridians, displaces in divergent channels, and overdetermines the sinews.

A puncture in condensation invokes semantic precipitation where it was compressed in anticipation. A puncture in displacement brings syntactical order where it was dammed in forgotten channels. A puncture in overdetermination restores an ambidexterity where it was lateralized in residual tendencies.

A puncturing is thus a reading of the body’s text, a deciphering of grammatical formation, to read in the palms of destiny, what was written and still suffices to say.

A puncture is a small wound, a perforation in a text, a traum of punctuation. A puncture is a punctual intervention in logical time, at the zenith of day and nadir of night. A puncture is an interpretation of dreams, a recitation of forgotten tones, the faint traces still spoken on the stave of hand and foot.

The needle is a stylus on recorded grooves etched in revolutions per minute as the oscillating stereogram of ambivalence and ambiguity, reproduced in skips for ambient auditions.

If a puncture projects an image divined in the mind of the puncturist, then only the imagination of meaning has been produced in a false prophecy. When a puncture reads the point of the symbol, then the puncturist becomes hierophant, a revealer of mysteries—carved as they are, these incisive words, born across the speaking body.

IV. The Body Without Organs

What is Foreclosed in the Symbolic is Possessed by the Imaginary and Invaded by the Real

What do we make of the body without organs, or the schizoidal form of psychosis? The body without organs is the foreclosure of the symbolic order. The body without organs lacks the symbolic function of the meridian structure. Therefore, psychosis must not be punctured at the level of the meridian, it must be fumigated on the surface.

The meridians are the territorializing flows in the official regime of the body. The body without organs is thus deterritorialized—it bears no cultural inscription even while it records the real on the anatomy of its surface. Officials without orders are crooked servants in an imperious curse, their master an emperor in abdication.

If the organs hold the spirits, then a body without organs is a hungry ghost, punished with paranoia. What he knows is everything that possesses the open spaces with messages produced by and for the socius. In place of spirits are traces of litter from the defiles of the signifier, a surplus without value in the capital bones of the body.

Psychosis lives in a kaleidoscopic field of human space, where the gaze is a visionary threat from the real. The psychosis of the meridian is a schizoidal splitting of names, where pathways are emptied of organic functions, left hanging like the strings of puppetry acts—the echo of their jouissance a haunt of the real.

V. The Clinic of the Real

Sooth-Saying is the Liturgy of a Boundless Self-Confession

What will suture these loose threads if not the formless acuity of analysis itself? How will the holy spirit of the signifier voice new truths in readable pictograms, rightside up?

Who will cast the last pantomime of this clinical theater? And where will the body without organs take its final flight—at the foolish precipice of the real?

Who will tremble at the second coming and the delirium of its revelations?

Whose hand will anneal the palms of pilgrims,
renunciated and raised,
in a palace of weariness?

The audacity of boundless self-confessions
rings true in a listening palace,
an auricle of the heart,
where the sovereign of the real
eternally enthrones.

If these questions are spoken in vain,
then I submit their testimony
before the audits of a witnessing body,
until only the real remains in place and sight.

Preface

This essay is part of a larger collection titled MDMA Papers, which explores the pharmacology and therapeutics of MDMA. “Mandible Wheel” follows in Freud’s footsteps by linking psychopharmacology and psychoanalysis. In this essay, I argue that jaw clenching is a symptom of repression that is therapeutically amplified by MDMA. On this basis, I propose a psychoanalytic mechanism and framework for MDMA-assisted therapy.

“Mandible Wheel” explores the therapeutic phenomenology of MDMA within a psychoanalytic and Chinese medical framework. The first part of the essay presents jaw clenching as a psychosomatic phenomenon of repression and its abreaction. I argue that our symptoms are cathartic mechanisms rather than mere side effects.

The second part of the essay examines a physiological perspective of jaw clenching through the anatomy of the Stomach meridian. I discuss the location and significance of ST-6, and consider jaw clenching a phenomenon related to Stomach Qi and the “digestion” of repressed content.

The third part of the essay explores the psychosomatic importance of the jaw by analyzing its correspondence with Hexagram 27 of the Yijing, the phenomenology of nourishment, and the Chinese meridian clock.

The conclusion of the essay examines the jaw and mouth from a Yogic perspective as a vital region of conductivity where tension accumulates. I posit the jaw as the organ of the speaking body and, therefore, the mechanism of the talking cure.

In terms of style, this essay oscillates between expository prose and poetic verse.

I. The Psychosomatics of Repression

MDMA is a psychosomatic medicine—it operates on psyche and soma. The somatic effects of MDMA are thus equally psychic. What is psychosomatic is also psychedelic. That is to say, MDMA amplifies psychic content—material that is not only in the mind but held deeply within the body.

One notable effect of MDMA is jaw clenching. A biochemical explanation for the symptom of jaw clenching is that MDMA is a stimulant, which is another way of saying that clenching is a phenomenon of stimulus. However, this explanation provides us with no further insight. If we accept that MDMA is a psychosomatic medicine, then none of its effects can be reduced to a purely physical explanation. From a psychosomatic perspective, so-called “side effects” are revealed as therapeutic mechanisms, or what psychoanalysis calls abreactions. In their landmark publication, Studies in Hysteria, Breuer and Freud define abreaction as a cathartic release of repressed emotion:

The injured person's reaction to the trauma only exercises a completely ‘cathartic’ effect if it is an adequate reaction—as, for instance, revenge. But language serves as a substitute for action; by its help, an affect can be ‘abreacted’ almost as effectively. In other cases speaking is itself the adequate reflex, when, for instance, it is a lamentation or giving utterance to a tormenting secret, e.g. a confession. If there is no such reaction, whether in deeds or words, or in the mildest cases in tears, any recollection of the event retains its affective lone to begin with.1

If we understand the side-effect of jaw clenching as an abreaction, then we recognize catharsis as the primary therapeutic mechanism of MDMA (and of psychedelic therapy in general). When we abreact, we recover and retrace the shocks that keep our vital force. We speak our dreams, chew on our reflections, and metabolize our memories. Abreaction is the re-emergence of vital intelligence where it was made unconscious.

Jaw clenching is a psychopathology common to everyday life.2 Jaw clenching is one of the more obvious psychosomatic conditions—its etiology is stress, specifically the stress of repression. In The Ego and the Id, Freud elucidates the relationship between repression and the unconscious:

We recognize that the unconscious does not coincide with the repressed; it is still true that all that is repressed is unconscious, but not all that is unconscious is repressed.3

The relationship between the repressed unconscious and the unconscious proper is the relationship between constitution and condition, or the structure and the symptom. When we cleanse repressed phenomena from the surface of the psyche, its deep structure self-emerges. Thus, cure unfolds from the unconscious proper—from the depth to the periphery, from above to below, and from present to past—while repression moves from the surface to the center, from below to above, and from past to present.

Trauma is a blocked affect.
Affection is libido,
and libido is a vital force.
The blocked affect is where our élan
loses vital contact with reality.

We relive our trauma by coming alive again,
purging to purify in dramatic release.
Therefore, healing is rebirth,
a resurrection of the vital force.

The psyche is a vital impetus that drives
the enlightenment of the whole body.
“Sometimes the frustrated wishes are neither possessive nor libidinal drives,
but rather drives toward self-realization”.4

At night, we chew and attempt to digest psychic content.
What we fail to digest becomes the substance of nightmares,
haunting us from near and afar.

Repression is indigestion,
a psychic artifact
that never ripens but only rots,
its fermentation a poisonous heat
that cooks our vital essences.

II. An Anatomy and Physiology of Jaw Clenching

“Anatomy is destiny”.5 In acupuncture anatomy, the Stomach meridian begins its flow inferior to the eye, between the infraorbital ridge and the eyeball (ST-1 “Receive Tears”). From here, the meridian flows downward into a depression in the infraorbital foramen (ST-2 “Four Whites”), continues to descend into the cheek, level with the lower border of the ala nasi (ST-3 “Great Cheekbone”), and down to the level of the lips, in the continuation of the nasolabial groove (ST-4 “Earth Granary”). From here, the Stomach meridian descends to the jaw, at the anterior border of the masseter muscle (ST-5 “Great Welcome”), and then flows upward into the prominence of the masseter muscle (ST-6 “Mandible Wheel”).

ST-6 is aptly named “Mandible Wheel” (jiáchē), as it is directly located in the mandible, but we will see that this name also has esoteric connotations. In addition to being a point on the Stomach meridian, ST-6 is also classified by Sun Si-Miao as one of the thirteen ghost points—points used to treat possession syndromes.6 In the ghost-point schema, ST-6 is given the alternate name “Guichang”, meaning “Ghost Bed”.

“Mandible Wheel” is J.R. Worsley’s translation of the Chinese jiáchē.7 The term jia means “cheek; jaw, jawbone; side, to press together from both sides; to assist, to support”. The term che means “cart, chariot, vehicle; jawbone; to ride, to turn (oneself)”. A “mandible wheel” is where the spokes of the psyche turn, where we initiate a digestive cycle that nourishes us in turn. Therefore, MDMA is a circulatio of healing—it moves the wheels of repression and steers our life.

In Chinese medicine, the Heart is described as the spiritual throne of the vital force. The Heart corresponds to the fire element, the period of solar noon, and the zodiac animal of the horse. The horse is an ancient symbol of the libido. A horse roams free in the wild, independent and related. The horse chews the day away and is thus an image of the jaw. As we see, one of the meanings of jia is a chariot, a wheeled carriage traditionally driven by horses. When we chew, we press the teeth together and amalgamate the food of life. Therefore, the Mandible Wheel is an image of libidinal freedom, the recovery of a balanced vehicle, a fusion of sides that powers the whole.

Peter Deadman comments that ST-6 is “an important point in treatment of a wide range of local disorders affecting the jaw, including inability to chew, inability to open the mouth after windstroke,8 lockjaw, and tension, pain or paralysis of the jaw”.9 Deadman adds that he is unable to find a rationale for the classification of ST-6 as a ghost point because ghost points were used “to treat mania and epilepsy” and that “there are no indications of this kind listed for the point”.10 But points do not exist for symptoms. Points are the language of the speaking body. Points are signifiers that articulate a line of resonance between constitution and condition.

We need to understand windstroke, mania, and epilepsy as possession syndromes. Sun Si-Miao’s classification of ST-6 as a ghost point indicates its relevance for possession syndromes in general, not only for palliating symptoms from windstroke.

Possession syndromes are pathologies of Stomach Qi. The Chinese term for Stomach is wei (胃), a character “drawn as a container full of grains and flesh . . . [it] represents the vitality of nourishment that can penetrate where it is needed”.11 The Stomach is the cauldron of life, where we consume the edible, and gather strength to move in the carriages of our destiny.

III. The Phenomenology of Nourishment

Hexagram 27, Nourishing

ST-6 corresponds to Hexagram 27 of the Yijing—Yi (Nourishing). Wilhelm translates Yi as “The Corner of the Mouth (Providing Nourishment)” and Blofeld translates it as “Nourishment (literally Jaws)”. The jaw and mouth are ancient images of nourishment that occur throughout the Yijing. Commenting on Hexagram 27 (Yi), Huang writes:

When we eat, the upper jaw holds still; only the lower jaw moves up and down. The subject of the first three lines is to nourish oneself; that of the next three lines is to nourish others.12

This hexagram is composed of two solid lines (at the top and bottom) and all yielding lines in the center. Hexagram 27 thus gives the image of an open mouth. When we dissect the hexagram into two trigrams, the upper and lower three lines each form the upper and lower jaw. Huang interprets the lower three lines (and lower jaw) as an image of nourishing oneself and the upper three lines (and upper jaw) as an image of nourishing others. He comments that the nourishment of this hexagram has less to do with “the act of eating and drinking, and more with the wisdom of nourishing oneself as well as other people”.13 Thus, the mouth and jaw are seen as images of relationship.

To nourish oneself is to nurture inner “virtue”; to nourish others is to feed them with your presence. The Commentary on the Symbol states:

Thunder beneath Mountain
An image of Nourishing.
In correspondence with this,
The superior person is careful of his words
And moderate in eating and drinking.14

Huang writes that “the ancient sages proclaimed that nourishing and nurturing were not a matter reserved for the family but concerned society as a whole . . . Compared with nourishing one’s virtue, nourishing one’s body was secondary. Thus, the sages were cautious of words and moderate in diet and provided nourishment and nurturing to the people”.15

We can thus understand the action of MDMA within the archetypal phenomenology of “nourishment”. MDMA is a mandible wheel of nourishment—fostering an ecological connection to self and other, to body and world.

Timing Nourishment: Clock Opposites and Identical Qi

The connection between nourishment and relationship becomes evident when we consider that the Stomach and Pericardium are “clock opposites”. In the context of the Chinese meridian clock, the Stomach corresponds to the hours of 7-9 am, and the Pericardium corresponds to the hours of 7-9 pm. Thus, the Stomach and Pericardium exist in a Qi dynamic, on opposite sides of the daily rhythm. In the morning, we extract the essence of food and drink; in the evening, we make love.

During the MDMA experience, we can digest significant portions of psychic material in a short span of time. The locus of psychical causality lives in a prayer, as a “totally lived interiorization”16 that operates beyond and prior to time. Minkowski writes:

But this interiorization does not bring me face to face with myself. It is, as we have said already, neither reverie nor the free play of the imagination. Quite to the contrary, in springing up from the depths of my being, it goes beyond the universe. It is in this sense a totally lived extrospection. In a flash of the eye my glance now passes through the universe, takes it in completely and goes beyond it . . . we could say that prayer puts us in the presence of God; of a God, however, whose activity ought to be manifest in the world in which we live.17

“Ecstasy” literally means to “stand outside oneself”.18 But this “standing outside” is simultaneously a “touching within”, an enstasis.

MDMA gives us a digestive capacity that is not limited by time. We cook time in the navel of our living. We vitalize the psyche in the soma. We pray in the fire for the fulfillment of our wishes. Digestion begins in the mouth. By chewing, we re-metabolize what we repressed. MDMA is a prayer of changes, a sacrament of universal sacrifice, a sacramental communion with the vital principle of life.

Chronic jaw clenching is a psychopathology caused by repression. The location of ST-6 in the mandible reveals repression as an indigestion, and health as a phenomenon of Stomach Qi. In Chinese medicine, the Stomach is viewed as an alchemical cauldron, the “official in charge of the rotting and ripening of food and drink”. The Stomach is our digestive container, the vessel in which we cook the raw materials of life into vital essences, nourishing our body, mind, and spirit.

From this, we can conclude that MDMA amplifies the Stomach Qi. MDMA kindles an inner flame, a crucible in which we place our traumas and memories, our dreams and reflections, our betrayals and rejections, our hopes and expectations, our pasts and futures. We are the dragon and its treasure—a wish-fulfilling jewel guarded in our bodies, loathsome jaws made edible in a mandible wheel of time.

IV. Unlocking the Jaw: Wish-Fulfillment and the Talking Cure

The jaw and mouth are an erogenous region—zones where the vital force naturally flows, and also where it contracts. In describing an oral phase of development, Freud was emphasizing the mouth as an organ of relatedness—the place where we not only sense but receive nourishment from the Mother. Adi Da describes the functional blocks that arise in the mouth and jaw:

The region of the mouth and jaw is an area of chronic tension for many people. Tension anywhere in the body is a sign that the flow of life-force is obstructed there. The “locks” on the life-force that we feel in the body are signs of reaction, mental, emotional, and physical, to the dilemma that bodily existence itself represents to us.19

Jaw tension is an energetic lock of the life-force on a fundamental level. Jaw stress reflects the tension of conditionality and the feeling of mortality. When we react, we contract the life-force. And all contractions of the life-force are built on the root-contraction of the lower abdomen, which Adi Da calls “vital shock”.20 This is why “external therapeutic approaches to relieving tension are not sufficient”.21 The root of our stress is spiritual, and it creates libidinal tension in the jaw.

Adi Da comments on jaw stress as a physiological block that contracts the nervous system:

The unnatural tension in the jaw obstructs (1) the natural flow of Bio-Energy and cerebrospinal fluid between the brain and spinal cord, and (2) the flow of blood between the head and the rest of the body. Thus, the tension that begins at the jaw is extended to the entire nervous system.22

Chronic jaw clenching creates secondary tensions in the head and neck, and contracts the vitality of the throat. With blocks in the upper burner,23 we struggle to receive and transform the qi of Heaven, which descends into the head, face, throat, and neck, and roots in the lower abdomen. Where we are locked, we lose the integrity of our structure and function. We are no longer placed in space or time, and we lack a gravitational center for our vitality to locus in.

In the traditions of Yoga and Qigong, the posture and conductivity of the mouth are given significance. The breath is initiated through the nose with the mouth closed, and the tip of the tongue should rest naturally at the roof of the mouth, behind the front teeth. Adi Da explains:

In the natural posture of the area of the mouth, the lips are closed, the lower and upper teeth and relaxed and slightly separated, and the tip of the tongue lightly touches the roof of the mouth. When the mouth is thus relaxed and closed, you can breathe easily and naturally through the nose. You can relieve dental stress by reestablishing this natural alignment of the lower and upper jaws.24

The conductivity of the mouth and jaw is central to life. “The relaxed jaw is a natural indication of the regenerative yoga of the body, a sign that the individual is responsible for the processes of the body and awake and relaxed as the body”.25 We can consciously relax the jaw muscles through intentional yawning and through tensing/releasing the jaw muscles. The traditional practice of gagging opens the flow of energy between the spine, neck, and brain. In Ayurvedic practice, a metal tongue scraper (copper or silver) is used for this purpose. Adi Da comments that “gagging also stimulates the digestive processes. Practiced first thing in the morning, it awakens the nervous system from the dormant, drowsy condition that tends to persist after sleep”.26

The Sacrament of Universal Sacrifice

Food is a sacrament, and eating is alchemical. “The taking of food is very important, not just because it is necessary for survival from the mechanical, biological point of view, but because it is a form of meditation. It is a sacrament, literally, and the term ‘sacrament’ symbolically describes the taking of food. It is the taking of God’s Body; it is the taking of Energy, the Force of Reality . . . You must perform alchemy in the mouth and the stomach”.27

Food is an image of the prima materia. The alchemical act is a sacrificial act. When we chew, we transform solid into liquid. This is why the medical traditions have long emphasized that digestion begins in the mouth. In other words, “the mouth is the conscious point of ingestion, not the stomach”.28 Adi Da describes eating as a sacrificial act in which the natural posture of the mouth is temporarily broken:

There is an old principle that you should chew your food many times, breaking it down into a liquid state before swallowing. This practice of eating slowly and carefully is not only for the sake of the stomach and the digestive system. The principal reason for conscious chewing is that the tongue in the aperture of the mouth, is a very important point in the circuit of the Life-Current of our living being.

Ordinarily the tongue should quite naturally touch the roof of the mouth just behind the upper front teeth. When the mouth is open and the tongue is dropped down, you have broken the circuit that conducts the manifest Light or Life-Energy of the cosmos and that makes you intelligent. But when you take solid food, you must bring down the tongue from the roof of your mouth. In other words, when eating you necessarily permit the conversion of solid food temporarily to replace the direct ingestion, through the breath, of the universal Life-Energy and the conducting of that Energy to the whole body from the nose and eyes via the tongue, mouth, and throat.

. . . Even speaking requires lifting the tongue from the roof of the mouth. So, if you are gossiping and speaking craziness and indulging negativity in speech, you are not eating, you are not being sustained . . . Speech should sustain you”.29

Through the mouth, we open to receive food for the body, mind, and spirit.
Our lips articulate the subtle thoughts given voice in the throat.
To eat and to speak.
To consume and to manifest.
The wheel of speech
a spoken phenomenon—
to mouth our prayers
and speak our intentions
into existence.

The tongue is the fruit of the Heart;
the jaw is the mechanism of the talking cure.
We speak our repressed thoughts
and give sound to the images of our dreams.
We voice the unheard
and recognize the real.

In speech,
the jaw unlocks,
and the mandible wheel
moves in motion,
powering our vital contact
with the real.

We find our voice from a place of nourishment
when we are Mothered again by life itself.
Vital shock closes the jaws of life
and leaves the mouth gaping.
We are hungry ghosts
whose unfulfilled wishes
gnaw at the seat of life.

The oral phase of development
is not only constituted by breastfeeding—
it also leaves infancy
to grow in mind and spirit.
In our second birth,
the mouth and jaw are born again
from shock.
Our spirit is reigned and wheeling.
We no longer seek an edible deity,
in tongue or cheek,
but teethe on vital currents.

The lips are the fruit of the Spleen,
a cathexis of the jaw
at the breast of life.
When we breathe in
the food of life
with an open heart
and porous body,
we no longer seek
with pouting lips.
We live in relationship
without otherness,
speaking and loving
in a continuous kiss.

The speaking body becomes
the jouissance of the real,
as we awaken to our dreams
and follow our desires.
The secret of the speaking body
is the letter of love.

To speak of love
is ecstatic.
To speak of love
is speaking as love.
To speak
is to enunciate in ecstasy
the locus mysterium of the real.

Introduction: Psychedelic-Assisted Therapy and the Consciousness Revolution

My writings thus far have been focused on the intersection between medicine, psychology, and astrology. With “LSD and the Alchemical Opus of Humanity”, I am initiating a series of essays that examine the medicinal value and mysterious nature of psychedelic substances. These writings represent the fruition of a long gestation period, fulfilling a motive that began twenty years ago when I first read Aldous Huxley’s essay, “The Doors of Perception”.

As always, the central concern of my writing remains therapeutic. I have chosen to write about LSD in particular, rather than the traditional and culturally-accepted plant medicines such as psilocybin mushrooms, ayahuasca, mescaline, etc. because LSD has a uniquely Western and human heritage. While traditional plant medicines have an established history of ceremonial use in indigenous cultures, LSD was born in the West in the twentieth century in the hands of a chemist. Twenty years later, LSD brought the mysticism of the East to the West and brought Westerners to the East.1

LSD straddles the divide between tradition and innovation, East and West, nature and synthesis. Plant medicines are given to us whole from the plant kingdom, but LSD is the consequence of chemistry and, as I propose, of alchemy. The alchemical attitude positions the human being in a unique relationship with nature—not only in reverence of nature but also as its steward. Perhaps the great endowment of the human being is neither an improvement upon nature nor a search for its molecular replication. Rather, the human being is handed the gift of craft, held in sanctity, and honed in consciousness.

This essay should not be misconstrued as a universal recommendation to ingest LSD. In addition to being a deeply individual matter, the use of psychedelics requires profound consideration, education, and preparation. The appropriate use of any medicine depends on a complex arrangement of individual and environmental factors (or “set and setting”). Hofmann himself lamented the use of LSD as an inebriant, advocating instead for its therapeutic use. As a natural chemist, Hofmann’s original intention was to synthesize an analeptic medicine from ergot alkaloids (which have a history of medical use). In modern medical language, an “analeptic” drug is a “restorative” drug that stimulates the central nervous system. In traditional terms, analeptic medicines are classified as “rejuvenatives” or “tonics”. The discovery of LSD’s psychoactive properties were an “accidental” revelation of a new spectrum of therapeutic effects.

Given its powerful psychic effects, Hofmann believed that LSD should only be used by psychologically stable adults in a therapeutic setting. The original monograph for LSD from Sandoz Laboratories recommends its use in “analytical psychology” and psychiatry. LSD-assisted psychotherapy has been further explored in the clinical work of Stanislav Grof and its process is also detailed in Blewett’s Handbook for the Therapeutic Use of Lysergic Acid Diethylamide-25: Individual and Group Procedures. Published in 1959, Blewett’s text details the clinical use of LSD and gives structured guidance for the therapist administering it to individuals or groups. In the first chapter, Blewett describes the value of LSD and gives a hopeful portrait of its use in LSD-assisted psychotherapy:

The great value of LSD-25 lies in the fact that when the therapeutic situation is properly structured the patient can, and often does, within a period of hours, develop a level of self-understanding and self-acceptance which may surpass that of the average normal person. On the basis of this self-knowledge he can, with the therapist’s help, clearly see the inadequacies in the value system which has underlain his previous behavior and can learn how to alter this in accordance with his altered understanding.

So sweeping a claim must, upon first reading, seem like nonsense but a growing number of people have come to accept it as undeniable fact. These are the people who have tried the drug on themselves and on their patients. They are convinced that within the next two or three decades LSD-25, will be by far the most common adjunct to psychotherapy. They feel too that since the psychedelic experience can lead to a very high level of self-understanding, and since self-understanding is the key without which the doors to interpersonal, intergroup or international understanding can not be opened, its use as a catalyst in the development of better human relations will become almost universal. To reject the views of this group as being too extreme without investigating the matter seems a remarkably unscientific attitude. The fact that those who have tried it feel that it offers astonishing possibilities would, in itself, seem to be sufficient reason for a thorough testing of the claims made.2

Yet, the aftermath of American counterculture and the resultant stigma around “drugs” left LSD to the winds of history, where its therapeutic potential in medicine and psychology remains shrouded and untapped. However, plant-based entheogens are now gaining acceptance in the current renaissance of psychedelic therapy. Healthcare professionals with a naturalistic orientation find it easier to advocate for their use. But the naturalistic bias misses the mark of an alchemical purpose.

As a substance that stands between binaries, LSD beckons an alchemical perspective, a synthesis of opposites. What stands between the poles holds the possibility for their transformation. LSD catalyzed the consciousness revolution that fused East and West, natural and synthetic, biosphere and noosphere, medicine and spirituality. This consciousness revolution is not polarized—it is Realized. The fire to be forged is in our hands.

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I. Hofmann, Paracelsus, and the Alchemical Tradition

Albert Hofmann was born in Basel, Switzerland in 1906, where he pursued a career in natural chemistry. In 1938, Hofmann was researching the medicinal use of ergot alkaloids at Sandoz Laboratories when he discovered and synthesized LSD. Hofmann’s revelation initiated a revolution in human consciousness, the fruits of which are still burgeoning today. While a scientist by profession, Hofmann’s orientation to his craft is best understood in the context of the alchemical tradition, which is the ancient predecessor of modern chemistry.

Visionary artist, Alex Grey, places Hofmann within the alchemical tradition of the sixteenth-century Swiss alchemist, Paracelsus, and posits LSD as the coveted “philosopher’s stone”:

On St. Albert’s shoulder blade is a portrait of Paracelsus, the Alchemist of Basel, 500 years ago, who is credited with founding modern Chemistry, yet his alchemical goal was to discover the Philosopher’s Stone. Alchemy was the art and science of the transmutation of the elements, like turning lead into gold and the identification of the soul of the alchemist with the chemical transformations as a metaphor of their journey to enlightenment. Modern Chemistry took the psyche and mystery out of the material weighed and measured world, reducing the world to a heap of atoms. LSD brought psyche back, front and center to the chemical material world. That is partly why I believe that LSD is the Philosopher’s Stone, the discovery of which, also in the town of Basel, is the result of an alchemical process put in motion by the great Paracelsus.3

Grey has a substantial basis for pointing to Paracelsus—not only are Hofmann and Paracelsus both Swiss, but Hofmann mentions Paracelsus several times in his book, LSD: My Problem Child. Separated by a few hundred years in history, Hofmann and Paracelsus share much more in common than region and profession—they were both mystics in their own right. Hofmann makes the first mention of Paracelsus in the opening pages of his book, recounting the famous Paracelsian adage, “the dose makes the poison”:

With such a highly potent substance as LSD, the correct dosage is of paramount importance. Here the tenet of Paracelsus holds true: the dose determines whether a substance acts as a remedy or as a poison.4

In “LSD Experience and Reality”, Hofmann discusses the value of meditation practice and quotes a phrase from Paracelsus that describes the Divine nature of Creation:

It could become of fundamental importance, and be not merely a transient fashion of the hour, if more and more people today would make a daily habit of devoting an hour to meditation, or at least a few minutes. In consequence of a meditative penetration and broadening of our natural-scientific worldview, a new, deepened reality-consciousness would certainly evolve, which increasingly would become the common heritage of all humankind. This could form the basis for a new spirituality, which would not be based on belief in the dogmas of various religions, but rather on perception through the "spirit of truth." What is meant here is a perception, a reading and understanding of the text at first hand, "from the book that god's finger has written" (Paracelsus), from the Creation.5

What does Paracelsus mean by “the book that god’s finger has written”? The full passage appears in Paracelsus’s Liber Azoth Sive De Ligno Et Linea Vitae. Written in 1590, the text is a mystical exploration of Kabbalism and its relationship to alchemy. In the opening verse, Paracelsus writes:

Whoever desires to know the secrets of all occult things should seek them nowhere else but in the Lord God, for the reason that no one can better reveal all secrets to the seeker than He who is the originator of all secrets and arts, both heavenly and mundane.

One must first draw attention to the book in which the letters of the secrets are clearly written for all to see and understand, and one can discover everything one may wish to know written by the finger of God in this very book . . . All other books are but dead letters in comparison with this book if it be read properly. Man alone is this book in which all secrets are written; but the interpreter of this book is God.6

Paracelsus asserts the Divine as the revelatory source of esotericism and art. The book of secrets, written by the finger of God, is a metaphor for Creation itself. Hofmann was enamored of this phrase from Paracelsus, as he features the quotation again in two more essays. In a passage from “The Transmitter-Receiver Model of Reality”, Hofmann comments:

Paracelsus, the great physician, natural scientist, and philosopher of the Renaissance—to whom radio and television were completely unknown—employed another metaphor to illustrate this fact. He called the Creation a book, written by the finger of god, from which we must learn to read.7

Following in the footsteps of Paracelsus, Hofmann is placing chemistry as an alchemical and natural art, endowed with the sanctity of Divine Order. This illustrates the influence of Paracelsus on Hofmann, not only in the context of alchemy but also in the realms of philosophy and mysticism.

The most curious connection between Paracelsus and Hofmann raises several intriguing questions: What is the relationship between alchemy and chemistry? What is the philosopher’s stone? Is the alchemical art purely natural or does it also include synthesis?

II. Alchemy, Amrita, and the Philosopher's Stone

Materiality, Spirituality, and the Alchemical Attitude

Alchemy appears to be a lost art in the modern day. As Grey noted, the esotericism of the alchemical art has been lost to merely materialistic chemistry. In “Security in the Natural-Scientific Worldview”, Hofmann criticizes the materialistic view of reality as being incomplete:

It is essential to realize that the one-sided belief in the natural scientific worldview rest on a monumental mistake. Everything that it contains is quite true, nevertheless it constitutes but half of reality, only that part which is material and quantifiable. Lacking are all the spiritual dimensions of reality, which are neither physically nor chemically tangible, and to which belong the essential features of all living beings. These must be integrated into a complementary half of the natural-scientific worldview, such that our worldview embraces the complete, living reality to which humankind and its spirituality quite clearly belongs.8

It is clear from this passage that Hofmann viewed chemistry as a natural science that describes only the material aspect of reality. Hofmann’s worldview transcends and includes the material-chemical view by also accepting the spiritual “half” of reality. This outlook is entirely per the Paracelsian view of alchemy as a simultaneously material and spiritual art. It is a mysterious paradox that the LSD chemical would function as a profound revealer of the spiritual half of reality. But as Hofmann illustrates, the material and the spiritual are not diametrically opposed to each other but are complementary aspects of a total reality. As the alchemical adage warns: “Beware of the physical in the material”.

Alchemy is, on the one hand, a natural art, but it is also an opus contra naturum. This paradox brings us to the essence of the alchemical attitude. Paracelsus summarizes this apparent contradiction in his description of alchemy as a sacred art:

The generation of all natural things is twofold: one which takes place by Nature without Art, the other which is brought about by Art, that is to say, by Alchemy….9

Paracelsus viewed alchemy as the divine endowment of humankind, a necessary and gifted unfolding of nature itself that nature cannot itself develop. The human being thus has a sacred purpose, a “great work” to accomplish. Paracelsus elaborates on this point in his definition of an alchemist:

Nature is so careful and exact in her creations that they cannot be used without great skill; for she does not produce anything that is perfect in itself. Man must bring everything to perfection. This work of bringing things to their perfection is called "alchemy." And he is an alchemist who carries what nature grows for the use of man to its destined end.10

Alchemy is thus a work against nature that also fulfills natural laws, bringing “everything to perfection”. Paracelsus posits that what nature provides is even purposed for this opus, this “destined end”.

In his writings on alchemy, James Hillman spoke directly to this alchemical attitude:

Although the work is always stated as an opus contra naturum (a work against nature), it was of course a following of nature, guided by nature, instructed by the book of nature . . . Thus the best statement for summarizing the alchemical attitude is from Ostanes, whom Jung cites frequently: “Nature rejoices in nature: nature subdues nature: nature rules over nature”.11

By referencing the “book of nature”, Hillman draws our attention once more to Hofmann’s beloved phrase—Creation as the “book written by the finger of God”. It is Creation itself that holds the secrets of transformation, that instructs the alchemist’s work. Therefore, alchemy is necessarily a work based on natural laws but which nature cannot bring to completion via its own agency—the instrumentality of the human being is required. This makes alchemy a natural art that transcends what Hillman terms the naturalistic fallacy.

The Nature of Synthesis and the Naturalistic Fallacy

The naturalistic fallacy harkens back to the Romantics and Transcendentalists, who saw in nature itself the unspoiled aura of creation. Their reverence for nature contraindicated any form of human intervention in the natural process. This controversy continues today in the debate over natural vs. synthetic medicines. In the context of entheogenic substances, arguments are made for natural plant-based entheogens (psilocybin mushrooms, mescaline, DMT, etc.) and against plant-derivatives (LSD) or synthetic chemicals (MDMA, Shulgin’s chemicals).

Herbal medicines are also subjected to alchemical processing before being administered for therapeutic use. Asian medical traditions feature numerous poisonous substances in their pharmacopeia—from aconite to mercury—all of which are purified before being considered medically usable. The medical tradition itself has an alchemical premise—the human hand holds the harvest and makes it medicine. Asian medical systems practiced medicine as a natural art, assigning cure to nature’s province but its administration to human hands. Medicine is thus alchemical because it intervenes in nature on the basis of natural laws and for the sake of a natural cure.

With the advent of scientific materialism, medicine (like chemistry) has been confined to nothing more than matter itself. In the last two hundred years, Western medicine has dispensed with the book of nature and, thus, with the art of medicine. When medicine ceases to be an art, then its laws are no longer natural, and its instructions are no longer embedded in Creation itself. Nature is no longer the revered source but the exploitable opportunity, no longer a development but a mockery by man. Pharmaceutical medicines seek to manipulate nature and, thereby, propose a strictly human agency for cure. Therefore, not all synthesis is equal, and not all practice is artful.

The term synthesis comes from the Greek sunthesis, derived from suntithenai, “place together”. In chemistry, synthesis refers to “the production of chemical compounds by reaction from simpler materials”.12 These chemical compounds are thus regarded as “synthetic” materials. In alchemy, synthesis refers to the progressive refinement of a material substance, as in the Ayurvedic, Tibetan, and Siddha medical traditions of metallurgy. This refinement can also be seen in homeopathic preparations, where a material substance is progressively purified via dilution until only an energetic imprint remains. Synthesis is purification, a substantial catharsis, a cleansing of outer sheaths that reveal an inner essence. Synthesis is the fundamental law of alchemy and is described by Paracelsus as a course of seven stages, known as the Magnum Opus (or “Great Work”). He considered the ultimate goal of alchemical synthesis—its magnum opus—to be the philosopher’s stone.

LSD is a product of synthesis, but it is also naturally derived. As a “semi-synthetic” substance, LSD stands at the threshold between nature and humanity—a chemical key of plantar essence, opening the doors of a new medical perception.

The Spirit of the Stone: Elixir as Entheogen

Jung, the Swiss founder of Analytical Psychology, was deeply influenced by the alchemical tradition of Paracelsus. In Psychology and Alchemy, he interprets the stages of alchemy as an image of the individuation process:

The alchemical opus deals in the main not just with chemical experiments as such, but with something resembling psychic processes expressed in pseudochemical language.13

Jung described the psychic process of individuation in alchemical terms as the “four in one, the philosophical gold, the lapis angularis, the aqua divina”.14 On this basis, Jung posits a four-fold Self, or quaternity, in correspondence with the four elements of alchemy (earth, fire, water, and air). The four-fold Self is an ontology of being-in-wholeness that Jung likens to the “god within”, a phrase that echoes the ancient concept of ātman and the modern neologism, entheogen. Individuation can thus be interpreted as an entheogenic process.

Following in Jung’s footsteps, James Hillman explores the psychological connotations of the philosopher’s stone:

The alchemical lapis was considered a ripened metal, a seed that had been brought to maturity by the opus; it was the made soul. But, before it could be ripened, it had already been in nature for a long, long time, the Stone Age (not the Golden Age of Hesiod). The stone has time in it, filled with time, it must of course be a lapis philosophorum, a philosophical stone, stone as philosopher, stone of wisdom. Because its body condenses in one solid object the history of time, it can overcome the conditions of history and serve as elixir to give longevity.

The philosopher’s stone is regarded as an elixir of immortality. Paracelsus describes it as the alkahest, or “universal solvent”. The philosopher’s stone is also described in Hindu and Buddhist texts as cintāmaṇi, the “wish-fulfilling jewel”. The concept of an elixir of immortality is known in Indian Yoga as amrita, literally “nectar of immortality”.15 Indian myths describe amrita as a spiritual substance created by Vishnu’s churning of the ocean of milk and subsequently bestowed by him as a gift to the gods. Amrita is thus the “food of the gods”, but this essence is not merely edible—it circulates in the spiritually-awakened body. The twentieth-century Spiritual Realizers, Ramana Maharshi and Adi Da, describe amrita as the spiritual substance of Reality and posit its location in a channel known as amrita nadi, which connects the heart to the crown of the head.

However, Adi Da cautions against projecting the elixir of immortality into an “edible deity”, describing the “native alchemy” of the body instead:

Just as today certain rejuvenating herbs are fairly commonly known, herbs were also used in the ancient cultures in conjunction with symbols and archetypes and religious observances. Modern researchers are trying to discover what the ancient herbs might have been. One of the famous herbs, or "Edible Deities," of ancient times was called "soma." There are a number of plants and mushrooms that have tentatively been identified as this soma. But the true soma is not anything external to the body-mind, not a plant or a mushroom or an elixir or one's own urine.16 The true soma is like the true practice—it is native to the body-mind. It is a substance secreted in the brain core by the glandular centers associated with the pituitary gland when the body is in a purified, harmonious condition, and its energies are rightly polarized.

. . . We are healthy not only because we take the right dietary substances into the body, including rejuvenating herbs and the like, but primarily because we are enlivened by direct Communion with the All-Pervading Life, and that direct Communion, associated with right psycho-physical disciplines, enables the body to secrete chemical substances as well as distribute bio-energetic force to every area of the body, from head to toe, toe to crown. This alchemy, native to the body itself, rejuvenates us, keeps us in good health, keeps us capable of growing, and keeps every area, every aspect, every dimension of the body-mind alive . . . This nectar pervades the entire body and enlivens it. . . .17

If the elixir of life is native to the body-mind, then substances and practices only serve as catalysts and amplifiers of this higher chemistry. This truth points to an entheogenic basis for rejuvenation—whether catalyzed by psychedelics, yoga, meditation, breathwork, etc. The word “catalyst” comes from the Greek kataleuin, which means “dissolve”. Thus, a catalyst is also a solvent, an alkahest for the spirit. The philosopher’s stone is thus a universal solvent, a solve et coagula that dissolves the ego and reveals Reality.

Ergot Fungus and the Forbidden Fruit

LSD is derived from ergot, a fungus that naturally grows on grasses and cereals. Ergot has been found in anthropic sites in the Middle East dating back 18,000 years, in Europe dating back 5,400 years, and in sclerotic fragments in a Spanish temple dating to the fourth-second century BCE. Textual evidence also proves its historical use: Chinese texts dating to 1100 BCE describe the use of ergot in gynecology;18 in 350 BCE, the Parsees described ergot as “noxious grasses that cause pregnant women to drop the womb and die in childbed”;19 in 600 BCE an Assyrian tablet described ergot as a “noxious pustule in the ear of grain”.20 Ergot has been with us since time immemorial, but can it bestow the gift of longevity?

Hofmann was sensitive to the alchemical nature of LSD as an opus contra naturum and raised this question in a letter to Ernst Jünger. In the following excerpt, Hofmann ponders the role of LSD and the “transgression of limits”:

On the other hand, I must admit that a fundamental question very much preoccupies me, whether the use of these types of drugs, namely of substances that so deeply affect our minds, might not in fact represent a forbidden transgression of limits.21

Hofmann then quotes Goethe:

Were the eye not sunny,
It could not behold the sun;
If the power of the mind were not in matter,
How could matter perturb the mind?22

Following this quotation, Hofmann concludes:

This would correspond to the cracks which the radioactive substances constitute in the periodic table of the elements, where the transition of matter into energy becomes manifest. Indeed, one must ask whether the production of atomic energy likewise constitutes a forbidden transgression of limits.

A further disquieting thought concerns free will, and follows from the possibility of influencing the highest intellectual functions by traces of a substance.

The highly active psychotropic substances like LSD and psilocybin possess in their chemical structures a very close relationship to substances intrinsic to the body, which are found in the central nervous system and play an important role in the regulation of its functions. It is therefore conceivable that through some disturbance in the metabolism of the normal neurotransmitters, a compound like LSD or psilocybine be formed, which can determine and alter the character of the individual, his worldview and his behavior. A trace of a substance, whose production or nonproduction we cannot control by our will, would then have the power to shape our destiny.23

Hofmann echoes Adi Da’s understanding when he notes the nature of LSD as a similimum—a substance whose structure is in likeness to “substances intrinsic to the body”. Therefore, a similimum is also in resonance with the anatomy and physiology of the human being. This understanding forms the principal axiom of homeopathy— similia similibus curantur—“like cures like”. The fact that LSD is active at trace dosages invokes another homeopathic maxim: the more dilute the substance, the more potent its therapeutic action. Dilution is dissolution, and what remains is a final kernel of purity and potency.

Hofmann was destined to synthesize LSD and to thereby present us with the alchemical quandary once more, of forbidden fruits and transgressed limits,24 of an opus contra naturum that evolves and revolves upon natural laws nonetheless. Therefore, synthesis is not merely artificial but an artificium—hand-crafted from the wild. Synthesis requires a mixing of contra, just as the human being is a fusion of Heaven and Earth, an opus of nature whose opposable thumbs enact an awakening, anew and again.

III. The Astrology of LSD Synthesis and Bicycle Day

Paracelsus correlates the seven stages of alchemical work with the seven planetary bodies, and astrological observations permeate his medical, philosophical, and alchemical writings. Since we know the dates of Hofmann’s first synthesis of LSD (and re-synthesis five years later), we can examine the astrological “birth” of LSD, its “father”, and what these patterns reveal about the mysterious medicine.

The First Synthesis: November 16, 1938

Hofmann was born on January 11, 1906, in Basel, Switzerland. He first synthesized LSD on November 16, 1938, in the city of his birthplace at the age of thirty-two. In Vedic astrology, specific ages are associated with the maturation of planetary energies—the notion being that it takes time for different planetary energies to ripen in our consciousness. Thirty-two is the age of Mercury’s maturation, and as Hofmann is a Gemini Ascendant,25 Mercury is his Ascendant Lord. The Ascendant corresponds to the physical body and its life-path. The Ascendant is the inner basis of vocation, the first house of the unique individual. The timing of Hofmann’s discovery reveals his synthesis of LSD as a key that unlocks the door of his destiny. Hofmann’s natal Mercury is placed in Sagittarius, giving him a philosophical and mystical nature. Hofmann is someone who desires to articulate the Truth, to give it voice, to be a messenger.

On November 16, 1938, we see several remarkable transits and conjunctions:

• Chiron conjunct natal Neptune in Cancer (within 1°)

• Pluto conjunct natal Moon in Leo (exact degree)

• Jupiter conjunct natal Ketu in Aquarius (within 2°), Jupiter conjunct Midheaven in Aquarius (within 2°)

• Rahu conjunct Sun and Venus in Scorpio (within 12°)

• Ketu conjunct Uranus in Taurus (within 2°)

The close conjunction of Chiron and Neptune on the day of Hofmann’s first synthesis of LSD reveals a therapeutic discovery. The placement of this conjunction in Cancer illustrates the healing nature of the synthesis and its value for the inner emotional landscape. The Moon rules Cancer—and the Moon is known as soma because it governs the essences that ripen plant medicines and the vital essences that rejuvenate the human body. Cancer is also the sign of Jupiter’s exaltation,26 revealing that Hofmann’s synthesis has a spiritual import for the growth and expansion of human consciousness.

Another consequential dynamic in Hofmann’s natal chart is the Uranus-Neptune opposition. Richard Tarnas notes that “many crucial figures who subsequently mediated the spiritual, philosophical, and imaginative awakenings of the twentieth century” were born under this opposition.27 In particular, Tarnas describes Hofmann’s birth, the discovery of LSD, and the cosmic epiphanies of psychedelic culture as a consequence of the Uranus-Neptune dynamic:

Recalling that the discoverer of LSD, Albert Hofmann, was born during the preceding Uranus-Neptune opposition, we can also recognize the characteristic themes of the Uranus-Neptune complex during this period in the introduction of psychedelic experimentation as a path of psychological change and spiritual epiphany, as reflected in Aldous Huxley’s The Doors of Perception of 1954, Humphrey Osmond’s coining the word psychedelic (“mind-manifesting”) in a letter to Huxley in 1956, Gordon Wasson’s meeting the Mexican curandera Maria Sabina and publishing his influential Life magazine article on the sacred psilocybin mushroom in 1957, and the beginning of Stanislav Grof’s research on LSD in Prague in the same years through which he developed an approach to psychotherapy that integrated psychoanalysis with an openness to transformative mystical experience.2829

Tarnas’s observation of the macro-cycle of Uranus-Neptune accurately describes the revelatory and revolutionary import of Hofmann’s LSD synthesis. He also notes the influence of this transit a century prior in the Romantic period, an artistic and intellectual movement characterized by an ecological awakening.

Pluto’s conjunction with Hofmann’s natal Moon is notable as an exact conjunction and, therefore, as the strongest transit. Pluto is a Dionysian and Shiva-like energy—it wrathfully destroys the vestiges of egoic life. In conjunction with the Moon, Pluto initiates a rapid deconstruction of one’s inner life on emotional and psychological levels. The Pluto-Moon conjunction takes place in the sign of Leo, where Hofmann’s natal Rahu is also placed. While the conjunction is 19° apart from Rahu, this is still a significant placement. As the north node of the Moon, Rahu represents the evolutionary urge of the native’s consciousness. In Leo, this urge is uniquely individual, highly creative, and designed for leadership.

Jupiter is in close conjunction with Hofmann’s natal Ketu and Midheaven in Aquarius. The natal placement of Ketu in proximity to the Midheaven shows that Hofmann’s career has a karmic and past-life basis and that, over time, his energies will shift from vocation to a focus on inner cultivation. However, Ketu and the Midheaven are both in Aquarius, showing Hofmann’s purpose in the world as a water-bearer. Indeed, the Aquarian image is interpreted in Vedic astrology as the image of Vishnu offering amrita to the gods. Thus, Hofmann’s synthesis has tremendous value for uplifting the collective consciousness in outer cultural forms and its inner unconscious forms. Jupiter’s transit in Aquarius empowers Hofmann’s karmic hermitage and vocational destiny, enabling him to make a discovery that changes the future of human culture.

Transiting Rahu is conjunct transiting Sun and Venus. I mention this transiting conjunction not only because of Rahu’s evolutionary nature but also because the conjunction takes place in Scorpio. It only makes sense that Hofmann would first synthesize LSD while the lunar nodes are abiding in the Scorpio / Taurus axis. Scorpio is the sign of inner transformation and has the strongest alchemical connotations of all the twelve signs. The scorpion gives us the image of poison and the importance of its transformation into nectar. Scorpio is a solve-et-coagula, the place of the putrefactio that ultimately renders the elixir of life. Taurus gives us the image of stability, an anchor for the spirit, and a place where the doors of perception are fully opened. Taurus is the most sensual sign of the zodiac, Venus-ruled and uniquely engaged with the perceptual world. Taurus also points to the aesthetic nature of the LSD experience.

Transiting Ketu is in a tight conjunction with transiting Uranus. This conjunction suggests a profound karmic revolution, a deeply fated breakthrough. Hofmann was meant to synthesize LSD on this day, and in doing so, he fulfilled a soul-motive that would catalyze a counterculture revolution.

Although Hofmann first synthesized LSD on November 16, 1938, he would not understand the full import of his discovery until he re-synthesized it five years later. On the mysterious intuition that led him to pursue a re-synthesis in 1943, Hofmann writes:

The solution of the ergotoxine problem had brought fruitful results, here described only briefly, and had opened up further avenues of research. And yet I could not forget the relatively “uninteresting” LSD-25. A peculiar presentiment—the feeling that this substance might possess properties beyond those established in the first pharmacological studies—induced me, five years after that first synthesis, again to produce LSD-25, so that a sample could be given to the pharmacological department for further tests.30

Hofmann says that he repeated the synthesis of LSD on April 16, 1943, when his “work was interrupted by unusual sensations”. In a report written to Professor Stoll, Hofmann reports an “intoxicated-like condition, characterized by an extremely stimulated imagination”, in which he “perceived an uninterrupted stream of fantastic pictures, extraordinary shapes with an intense, kaleidoscopic play of colors”.31 This was the first time a human being had ever ingested LSD, though Hofmann had done so unintentionally and sought to understand how it had even happened. Seeking to understand whether his experience had been caused by LSD, Hofmann intentionally ingested the substance three days later, on April 19, 1943. This day is now commemorated as “Bicycle Day”, named for Hofmann’s legendary bicycle ride home from the laboratory while experiencing the effects of LSD. Hofmann wrote extensively about his experience that day, summarizing his findings in the following paragraph:

This self-experiment showed that LSD-2532 behaved as a psychoactive substance with extraordinary properties and potency. There was to my knowledge no other substance known that evoked such profound psychic effects in such extremely low doses, that caused such dramatic changes in human consciousness and in our experience of the inner and outer worlds.33

Re-synthesis and First Trip: April 19, 1943

On Bicycle Day, April 19, 1943, we see more interesting transits:

• Nodal Return: Rahu and Ketu are transiting their natal placements in the Leo/Aquarius axis

• Ketu conjunct Midheaven in Aquarius (within 1°)

• Rahu conjunct Chiron in Leo (exact degree)

• Sun Exalted in Aries and conjunct 12th house (exact degree)

• Mars return in Pisces and conjunct Saturn (within 1°)

• Jupiter Exalted in Cancer and conjunct Neptune (within 9°)

• Neptune on the cusp of Virgo/Libra

• Uranus conjunct Venus and Saturn in Gemini (within 7°)

Hofmann is now thirty-six years old, the age of Saturn’s maturation. As it takes the lunar nodes eighteen years to move through the zodiac, age thirty-six also represents the second nodal return of one’s life. The lunar nodes represent the karmic and evolutionary trajectory of the psyche. When they return to their natal placements, the native experiences a “re-tracing” in consciousness that is potentially a rebirth. Hofmann’s second nodal return coincided with his initial ingestion of LSD and, thereby, his discovery of its unique psychic effects.

Yet, the nodal return is only the beginning of the story. Since Hofmann’s natal Ketu is placed near the Midheaven, Ketu’s return re-empowers this conjunction in real-time, allowing this natal characteristic to fully manifest and emerge in consciousness. Hofmann’s description of LSD as his “problem child” is noteworthy for this reason, as his discovery became a karmic burden in light of its use as an intoxicant in the counterculture movement and resultant status as an illegal substance.

The wound of Hofmann’s problem child is evident in the exceptionally exact conjunction of Rahu with Chiron in Leo. Chiron plays an important role in Hofmann’s life, in both the synthesis and re-synthesis of LSD. On the day of his first synthesis, Chiron was conjunct Hofmann’s natal Neptune in Cancer within 1°. Now, on the day of his first conscious ingestion of LSD, Chiron is exactly conjunct with transiting Rahu and conjunct within 1° of Hofmann’s natal Rahu. Thus, Chiron’s conjunction with Rahu has two levels, owing to the simultaneous reality of Hofmann’s nodal return. In Hofmann’s natal chart, Chiron is placed alongside Ketu in Aquarius and, therefore, is on the natal nodal axis. On Bicycle Day, Chiron is placed along the nodal axis during the nodal return, where it conjuncts Rahu on two levels and forms a very dynamic opposition to Hofmann’s natal Chiron in Aquarius (where it is also being influenced by natal and transiting Ketu).

The significant influence of Chiron, both natally and in transit, reveals the therapeutic and healing nature of Hofmann’s discovery. It also shows that LSD would have a deeply healing impact on Hofmann’s own life and, by virtue of the Aquarian placement, on humanity as a whole.

The Sun is Exalted in Aries and exactly conjunct with the 12th house cusp. The Exaltation of the Sun shows the peak of creative energy and the quality of initiation. This is in dynamic relationship to the 12th house, which is seen in Vedic astrology as a moksha house. In an inscription to Hofmann, Aldous Huxley described LSD as the “moksha medicine”.34 This transit illustrates Hofmann’s ingestion of LSD as an initiatory event and his subsequent discovery of its effects as a spiritually liberating discovery. However, the 12th house also connotes imprisonment, a fate that would fall upon Timothy Leary, the prophet of LSD, and ultimately upon LSD itself when it was made illegal and classified as a “Schedule I” drug.35

Mars, the ruler of Aries, is placed in Pisces, where it transits Hofmann’s natal Mars. This is a Mars return, and while not as uncommon as a nodal return, it remains significant. The natal placement of Mars in Pisces indicates a drive for spirituality and a highly intuitive personality. The return of Mars in Pisces re-awakens Hofmann’s natal placement, bringing it to consciousness. Hofmann’s motivation to re-synthesize LSD was based on a “peculiar presentiment”, and his ingestion of it led to a spiritual experience, the likes of which he had once known in childhood.36 Mars is also in close conjunction with Hofmann’s natal Saturn (within 1°). Mars and Saturn have an interesting dynamic: Mars exalts in the Saturn-ruled sign of Capricorn, but Saturn debilitates in the Mars-ruled sign of Aries. This paradoxical dynamic creates a mutual tension between Mars and Saturn. For this reason, Mars-Saturn conjunctions are often interpreted as causing accidents. As Hofmann recounted, his first ingestion of LSD on April 16 was accidental.

Jupiter is Exalted in Cancer, bringing more energetic focus in the Water signs (as we just saw with Mars in Pisces). In Vedic astrology, the three Water-element signs—Cancer, Scorpio, and Pisces—are associated with the priestly state of consciousness and the aim of moksha. Thus, we see a concentration of energy in Water and Fire elements, the interaction of which is archetypally alchemical.

We will remember that Chiron was placed in Cancer during Hofmann’s first synthesis of LSD, and now Jupiter has reached its climax there. Jupiter moves through the zodiac in twelve years, and therefore, it moves into a new sign of the zodiac every year. Hofmann’s re-synthesis and first psychedelic experience is thus synchronous with the exaltation of Jupiter in Cancer. As Jupiter governs the growth and expansion of consciousness, its quality is most characteristic of the psychedelic experience. Jupiter is also conjunct Neptune, and Chiron was conjunct Neptune during Hofmann’s first synthesis. The conjunction of Jupiter and Neptune is spiritually empowering and points again to the mystical basis of Hofmann’s experimentation.

The movements of Neptune have a curious relationship to Hofmann’s synthesis and re-synthesis. On November 16, 1938, Neptune was transiting Virgo. On October 3, 1942, Neptune entered Libra before beginning a retrograde cycle back into Virgo on April 17, 1943—one day after Hofmann’s accidental dosing of LSD. On April 19, when Hofmann intentionally took LSD for the first time, Neptune was in Virgo again, the same sign it was in when he first synthesized it five years prior. Indeed, retrograde cycles lead to a “re-tracing” of events and, in this case, complete a “magic circle” for Hofmann.

We must note that the Sun and Jupiter are exalted, and Mars is influentially present. According to Chinese five-element theory, Jupiter corresponds to the Wood element, Mars corresponds to the Fire element, and the Sun represents the quality of yang. Hofmann’s experience takes place in the springtime when the Wood element is naturally predominant. Wood corresponds to the Liver/Gallbladder network, and its aperture is in the eyes. Therefore, the Wood element is the source of visionary experience and perspective. The Fire element is closely associated with the spirit because it corresponds to the Heart, the organ regarded as the “seat of the spirit”. The influence of the Fire element is evident in the spiritual quality of Hofmann’s LSD experience.

Uranus is conjunct Venus and Saturn, and all three are transiting Hofmann’s Ascendant and natal Pluto. The natal conjunction of Pluto with the Ascendant is a notable quality of Hofmann’s chart and confers upon him a markedly Dionysian character and purpose. The transit of Uranus in Gemini is critical in Hofmann’s first house, a house most intimately connected with his physical body, constitution, and life path. Outer planet transits are particularly notable when they cross the first, fourth, seventh, or tenth houses—the most personal houses of self, home, marriage, and vocation. Uranus transmits a Promethean impulse, a revolutionary breakthrough in consciousness, a stealing of fire that is a transgression of limit and an opus contra naturum. Fire and flower in hand, we craft a new essence and elixir. Hofmann’s re-synthesis and first ingestion of LSD occurring under this transit signify the most significant personal breakthrough of his life.

Uranus is also in a dynamic relationship with Pluto on two levels—it is transiting Hofmann’s natal Pluto and is squaring the transit of Pluto in Leo. Tarnas discusses this Uranus-Pluto cycle at length, crediting it with catalyzing the counterculture era of the 1960s. On the transit of Uranus in the first house, Robert Hand writes:

The transit of Uranus through the first house is predominantly a drive for freedom. To others it may seem to be a period of pointless rebellion. And indeed, in terms of your old life, you may be acting quite irresponsibly, but if you feel very strongly the need to break free, it is a sign that the change is overdue.

As you change your way of handling the world, you will become open to experiences that you would never have allowed before, and your life may take on a whole new outlook. Certainly this is a good time to explore new kinds of awareness or to encounter astrology, yoga, human potential studies and other consciousness-expanding techniques. The avenues to new perception are open, and if you allow yourself to receive it, you will gain new tools for your future life.37

Hand’s analysis rings true for this period in Hofmann’s life, characterized as it was by experimentation with LSD and openness to the psychedelic experience it engenders.

IV. Eleusis and Eleutherios

What, then, do we make of this odorless, tasteless, porous, and potent chemical? Is it a drop of immortal nectar or a decanting of godless games? What exactly is this mysterion?

Hofmann’s research into ergot alkaloids led him to the Eleusinian mysteries of ancient Greece. The Eleusinian mysteries were secret religious rites associated with the cult of Demeter and Persephone and held in the city of Eleusis. Hofmann writes:

The Mysteries of Eleusis, which were celebrated annually in the fall, over an interval of approximately 2000 years, from about 1500 BC until the fourth century of our era, were intimately connected with ceremonies and festivals in honor of the god Dionysus. These Mysteries had been founded by Demeter, the goddess of agriculture, in appreciation of the recovery of her daughter, Persephone, who had been abducted by Hades, god of the underworld.

. . . The climax of the yearly ceremonies, which began with a procession from Athens to Eleusis lasting several days, was the concluding ceremony, the initiation, which took place by night. The initiates were forbidden under penalty of death to divulge what they had learned or beheld in the innermost, holiest sanctum of the temple, the telestrion (goal).

. . . In accordance with traditional knowledge, during the climactic ceremony, the initiates imbibed a potion, the kykeon. It is also known that the ingredients of the kykeon were barley extract and mint. Religious and mythological scholars like Karl Kerényi . . . with whom I have collaborated on research into this mysterious potion, are of the opinion that the kykeon constituted an “hallucinogenic” drug. That would make understandable an ecstatic and visionary experience of the Demeter/Persephone myth, in both a comprehensive and timeless reality, as a symbol of the cycle of life and death.38

Jonathan Ott notes that Hofmann’s publication The Road to Eleusis: Unveiling the Secret of the Mysteries (1978), co-authored with Gordon Wasson, “conjectured that the kykeon might have acted through an LSD-like aqueous extract of ergot of barley, containing the psychoactive, water-soluble alkaloids”.39 Fielding notes that Hofmann’s thesis has since been corroborated by archaeological findings:

Decades after Wasson, Ruck, and Albert presented their thesis in The Road to Eleusis, archaeologists found ergot in a Greek ceremonial cup and the dental cavities of an initiate to the Mysteries at Mas Castellar, Spain, in a Temple devoted to Demeter and Persephone.40

This understanding is further confirmed by Carod-Artal in the journal article “Psychoactive plants in ancient Greece”, where the author writes:

There is evidence supporting the hypothesis that ergot could have caused the Eleusinian visions. The purple colour of the fungus is associated with Demeter. Furthermore, the ear of grain was the symbol of the Eleusinian Mysteries. An example of Greek pottery from the 5th century BCE shows Demeter and Triptolemus holding a sheaf of grain infected with ergot. Traces of C. purpurea have also been found on the interior of a vessel in a sacred shrine dedicated to Persephone.41

Earlier, Hofmann noted that the Eleusinian Mysteries were associated with Dionysus and the recovery of Persephone from the underworld. Both Dionysus and Hades lend a Plutonian quality to the rites. Indeed, Pluto is archetypally responsible for the experience of “ego-death” on all levels. This observation leads me to characterize LSD as a liberator, or in the Greek language, Eleutherios. The name Eleutherios is an epithet of Dionysus, Eros, and Zeus. In the twentieth century, this name was invoked again by Adi Da, who adopted it as one of many appellations. One of the principal texts in Adi Da’s vast corpus is tilted Eleutherios: The Only Truth That Sets the Heart Free. The text is structured aphoristically and opens with the following verses:

Truth Is the Ultimate Form (or the Inherently Perfect State) of “Knowledge” (if mere knowledge becomes Truth-Realization).

Truth Is That Which, when fully Realized (and, Thus, “Known”, even via the transcending of all conditional knowledge and all conditional experience), Sets you Free from all bondage and all seeking.

Truth Is Eleutherios, the Divine Liberator.42

If LSD serves the function of revealing Truth through perception of the Real, then the entheogenic experience sets the Heart free. Perhaps the opus of humanity is not only alchemic but equally entheogenic—a god within a drink or a drop, our birthright a watery palindrome reflected in a looking-glass, beholding our conscious destiny in the peaks and vales of spirit and soul. Then, with open eyes of infinitude in the Heart’s heaven-born gaze, our lips confess the nectarous gospel, the liberating opus of humanity: Reality Itself Is Truth Itself Is the Beautiful Itself.

The essay is structured in four parts. Below, I give an overview of each part, followed by the table of contents. I hope this aids the reader in navigating the length and structure of the argument.

As always, thank you for reading!

—Neeshee Pandit

Overview

My thesis examines the meaning of “possession” in Chinese medicine, Freudian and Jungian psychology, and the Worsley school of five-element acupuncture. I examine the meaning of “psyche” in psychology and acupuncture and ultimately posit acupuncture treatment as a form of psychotherapy.

In Part One, “Demons Dragons, and Ghosts”, I trace the history of demonology in Chinese medicine, the philosophical transition from early shamanism to Han-dynasty naturalism, and the origins of acupuncture in exorcism.

In Part Two, “Acupuncture and Psychoanalysis”, I explore the relationship between acupuncture and psychoanalysis, Freudian and Jungian interpretations of possession, and the nature of acupuncture as a psychological therapy.

Part Three, “Possession in Five-Element Acupuncture”, represents the core of the thesis. Here, I outline my theory of acupuncture as psychotherapy, meridians as the somatic unconscious, and treatment as an alchemical event. I then proceed to give a clinical portrait of possession—its etiology, diagnosis, pathogenesis, and treatment. I explore treatment as exorcism, the practitioner as shaman, and the meaning of resurrection. This section closely examines the revival of possession treatment by J.R. Worsley and its clinical applications.

Part Four concludes with a reflection on demon vs. daemon, the nature of character and calling, and the role of acupuncture in the vale of soul-making.

Table of Contents

I. Demons, Dragons, and Ghosts: A Brief History of Demonology in Chinese Medicine

1. Demonology and Systematic Correspondences

2. From Demons to Nature

3. Possession as Parasitism

II. Acupuncture and Psychoanalysis

1. Possession, Superego, and Western Psychiatric Disorders

2. Spirit and Psyche

   1. Anima/Animus

3. Possession as Complex

III. Possession in Five-Element Acupuncture

1. Possession and the Somatic Unconscious

2. Definition and Etiology

3. Diagnosis and Pathogenesis

4. Treatment: Seven Devils, Seven Dragons

   1. Treatment as Exorcism

      1. Possession as Obsession

      2. Instrumentality: Practitioner as Medium

   2. Internal Dragons

   3. External Dragons

   4. Soul-Loss and Resurrection

IV. Demon or Daemon: The Vale of Soul-Making

NOTE: J.R. Worsley’s influence on my views is obvious. My intention has been to honor and positively explore his teachings (alongside those of Freud, Jung, Hillman, and others) while adding creative insights of my own. Thus, the views presented here are entirely my own and do not—necessarily or officially—reflect the views of J.R. Worsley, the Worsley Institute, or the Worsley lineage.

I. Demons, Dragons, and Ghosts:
A Brief History of Demonology in Chinese Medicine

The belief in spirits stems from the indigenous worldview of an animated world, where the boundaries between dreams and waking reality are fluidly perceived. Spirit-possession and soul-loss are perhaps the original pathologies imagined by human beings for which a healing intervention was needed. Shamanism was the original form of therapeutic concern, expressed as a need for protection (or “immunity”) from invasive influences.

In Chinese medicine, invasive pathogenic factors are examined with a multidimensional phenomenology. The human being is composed of physical, mental, and spiritual levels of existence. Thus, invasive pathogenic factors are seen on a spiritual level as spirit-possession and soul-loss; on a mental level as astrological factors; and on a physical level as climatic factors, parasites, and communicable diseases.

Interest in the treatment of possession pathologies has been rekindled throughout the history of Chinese medicine, both at home and abroad. In the seventh century, Sun Simiao (ca. 581 – 682  CE) resurrected Zhou dynasty notions of demonological disease with herbal prescriptions and acupuncture protocols. By the twentieth century, Chinese medical notions of possession had mingled with European thinking, especially the tradition of psychoanalysis. Possession was notably re-imagined by J.R. Worsley (1972 – 2003 CE), who interpreted the illness in psychological terms as a loss of agency and taught two acupuncture protocols for its treatment.

As a concept, possession represents the nexus of culture and medicine, where a cultural notion is sublimated into a medical concept. A medical understanding of possession must attend to its cultural context while viewing possession with the pathologized eye of the profession. In order to understand possession, we have to examine multiple disciplines—animism, shamanism, demonology, anthropology, and psychology.

Possession has been a central concern of medicine since antiquity. The Chinese term for medicine, yi, has etymological links to possession. This linguistic link reveals that possession has been a central concern of medical practice since antiquity. Through analyzing the characters in yi, Jarrett (2005) concludes that it “contains the notion of piercing the skin with arrows similar to piercing the air with lances to chase away the demons.” (p. 39). This interpretation is shared by Unschuld (2010), who also traces the origins of acupuncture to the spears used to drive away demons. The etymological and conceptual link between medicine (yi), possession, and acupuncture is thus well-established in the history of Chinese medicine.

From a medical view, the existence or non-existence of spirits is a peripheral concern because the phenomenon of belief in spirits is consequential in itself. In medicine, we look to interpret the nature of an object based on its subjective value—does it promote health or not? Therefore, while possession may conjure sentiments of antiquated superstition, we will see how these ancient ideas are resurrected in modern acupuncture therapeutics.

Demonology and Systematic Correspondences

Belief in spirits as causative agents of disease dates to the earliest periods of Chinese history. According to Harper (1998), “The idea that demons and the spirits of the dead sicken the living is in evidence in the earliest Chinese written records, the Shang inscriptions on bone and turtle shell (ca. thirteenth to eleventh century B.C.)”. (p. 69). Naturalistic notions of health and disease from the Han dynasty classics eventually replaced the etiology of demons. However, the idea that health is dependent on exogenous entities (whether spirits or climatic factors) persists throughout Chinese medical history. If demons are the cause of illness, then the nature of illness is a form of a spirit-possession, and the method of treatment is exorcism. Such demonological notions of health existed long before the advent of systematized medicine and meridian theory.

The Shang dynasty was conquered by the Zhou in 1046 BCE. With its nearly eight-hundred-year reign, the Zhou period remains the longest historical epoch of Chinese history. Unschuld characterizes the transition from the Shang to Zhou dynasty as a shift in attitudes toward shamanism—a movement away from ancestor worship and toward demonic spirits. Unschuld (2010) writes that the “belief that demons could cause illness is widely documented in the literature of the later [Zhou] period”. (p. 37). The healers who healed possession were known as wu, a character that depicts two female shamans dancing. Wu were magical healers who used ritual chants, herbal medicines, talismans, and ritual fumigations to exorcise demons. By the first millennium, demonology was evidenced as distinct illnesses attributed to malevolent spirits:

Demonic medicine is based on the beliefs that illness is caused by the actions of evil spirits. Typical views of demonic medicine, present in the literature of the first millennium A.D., are expressed in the following conditions defined as illness: “struck by evil” (chung-o), “assaulted by demons” (kuei-chi), “possessed by the hostile influence of demonic guests (kuei-k’o wu-chi), and “possessed by the hostile” (chu-wu). (Unschuld, 2010, p. 36)

From Demons to Nature

Demonic possession is often misconceived as a pre-medical concept. However, demonic possession has long been part of the systematized nosology of Chinese medicine into the seventeenth century. Harper argues that demonic concepts of illness were re-translated (but not truly replaced) by naturalistic concepts of illness in the Han Dynasty classics. He groups demonic and naturalistic concepts within the broader nosology of “ontological pathology”: an illness that exists in the form of an entity—whether demon, season, element, wind, vapor, heat, cold, etc. (Harper, 1998, p. 69). The pathogen changes, but the concept perseveres through all its guises. Therefore, the root of demonology is not merely a belief in the existence of spirits, but the paradigm of external pathogenic factors.

By the time of the Han Dynasty (206 BCE – 220 CE), Chinese medical philosophy began to embrace a rational and empirical theory of health and illness that left demonology behind. Unschuld refers to this philosophy as “the theory of systematic correspondences”, which views the human being as a microcosm of the natural world governed by natural laws. Health was no longer freedom from spirit-possession, but a rhythmic synchronization with the cycles of nature, seasonally and astrologically. Calendrical notions of health arose in tandem with agrarianism—health became a matter of “cultivating” the inner landscape of the body, now “irrigated” by a network of channels. Thus, calendrical patterns became circulatory perceptions—health is circulation, disease is blockage.

In the Tang Dynasty (618 – 907 CE), the concept of spirit-possession was revived by the Chinese scholar-physician, Sun Simiao. One of the earliest prescriptions for the fumigation of demons is found in Sun Simiao’s treatise on alchemy, Dan Jin Yao Jue (“Great Secrets of Alchemy”). In a later compendium, the Qian Jin Yi Fang (“Supplement to the Prescriptions Worth a Thousand Gold”), Sun Simiao listed thirty-two herbs regarded as being effective against demons. Unschuld (2010) quotes a passage from Sun Simiao that illustrates his view of illness as a “central thesis of demonic medicine”, in which Sun Simiao expresses the “conviction that illness and suffering are natural and unavoidable”, clearly illustrating the influence of Daoism and Buddhism in Sun Simiao’s worldview. (p. 43). Unschuld argues that Sun Simiao’s view runs counter to the predominating medical theory of the time—the theory of systematic correspondences—which placed the agency of health in individual behavior following natural laws. Unschuld (2010) states that this theory is based on “the belief that illness could be avoided by means of an appropriate way of life”, a point of view that he sees as an extension of Confucianism. (p. 43).

By the Ming Dynasty (1368 – 1644), ritual shamanism conflicted with the dominant philosophy of Confucianism and was thus regionally contained. Despite this tension, we see an overlap of values between shamanism and Confucianism in ancestor worship and filial piety. However, the shamanic focus on the individual remained a critical divergence between Confucian ideals of the collective. During this time, the Ming dynasty physician, Zhang Jiebin, “enumerated demonology as the thirteenth medical specialty in his 1624 work, the Classic of Categories”. (Eckman, 2007, p. 215). Eckman (2007) also notes the tripartite etiological model of Chen Yan (1121 – 1190 CE), a Song dynasty physician who placed demonic possession in a “miscellaneous” category, “meaning it was neither an exogenous nor endogenous cause of disease”. [1] (p. 215).

Possession as Parasitism

The concept of possession has also mingled with the concept of parasitic pathogens.[2] For the Chinese, parasitism is conceived in demonological terms as a “worm spirit” (ku). Fruehauf translates the concept of ku into a syndrome (“Gu syndrome”) encompassing a range of autoimmune pathologies. He approaches Gu syndrome as a “forgotten clinical approach for chronic parasitism.” Fruehauf remarks that Gu syndrome has been “dismissed” and “submerged” in modern clinical practice where it is largely regarded as “superstitious.” However, Fruehauf translates the demonology of Gu syndrome into a modern “clinical approach that may provide an answer to the many invisible ‘demons’ that plague patients in the modern age, namely systemic funguses, parasites, viruses, and other hidden pathogens.” (Fruehauf, 1998).

A “hidden pathogen” is an invisible etiological factor. Earlier, we grouped demonic and naturalistic ideas of illness as “ontological pathologies”—etiological factors as entities. Within this, we can now identify a subcategory—“invisible pathologies”. Demons, wind, and parasites are all invisible pathogens. What is hidden is invisible, and what is invisible is unconscious, a point we will examine later. For now, we can situate the pathology of possession in three forms: (a) an ontological pathology, (b) an invisible pathology, and (3) an unconscious pathology.

Fruehauf re-interprets Gu syndrome in modern terms via a range of physical, neuromuscular, and psychological symptoms: chronic diarrhea, alternating diarrhea and constipation, explosive bowel movements, abdominal bloating, muscle soreness, wandering body pains, cold night sweats, depression, frequent suicidal thoughts, fits of rage, confusion, visual and/or auditory hallucinations, epileptic seizures, and the sensation of “feeling possessed”. Elaborating on the nature of Gu syndrome as a “possession syndrome,” Fruehauf (2008) writes:

I found chronic parasitism reflected in a huge area of classical Chinese medicine that was called Gu zheng, or Gu syndrome, which essentially means “Possession Syndrome”. Gu is a character that is very old, perhaps one of the oldest characters in the Chinese textual record altogether, since it is a hexagram in the Yijing. It is literally the image of three worms in a vessel. This to me is one of those strokes of brilliance that you find in the symbolism of the ancient Chinese—that they recognized 3000 years ago that chronic parasitism can cause psychotic or psychological symptoms. Because of the psychological, emotional, and perhaps spiritual implications of this term, Gu, when the Chinese standardized the classical record for the much simplified barefoot doctor approach of the TCM system in the 1950’s, they threw out lots of complicated and ideologically problematic topics, and obviously this “Possession Syndrome” was one of the first ones to go.

While he associates Gu syndrome with chronic parasitism, Fruehauf notes that the Chinese concept of Gu is not analogous or reducible to the Western understanding of acute parasitic infection. In the following passage, Fruehauf (2008) elaborates on the nature of Gu syndrome as a shamanic category of illness, a recalcitrant form of disease, and gives some modern examples:

Not all cases, that, from a classical perspective, would be diagnosed as Gu syndrome, would be patients with parasites, and vice-versa, not all people with a positive parasitic test from the Western perspective would be accurately diagnosed as Gu. Gu syndrome actually means that your system is hollowed out from the inside out by dark yin forces that you cannot see. This not seeing often includes Western medical tests that come back negative for parasites. So from a certain perspective, AIDS falls into this category, with body and mind being hollowed out from the inside out, without knowing what is happening. Gu syndrome originally meant “black magic.” To the patient it felt as though someone had put a hex on them, without anybody—whether it’s the Western medicine community or, in ancient times, the regular Chinese medicine approach—being able to see what was really going on.

Gu syndrome is caused by a dark yin pathogen. As we noted earlier, the idea of a “hidden” pathogen already has psychological resonances. As examples of dark yin pathogens and the pathologies they cause, Fruehauf cites the spirochetal pathogen of Lyme disease along with conditions of chronic fatigue syndrome, fibromyalgia, dysentery, and viral infections such as herpes. Fruehauf (2008) ultimately differentiates between two subcategories of Gu syndrome—brain Gu and digestive Gu:

Brain Gu is “caused by chronic viruses that target the nervous system (such as coxsackie, herpes, and in some cases HIV), or spirochetes (especially Lyme disease and its coinfections), or other exotic pathogens causing chronic forms of meningitis, malaria, leptospirosis, etc. A lot of patients in this category are diagnosed with fibromyalgia these days. There may be symptoms of body pain, anxiety, depression, headaches, eye aches, visual hallucinations, strange sensations that there is something stuck in their head, etc. Very often these people have been put on Prozac or some other kind of anti-depressant, which often doesn’t work . . . Digestive bloating, pain, and altered bowel movements are the primary signs of Digestive Gu. But both of them will have a certain degree of mental symptoms, therefore the “demonic possession” label—the Digestive Gu less, and the Brain Gu more.

Drawing a parallel between the neurological pathogenesis of brain Gu and demonic possession, Fruehauf classifies possession (with its mental-emotional symptomology) as a nervous system disorder, recalling the ancient observation of epileptic seizures as “possession”.

The treatment of Gu syndrome consists of herbal prescriptions, acupuncture/moxibustion, dietary advice, and qigong exercise. Fruehauf compiles the recommended acupuncture treatment from “Master Ranxi’s Treatise on Expelling Gu” from 1893. The recommendations include several points, including Sun Simiao’s thirteen ghost points:

• vigorous garlic moxibustion on BL-43

• moxibustion on BL-13, ST-36, and Guikuxie (Demon Wailing Points)

• acupressure with menthol preparations on the thirteen ghost points

• selective needling of the thirteen ghost points

The thirteen ghost points are GV-26 (Demon Palace), GV-16 (Demon Pillow), GV-23 (Demon Hall), CV-24 (Demon Market), LU-11 (Demon Evidence), LI-11 (Demon Leg), ST-6 (Demon Bed), SP-1 (Demon Pile), P-7 (Demon Centre), P-8 (Demon Hole), BL-62 (Demon Path), CV-1 (Demon Hideout) for males / extra point (Yumen) on the head of the clitoris for females, M-HN-20 (Demon Envelope) under the tongue. These points are given “demon” names in the ghost point schema but are given other names in classical sources, as documented by Deadman (2016) and Worsley (2004).[3] (See Appendix B). Unschuld elaborates on the origins of the thirteen ghost points and the roots of acupuncture in shamanism:

In his Ch’ien-chin i-fang, Sun Ssu-Miao cited the physician Pien Ch’io, purportedly active in the fifth century B.C., and indicated the exact location of thirteen puncture points for the needle treatment of demon-related illnesses. The . . . puncture points bear such revealing names as “demon camp,” “demon hearts,” “demon path,” “demon bed,” or also “demon hall”. The needles used to penetrate a “demon heart” in the treatment of an individual were analogous to the spears used by exorcists at the time of Confucius . . . . (Unschuld, 2010, p. 45)

Unschuld comments that it is possible that early uses of acupuncture “originally had purely demonic medicine functions” (Unschuld, 2010, p. 45). The thirteen ghost points are used to treat possession, but we have to examine what possession meant to Sun Simiao. As Jarrett (2005) points out, “definitions of all illness are culturally determined”. (p. 45). In Sun Simiao’s time, possession was associated with symptoms we now understand as mental illness and epilepsy, as Jarrett (2005) remarks, the thirteen ghost points are used “in modern times for the treatment of manic disorders and epilepsy”. (p. 45).

Thus, the demonology of early Chinese medicine has been translated into a psychological paradigm of illness and treatment which Fruehauf asserts is clinically evident and efficacious in pathologies of the gut-brain axis. Modern understandings of the microbiome shed more light on the matter, especially when we consider that neurotransmitters are synthesized and regulated in the gut by intestinal microbiota. Therefore, psychological pathologies manifest in a bi-directional relationship to the gut: microbiome imbalances are reflected in mental-emotional pathologies and psychological disorders are reflected in digestive pathologies. While parasitism can be understood in relationship to the gut-brain axis, it can also be interpreted purely in psychological terms, as Ellenberger (1970) does when he refers to possession as “intrapsychic parasitism” (see Appendix D) and as Worsley does when he links possession with mental and spiritual vulnerability.

II. Acupuncture and Psychoanalysis

In “The Psychologizing of Chinese Healing Practices,” Barnes describes how Western practitioners of Chinese medicine began incorporating psychotherapeutic ideas and explanations into medical theory, where “blocked” emotions and suppressed memories became part of the explanatory model of illness. Barnes (1998) explores how practitioners have cross-pollinated psychotherapy and acupuncture, with some practitioners blending the two and others maintaining strict distinctions:

For [some] practitioners, acupuncture is a plausible alternative to psychotherapy. Indeed, they feel it is possible to perform interventions for psychological problems that would eliminate the need for psychotherapy altogether. Still other practitioners, who distinguish between what one does as an acupuncturist and as a psychotherapist, choose not to blend the two.

The relationship between acupuncture and psychotherapy became a subject of consideration when Chinese medicine entered the European imagination, where acupuncture mingled with psychoanalysis, homeopathy, and naturopathy. The five-element tradition transmitted by J.R. Worsley brought acupuncture into the realm of psychological concern in the 1970s in the UK and America. The American psychiatrist and psychoanalyst Leon Hammer was another significant figure who consciously sought to bridge the two disciplines, regarding Chinese medicine and acupuncture as “congenial therapeutic partners”. (Hammer, 2010).

Worsley and Hammer were influenced by the available literature of the time, including Lawson-Wood’s Five Elements of Acupuncture and Chinese Medicine (1965), regarded by Eckman as the “first coherent book about acupuncture in English” (Eckman, 2007).[4][5] The text presents the basics of Chinese medical theory, emphasizing five-element theory. In a chapter titled “Psychological Considerations,” the authors mention Hahnemann’s Organon and the possibilities of a marriage between acupuncture and homeopathy. They also mention Georg Groddeck, a contemporary of Freud who explored the nature of psychosomatic illness.[6] The authors advocate for acupuncture treatment as an alternative to psychoanalysis:

When we talk about treatment of the psyche we are not thinking in terms of modern Western psychiatry, with use of shock and drugs, but rather in terms of psycho-analysis and systems derived therefrom. (Lawson-Wood, 1965).

Speaking only four years after Jung’s passing, the authors refer to the psychoanalytic tradition as a whole before presenting two key points:

(a)  Psycho-analysis, from the patient’s point of view, can be an expensive way of having the psyche treated; especially as a beneficial outcome is by no means certain.

(b)  Whether it is in the end successful or not, psychoanalysis seems inevitably to be accompanied by a great deal of emotional torment and distress. (Lawson-Wood, 1965).

With these practical concerns (expense and torment), the authors make a case for the capability of acupuncture to treat the psyche more effectively, more reliably, and with significantly less expense:

It is desirable, therefore, that there should be some alternative and far speedier method of resolving analytical problems. But this does not mean to say that we regard Chinese acupuncture by itself as an alternative to psycho-analysis in all cases; but rather do we intend to convey that a judicious use of Chinese acupuncture points can serve as an extremely useful technique for bringing about more rapid results, without torment, and with greater predictability. (Lawson-Wood, 1965).

We may be inclined to presume that such notions are entirely European in origin. However, the authors continue their thesis by providing classical justifications:

If one wants classical justification for lining psycho-analysis with acupuncture, we draw attention to the passages in the Nei Ching dealing with interpretation of dreams. Several thousand years before Freud the Chinese recognized that dreams represent a mechanism for symbolic wish-fulfillment.[7]

There should be no difficulty in appreciating that any disturbances in the flow and balance of Life-Force, with its two poles YANG and YIN, manifests itself as a disturbance of some degree in both psyche and soma. (Lawson-Wood, 1965).

The authors are referring to several passages from the Nei Jing that discuss pathological dreams. The first mention of dreams is found in chapter seventeen, “Discourse of Vessels and the Subtleties of the Essence,” verses 102-3:

When the yin [qi] abounds,
then one dreams of wading through a big water and is in fear.

When the yang [qi] abounds,
then one dreams of big fires burning.

When both yin and yang [qi] abound,
then one dreams of mutual killings
and harmings.

When [the qi] abounds above,
then one dreams of flying.

When [the qi] abounds below,
then one dreams of falling.

When one has eaten to extreme repletion,
then one dreams of giving.

When one is extremely hungry,
then one dreams of taking.

When the liver qi abounds,
then one dreams of anger.

When the lung qi abounds,
then one dreams of weeping.

When there are many short worms,
then one dreams of crowds assembling.[8]

The passage mentions several types of dreams. The dreams associated with organs reflect elemental and emotional correspondences in the five-element schema. Thus, “when the liver qi abounds, then one dreams of anger”. In the case of the Lung, the corresponding sound (weeping) is given instead of the emotion (grief), “when the lung qi abounds, then one dreams of weeping”. The Kidney is not mentioned by name but is associated with “yin qi” and “dreams of wading through a big water . . . “and fear.” The Heart is also not mentioned by name but subsumed in the category of “yang qi” that “abounds,” causing dreams of “big fires burning.”

“Dreams of crowds assembling” as a result of “many short worms” is a reference to parasitic infection. Dreams “of taking” when “one is extremely hungry” is the classic example of a wish-fulfilling dream. Some dreams simply reflect the pathological condition itself: “when the qi abounds above, then one dreams of flying”, “when the qi abounds below, then one dreams of falling”. Another type of dream reflects the opposite nature of the pathology: “When one has eaten to extreme repletion, then one dreams of giving,” a reference to food retention and the Earth element.

In chapter eighty, “Discourse on Comparing Abundance and Weakness,” dreams are mentioned again. Verse 568-5 states:

It is therefore that
a recession of [the type] being short of qi
lets one have absurd dreams.

In extreme cases, this leads to hallucinations.
(Unschuld, 2016).

Being “short of qi” is defined as qi stagnation in the yang meridians and qi deficiency in the yin meridians. In the following verse, five-element correspondences are referenced again in a dream associated with the Lung:

Therefore,
when the lung qi is depleted,
then this causes man in his dreams to see white items,
to see people executed, with [their] blood flowing in all directions.

When it is its time,
then he dreams of weapons and combat.
(Unschuld, 2016).

In this verse, the corresponding color of the Metal element is represented as the “white items” in the dream. We need only reflect on the potentially sharp and destructive quality of the Metal element to see the significance of the “vision of execution.”[9] “When it is its time” refers to the three months of Autumn in which the Metal element predominates. The chapter discusses dreams resulting from the depletion of liver qi, kidney qi, heart qi, and spleen qi. A concluding verse states:

In all these [cases],
the qi of [one of] the five depots is depleted.

The yang qi has a surplus, while
the yin qi is insufficient.
(Unschuld, 2016).

In other words, these dreams arise when the yin organs become deficient, resulting in overall yin deficiency and yang excess. This is why “dream-disturbed sleep” is generally regarded as a symptom of yin deficiency and/or pathogenic fire. Daoists view the having of dreams as an inherently pathological state, and the ceasing of dreams is symbolic of having transcended the psyche and thus become “immortal”—as Hammer recounts, “some authorities on Chinese medicine believe that a contented spirit does not dream.” (Hammer, 2005).

The dreams referenced in the Nei Jing illustrate a psychosomatic paradigm, with dreams functioning as a link between them. We can only retrospectively consider this to be “psychological” since the systematized discipline we call “psychology” is a nineteenth-century phenomenon, but its subject—the psyche—is universal. The psyche itself precedes nomenclature and tradition. Therefore, the so-called “psychologizing” of Chinese medicine may be a twentieth-century phenomenon of an indigenous medicine in exile, but this is only true in the superficial context of semantics. With its understanding of the pathogenesis of dreams, emotions, and organic imbalances, Chinese medical theory contains a psychotherapeutic paradigm.

Worsley gives diagnostic value to dreams, but cautions against overemphasizing their importance. He writes that a “dream can signify a message from a particular official” and that “such a dream, oft-repeated, may point specifically towards the element in distress which is causing element-related images to disturb the unconscious mind”.  (Worsley, 2012, p. 110)

Possession, Superego, and Western Psychiatric Disorders

Ellenberger (1970) distinguishes between two types of possession: somnambulic and lucid. He notes that in Catholic theology, “possession” refers to the “somnambulic” form, while “obsession” refers to the lucid form, a word he notes “has been adopted by psychiatry”. (Ellenberger, 1970). Worsley thus indicates a psychiatric pathology when he links spiritual deficiency with becoming “possessed by obsessions.” The theme of “obsession” gives us an immediate link to obsessive-compulsive disorder (OCD). OCD was initially known as “scrupulosity,” a reference to the term “scruples” in religious literature, meaning “obsessive concern with one’s own sins and compulsive performance of religious devotion.” The etymology of “scruples” traces to the Latin scupulum, meaning a “sharp stone” and implying a “stabbing pain on the conscience.” The eighteenth-century French psychiatrist Jean Esquirol described OCD as “monomania” and “partial insanity.” In the early nineteenth century, the French psychiatrist Henri Dagonet described OCD as “the more one tries to discard an idea, the more it becomes imposed upon the mind, the more on tries to get rid of an emotion or tendency, the more energetic it becomes.” In other words, repression is obsession is possession. Dagonet’s description thus conjures the Freudian concept of repression, that what one denies becomes repressed in the unconscious, where it gains strength through compensatory neuroses and defense mechanisms.[10]

In the late nineteenth century, Freud characterized obsessive-compulsive illness as an “obsessive neurosis” (zwangsneurose) arising from a deep inner conflict in the unconscious mind. His phrase is the origin of the modern terminology of “obsessive-compulsive disorder.” Freud viewed obsessive neurosis as a maladaptive pathology fueled by an egoic conflict between the id and superego. As Freud described, the superego is an “ego ideal,” the realm of the conscience, an internalization of parental and societal images, and the repressive force of conditioning.[11] The conflict between the ego and the “ideal” (superego) “reflect the contrast between what is real and what is psychical, between the external world and the internal world.” (Freud, 1960). This confusion between internal and external reality may be a hallmark of possession: the patient cannot access his own mental and spiritual resources (ego) and, in extreme cases, does not know how to function in society (superego). As a result, the patient’s libido (id, psychic energy)[12] remains deeply repressed.

Jung described the superego as an internal moral voice that arises from the anima/animus. He argued that this aspect of the psyche is both “consciously acquired” and “an equally conscious possession”:

The Freudian superego is not, however, a natural and inherited part of the psyche’s structure; it is rather the consciously acquired stock of traditional customs, the ‘moral code’ as incorporated, for instance, in the Ten Commandments. The superego is a patriarchal legacy which, as such, is a conscious acquisition and an equally conscious possession. (Jung, 1970).[13]

We have to note yet another shadow quality of the superego: perfectionism. The perfectionistic drive so often accompanies obsessions that they are practically inextricable. Perfectionism arises from the superego’s internalization of parental and cultural values and the conscience-driven need to fulfill them perfectly. Freud notes that the superego pursues perfection over and against the pleasure and reality principles (which belong to the id and ego, respectively). However, we have to apply this knowledge carefully: not every patient with perfectionistic tendencies is possessed, and not all perfectionistic drives are pathological.

Freud and Jung concluded that obsessive neuroses are a pathology in the unconscious egoic structure caused by a range of repressive reactions to moral, ethical, childish, emotional-sexual, and.or cultural conflicts. Thus, it can be argued that possession (as an obsessive pathology) is necessarily possession by the unconscious superego.

OCD is now woven into the modern colloquial lexicon, where “being OCD” is casually mentioned as a behavioral synonym for “anality.” Of course, the anality of OCD can only serve to bring us back to Freud, who traced many adult neuroses to arrested psychosexual development in the “oral,” “anal,” and “genital” stages of early life.[14] The anal stage spans from ages one to three and concerns the erogenous zone of bowel and bladder elimination. Psychological fixation in the anal stage results in “anal retentive” and “anal expulsive” pathologies. In five-element theory, eliminative pathologies belong to the Metal and Water elements. Whether patients diagnosed with possession also exhibit eliminative symptoms (constipation, diarrhea, nocturia, dysuria, enuresis, etc.) is worthy of further clinical exploration.[15]

From the perspective of psychoanalytic psychology, the treatment of OCD is the classic “talking cure,” whether in the form of Freud’s original “psychoanalysis” or Jung’s “analytical psychology.” Today, cognitive-behavioral models of psychology have become dominant, with treatments consisting of cognitive behavioral therapy and SSRI medications: fluoxetine (Prozac) for seven years and older, fluvoxamine (Luvox) for eight years and older, paroxetine (Paxil) for adults only, sertraline (Zoloft) for six years and older, and clomipramine (Anafril) for ten years and older. (Mayo Clinic, 2023). Other treatments include outpatient and residential treatment programs, deep brain stimulation,[16] and transcranial magnetic stimulation.[17] 

Spirit and Psyche

We must remember that a psychic substance does not and cannot mean one thing
—James Hillman, Alchemical Psychology, 2009.

What the Chinese call shen, the Greeks call psyche. While the term “spirit” has been adopted as a standard English translation for shen, the Chinese concept includes “spirit” and “soul.” The three treasures are expanded into five shen that reside in each of the yin organs:

• The Heart is the seat of shen—consciousness, memory, thinking, and sleep.

• The Lungs are the seat of po—the corporeal soul that animates the body while alive.

• The Liver is the seat of hun—the ethereal soul that wanders outside of the body and survives death.

• The Spleen is the seat of yi­­—intentionality and intellect.

• The Kidneys are the seat of zhi—willpower and wisdom.

The five shen describe the psychological qualities of the organs, illustrating the Chinese vision of organic physiology as a network of communication that integrates the body, mind, and spirit. The five shen are the spirits that naturally possess us.[18] They are the most profound aspect of organ function, the spirit of the physiology, the ghost in the machine.

Anima and Animus

Jung correlates the anima and animus with the hun and p’o, respectively. He writes:

According to our text, among the figures of the unconscious there are not only gods but also the animus and anima. The word hun is translated by Wilhelm as animus. Indeed, the concept ‘animus’ seems appropriate for hun, the character for which is made up of the character for ‘clouds’ and that for ‘demon’. Thus hun means ‘cloud-demon’, a higher ‘breath-soul’ belonging to the yang principle and therefore masculine. After death, hun rises upward and becomes shen, the ‘expanding and self-revealing’ spirit or god. ‘Anima’ called p’o, and written with the characters for ‘white’ and for ‘demon’, that is, ‘white ghost’, belongs to the lower, earth-bound, bodily soul, the yin principle, and is therefore feminine. After death, it sinks downward and becomes kuei (demon), often explained as the ‘one who returns’ (i.e. to earth), a revenant, a ghost.[19]

Jung’s articulation of the anima/animus extends from his notion of the unconscious as a structure of polarities. Every man has a feminine shadow known as the anima, and every woman has a masculine shadow known as the animus. The failure to integrate with these polarized unconscious elements is the source of all neurosis. Jung is drawing on Latin as he often does, where anima means “mind, soul” and animus means “spirit, mind.” Anima is yin, animus is yang; anima is the p’o soul, animus is the hun soul.

Jung discussed anima- and animus-possession as pathological states in which the unconscious shadow engulfs the psyche. One is possessed by the anima or animus, by the p’o or the hun. In this sense, we can interpret the broad category of yin or yang syndromes in terms of anima/animus possession: anima possession is a yin complex, animus possession is a yang complex. Severe possession by the anima or animus may result in the form of possession discussed by Worsley. However, anima/animus possession may also be evident as a Husband-Wife imbalance, Liver-Lung block, or a split within an element.

The Husband-Wife imbalance is a severe block that Worsley considered life-threatening. The basic premise of the block is that the right-hand pulses are stronger in quantity and quality than the left-hand pulses. This pulse picture is interpreted by Worsley as a separation of yin and yang, which is how Chinese medicine describes death. Given the feminine/masculine polarities of the anima/animus, we can surmise a severe conflict between these aspects as a relational crisis (either internal or external).

The Liver-Lung is one of several possible “exit-entry” blocks. This particular block is diagnosed when the Liver pulse (left middle position, deep) is excess relative to the Lung pulse (right first position, deep). Since the Lung follows the Liver in the circulatory flow of the meridian clock, this pulse picture is interpreted as a failure to transfer energy from the Liver to the Lung in the natural circulation cycle (per the meridian clock).[20] We can interpret the Liver-Lung block as a form of animus possession—the deficient Lung pulse shows that the p’o (or anima) is repressed and dominated by the animus (or hun). This would lead us to theorize that the Liver-Lung block is more common in women, but this premise needs further clinical evaluation.

The failure of the integration between the anima/animus can also manifest as a “split within an element”. This split within an element refers to an unequal amount of energy in the paired organs of a single element. When this block is evident, the superficial and deep pulses of the same position will differ in quantity. For example, if the Liver pulse is noticeably deficient in relationship to the Gallbladder pulse, then the paired organs of the Wood element are not sharing energy equally. Since the paired organs of an element are necessarily a yin-yang polarity, the split within an element indicates a defense mechanism destabilizing an element’s polarity. Jung’s definition of neurosis as “one-sidedness” comes to mind, as does Freud’s consideration of “splitting” as a defense mechanism. In the example of deficient Liver / excess Gallbladder, the anima represses the anima. (The association between anima-animus and yin-yang can be made for the remaining organ pairs within each element).

Possession as Complex

A psychoanalytical view of spirits views their existence and perception as a projection from the unconscious. Spirit phenomena are interpreted as a psychological phenomenon, rather than an ontological reality. Thus, possession is re-interpreted as a complex rather than an entity.

In “The Psychological Foundations of Belief in Spirits,” Jung (1969) argues that belief in spirits is itself the result of mental illnesses such as hysteria, schizophrenia, and nervous disorders. In anthropological fashion, he argues that what possesses us is the notion of possession itself. However, Jung’s intention is not to discount the phenomenon of spirit-possession; rather, it is to enfold possession within a psychological phenomenology. Thus, Jung asserts that the belief in and experience of possession results from an animistic consciousness, a participation mystique[21] in which the dream world and physical reality are fluidly merged. Jung (1969) identifies three phenomena in particular as the origin of belief in spirits: (1) “the seeing of apparitions, (2) dreams, (3) pathological disturbances of psychic life”. He describes these three phenomena as “psychic fragments” and places them in the “autonomous complexes” category.

In Jungian psychology, a complex represents an unconscious and thus disconnected aspect of the psyche: “Although the separate parts are connected with one another, they are relatively independent.” (Jung, 1969). What is separated from the whole becomes pathological, and its incomplete view of reality possesses our psyche. Therefore, all that we fail to integrate with becomes a complex of psychic possession.

Through our experiences in dreams, apparitions, and visions, we associate with an aspect of the psyche independent of the waking-state ego. Where do dreams, apparitions, and visions come from? Jung describes all three as an “irruption from the unconscious” in different contexts: dream is a “psychic product originating in the sleeping state without conscious motivation”; visions are “like dreams, only they occur in the waking state”; and apparitions are hallucinations from mental illness where “quite out of the blue . . . the ear, excited from within, hears psychic contents that have nothing to do with the immediate concerns of the conscious mind”. (Jung, 1969).

If dreams, apparitions, and visions are all irruptions from the unconscious, then belief in spirit-possession—and, by extension, the phenomenon of possession itself—is caused by a repression of unconscious material. Jung distinguishes between spirit-possession and soul-loss, correlating spirit-possession with the collective unconscious and soul-loss to the personal unconscious. Indeed, we see this idea in Worsley’s interpretation of possession as a psychic “block,” not as possession by a demonic entity but as possession by the shadow.

III. Possession in Five-Element Acupuncture

In the twentieth century, possession was re-examined by European thinkers. Freud, Jung, Ellenberger, and Worsley each brought forth a new cultural interpretation of spirit-possession as a psychological phenomenon rooted in the unconscious. In particular, Worsley’s presentation of possession represents a critical intersection between nineteenth-century psychoanalysis and classical acupuncture. (See Appendix C). As we encounter Worsley’s concept of possession, we will see how he articulates a theory of possession that leaves behind its demonological past and places it more firmly in a psychological category of illness.

Possession and the Somatic Unconscious

The part of the unconscious which is designated as the subtle body becomes more and more identical with the functioning of the body, and therefore it grows darker and darker and ends in the utter darkness of matter. . . . Somewhere our unconscious becomes material, because the body is the living unit, and our conscious and our unconscious are embedded in it: they contact the body. Somewhere there is a place where the two ends meet and become interlocked. And that is the [subtle body] where one cannot say whether it is matter, or what one calls “psyche.”
—C.G. Jung, Nietzsche’s Zarathustra, 1939.

If possession is a psychological pathology, then its treatment by acupuncture implies the existence of a somatic unconscious. The unconscious offers the meaning-values of interior, hidden, and yin. Therefore, the unconscious is the yin aspect of the psyche, the shadow of the spirit.

The unconscious can be posited as an interior and hidden structure analogous to the meridian system. The meridians function as invisible pathways that link the body's organs, emotions, and spirits, serving as unconscious structures within human physiology. The psyche is thus understood not only as the mind but as a substance in circulation. Meridians are thus the pathways of psychic circulation, a structure of the unconscious, the invisible domain of archetypes, images, and ancestries residing in our bodies. Meridians are interior, invisible, and hidden, but they are also palpable structures capable of being assessed and treated. We once drove demons out of bodies with spears, and now we adjust the psyche with the intention of fine needles.

The vessels of acupuncture are not reducible to arteries, veins, nerves, or pathways of fascial conduction. The vessels of acupuncture are invisible lines that circulate the vital essence known as qi. This is the image of an alchemical vessel—a container, cauldron, rotundum. A vessel is a method of containment. As a jug carries water, the vessels carry the life-force throughout the body, providing a container for qi. We heat the vessels with fire and puncture the vessels with metal to engender an alchemical transformation that is at once physical, mental, and spiritual. Thus, the alchemical vessels of the body are shapes of soul—pathways within which the spirits of libido circulate, containers within which the unconscious is made conscious.

Jung found that his psychological discoveries were best represented in the language of alchemy. In his commentary on The Secret of the Golden Flower, Jung (1962) remarks that “in content it is a living parallel to the psychic development of my patients.” (pp. 86-87). Jung discusses the nature of circulation as a symbol of psychic development, drawing parallels to the image of mandalas. Jung (1962) writes, “This symbolism refers to a sort of alchemical process of refining and ennobling; darkness gives birth to light; out of the ‘lead of the water-region’ grows the noble gold; what is unconscious becomes conscious in the form of a process of life and growth.” (p. 102). Circular movement is the nature of qi—and qi moves in vessels. The meridian structure thus becomes a circumambulatio of psychic circulation. Therefore, it is not so far-fetched to imagine that by puncturing the meridians, we are restoring psychic circulation where it has become stagnant, perverse, rebellious, invasive, or blocked.

Definition and Etiology

Worsley placed possession within the clinical schema of “blocks to treatment”, which he defines as secondary imbalances that prevent treatment efficacy and which therefore must be addressed before the root-treatment of the “causative factor” (C.F.).[22] Worsley describes seven different blocks to treatment. One or more may be present in any given treatment. (See Appendix C.)

If we accept the psyche as a circulatory process, then blocks represent an inhibition, even repression, of this natural flow. If health is circulation, then disease is a block. Stated differently—if health is sufficiency, then disease is insufficiency (or deficiency).

In Worsley’s system, possession is regarded as one of the more severe blocks to treatment. The idea of a possessed patient returns us to the magical context of shamanism and “spiritual” cure, but Worsley’s presentation of possession is less magical and more psychoanalytical. At the outset, Worsley (2012) disavows the demonic and other-worldly connotations of possession, defining it instead as a loss of psychological agency:

To many people, including students of acupuncture, the terms 'possession' and 'being possessed' may sound rather melodramatic and archaic. They are usually associated, in the psychological sense, with stories from the Bible and those modern horror films depicting the way people used to explain madness years ago. However, we only need to consider 'possession' in the basic and simple sense of 'taking over' to appreciate how appropriate it can be as the description of what we may find happening to some patients. It is as if some external agency or force has taken over a part of that person's control of energy. In a very real way, that person is no longer in control of his whole self. Someone who has lost control of a part of his energy system is not going to be able to respond properly to treatment. (p. 170)

Here, Worsley references the literal meaning of “possession” as “taking over”. Possession comes from the Latin possess-, meaning “occupied, held”. In Worsley’s interpretation, possession is a loss of autonomy and subsequent loss of access to vital resources. In other words, a possessed patient has lost connection to themselves—there is a vacancy in their spirit. A psychoanalytic interpretation indicates that the patient is not possessed by an external spirit or demon, but by the shadow of the unconscious.

Worsley (2012) places the etiology of possession internally, where a weakness of “spirit” leaves the person vulnerable to negative influences from within and without:

. . . A person who is strong in spirit, no matter how weak or defective his body, will not be as affected by internal or external destructive forces as someone whose spirit is weak. People whose mental and spiritual resources are deficient are vulnerable. They can more easily become possessed by obsessions of one kind or another. Sadly, this vulnerability is becoming more rather than less common and its incidence owes a great deal to the priorities which our present society sets for itself. (p. 170)

Mental and spiritual weakness leads to vulnerability, and vulnerability leads to obsessions—these are the keywords we will see repeated in five-element discussions of possession.[23] Worsley (2012) elaborates on the nature of obsessive behavior, giving the example of anal-retentive compulsions:

There are the sad cases of people who have become so worried about dirt and obsessed with hygiene that all through the day they have to wash themselves over and over . . . There are other people who become obsessed with the idea that they are failing to do something perfectly. They will continue to repeat the same sequence of actions over and over again because they are never satisfied. If we come across anything in the patient’s behaviour or case history that suggests obsessions of any kind, we become alerted to the possibility of possession. (p. 173)

Worsley’s description of obsessive behavior is similar to the Western psychiatric diagnosis of OCD and related disorders. Western psychiatry has explored the relationship between obsessive neuroses and possession since the early nineteenth century. More importantly, obsession implies a loss of control, and loss of control is Worsley’s fundamental definition of possession.   

Worsley refers to mental and spiritual weakness as a cause of possession. What does he mean by this? Worsley’s usage of “spirit” is an approximation of the Chinese shen, a term which is closer in meaning to the Greek “psyche” than it is to the common understanding of something “spiritual.” From a psychological perspective, a depletion of mental and spiritual resources describes a psychic deficiency, a loss of access to the psyche, a vacancy in the soul. Loss of access is another way of saying “unconsciousness”. When we lose access to the psyche, its resources and truths become invisible to us. Engulfed in the shadow of the unconscious, we become vulnerable to impositions of all kinds.

Worsley discusses the etiology of possession in broad terms, as there is no singular cause of the condition. In classical fashion, he organizes the etiology into internal and external causes:

Causes of possession can be internal or external, and they are not necessarily confined to mental and spiritual levels only. A physical shock, such as exposure to a sudden and extreme change of climate or temperate, can lock a person’s energy system into an abnormal pattern which he cannot unlock and restore to normal. At the mental level, possession can be caused by an external influence, as in the case of people who succumb to the hypnotic power exercised over them by others . . . In the majority of possession cases, however, the causes are internal. Such possession can take place either suddenly or insidiously over a period. The former can happen as the result of some terrible and shocking experience which literally terrifies the person out of his mind. The latter can happen, for example, in the case of drug-taking where the person is taken over by so-called ‘mind-expanding’ drugs; or in the case of meditation techniques intended to induce ‘out of body’ experiences. (Worsley, 2012, p. 173)

Worsley lists climatic shocks, psychological shocks, mind control, psychedelic drugs, and out-of-body experiences as potential causes of possession. Shock unseats the spirit, making us vulnerable to possession. Worsley’s mention of psychedelic drug use and meditation-induced experiences is primarily a criticism of escapism and disembodiment via a stimulus of some kind (whether drugs or meditation). However, these critiques cannot be taken as blanket statements. Worsley is pointing out possibilities, and we should not jump to conclusions simply because a patient discloses drug use or meditation practice. What makes health and disease in each person is unique to that person, their motivations, and the larger context of their life.

Worsley also suggests that possession has a cultural etiology, noting that spiritual vulnerability is becoming more common due to the “priorities which our present society sets for itself”. The idea that cultural conditioning is a cause of illness was one of Freud’s most influential observations.[24] Echoing his view, Hillman writes:

Our neurosis and our culture are inseparable . . . [it was] Confucius who insisted that the therapy of culture begins with the rectification of language. Alchemy offers this rectification. (Hillman, 2009)

Referencing Confucius and alchemy, Hillman brings the consideration of culture and illness into the history of Chinese medicine. The “rectification” of culture or patient also leads us to the Chinese medical concept of zheng qi—the “upright” or “righteous” qi.

The concept of zheng qi describes the body’s ability to maintain health in the face of external pathogenic factors. While it has some resonances with the Western medical concept of “immunity”, zheng qi is more than physical immunity—it is the integrity of the body, mind, and spirit that keeps us vulnerable and susceptible to possessions of all kinds. We can thus trace Worsley’s observations of “vulnerability” and “susceptibility” to a deficiency of zheng qi.  The function of zheng qi can be further elaborated as a conflict between zheng qi and xie qi where xie qi is translated as “perverse”, “evil”, or “pathogenic” qi. The upright qi prevents susceptibility to and eliminates pathogenic (or xie) qi. Thus, a deficiency in zheng qi results in an accumulation of xie qi. The relationship between zheng qi and xie qi may also help us understand why Worsley advised draining aggressive energy after clearing possession.[25]

Returning to Worsley’s assertion of a cultural etiology in possession, we understand xie qi to include any external pathogenic factor—including community, culture, society, and civilization. This focus reflects the Confucian understanding of the import of society and the “rectification” of virtues that enable harmony between the individual and society. Rectifications include the cultivation of five virtues—ren (compassion), yi (selflessness), li (recognition of the sacred), zhi (wisdom), and xin (integrity).[26][27]

Diagnosis and Pathogenesis

According to Worsley, possession can only be diagnosed by looking into the patient’s eyes. The practitioner knows the patient is “possessed” when there is a vacancy in the eyes, described by Worsley as the feeling that no one is looking back at you. This is distinguished from a sense of dullness or resignation in the eyes, signs that constitute a “spirit-level block” and lead to a different treatment protocol (which we will discuss shortly). Possession is diagnosed via the eyes because Chinese medicine regards the eyes as the “seat of shen”, confirming the adage that the eyes are the “windows to the soul”. Hammer elaborates on the Chinese concept of shen and its relationship to the Heart, Liver, and eyes:

The combined shen qi is the ‘spirit’ of the individual, which is said to live in the Heart by day, and in the Liver by night. During the day it may be accessed through the pupils of the eyes. In health it will be expressed as a shining light. In disease it may be dull, withdrawn, or out of control (wild). At night, it rests in the Liver and may be assessed by a person’s dreams. (Hammer, 2010, p. 6)

If we look at possession in terms of shen, then it appears to be more than a shen deficiency—it is an obscuration of shen, an eclipsing of the Sun within. According to Worsley, a possessed patient is fundamentally “unreachable.” Worsley (2012) continues to describe the possessed patient as someone drowning in the mask of persona:

How do we recognise that somebody is possessed? If his energy state is partially or seriously beyond his own control, we will soon sense that we are failing to reach him, that we are not really communicating with him. We will find that we are not getting honest responses, that we are continually talking to a mask or shell. (p. 170)

“Persona” literally means “mask”. Jung describes the persona as a compensatory personality that represses the unconscious. Persona is the “social face,” the constructed presentation in diametric opposition to the “Self.”[28] Therefore, the possessed patient may have a powerful persona, a mask that the practitioner needs to see behind for a proper diagnosis. While everyone exhibits a persona to one degree or another, those who are lost in their persona become vulnerable to possession. Thus, a practitioner may encounter various types of personalities with diverse levels of coherence. A possessed patient is not necessarily a psychiatric case, but Worsley (2012) gives possession psychiatric connotations when he describes the “worst cases”:

The worst cases are those where the person has lost control of mind and spirit to such an extent that he ought to be in a mental home under external care and control. In such cases, where the person is totally possessed, he simply cannot be reached, nor can he make any sense of what is happening around him. (p. 170)

Worsley indicates that the most severe forms of possession are akin to psychosis or “total insanity” (Worsley, 2012). He acknowledged that acupuncturists are not likely to see “many extreme cases of possession”. We can correlate such cases with “psychotic disorders”, a category in the DSM-5 that includes schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, psychotic disorder due to a general medical condition, substance-induced psychotic disorder, and unspecified psychotic disorders. Key symptoms across this class of disorders include delusions, hallucinations, disorganized speech, and manic or major depressive episodes.[29] (Substance Abuse and Mental Health Services Administration, 2016)

Traditional accounts of demonic possession have been translated into the clinical language of psychiatry as “schizophrenia”, due to the overlapping nature of the symptoms (hallucinations, hearing voices, etc.). Irmak (2012) holds that demonic possession may be a viable explanation for the hallucinations of schizophrenia:

We thought that many so-called hallucinations in schizophrenia are really illusions related to a real environmental stimulus. One approach to this hallucination problem is to consider the possibility of a demonic world. Demons are unseen creatures that are believed to exist in all major religions and have the power to possess humans and control their body. Demonic possession can manifest with a range of bizarre behaviors which could be interpreted as a number of different psychotic disorders with delusions and hallucinations. The hallucination in schizophrenia may therefore be an illusion—a false interpretation of a real sensory image formed by demons.

Irmak (2012) notes that the treatment of schizophrenia by a local faith healer has proved successful, with patients becoming “symptom-free after 3 months”. Irmak concludes that medical professionals should work in tandem with traditional healers to improve treatment outcomes for schizophrenia. While five-element acupuncture is not a form of “faith healing”, it does accommodate and operate within indigenous views of the world and illness. Therefore, I expand upon Irmak’s suggestion and propose that medical professionals consider the role of five-element acupuncture in treating possession syndromes.

In terms of diagnosis, Worsley cautions against developing any conceptual protocol around diagnosing possession and differentiates it from personality limitations of introversion or stylistic limitations in communication. Worsley (2012) calls practitioners to see with the eye of spirit to diagnose possession:

If diagnosis of possession were simply a matter of recognizing a particular look in the eye or a particular kind of introverted behaviour, then we would simply be able to look it up in a textbook and diagnose it in five minutes. Possession, however, is far too subtle for that. It is not simply a temporary failure to communicate. It is a failing of the spirit of the person, and in order to see it clearly, we have to be able to see with our own spirit. (p. 171)

While we can notice many similarities between the symptomology of possession and Western psychiatric disorders, the two do not necessarily overlap. A patient with a Western medical diagnosis of OCD or schizophrenia may not necessarily be possessed per Worsley’s criteria. It is best if we view these conditions as possibly overlapping but not directly correlative. For one, the diagnosis of possession relies on a subtler form of perception than symptomatic analysis. Therefore, in the context of acupuncture, possession remains a spirit-level pathology diagnosed by the practitioner’s spiritual eye.[30]

Treatment: Seven Devils, Seven Dragons

The quality of an acupuncture point is metaphorically embedded in its name—this principle can be applied to all of the point names and the functions they represent.[31]
—Sun Simiao

Worsley taught two acupuncture protocols for clearing possession: “internal and external dragons.” While the protocol is clearly described in the mythical language of the Chinese imagination, it is not referenced in any texts. Worsley attributes the protocol to the oral tradition of his teachers.

Worsley (2012) describes possession as “being taken over by” seven devils. In the broader context of Chinese medicine, the seven “devils” refer to the seven emotions (qi qing): joy, anger, worry, grief, fear, fright, and pensiveness. By needling a sequence of seven points with a specific needle technique, the practitioner could release the “seven dragons” to consume these seven devils:

The ancient Chinese used picturesque language to describe possession and its removal. They spoke of people being taken over by external or internal devils, and needling the special points as releasing the seven external or internal dragons which could drive the devils away. (Worsley, 2012, p. 174)  

On the nature of the protocol, Worsley (2012) indicates that possession treatment is not technically part of the five-element tradition but is utilized as a preliminary procedure:

Such treatment follows set formulae and hence belongs to what we call a different ‘patron’ of acupuncture . . . However, Worsley Acupuncture will not work if possession is present, we must ‘borrow’ this method of removing it. (p. 173)

The seven-needle protocol for “releasing the seven internal dragons” is mostly located on the Stomach meridian: CV-15, master point[32] (Dove Tail), ST-25 (Heavenly Pivot), ST-32 (Prostrate Hare), ST-41 (Released Stream). When needled bi-laterally, a total number of seven needles are employed. The points are needled top to bottom with what Worsley calls “sedation technique”—right to left and retained with a 180°counter-clockwise action on the needle.[33] A perpendicular insertion to the appropriate fen[34] depth is favored for all points. The needles are retained for up to twenty minutes. The practitioner only knows that possession has cleared by looking into the patient’s eyes again.[35] If, after twenty minutes, there is no change in the patient’s eyes, then the practitioner should tonify the needles (left to right, 180° clockwise action).[36] Once the needles are removed, the hole should be left open, to “vent”.

A variant protocol first published in Worsley’s Acupuncturists’ Therapeutic Pocket Book (1975) substitutes a “master point below ST-36” for ST-32 in cases of “possession with depression”.[37] This protocol was subsequently maintained in the first, second, and third editions of Worsley’s Meridian and Points textbook.[38] According to Judy Worsley, when the fourth edition was being revised in 2003,  J.R. Worsley suggested its removal:

When we were revising the fourth edition of Meridians and Points, J.R. felt that it would be best to remove the possession with depression protocol. J.R. remarked that it was not something he really found useful in practice and that it added unnecessary complication to the possession treatment protocol. He said that in his experience, the internal dragons protocol without depression works in all cases of possession. The other thing that was concerning to him was that whether or not someone has depression is too subjective of a factor. If you say to somebody, “Do you feel depressed?” it becomes too focused on a symptomatic orientation. Ultimately, J.R. felt that the possession with depression protocol introduces a level of complication that is not needed or clinically useful. (Judy Worsley, personal communication, June 19, 2024)

If possession has not successfully cleared with the internal seven dragons protocol, then the practitioner should re-check their point location before moving on to the seven external dragons protocol. The external dragons are invoked with the same technique but with the patient seated upright:[39] GV-20 (One Hundred Meetings), BL-11 (Great Shuttle), BL-23 (Kidneys Correspondence), BL-61 (Servant’s Aide).[40]

The seven internal dragons correspond to pathological emotions; the seven external dragons correspond with climatic factors: cold, wind, heat, fire, dampness, dryness, and trauma. Despite this theoretical link, Worsley does not consider emotional symptoms or climatic invasions as a basis for diagnosing possession, owing to his emphasis on direct perception rather than symptomatic analysis. As with several of Worsley’s treatment protocols, clearing possession is a potentially multi-step protocol. It should be noted that internal and external dragons are not chosen based on the perceived nature of the etiology (internal or external) or the patient’s symptoms. If possession is diagnosed, one first proceeds to the internal dragons treatment.

Worsley’s blocks to treatment are all employed in a specific sequence. In an initial treatment, if a patient is diagnosed with possession, it should be treated before draining Aggressive Energy[41] or clearing a Husband-Wife block (if present). After clearing possession, Worsley advises the practitioner to treat the patient on their “level” and use command points[42] to anchor the treatment and prevent recurrence.[43] Source points on the patient’s C.F. are recommended to conclude a possession treatment. Worsley (2012) writes:

Just as sickness does not occur on one level alone, so there are no acupuncture points that affect one level alone. The least to the most experienced practitioners will most frequently use the command points which beneficially affect body, mind and spirit in a variety of ways. Simply using a source point also helps to restore balance at all levels simultaneously. It is thus possible to treat the spirit with command, source, and simple element points. There are, however, certain points that reach the spirit even more directly. If a person’s illness is primarily at this level, we may select these points in order to bring help directly to his spirit. [44] (pp. 184-185)

Worsley is referring to points on the upper Kidney meridian and outer Bladder meridian. These points (along with points on the Conception and Governor Vessels) are used in the context of treating any C.F.[45] A majority of these points have “spirit” or “soul” in their names. [46] (See Appendix D). Worsley’s emphasis on possession, point names, and the spirit of the patient makes his approach a revival of Tang dynasty values, especially as seen in Sun Simiao.

According to Judy Worsley, "A person becomes possessed at a point when they are vulnerable. If they do not move beyond that vulnerability through treatment and lifestyle, then possession could recur”. (Judy Worsley, personal communication, 2022). To prevent recurrence, we have to consider the treatment as a whole. After clearing possession, Worsley recommends draining Aggressive Energy as a standard procedure, even if Aggressive Energy has been drained in previous treatments. Any of the points referred to above can be considered following a possession treatment to further support the patient’s spirit level and to prevent recurrence. However, the “less is more” maxim applies here, and our point selection is carefully considered to support the patient post-possession without overtreating.

Treatment as Exorcism

Although Worsley interprets possession as a psychological imbalance, a shamanic perspective still pervades his perception, especially in his discussion of patient reactions to the possession treatment:

This reaction can be so mild as to be scarcely perceptible, but in some cases, it can be dramatic, and we should be prepared for it. In the clearing process, many patients will experience a degree of shivering or uncontrollable movement. (Worsley, 2012, p. 173)

Worsley’s description reads identical to what one envisions in an exorcism. We can also understand shaking movements as a natural response to the re-introduction of the life-force where it was previously stagnant, deficient, or blocked. Such movements are similar to the purifying movements (kriyas) that yogis experience when the Kundalini awakens and courses through the body. The “serpent power” of the Kundalini shares symbolism with the East Asian dragon—both are alchemical archetypes of inner transformation and spiritual awakening.[47]

In “Depression and demonic possession: the analyst as an exorcist”, Asch (1985) compares the process of psychoanalysis to exorcism:

Psychoanalysis has evolved a concept of depression that deals with ideas about introjects,[48] rather than conceiving of them as concrete toxins or demons. Psychoanalytic treatment is a cognitive technique for "exorcising" certain identifications by delineating them and then neutralizing them through understanding. 

Where psychoanalysts view demons as introjects, acupuncturists view demons as energetic vacancies. Where psychoanalysts exorcise through understanding, acupuncturists incise with needles.

From Possession to Obsession: Blocked Affect as Block to Treatment

In The Discovery of the Unconscious, Ellenberger (1970) asserts the origins of psychotherapy in exorcism:

Exorcism has been one of the foremost healing procedures in the Mediterranean area and is still in use in several countries; it is of particular interest to us because it is one of the roots from which, historically speaking, modern dynamic psychotherapy has evolved.

Ellenberger’s supposition is confirmed by Jung in a memoriam written two weeks after Freud’s passing on September 23, 1939:

Freud owed his initial impetus to Charcot, his great teacher at the Salpetriere. The first fundamental lesson he learnt there was the teaching about hypnotism and suggestion, and in 1888 he translated Bernheim`s book on the latter subject. The other was Charcot’s discovery that hysterical symptoms were the consequence of certain ideas that had taken possession of the patient’s “brain.” Charcot’s pupil, Pierre Janet, elaborated this theory in his comprehensive work “Nevroses et idees fixes” and provided it with the necessary foundations. Freud’s older colleague in Vienna, Joseph Breuer, furnished an illustrative case in support of this exceedingly important discovery (which, incidentally, had been made long before by many a family doctor), building upon it a theory of which Freud said that it “coincides with the medieval view once we substitute a psychological formula for the `demon` of priestly fantasy.” The medieval theory of possession (toned down by Janet to “obsession”) was thus taken over by Breuer and Freud in a more positive form, the evil spirit—to reverse the Faustian miracle-being transmogrified into a harmless “psychological formula.” It is greatly to the credit of both investigators that they did not, like the rationalistic Janet, gloss over the significant analogy with possession, but rather, following the medieval theory, hunted up the factor causing the possession in order, as it were, to exorcize the evil spirit. Breuer was the first to discover that the pathogenic “ideas” were memories of certain events which he called “traumatic.” This discovery carried forward the preliminary work done at the Salpetriere, and it laid the foundation of all Freud`s theories. As early as 1893 both men recognized the far-reaching practical importance of their findings. They realized that the symptom-producing “ideas” were rooted in an affect. This affect had the peculiarity of never really coming to the surface, so that it was never really conscious. The task of the therapist was therefore to “abreact” the “blocked” affect. (Jung, 1939).

It appears that both Freud and Worsley propose an interpretation of “possession” as a “block”—for Freud, it is a “blocked affect”, for Worsley a “block to treatment”.

Instrumentality: Practitioner as Medium

            Here, it is worth recalling Kaptchuk’s remark about Worsley as a shamanic healer. Eckman (2007) recounts:

Ted Kaptchuk mentioned to me, after watching Worsley at work, that he thought Worsley was the greatest shamanistic healer he had ever seen. I think this is an aspect of our profession that needs to be brought out into the open, and Worsley has constantly stressed that developing the deepest possible rapport with patients and then allowing yourself to become an instrument for forces beyond your own personal power, is what we should all be striving for. That’s a good definition, as far as I’m concerned, of a shaman.

Worsley emphasized the function of the practitioner as an “instrument of nature”, an emphasis that invokes the shaman as a medium. However, in Worsley’s tradition of acupuncture, the practitioner is not an instrument for spirits, guardians, or entities of any kind. Rather, nature is the force that moves through the practitioner. Thus, nature itself is the agency of treatment, and the practitioner is nature’s instrumentality. Eckman (2007) later confirms our earlier premise when he writes, “Acupuncture itself likely originated from the exorcistic practices of the early shamans or wu”. (p. 215)

Internal Dragons

Returning to the seven dragons, the origins of Worsley’s treatment protocol remain somewhat mysterious. Worsley states that he learned the protocol from his Master Hsuie. (Eckman, 2007).[49] Eckman’s research suggests the origins of the internal dragons treatment as a Tang dynasty protocol:

The Internal Dragons treatment, including the Master Point on the conception Vessel, was identified as a Tang dynasty prescription for hysteria by an aged acupuncturist interviewed by Allegra Wint at the Yunnan College of TCM in Kunming in 1982. (Eckman, 2007, pp. 227-228).

However, the reason for choosing either seven-point combination remains open to interpretation. To my knowledge, Worsley did not discuss why any of the points chosen are used to treat possession; he simply passed on the protocols he was taught. However, if we reflect on these points, possible interpretations surface. Six of the seven points are located on the Stomach meridian, one of two meridians constituting the Earth element. The Earth is regarded as yin and is therefore receptive. Spending time in nature and walking barefoot on the ground are considered a means for releasing negative psychic tensions. The Earth receives our tensions and transforms them. Thus, Worsley’s possession protocol may very well be a form of “Earthing” the psyche to release and transform its devils. Worsley writes on the function of the Stomach, “It is like having an anchor, a point which grounds us to the Earth and guarantees us the same sense of connection which we had when were babes in arms and depended entirely on our physical mothers.”[50] (Worsley, 1998, p. 144).

The reliance upon the Stomach meridian to treat possession also points us to the role of “Stomach Qi” in maintaining health. In the Nan Jing, “Stomach Qi” is regarded as the basis of health. When Stomach Qi is sufficient, the zang-fu are healthy, and the body is protected from external invasions. Therefore, attending to Stomach Qi remains the basis for preventing “possessions” of any kind, whether climatic or demonic. Master Nagano is famous for remarking, “Always attend to Stomach Qi.”[51]

As the “official in charge of rotting and ripening,” the Stomach returns us to the alchemical image of the rotundum, the cauldron in which poisons are transformed into nectar, where pathogens and parasites are “cooked” in the fire of health, where possession is cleared through invigoration of Stomach Qi.

Looking at the points more closely, we see that ST-25 (Heavenly Pivot) is located on the same level as the umbilicus)[52], a region regarded as the “Celestial Pivot” in the body. The Essential Questions states:

The area above the celestial pivot is ruled by the celestial qi; [the area] below the celestial pivot is ruled by the earthly qi. The place where these qi intersect is the origin of man’s qi and the ten thousand things. (Deadman, 2016, p. 148)

This passage describes the umbilicus as the transitional pivot between heavenly and earthly sources of qi. As a transitional zone, the umbilicus is an alchemical locus where heavenly and earthly qi mix in the middle. The umbilicus (CV-8) is also seen as the central confluence of all the vessels in the body, making this an important area for achieving a global effect.[53] ST-25 is classified as the front-mu point of the Large Intestine, where connotations of “elimination” and “release” seem relevant. One notable indication for this point is “severe heat with manic raving”. (Deadman, 2016, p. 148)

ST-32 (Prostrate Hare), the next point in the protocol, is listed in Deadman (2016) with indications for “mania” and “ghost talk”. (p. 155) ST-32 is located on the thigh and is rarely used in TCM applications. The name of the point, “Prostrate Hare”, invokes the image of the Rabbit, a prominent lunar symbol in East Asian cultures.[54] The Rabbit is said to hold the essence of the Moon, and thus the Rabbit embodies yin. The Moon is both a symbol for the psyche and an image of benevolence, epitomized in the peaceful Rabbit, burrowed underground where nothing can possess it. Rabbits are also notoriously difficult to catch (or “possess”), owing to their clever minds and agile movements.

ST-41 (Released Stream) is the fire point of the Stomach meridian. Since Fire is the Mother of Earth, ST-41 is the tonification point for the Stomach meridian. We can interpret this point as igniting the fire of transformation, in tandem with the symbol of the fire-breathing dragon. The name of the point, “Released Stream”, suggests a liberation of blocked energy, a free and coursing movement previously obstructed. Deadman (2016) lists “mania”, “epilepsy”, “agitation”, “sadness and weeping”, “fright palpitations”, and “seeing ghosts” among the indications of ST-41. (p. 168) As a distal point located in the center of the ankle, ST-41 is the most yang of the seven points in the protocol, and thus one of the most powerful points invoked in the treatment. 

The last point to consider is CV-15 (Dove Tail), the luo point of the Conception Vessel. Worsley’s precise instruction is that the “master point” of CV-15 (located halfway between CV-15 and CV-14) should be needled in the possession treatment. The point name refers to the Asian turtle dove, a bird whose native distribution spans from Central Asia to East Asia and Japan. In one Chinese legend, a turtledove helped the Han-dynasty Emperor, Gaozu, escape from his arch-nemesis, Xiang Yu. This myth portrays the Chinese view of the turtledove as a symbol of heavenly protection from evil. If we translate this myth into the language of Chinese medicine, then the turtledove protects the “emperor” (Heart) from evil influences. As Deadman (2016) notes, the primary action of this point is to regulate the Heart and calm the spirit, with its indications including the “five types of epilepsy”, “mania”, “mad-walking”, “mad singing”, “fright palpitations”, and “oppressive sensation in the Heart”. (p. 516)

What we know as epilepsy today was often regarded as a form of possession in indigenous cultures—and epilepsy is an indication for CV-15 and ST-41, while mania is a pervasive indication of all seven points. Whether these indications, point names, and “Earthing” theory serve as adequate explanations or not, they do establish a resonance in tandem with Worsley’s usage. We can also consider that individuals who have experienced shock or overindulge in psychedelic drugs or use meditative practices to ascend from the body are becoming ungrounded—the psyche is uprooted, and the navel is empty. 

External Dragons

The internal and external dragon protocols encompass the front and back of the body, respectively. Chinese medicine regards the front of the body as yin and the back of the body as yang. These meanings resonate with Worsley’s designation of the protocols as “internal” (front, yin) and “external” (back, yang). As we noted earlier, the choice between internal and external dragons has nothing to do with the etiology of possession or the patient’s symptoms. However, we can still offer some insights on the points chosen for external dragons.

GV-20 (One Hundred Meetings) is the baihui, located on the crown of the head, corresponding to the crown chakra of Indian yoga and the entry point for heavenly qi in Daoism. Deadman (2016) notes that one connotation of the point name is its function as the meeting point of the Governing Vessel with the Bladder, Gallbladder, Sanjiao, and Liver meridians. GV-20 is also listed in the “Sea of Marrow” category. Deadman (2016) references other names for this point that reveal its function: niwangong (Mud Ball Palace) is a reference to Daoist qigong theory which located the “material aspect of spirit” in the brain; tianshan (Mountain of Heaven) is a reference to the point’s location on the summit of the body; guimen (Ghost Gate) is a reference to the point’s ability to expel ghosts, which Deadman interprets as its “influence on psycho-emotional disorders”. (p. 553) Deadman (2016) lists several indications for GV-20, of which the following are noteworthy: wind stroke, loss of consciousness, wind epilepsy, agitation and oppression, fright palpitations, disorientation, much crying, sadness and crying with desire to die, and mania. (p. 553) These indications represent different aspects of possession syndromes. The psychological symptoms are obvious, but beyond this, we see stroke, epilepsy, disorientation, loss of consciousness, and fright—conditions that have been historically associated with spirit-possession.

BL-11 (Great Shuttle) is the meeting point of the Bladder, Small Intestine, Sanjiao, Gallbladder, Governing Vessel, and bones. It is also one of the points grouped in the “Sea of Blood” category. The point is located 1.5 cun lateral to the lower border of T1, an area in proximity to the “wind gate” where pathogenic invasions enter the body. Indeed, the point is used for expelling pathogenic factors and “firming” the exterior. Deadman (2016) notes that BL-11, as the meeting point of bones, is indicated for “various bone diseases and rigidity and pain of the neck, spine, and lumbar region” due to external pathogenic invasions. (p. 264) Its relevance for treating possession is given in the Ling Shu which recommends BL-11 “for treating contraction of the sinews that may accompany madness”. (Deadman, 2016, p. 265) As a point in the “sea of blood” category, BL-11 has a powerful effect on Blood, an essential yin substance that anchors the spirit.

BL-23 (Kidney Correspondence) is the back-shu point of the Kidney, located on the lower border of L2, 1.5 cun lateral to GV-4 (mingmen, the gate of life-destiny). Deadman (2016) writes that BL-23 is “one of the principal acupuncture points to strengthen the Kidneys, fortify yang, nourish yin, and benefit essence”. (p. 283) The Kidneys are the root of life, the seat of jing (essence), and the source of pre-natal qi. The location of this point on the same level as the mingmen indicates the depth of its function in restoring the yuan qi of the individual. By empowering the mingmen, this point nourishes the source qi and, thereby, our alchemical destiny—seen in Daoist alchemy as the dynamic interaction of constitutional nature (xing) and life-destiny (ming).[55] 

In summary, we see that the points used in the external dragons protocol are appropriate and well-justified in classical sources. Together, these points form a critical dynamic in the treatment of possession: GV-20 connects the patient to the heavenly source of qi, BL-11 expels pathogens, restores yang, nourishes Blood, and BL-23 resurrects the root-vitality of the mingmen.

Soul-Loss and Resurrection

For every needling, the method above all is not to miss the rooting in the Spirits.
—Ling Shu, Chapter 8.

The symbol of exorcism is encountered again in another of Worsley’s blocks to treatment, the “spirit block”, defined by Worsley as a block in “level”. Worsley describes needling a point as a multi-dimensional event that simultaneously reaches the patient's body, mind, and spirit. A block in “level” occurs when the patient’s “spirit” is unable to be reached in treatment. Worsley differentiates this from possession—the patient is not possessed, but they are spiritually resigned and robotic in presentation. The “spirit block” is also diagnosed in the eyes, where a patient is still present but the light in their eyes is dim. Thus, the “spirit block” is a form of temporary spiritual deficiency that is less severe than possession (where the patient is not spiritually deficient but spiritually absent).

The treatment of this block centers around one point, needled bi-laterally: KD-24 (Spirit Burial Ground). Worsley places great emphasis on the name of this point, describing the spirit burial ground as the place where the patient’s access to the spirit-level of existence can be resurrected. The word “access” is key here, because Worsley did not believe that acupuncture could treat the spirit, rather it could restore a person’s access to the spirit level. The idea of a burial site (death) being the site of new life (resurrection) is ancient. Thus, there is life where there is death, and transformation in the burial ground. In discussing the meaning of an acupuncture point, Matsumoto and Birch (1998) suggest that the Chinese term for an acupuncture point (xue) refers to a burial ground:

The character xue, commonly translated as "point" or "acupoint," literally means "hole” . . . The true connotations that accompany the Chinese character need to be associated with the English translation. The character xue itself has more the meaning of a hole, a pit, than the more geometrical concept of a point or position. Classically it meant a cave. The Shuo Wen Jie Zi says the xue refers to a "chamber below the earth" (Mor). Several other classical texts report that the term refers specifically to a grave or gravesite. (p. 20)

The location of KD-24 in the third intercostal space is also significant because of its proximity to the Heart (the seat of shen). Jarrett describes the location of this point as being on the “Kidney / Heart axis”, two organs that are related in six-channel theory as comprising the shaoyin channel. The treatment consists of burning seven moxa cones on KD-24, bi-laterally, and then needling the points with tonification technique.[56][57] The efficacy of the treatment is confirmed by examining the patient’s eyes post-treatment, and noting whether the “shine” of the spirit has returned or not. If not, point location, the presence of other blocks, the use of spirit-level points, or an inaccurate C.F. diagnosis should be considered.

A variant of the “spirit block” is noted in rare cases where a patient is not merely spiritually resigned but spiritually disconnected. The treatment of this block involves needling HT-1 (Utmost Source) bi-laterally, where the meaning of the name describes the function of reconnecting the patient to the spiritual source of existence. Thus, in Worsley’s system, we see parallel themes of possession/exorcism and resurrection/re-connection. Encompassed within them is the rich history of Chinese medicine, its shamanic origins, and the clinical relevance of their psychotherapeutic applications today.

IV. Demon or Daemon: The Vale of Soul-Making

Call the world, if you please, “the Vale of Soul-making.” Then you will find out the use of the world.
—John Keats, Letter to George and Georgiana Keats, 1819.

We cannot conclude our discussion of possession without asking the question it so clearly begs: What is it that possesses us? In the course of our examination, we encountered an evolving answer to this ancient query. We traced the notion of invasive pathogens from malevolent spirits to climatic conditions, from possession by entity to possession by shadow, and from obsessive compulsions to soul loss. Regardless of how we conceive of possession, the ritual of treatment in acupuncture therapy maintains the ceremony of exorcism—from excising demons to empowering the psyche, from driving spears to inserting needles, from fumigation to moxibustion, from tribal relations to professional rapport, from mediumship to instrumentality.

Despite the pathological connotations of possession, our consideration would remain incomplete without examining possession as a phenomenon of health. Spirits are not only external invasive factors that rob us of life-force, they are also intrinsic energetic factors that maintain the life-force, as each of the yin organs are said to have a spirit. The question returns: What are we possessed by? We are not only possessed by the other, we are also in possession of soul and spirit. Perhaps we are not possessed by demons but dis-possessed by our daemon, left vacuous in our soul. What if possession is not an invasion but an emptiness in our soul, a block in our creative instinct? What the Greeks referred to as daemon was the guiding spirit of fate, as daemon means “god”, “power”, and “fate”.

The daemon is the calling of character, and it possesses us with purpose, meaning, and destiny. The truth hidden within the unconscious emerges of its own accord as the synchronicity of the present and the fate of the future. As Hillman said, “A calling may be postponed, avoided, intermittently missed. It may also possess you completely. Whatever; eventually it will out. It makes its claim. The daemon does not go away.” (Hillman, 1996, p.8). Perhaps the only demon is the one who blocks our daemon, who silences the call of the spirits, who cools the gate of life and delays our destiny.  If so, then the treatment of possession can be re-visioned as a clearing of this daemonic block, empowerment of calling before empowering the character it emerges within. Thus, when entering the clinic, we are not only asking for a cure, we are standing in the vale of soul-making.

As Keats said, “There may be intelligences or sparks of the divinity in millions—but they are not Souls till they acquire identities, till each one is personally itself.” (Keats, 1965) The treatment of possession with acupuncture beckons us to consider the esoteric mechanism of its therapeutics for the body, mind, and spirit. Acupuncture can be used not only to relieve physical pain but also psychological suffering. Our existential angst can be transformed by making the unconscious conscious in the body, by becoming who we are in the spirit of every point and flow. 

Notes

[1] Demonic possession is also a well-established category of illness in Ayurvedic medicine where it is known as bhūta vidya (the knowledge of spirits) and in Tibetan medicine where it is known as gdön nad (provocation disorders).

[2] In Tibetan medicine, parasites are not necessarily regarded as demonic spirits, but demonic spirits (provocations) are regarded as the primary etiology in contagious and epidemic diseases (rims nad and nyen-rims).

[3] “Demon” is a translation of the Chinese gui. The term is also translated as “ghost”. Jarret (2005) substitutes “ghost” for “demon” in his list of the thirteen ghost points.

[4] Hammer (2005) writes that the inspiration for his perspectives on integrating Chinese medicine with psychoanalysis came from Lawson-Wood (1965) in 1973. He writes, “My exposure to the Worsley school came long after these ideas were conceived. Recently, I have been drawn to that school, as well as to the Japanese system of the hara and Toyahari, as a part of returning to a way of working with energy that accentuates balance and a more sensitive, delicate, and respectful use of energetics.” (Hammer, 2005).

[5] Eckman (2007) cites Lawson-Wood as a “an early colleague of Worsley’s” (p. 99).

[6] See The Book of the It and The Meaning of Illness. Alan Watts said of Groddeck. “. . .  He practiced massage for people who came to him for analysis, and analysis for people who came to him for massage”. (https://www.organism.earth/library/document/who-is-it-that-knows-there-is-no-ego)

[7] Freud formulated the hypothesis that dreams were a symbolic expression of wish-fulfillment in The Interpretation of Dreams (1899).

[8] Unschuld, Su Wen, 286.

[9] For more on the relationship between the Metal element, destructiveness, and tyranny, see Fruehauf’s article, “Visions of the Baojun: Donald Trump and the Pathological Large Intestine Archetype in Classical Chinese Medicine” (2017).

[10] See Anna Freud’s elaboration of her father’s concepts in The Ego and the Mechanisms of Defence (1936).

[11] Freud’s theory of the superego is intimately tied to the Oedipus complex. He writes, “The ego ideal is therefore the heir of the Oedipus complex, and thus it is also the expression of the most powerful impulses and most important libidinal vicissitudes of the id”.

[12] Jung’s concept of the libido expands upon Freud’s instinct theory to include the totality of one’s “psychic energy”. See The Psychology of the Unconscious (1907).

[13] Jung’s discussion of conscience runs parallel to Freud’s superego, but differs in its specification of two levels of the conscience—the ethical and the moral—where Freud had only identified the “moral” aspect of the superego.

[14] For an excellent interpretation of anality, see Brown, N. O. (1959). Life Against Death: The Psychoanalytical Meaning of History, Part Five: Studies in Anality, pp. 179-307.

[15] While eliminative pathologies can be described in correspondence with the Metal and Water elements, this does not mean that Metal and Water C.F.s are necessarily possessed, or that a higher incidence of possession is found in patients diagnosed as Metal and Water C.F. Worsley would strongly discourage making such diagnostic associations, because symptoms in any of the five elements are necessarily in evidence due to the presence of a C.F. in any element. The purpose of highlighting the association with obsession, possession, and anal-stage pathologies is to better understand the psychological sources of possession.

[16] DBS treatment is indicated for adults eighteen years and older who have not responded to other therapies. Electrodes are implanted in parts of the brain, the idea being that electrical impulses will help control the obsessive impulses of the OCD patient. This treatment is not widely available and is rarely used.

[17] TMS treatment makes use of one of three FDA-approved devices that uses magnetic fields to stimulate nerve cells in the brain.

[18] For a psychological exploration of the five spirits, see Dechar, L. (2006). Five Spirits: Alchemical Acupuncture for Psychological and Spiritual Healing. Lantern Publishing and Media.

[19] Wilhelm, Jung, Golden Flower, p. 115.

[20] Worsley differentiates between two levels of energetic circulation: ying and wei. The ying level reflects the flow of “nutritive” qi within the meridians, the wei level reflects the superficial flow of protective qi and moves in a cycle per the meridian clock.

[21] The concept of participation mystique is credited to the French philosopher, Lucien Lévy-Bruhl, who coined the phrase in his book How Natives Think (1912).

[22] Worsley defines the “causative factor” (C.F.) as the source of imbalance in the five-element cycle. The C.F. is necessarily one of the five elements, the diagnosis never changes, and is evident at birth. According to Worsley, the C.F. is discovered solely via a perceptive diagnosis of the patient’s color, sound, odor, and emotion—not through symptomatic, behavioral, astrological, or structural analyses. For a discussion of C.F. diagnosis, see Worsley (2012, pp. 29-45). While Worsley maintained the C.F. as an etiological factor rather than a constitutional component, Hicks (2004), Jarrett (2005), and Eckman (2007 ) refer to the C.F. as the “constitutional factor”, maintaining that the term “constitutional” is more accurate. Judy Worsley elaborated upon this issue in “Professor J.R. Worsley: Causative Factor (C.F.) and More”.

[23] In occult literature, obsession is explicitly linked with demonic possession. In Psychic Self-Defense (1930), Dion Fortune writes, “The question of obsession is an exceedingly important one. The word is used freely in occult circles, and is held to mean the withdrawal of a soul from its body and its replacement by another soul. . . . (p. 51)

[24] See Freud’s landmark essay, “Civilization and Its Discontents.”

[25] Per Worsley, the draining of aggressive energy is conducted as a preliminary procedure in an initial five-element treatment. Needles are inserted superficially and bi-laterally into the back shu points of the yin organs, with the patient seated in a chair. If erythema appears around any of the needles, then aggressive energy is indicated, and the needles are retained until the redness dissipates (or the aggressive energy “drains”). Worsley taught that aggressive energy was held in the yin organs (because yin has the function of “storing”), and thus aggressive energy circulates throughout the k’e cycle. If left untreated, aggressive energy can re-circulate as a consequence of five-element treatment and thus make the patient worse. The concept of “aggressive energy” can be likened to xie qi and/or yin fire. For more discussion on aggressive energy and its treatment, see Worsley (2012, pp. 175-178).

[26] These English translations are from Heiner Fruehauf.

[27] The Confucian application of the five virtues is one of the earliest examples of five-element theory in Chinese history.

[28] Jung uses the term “Self” to refer to the individuated person who now exists in a condition of wholeness, where previously the ego maintained partiality through repression. 

[29] These symptoms can be correlated to the eight-principle diagnoses of “Heart-Fire Blazing”, “Phlegm-Fire Harassing the Heart”, and “Phlegm Misting the Mind”. (Maciocia, 2015).

[30] Although pulse diagnosis is used in identifying other blocks to treatment, Worsley does not use the pulse to diagnose possession or to confirm its clearing. In classical texts, the closest notion to a possession pulse is found in the Nan Jing. In difficulty fifty-nine, the pulse quality associated with mania and epilepsy is that “the three positions yin and yang are all exuberant”. The Tibetan medical tradition features numerous descriptions of possession pulse qualities (see the Subsequent Tantra of Tibetan Medicine).

[31] This translation is from Heiner Fruehauf (2024).

[32] The point needled is the “master point” of CV-15, located 0.25 cun below CV-15, or halfway between CV-15 and CV-14.

[33] Jarrett (2005) notes that the needle action should produce a qi sensation for the practitioner: “You must feel the qi at all points for the protocol to be effective”. (p. 49). I have not encountered this emphasis in Worsley’s discussion of possession but include it here for further consideration regarding the role of needle stimulus in treatment efficacy.

[34] Worsley uses the Japanese system of measurement for needle depth, known as fen. Ten fen = one cun, therefore, one fen is 1/10 of a cun. A 30mm needle = 10 fen, though the fen measurement should always be made relative to the patient’s own body rather than the length of the needle.

[35] The pulse is not used as a benchmark for either diagnosing possession or verifying its successful treatment. In Tibetan Medicine, a possession pulse is described as irregularly irregular and is measured on the radial and ulnar arteries. 

[36] Worsley only recommends tonifying the needles if possession does not clear with sedation technique. Jarrett (2005) recommends tonifying the needles before removing them in patients who are qi or yang deficient.

[37] The idea of “possession with depression” can be compared to the ancient concept of melancholia. In the Middle Ages, melancholia was thought to have been caused by demonic possession. While synonymous with depression, melancholia included a broader range of symptoms that were largely delusional. For example, Galen added “fixed delusions” to the Hippocratic symptomology of melancholia. See also Freud’s “Mourning and Melancholia” (1917).

[38] The variant protocol of “possession without depression” is maintained in Hicks (2004), published one year after J.R. Worsley’s retraction of the protocol and subsequent passing.

[39] In Worsley’s approach, back treatments are always given with the patient seated upright on the table or in a chair.

[40] Worsley numbers the outer Bladder line differently from Deadman. However, for the points listed in the external dragons protocol, there is no disagreement in numbering between Worsley and Deadman.

[41] If Possession is not present, then Aggressive Energy would be drained first in all initial visits.

[42] In Worsley’s language, command points refer to all the acupuncture points located distal to the elbows and knees, as originally discussed in the Nan Jing. Command points of the meridians on the C.F. are typically employed as the conclusion of any given treatment, for their stabilizing and anchoring effect. In TCM, the phrase (command points) refers to a set of six points (ST-36, BL-40, LU-7, LI-4, P-6, GV-26) that each have a broad effect on a bodily part or region. There is no relationship between the two concepts aside from sharing identical nomenclature in English.

[43] After clearing possession, Jarrett (2005) recommends treating HT-7 in addition to the source point on the patient’s “constitutional meridian”. He also advocates for coupling KD-6 with KD-27 immediately after clearing possession, noting that it is an “excellent treatment for people who wake with night terrors or who are in shock from near-death experiences”. (p. 50). Jarrett credits this latter point combination to a student of Kiiko Matsumoto.

[44] A practitioner may also use Windows of the Sky points to treat the spirit level directly, though Worsley recommends using these points judiciously, when a patient is seriously in need of perspective, and after an established period of treatment frequency. While not impossible, it is unlikely that “windows” would be used in the same treatment as a possession clearing.

[45] In treatment, point selection is otherwise limited to the two meridians associated with the C.F. element.

[46] Eckman notes that a focus on point names was historically important to the “medically inclined religious Daoists” and is “exemplified in the Yellow Court Classic (c. second century) a component of Daoist Patrology (Dao Zang)”. In addition to Worsley, he cites Jeffrey Yuen as a contemporary practitioner with a similar emphasis. (Eckman, 2007, p. 227).

[47] For a discussion of the relationship between Kundalini Awakening and possession, see Lee Sanella’s Kundalini: Psychosis or Transcendence? (1976).

[48] In psychoanalysis, introjection is the unconscious adoption of the traits of others and is considered a defense mechanism.

[49] Eckman (2007) notes that “Hsuie” is also “reported as being spelled Hsiu, Hsui, Shiu and Shsiu at different times, and as being pronounced ‘Shoo’ or ‘Su.’”).

[50] Worsley uses the analogy of a child’s relationship to the mother throughout his description of the Stomach official. The relationship between Worsley’s possession and Jung’s mother-complex is worth further exploration.

[51] Master Kiyoshi Nagano was a famous twentieth-century blind acupuncturist from Japan. He is well-known for his influence on Kiiko Matsumoto and for his “Stomach Qi Line” protocol.

[52] Worsley places the Stomach meridian 3 cun lateral to the umbilicus, while Deadman places it 2 cun lateral to the umbilicus.

[53] This may explain Worsley’s emphasis on centering the umbilical pulse.

[54] Some might say that this point name refers to the shape of the thigh muscle it is located upon. This is likely to be true, and we should be open to point names being anatomically and archetypally resonant. 

[55] See Lonny Jarrett’s text, Nourishing Destiny (1998), for a deeper consideration of xing and ming in acupuncture treatment.

[56] In Worsley’s tradition, tonification technique refers to a slow needle insertion in tandem with the patient’s exhalation, a 180° clockwise rotation of the needle, and a swift withdrawal of the needle. The needle is not retained. The hole is then quickly covered by the practitioner’s thumb to prevent leakage of qi. Tonification technique is the most widely applied needle technique in Worsley five-element acupuncture.

[57] Deadman states that KD-24 should be needled with a transverse-oblique insertion laterally along the intercostal space. However, in Worsley’s approach, KD-24 is needled perpendicularly to a fen depth of 3 (or 0.3 cun). The superficial nature of the insertion and the lack of needle retention in this point makes Worsley’s method a safe approach.

References

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Deadman, P., Al-Khafaji, M., & Baker, K. (2016). A manual of acupuncture (pp.148-149, p. 155, pp. 167-168, pp. 264-265, pp. 283-285, pp. 515-516, pp. 552-554). Journal Of Chinese Medicine Publications.

Eckman, P. (2007). In the Footsteps of the Yellow Emperor: Tracing the History of Traditional Acupuncture (p. 173, 215, pp. 227–228, p. 468). Long River Press.

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Jarrett, L. (2005). The Clinical Practice of Chinese Medicine. (pp. 45-46, pp. 49-50). Spirit Path Press. 

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Appendix A

Pills for the Five Kinds of Possession

Compiled by the herbalist Zhen Quan in 600 CE

Cinnabar—pulverize

Arsenopyrite—burned for a half-day in earth

Realgar—pulverize

Croton seed—discard the skins, roast

Hellebone—roast

Aconite root—subject to dry heat

Use 2 fen of each of the above ingredients

Centipede—broil, remove the feet

Press these seven ingredients through a sieve and combine with honey to form pills the size of small beans. The correct dose is one pill daily. This will result in a cure. If the suffering is not relieved, an additional pill should be taken at midnight. This will certainly end all complaints. One pill should be carried on one’s person at all times to ward off future misfortune. Pork, cold water, fresh-bloody things, and fox meat are to be avoided. (Unschuld, 2010).

Appendix B

Ghost Point Names

[58] CV-1 is used for men.
[59] Yumen is an extra point used for women.

Appendix C

Worsley’s Blocks to Treatment

The following list includes all of Worsley’s blocks to treatment, listed in order of their treatment.

Appendix D

Spirit-Level Points in Worsley Five-Element Acupuncture

Central to Worsley’s observation of possession is the idea of three etiological layers (or “levels”): physical, mental, and spiritual. Worsley established possession as a spirit-level pathology and lamented the rise of mental and spiritual levels of disease. In another passage, he writes:

It is astounding how much the level of disease has changed within my lifetime. When I first began to practise, the vast majority of my patients were relatively strong in mind and spirit and they thus presented predominantly physical problems, usually the result of the poor conditions in which they lived. Despite all the modern advantages of good housing, heating, and food, physical problems have not only persisted but have become more common. This is not, however, because the physical level is still the primary source of illness; it is because people are so much more troubled at the level of the spirit. (Worsley, 2012).

What does Worsley mean by “mind” and “spirit”? In my interpretation of Worsley’s schema, the body represents the physical and gross dimension of the being; the mental represents the subtle mind of thoughts; and the spiritual represents the psyche. Worsley often uses “spirit” to refer to the quality of the patient’s shen, evident in the eyes but also in the vitality of their presentation and the quality of their pulses.

In the Worsley tradition, every point has a “spirit,” an esoteric action coded in its name and its character image. In addition, certain points are called upon for their unique ability to reach the patient’s spirit level. These points are located on the outer Bladder line, upper Kidney meridian, and the Conception and Governor vessels. They should be considered in the context of possession treatment and follow-up treatments to support the patient’s spirit.

Of these points, III 37, III 39, III 41, III 42, and III 47 correspond to the five spirits, respectively:

• III 37 is the outer shu for the back shu of the Lung (III 13)

• III 39 is the outer shu for the back shu of the Heart (III 15)

• III 42 is the outer shu for the back shu of the Liver (III 18)

• III 44 is the outer shu for the back shu of the Spleen (III 20)

• III 47 is the outer shu for the back shu of the Kidney (III 23)

In contrast to the outer Bladder line and Kidney chest points, any points on the Conception and Governor vessels can be used to support the C.F., especially when the C.F. is notably deficient. However, a few points on these vessels can be used to reach the spirit level in particular.

[60] Jarrett (2016) has given consideration to the diaphragm as the “internalized wall” of repression in the body. His insights help establish a useful rationale for the psycho-spiritual import of III 41 (Diaphragm Border) and III 46 (Diaphragm Gate of Vitality). See Jarrett’s article, “Chinese Medicine and Psychoanalysis”.

For her integrative medicine class, Tai would write an essay for each class, and instead of lecturing, would read her essay to us, interspersed with colorful commentaries and unforgettable stories. Tai felt that we could not truly consider integrative medicine without understanding the history of medicine in the West, a history inextricable from politics, society, and prejudice.

Tai was not one to mince her words. She was not afraid to explore the uncomfortable dualities of East and West, imperialism and indigenous rights, white privilege and misogyny, integration and pluralism. Her clear perspectives on medicine as a cultural phenomenon made her impulse toward integrative care depthful and sincere.

A biography shared by Middle Way Acupuncture Institute summarizes Tai’s diverse life-experiences and contributions:

Tai began her studies in medicine by earning a Ph.D. from UC Berkeley in Medical Anthropology. Her dissertation was on the Ayurveda Shastras. She lived in Mumbai for six years serving the poor of Dharavi Slum as part of a team of medical providers who utilized Ayurvedic, Western medicine, homeopathy, and Chinese medicine. The clinic she co-founded served the very rich of Bollywood in order to subsidize the medical care for the outcaste poor of Dharavi which at that time was the largest slum in the world with over one million people living in it. She began studying Chinese medicine in the 1970s and practiced Chinese medicine for the past 38 years serving mainly patients with chronic viral diseases and cancers.

Tai taught at several schools, including Bastyr University and Seattle Institute of Oriental Medicine. She has also taught in several clinical settings including integrated hospital oncology units. She lived in the PRC for four years studying and working on oncology units. She held a Ph.D. in Integrated Oncology from the China Academy of Chinese Medical Sciences in Beijing. Tai also wrote Integrating Conventional and Chinese Medicine in Cancer Care: A Clinical Guide and The Geology of the Modern Cancer Epidemic: Through the Lens of Chinese Medicine.

In addition to her medical knowledge, Tai had an interest in astrology, and considered herself a Buddhist. I remember discussing Pluto in Aquarius, Dane Rudhyar, Liz Greene, and the Sabian symbols. She was hopeful that Pluto in Aquarius would initiate a cultural transformation.

On the first day of her integrative medicine class, Tai presented “Medicine and Empire” to the class. Moved by her provocative discussion of medicine and culture, I asked Tai if she had the intention of publishing the essay. In response, Tai said:

I feel that anything I say in class has barbed wire around it for some people and a purple ribbon around it for others. As for the little paper I wrote for this class on empire and its effects on medicine: I rarely ever sign anything that comes from my mind. I feel it is a download from above. I consider it or really all that I say, for better or for worse, as part of the Commons. To be used. So use it in any way you feel moved. Others have written similarly on this subject. I believe that truth is a constantly evolving transformation. And can be used to move us down the road. We desperately need that movement down the road right now.1

Tai’s remarks function as a preface to her essay. Take the purple ribbon or barbed wire comment as a trigger warning, as Tai’s writing is passionate, ecological, anthropological, and unabashedly polemical. As her response makes clear, Tai did not believe in the concept of “intellectual property”. When I told her I would love to publish “Medicine and Empire” on my Substack, she gave an enthusiastic, “Thank you!!!!”. This was in December 2023, and I did not know then that I would end up publishing her essay posthumously six months later. But it feels like a way that I can honor Tai, by sharing “Medicine and Empire”, as it so beautifully summarizes the themes of her thinking.

When I wrote “Medicine and Imagination”, I was remembering Tai, and knew she had been in the hospital. In some sense, “Medicine and Imagination” is my consideration of the concluding query she poses in “Medicine and Empire”: Integrated or not, what do you want for the future of our medicine? As Tai vividly illustrates, empire tried to destroy the indigenous imagination of medicine and replace it with the barren landscape of monoculture. Yet, as she says, “We’re still here”. We need medicine that participates again in the cultural and collective imagination it originally came from.

Despite her tenacity for addressing difficult and uncomfortable topics, Tai never lost hope for the future, and was always looking for ways to empower it—in service to her students, patients, and community. If anything, Tai wants us to remember the good, the true, and the beautiful before we go too far in the name of progress.

My introduction, “Patient and Polis”, offers some context for Tai’s essay. Due to the length of “Medicine and Empire”, I have taken the liberty of adding numbered sections with titles for ease of reading amidst topical shifts. Minor adjustments were made to punctuation for the sake of flow or clarity of argument. All bold words were bolded by Tai and are not my additions. I have added footnotes where I felt a concept benefitted from a definition or elaboration. In-text links to Tai’s references have been added where possible. “Medicine and Empire” has not been published before, though a precursor of its focus can be found in Disease, Medicine, and Empire by Roy Macleod and Milton Lewis.

Lastly, a GoFundMe page was made to raise funds for Tai’s end-of-life care, and now all contributions go to the Indigenous Student Scholarship at Middle Way Acupuncture Institute. Organizers write:

One of Tai's final wishes was that any extra funds go to an Indigenous Student Scholarship at Middle Way Acupuncture Institute. Tai saw the power of our medicine as an Indigenous medicine and a bridge across the oppression of colonization. With your support, we hope to make Tai's final wish a reality.

Patient and Polis

An Introduction to Medicine and Empire

By Neeshee Pandit

The first task of the doctor is . . . political: the struggle against disease must begin with a war against bad government. Man will be totally and definitely cured only if he is first liberated”.2

“Medicine and Empire” follows in the footsteps of Foucault’s structuralist critique of power relations and asks the important questions: How can we approach integrative medicine without acknowledging power and its relationship to knowledge, specifically European medical knowledge? How can indigenous forms of medicine integrate with Western medicine, without ignoring the history of imperialism? How do we integrate without being categorized professionally but pejoratively as “alternative”, “complementary”, or what these words really mean: subordinate, lesser than, irrelevant. Integration has become the official cover for assimilation, where validity and efficacy are defined by Western medicine alone, with traditional physicians forever cow-towing for approvals. Our only peers are journal reviews documenting clinical trials and studies conducted with both eyes closed. Placebo, once pejorative, has been re-assigned as the mechanism of “alternative” therapies—read: it works for subjective reasons only, the real medicine is in science.

Tai manages to raise all of these issues while remaining an advocate for integrative care. Tai was one of the first acupuncturists licensed in the State of Washington and her journey reaches into the history of American counterculture. She has been on the frontlines of the struggle to legitimize Chinese medicine in the United States. She worked in hospitals abroad where integrative care is normative. She passed through her own health struggles with the aid of Chinese medicine and Western medicine. Perhaps most importantly, Tai is an indigenous person, belong to the Anishinaabe tribe. Her mother was forcibly taken to residential schools in Canada, and the trauma of her ancestors reverberates in the psyche of her writing.

The history of American acupuncture begins in 1971, when James Reston published an article about acupuncture in The New York Times—“Now, About My Operation In Peking”. The article details Reston’s experience undergoing an appendectomy in China with acupuncture anesthesia. Reston was awake for the entire surgery. Reston also recounts receiving acupuncture for post-operative pain management. His editorial brought acupuncture into mainstream American curiosity. Reflecting after surgery, Reston writes:

Since then I have lived with the rhythm of what must be the quietest city hospital in the world, constantly regaining strength and acquiring an intense curiosity about the politics and medical philosophy of the doctors in attendance.

They insist that the two cannot be separated and they are quite frank in saying that the sole purpose of their profession since the Cultural Revolution of 1966‐ 1969 is to serve all the people of China, 80 percent of whom live on the land.3

Indeed, since the cultural revolution in China, indigenous forms of Chinese medicine suffered at the hands of a growing empire. The moniker, “Traditional Chinese Medicine”, refers to a Maoist revision of Chinese medical thinking, re-purposed and standardized for the masses. We need not dig into the ancient annals of history to discover the influence of empire upon medicine, and of politics upon patient.

With “TCM”, Mao supposedly sought an integration between Chinese medicine and Western medicine. By standardizing Chinese medicine, Mao was able to extend medical care into rural areas with “barefoot doctors”. But Mao did not truly integrate two medical traditions, he reduced one to the other, removing indigenous forms of thought (now “superstition”) and replaced it with the naive rationalism of Western scientism. Therefore, if we laud Mao for his progressive vision, then we have lost sight of medicine in the aegis of empire.4

In “Medicine and Empire”, Tai asserts that medicine and politics are not merely related to one another, but nested within each other—historically and culturally. We cannot divide or enclose these fields from each other without feigning ignorance. Medicine has not emerged in isolation, somehow separated from society and its politics. Medicine is not only of the human body, but the culture in which it lives—the body politic. Within our theories and diagnoses lays a complicated foundation, informed by prejudice and poison just as much as nectar and nirvana. Tai elucidates these nuances with an anthropological perspective of medicine, assigning a socio-cultural basis to medical theories and practices. In other words, the phenomenology of medicine is cultural, its syndromes societal, its patients citizens.

Tai defines medicine as “the art of healing and of preventing diseases” and calls for a resolution of its identity crisis:

We need to regain and maintain agency over our own medicine. At a basic level, agency is the essence of being human . . . We cannot wait for conventional medicine to tell us who we are. 

In the same breath, she defines the physician as “a sage, a counselor, a community activist, a medical doctor, a spiritual adviser” who realizes that “poverty is a major cause of illness” and that “capitalism, urbanization, commercialization of agriculture and our food system are not working to promote health”. 

In the medical focus on internal and external pathogenic factors, we have missed the biggest one of all: civilization itself. We have to ask ourselves if our profession exceeds the parameters of merely doing no harm. Does the practice of medicine not carry within its germ a civic duty? Our patients are citizens before they are cases, and persons before they are citizens. This lends a cultural etiology to every illness, since every person is a microcosm of the polis. The clinic appears within the city like an inner sanctum, a refuge for one’s ills, a cure for the disease of culture. Our symptoms are more than our own, they are given to us by nature, and against it.

In Civilization and Its Discontents, Freud explored the issue of culture as a repressive force, the so-called individual deeply conditioned and hardly independent. The repressive force of civilization displaces our agency, and drives our individual instincts deeper into the collective mud, where it awaits sublimation in war. We are guilty for all that we cannot be, and for the damage we cannot undo. Ecological havoc pervades the system, and we are inside of it, a growing sickness. Ecological wounds are the trauma of warfare, of life against life, where death is done before its overture. Medicine is ostensibly the cure that arises in a self-correcting system; a physician is ideally one who cultivates natural order, but medicine cannot correct what it does not acknowledge.

In Tai’s vision, medicine becomes meaningful as an individual and collective force, a pressing upon society from its own physiology. She argues that medicine has been shaped by empire for hundreds of years, and has lost its cultural roots while being subjugated to the ongoing hegemony of scientific-materialist medicine.

Empire conquers civilization. Empire invades and takes the territory of any tradition it so desires to de-flower with heads of war. Empire is imperialism, an opus contra naturum, the opiate repressing the masses everywhere. Empire is the fault line where no boundary exists. Empire is the eye of evil, looking for its next meal. And we are its citizens.

The problem is that politics are polarizing. Social media gives us a world in apparent dialogue with itself on virtual sides of the internet. Disagreement breeds conflict, limited contexts foster misunderstanding—we cannot see over the line in the web. We are triggered, our fingers pointed like guns, typing on frontlines we’ve never seen. If we define people by their beliefs, then a conceptual disagreement breeds estrangement. We need to agree to disagree. The ethic of therapy necessarily contains dualisms, and medicine widens the container that accommodates them. Jung defined neurosis as “one-sidedness”. Medicine is working with neurosis itself, in various forms and levels. Therefore, medicine has to free itself from all “sides” to become a true vessel of wholeness, a temenos amidst the secular.

The question is—who is the patient? On one level, the patient is an individual, a person. On another level, the patient is also part of society, and therefore a citizen. In other words, “who” has a personal and collective ontology. Do our cities have souls or only the ghosts of persons past? Is the metropolis a cemetery of the collective unconscious, a polis without a psyche? Whether shaman or surgeon, the patient is body and soul.

The problem is that the polis is in our psyche, and we can’t get it out of our heads. It stares back at us when we didn’t think we were looking. It infiltrates our lives with algorithmic invasions. Our synchronicities are nothing more than programmed eavesdropping, a calculated coincidence waiting to startle us. Our memories are fake recollections of a new design. There is no déjà vu, only a vague illusion of familiarity to leave us vacant and agape.

The problem is progress. The privilege of civilization, the onward march, the omega-point of Westernized culture. Postmodern egalitarianism postures justice by neutralizing our values and destroying its hierarchies. But do we not have a hierarchy of needs? We don’t need neutrality or moderation, but a radical voice that pleads for understanding from the rubble.

How can a doctor remain walled in cloaks when a war continues, delivered in our hands, like a cup of coffee? Our phones are the new dawn, the first light of sleep, and what rises there is ravenous. We risk repressing our patients with medicine, keeping their symptoms quiet like a sanitized gestapo delivering legal aid. Our sins are sanitary now, but we’ve had a hundred years of it—and our sickness is getting worse.5

Discovery, empire, and progress are the troubles of today. They pollute our minds and then our body politic. For all this disdain of “primitivity”, our civilizing cures seem more savage by the hour, at ever more cost to the consumer. Progress pre-empts tradition, empire co-opts it, “pioneers” replace it. We self-destruct because there is nothing left to create. Suicide in the city. Drowning in the workforce. Cancer in the collective. A polis that has no telos reaches the point of no return. Only a perpetual precipice is provided to volunteer our death upon.

Tai tackles these issues and deconstructs them, paragraph by paragraph. She criticizes colonialism, imperialism, misogyny, patriarchy, racism, nationalism, and materialism. She raises the issues of settler responsibility, indigenous rights, ecological awareness, and spiritual understanding. Tai poses a query to all of us, patients and practitioners: What kind of a world do we want to see? What does it mean to integrate indigenous systems of medicine within colonial paradigms? Where is the reunion of medicine and meaning? In her concluding remarks, Tai writes of the current moment:

“We’re in it—a massive rethinking of the meaning of life and how we want to live it”.

Medicine and Empire

by Tai Lahans

I. The Doctrine of Discovery

The Doctrine of Discovery is the first mandate to codify the rules of the road, so to speak, about how an explorer in the early days of discovery was to handle the fauna and flora of the new places discovered as a result of searching for a circular trade route between Spain and India. It was written by a Roman Catholic Pope and given to Ferdinand and Isabella of Spain exemplifying the connection of church and state at the time in the 1400s CE. It came about as the result of the “discovery” that the world was, in fact, round and not a flat disc floating in space off of which one could fall.  This mandate was both a Christian and a European political statement. It stated many things but one was especially ominous for human beings; it said that all humans that were encountered who were not baptized in the name of Jesus Christ could be considered as normal fauna and dealt with in any manner necessary. This set the stage for all future explorations across the world. And since no one outside of the Middle East and Europe had ever heard of Jesus Christ at that time, it meant that a great many peoples of the Earth were purged in the name of progress. It is estimated that when Columbus reached the New World there were already approximately 100 million people living in South, Central, and North America. In the first 50 years after Columbus made landfall in the Caribbean it is estimated that 60 million human beings died of disease, starvation, and murder. Almost two thirds of the people already here were extinguished. The Doctrine codified the concept that humans were one thing and nature was another and it codified what was the definition of a human, that is, a Christian.

This period of time of discovery overlapped with many events in Europe including the Inquisition that went on from 1100 to 1700 CE. At this time a great many people were found guilty of heresy as defined by the Roman Catholic Church at the Vatican in Rome. The Malleus Maleficarum—the Hammer of God against evil—was instituted against anyone who could be proven to be a disciple of Satan. And 80% of all the people burned at the stake or hung or drowned were women. Good witches, midwives, nurses, herbalists, farmers; these were the people who took care of the common people. The elite saw doctors most of whom were also clergy. The inquisition was a war of class and religious elites against common people who worked the land, had a different set of values and knowledge, and were a community of vast numbers. It was also an Abrahamic patriarchal indictment against women with knowledge and skills that served people.

How did the landed gentry and the European religious establishment build global empires from the 15^th century on? During the Age of Commerce that followed the Age of Discovery new trade routes were discovered by mainly the Spanish and the Portuguese as they built maritime empires in the Atlantic and Indian oceans. Other European nations like the Dutch and the French and British entered the maritime expansion in the 17^th century, leading to major colonial warfare in the 18^th century. Trade and commerce were the critical components of power and prosperity in this period. Historians have described this as the first age of globalization in modern history. It was mainly European nations sanctioned by the Roman Catholic church in the Vatican gathering resources and accruing wealth and power by scavenging the Earth outside their own countries.

The Age of Empire followed in the 19^th century. In this period, European nations, especially France and Britain, established vast territorial empires in Asia and Africa. They devised colonial administrative services, developed new agrarian policies, instituted laws, started universities, and established their own medical ideas and practices in the colonies as the mainstay of their rule. The industrialization in Europe led to the colonies gradually becoming the suppliers of raw materials for European industries. The use of the human body as a form of raw material and a beast of burden began in earnest in the 1600s, peaked in the 19^th century and in many ways continues to this day in the form of men, women, and children in colonized countries being used to supply cheap labor and goods to the Global North.   

The high point of imperialism culminated in the First World War with the European colonial powers expanding across all the continents of the Earth. European medicine specialized to serve colonial purposes and interests, including tropical medicine and the use of bits and pieces of indigenous medicine to treat diseases and conditions relevant to the Global South acquisitions and European people living and working in them.

In the 1800s medicine in China was mostly indigenous and that medicine was the equivalent and often the superior medicine when compared to European medicine. It was the missionary effort of colonization that combined the proselytization of Christianity with Western or European medicine and sold it as superior. People could not receive medical care from missionaries without being subjected to constant efforts to reform them and make them Christian. However, there was a cross pollination of Western herbalism and medicine and Chinese herbalism and medicine.  Early Jesuit priests brought back to Europe much of the first information of acupuncture and herbal medicine in a codified form. Before that the Dutch East India Company in the early 1600s had been the vehicle for the acupuncture modality of Chinese medicine from Japan into northern Europe but that effort was small and died out in the first 100 years after arrival in Europe. Elizabeth Rochat de Vallee is a student of a Jesuit priest, Claude Larre, who studied in China and Vietnam the native medicine of those places; i.e. Chinese medicine. Some of the finest translations and interpretations of Chinese medicine and the philosophy from which it comes are from Monkey Press founded by Elizabeth and Claude in France in the 20^th century. And auricular medicine was a modern interpretation of the microsystem concept of acupuncture by Nogier, also French. And in modern France, advanced palpation skills were evolved into visceral manipulation and other techniques in the osteopathic repertoire—also an energetic medicine like acupuncture.

Decolonization began after WW1. The missions by the Spanish in the Americas, the French in parts of Africa, and most of the European nations involved in the Age of Discovery were justified in terms of a religious mission to bring Christianity to peoples they considered to be savages. This mission began to unravel as people viewed the atrocities of the WW1 and decided that perhaps Christianity and the superiority of the West was not what it was cracked up to be. If Christianity was to transform and save the world, the atrocities by Christian nations in Europe during WW1 could not be justified, and therefore, Christianity was not a saving grace.  Christians were doing the same things in Europe that they espoused to be against, better than, inoculated against with Baptism.

All of the countries inhabited and colonized by Europeans were used as a collecting expedition for specimens (including human ) of flora and fauna to study and display in museums in Europe. These overlaps are important in our history of medicine as they help us to note and compare the connections and similarities of historical events across continents and periods of time. Each of these phases of imperialism was marked by almost corresponding changes in the history of medicine—not only medicine in Europe but all indigenous forms of medicine where colonization had occurred. European medicine was an important component of European imperialism from the 16^th century on and it also evolved along with the history of imperialism. The European materia medica expanded and diversified rapidly from the 17^th century in the Age of Commerce. Exotic drugs came into European markets. Even the tulip for which the Netherlands is famous is actually a Turkish plant. Huge amounts of money were made off of the tulip and still are today. The list of plants imported to the West is humongous. And today the national website of the PRC states that one of their goals is to become the world’s leading exporter of herbal plant materials and herbal medicine. What this means for us is predictable: industrial monocultural agriculture and everything that means. The PRC is a pseudo-capitalist country running on the fumes of communism and ruled by a CCP dictatorship or emperorship with lackeys underneath. 

All that suffering—what was the point?

II. The Age of Empire

Physicians reworked their traditional medical theories to explain diseases, especially when it came to fevers because of their experience in tropical hot weather and the fevers some diseases caused—like malaria. Putrid or pestilential fevers that ravaged the health of European sailors were re-evaluated. Theories of sanitation and hygiene, the disposal of waste, maintaining cleanliness and ensuring ventilation all became part of general European preventive medicine but they were, in fact, imports from the indigenous cultures of the global South. Preventing cholera was a main effort in the 19^th century. And in the USA the treatment of mid-century cholera was with naturopathy, herbal medicine, Eclectic medicine,6 and homeopathy. And of all those efforts, the most successful treatment was with homeopathy. Homeopathy is a German evolution of herbal medicine that includes plant materials from Greece and beyond and also includes European plant materials. It is still considered a world heritage medicine by some American institutions but is actually a part of naturopathy which those same institutions now consider to be Western medicine, i.e. modern medicine based in Western science. All of the nature-based components have been lost from naturopathy. This may happen to Chinese medicine also. 

Although many components of Western medicine are actually imports, the medical systems from which Western medicine came are now bending the knee to Western science as the modus operandi of that system of medicine, changing it into a western adaptation of the original nature-based medicine. This is imperialism. It is part of a playbook of changing common sense into mistrust, failure to believe the truth in front of your eyes, the complex simplicity of the mechanisms of life, the reality of living in and knowing deeply the place where you live, the connections between all of nature of which we are a part.

In the nineteenth century, the Age of Empire, laboratory-based medicine transformed European medicine. Industrialization in Europe became important in producing modern drugs and pharmaceuticals. This movement away from plant-based medicines that were compounded to pharmaceuticals that were extracted and synthesized (often from petroleum) was shaped by colonialism. The emergence of germ theory from the 1880s led to the development of vaccines for viral infections. The Chinese had used a form of vaccination called variolation since the 1400s.7 Soon the French Pasteur Institutes spread to the French colonies in Africa and South-East Asia and germ theory and vaccines became part of global and imperial medicine as an expression of progress. The Pasteur Institutes became a part of the “civilizing mission” of imperialism. Modern pharmaceuticals were presented as symbols of European modernity and superiority. We still deal with this reality in many forms whether or not we practice something other than “Western medicine”.

III. The Spirit of Medicine

What is medicine and why do we need to categorize it into different types, forms, or other frames? I think that at an essential level, medicine is the art of healing and of preventing diseases. This art took different shapes in different social, cultural and historical contexts. The Yi Jing, possibly the oldest and therefore first book of medical philosophy and theory from China, says that the true healer leads people to an encounter with their true being, their essential Self. This is the truly ancient interpretation of healing when humans were simply not what we have become. They lived not on the Earth but as an expression of Earth in the Earth community. They held spirit as a living reality surrounding them always—and to which they could communicate. Energetic medicine was all that was needed to right the ship of the human body and soul—shamanic medicine.  

In nineteenth-century parlance, definitions of modern medicine and science as singular, universal and progressive are still persistent today. The JAMA editor of a few years ago said, “there is only one science and that is Western science”.8 Amen. The context was in relation to a query about perennial medicines and the role that they play in defining medicine and, therefore, treatment. It was basically an early negation of integration of systems. It was saying that indigenous systems of medicine are ethnological and historical discussions but not clinically relevant in modern times. It was saying that the primary reason that these systems are not relevant today is because they insist on including a meaning to the workings of life. This meaning is the expression of belief in the sacred which is not definable nor measurable and therefore, non-Western science is not the expression of the truth because it is inherently biased. Taking the meaning out of science, medicine and truth equals the only truth because it is the only truth that can be measured. In other words, there is only material life in medicine and science. This eliminates agency and leaves us where we are recipients of a form of knowing that does not include spirit. Medicine has evolved in this reality as a “fix it” and not as a teacher or a revealer of the sacred in life.

Another question that is problematic and complicated in the idea of integration is the practice of naming medical specializations. In general, this is a practice of modern Western medicine. This particular view of medicine sees the human enterprise as a set of systems but rarely as a whole. Perennial systems as a whole—so to speak—see the human enterprise primarily as a whole and existing within working systems of other whole environmental systems: as Arthur Lovejoy said—The Great Chain of Being comprised of nests within nests of organic and emotional and spiritual structures all simultaneously intercommunicating with one another as a single thread of life.9 

It appears that part of what makes modern medicine modern is the elimination of knowledge and understanding that sees life as a universal enterprise with each apparently separate part related to other wholes and perhaps The Whole (whatever we might call it). This is the crux of the polarity of Western and Eastern science and medicine. And it becomes the crux of how to integrate the two. 

IV. Colonial Medicine

There were two key phases in European history of medicine. The first began in the thirteenth century when classical Greek medical and scientific traditions were gradually severed from their Arabic or Islamic lineage and ensconced within European and Christian thought and tradition. Greek texts were translated into Latin and Hippocratic and Galenic medicine in Europe. This means that those translations did not capture the entire message of Middle Eastern philosophy and interventions. And if they did, those elements were discarded as irrelevant to European culture, language, and intellectual modus operandi.

The second key episode started in the late-seventeenth century when European natural historians sought to develop objective views of nature. In China this effort actually began around 100 CE with the systematic correspondences. Those people tried to place a systematic orientation and understanding of myriad bits and bobs of knowledge to date using nature as the fulcrum. Isn’t that a kick? So natural history was incorporated as a key aspect of their medical knowledge. Alongside that were changing views of the human constitution and its relationship with the environment.  These views in the context of empire were richly informed by colonial experiences but filtered through a clearly European intellectual and social understanding of nature. That understanding was a hybrid of Christianity and a hierarchical format plus a systems approach that had separate silos of anatomy and function. Rarely was there an attempt to combine them nor was there a definition of health. We still wait today for Western medicine to give us a definition of health.

The search for a European antiquity and an objective understanding of nature was done primarily in institutions and this search is what gave them pre-eminence. For example, the British Royal Society in London and the famous quote of Sir Francis Bacon, “This new science has the capacity to not only control Mother Nature but to bring her to her knees”. This is exactly what has happened. But it happened not as evidence of that particular science but as a result of that particular science. And this is one reason why only today indigenous knowledge that grew as a part of being within nature and not separate from it is highly valued. This is the knowledge that was so expertly annihilated by colonialism and the Inquisition and the institutionalized intellectual enterprise that falsely claimed superiority and progress.

During the seventeenth century, precisely when medicine in the West was becoming modern or European, it was becoming colonial and dominant as well. The growing influence of natural history in early modern medicine; the growth and expansion of European drug markets; the rise of surgeons in status and influence within the medical profession; developments in ideas of sanitation, hygiene and public health in the wake of cholera epidemics; growth of modern quarantine systems; the search for active ingredients of cinchona, opium, and tobacco leading to the birth of modern pharmaceuticals; and finally the emergence of germ theory and prophylactic vaccination, and ideas of global health conjoined European and colonial histories.

In other words, medicine and science need not only be understood within laboratories, in scientific formulas and theories, or within esoteric texts and mathematical calculations; the social and cultural historical contexts of these intellectual traditions are equally instructive.

Historians have shown that colonial medicine (European medicine in colonial settings) was deeply implicated in promoting ideas of difference, in terms of race, gender, and class. These ideas became critical in modern medicine. The integration of medicine within colonial economy and governance was intrinsic to colonial administration and economy whether we are talking about West Indies rubber plantations, diamond mines in Southern Africa, the urban administration of Mumbai or Kolkata. There was a straightforward cause-effect relationship that medicine helped in colonization, benefitted from colonization in terms of absconding from other knowledge bases, set up ideas of color and race and gender as hierarchical, and fostered a system of European superiority that became global.

Nineteenth-century writings represented imperialism as a triumph of European cultural superiority and military power over other races and regions in the Americas, Asia, and Africa. These accounts were all written by Europeans and described this dominance as “beneficial”, as it spread ideas of progress, rationality, humanitarianism, and Christianity to those who were backward or less civilized. Modernity was tainted with paternalism which in turn has instructed even people of today to feel as though medicine is god and the doctor knows everything ever to be known. This orientation, I feel, has grossly contributed to people no longer taking care of themselves, understanding what their own health is materially and in terms of how they feel. We are cut off from our bodies and live in our heads.

The general tone of conquest of the Americas was a tale of European discovery (although the 100 million people already here at the time of Columbus would disagree), then of glorious European adventurism, and finally of the introduction of European civilization and modernity to the “savage” people. Even as late as the 1920s, Canadian and American planes flew over reservations and tribal communities seeking to identify children to be later removed to residential schools. By removing children, the language, the culture, the family structures of natives were lost and this became a new and “humane” form of colonization, otherwise known as genocide. The European project of the slave trade was never mentioned.10

There are many books of various genres that all speak to this interpretation of history. The Competition Wallah about waking up Indians in India to a modern life of competitive self-reliance through Western education and Christianity. Forget about Buddha, Sri Aurobindo, Ashoka, Nanak, and many others whom we study today.  Stanley wrote the travel book about Africa, Through the Dark Continent. And Joseph Conrad wrote The Heart of Darkness outlining how European imperialism was a form of enlightenment. The ethos of this imperialism was to transform Africa into a modern economy for and by Europeans. The indigenous people of those places were colonized to be the workforce enabling this economy in exchange for becoming enlightened.

In the 19^th century, Lenin wrote a book called Imperialism, the Highest Stage of Capitalism.  Later Hobsbawm wrote Industry and Empire in which he linked imperialism with pressures produced from within Western capitalism to export capital to colonial dependencies. These later ideas of economic imperialism have remained an important means by which historians explained the rise of colonialism.  The colonized were not only stolen from in terms of resources of all kinds including intellectual but also stolen from again in terms of selling products made from their own national resources back to them. 

A truly vicious cycle. This world system remains today—a globally connected network of economic exchange relationships. Europe was the center and at the periphery were the colonies, with a unilateral flow of capital and wealth from the periphery to the center. Think of the throw away clothing trade. Think of the Amazon and beef and soy to feed the beef that ends up in North America or at McDonald’s in Beijing. 

Writings on the history of medicine show that imperialism played a negative role, especially amongst indigenous communities, by spreading epidemics, destroying local medical institutions, and transforming the colonies into markets for expensive European drugs and vaccines while simultaneously stealing many of the effective interventions local to those same communities. Medicine ultimately became a tool of empire.

Wherever Europeans went they spread ghastly epidemics like smallpox, typhus, and TB to virgin populations who had no resistance. This devastation of local indigenous peoples helped to spread and expand European colonial territories. General Amherst here in Massachusetts spread smallpox to American Indians in the northeast by gifting to them smallpox laden blankets.11 They all died. Today, there are 580 recognized tribes in the USA but the percentage of the indigenous population is 5 million, 78% of whom do not live on a reservation. They live off the rez because there is no viable survival there. The highest rates of suicide in the USA are amongst Native American children. This holocaust remains active even today. 

In the book Orientalism (1978), Edward Said argued that imperialism led to cultural hegemony—dominance of the Western tradition and philosophy. He felt that the European division of the world into the Orient (those countries East of the Roman Empire) and the Occident (referring to the Western Empire) equaled Europe being the Occident and Asia being the Orient. These divides became prominent during the Crusades (1095-1291). The Arab world was viewed as backward and treacherous.  During colonialism, these divides acquired new significance, especially when Europe colonized large parts of Asia.

Europeans could travel to parts of the world they never could before. Universities and museums developed large collections of Asian texts and artifacts because the countries they were made in could not afford to protect them as a result of imperialism. Cultural imperialism was a form of dominance that disrupted indigenous cultures and knowledge traditions, resulting in loss of agency in writing their own histories and in defining their own destinies.

In the 1980s, more autonomous subaltern collectives of people from various disciplines wrote new histories in an attempt to recover agency for their people, cultures, and knowledge base. This is especially true for Africa and South Asia. These writings affected the questions that writers were asking. Did Western medicine play a disruptive role in the colonies by destroying indigenous institutions, co-opting indigenous medical ingredients and methods into modern medicine?

Colonialism in East Africa led to a series of environmental and medical disasters affecting animals and agriculture. The clearing of forests led to droughts, and modern plantation-style farms destroyed old pastoral systems and lifestyles. This was in many ways the beginning of the extinction of species in those places due to land loss, water displacement for a new way of agriculture, removal of whole forests, opening the land to mining and extraction. The horn of Africa is still trying and mostly failing to recover. South Africa has become a democracy and often the administrators of that democracy are black but the truth is black Africans still live in poverty. The horse was long out of the barn by the twentieth century. Colonial investments in these areas, and in Africa in general, have forever changed the landscape and cultures of native peoples—and not for the better.

The rapid increase in malaria in Asia and Africa during colonialism has been definitively linked to deforestation, expansion of the railways and consequent ecological changes. The British put in 44,000 miles of canals to irrigate a quarter of India’s total crop area. Flooding and salination of the canals led to more mosquitoes and breeding areas. Simultaneously, the advent of Western medicine in these same areas pushed out indigenous and effective medicines to deal with malaria and other infectious diseases. It was a win-win for the colonizer and a loss-loss for the native people in very many places across the world. 

One could say that modern monocultural agriculture requiring inputs from the chemical industry were/are also destroying the land everywhere, including North America, and creating diseases that then require Western medicine via pharmaceutical medicine that also relies on the chemical industry to supply.

V. Efficacy, Agency, and Art

European germ theory and laboratory medicine were represented as a crusade not merely against disease, germs and social/cultural practices and prejudices but also against the land itself. Mother Nature became Terra Nulla—good only for extraction of resources. The dominator role played by missionaries was used to introduce medicine to empire. Imperial medicine from Europe focused on Western science, great men evolving it, ideas of progress, and ideas of cultural and racial deficiencies. The truth is that we can now—looking back—trace the history of diseases and medicine through long-term changes across centuries that connect the histories of Amerindian depopulation in the sixteenth century to the sleeping sickness, HIV, ebola, and malaria epidemics in Africa in the twentieth century.

People fought back. There is evidence that indigenous medical workers in various places who worked as orderlies, nurses, ward attendants in hospitals and clinics in many places across the world translated their everyday practices and Western medical practices into languages and “heathen” concepts in order to translate Western medical terms and technologies—and thereby drained Christian medicine of its scientific connotations and simultaneously invested it with pagan meanings. In a sense, this happening in Africa ended in a new hybrid and complex medicine. In many ways, this is happening now within the growing event of integrated medicine.Western science is becoming dislocated from its European problematic and is becoming part of mostly Indian, Chinese, and nature-based medicines of Europe while becoming a new cultural and intellectual experience. This has happened where there is an equally strong and persevering culture of medicine that is local and highly developed.

Some of the issues that we face as “alternative” providers are overcoming a sense of nostalgia and romanticism for the past. Although the double-blind placebo-controlled study is almost always a very poor way to analyze the efficacy of an intervention from Chinese medicine, still we need to evaluate whether or not what we understand as the truthful basis of our medicine is of value, and if so, how and why. The way that we have always done this is through case studies. Case studies do require an objective observer. We can train ourselves to be active and objective observers of our medicine. In fact, there always has been and is now a resurgence of accruing case studies across our profession to be utilized in analyzing efficacy. We have to be engaged and maintain our medicine as an art. Colonialism manufactured a major break in and disruption of history, especially since 1600 CE. What would those indigenous medicines that were changed forever have evolved into without being pre-empted by European medicine?

We need to regain and maintain agency over our own medicine. At a basic level, agency is the essence of being human. We need to form ourselves into collectives of activity, preservation, and transformation of our medicine. We cannot wait for conventional medicine to tell us who we are. To have agency, we need to understand in modern language the material conditions that caused disease and death. This means in modern times all of the negative impacts on our environment; it means caring for the poor and working within the precepts of our medicine as a sage, a counselor, a community activist, a medical doctor, a spiritual adviser. It means realizing that poverty is a major cause of illness; it means that capitalism, urbanization, commercialization of agriculture and our food system are not working to promote health. The profit motive is an example of imperialism and when it comes to providing service to our human condition, it is part of the problem and not the solution. Service and profit do not work well together and require a new way of managing the human sin of greed.

VI. The Flexner Report

In the context of all that was just said and in the hay day of imperialism (the early 20^th century) the AMA and the Carnegie Foundation paid to have an individual named Abraham Flexner come up with a report on the status of American medical schools. They had an agenda as the representative professional organization of regular medicine—now called biomedicine or conventional medicine. In 1904 the AMA created the Council on Medical Education and Flexner was hired, and in 1910 his report was made final. In a nutshell it stated that:

• Standards should be increased to include anatomy and physiology and chemistry

• Partnerships should be formed between schools and hospitals for clinical training

• Schools that could not meet the new standards should be closed

Prior to the report there were 20 black medical schools in the USA. Ten years later, two remained (Howard and Meharry). Between 1910 and 1970, there was a near elimination of women physicians. Before the report came out, there were 155 medical schools of all kinds, representative of the forms of interventions and systems of medicine used until that time. There were chiropractic schools, herbal medical schools, eclectic medicine schools, naturopathy schools, osteopathic schools, and regular doctor schools (this last category referred to European modern medicine—the people who had orchestrated the Flexner Report). After the report came out, 89 medical schools immediately closed as they were unable to meet the standards of adding a surgical theater, adding labs, and maintaining upkeep of all of these mandated improvements. 

In effect, the perennial forms of medicine that had existed before the 20^th century were eliminated. Two remained—schools of chiropractic medicine and osteopathy were able to meet the standards. This is why osteopathy today reflects modern European medicine and not advanced manipulation of the cranial system of original osteopathy. This old system of osteopathy is considered (along with the acupuncture modality of Chinese medicine and homeopathy) to be the only surviving systems of medicine maintaining themselves as energetic systems—that is, systems that approached dysfunction from the place of energetic origins rather than the place of material symptoms. In other words, they practiced a medicine that had as a goal what the Yi Jing called an encounter with one’s true Self.

In 2018, only 5% of American physicians are black whereas blacks make up 14% of the population. The Flexner Report exacerbated racism in medicine because the remaining medical schools to survive this particular inquisition would not accept black students nor physicians due to racist policies. 

In 1900, women were 6% of practicing physicians and in 1909 they were accepted at 91 of the 155 medical schools. Women were rising as advanced practitioners of medicine. Many of the schools that closed were the ones that also accepted women. By 1940, just 4% of physicians were women, whereas it should have been about 40%. Not until the 1960s did women begin to catch up again. Women still lag males in compensation, leadership positions, and research publications. Flexner said that black students could be trained as sanitarians and their primary role should be to protect white people from disease. He also said that women were showing a decreased inclination to enter medicine at the time of his report and those that did go into medicine had obvious limitations.

The AMA has recently renamed the Abraham Flexner Award of Medical Excellence in light of the blatant racist and misogynist philosophy that underlies the Flexner Report. In regard to the systemized elimination of the perennial systems of medicine and our ability to learn them here in the United States, even Western trained physicians are beginning to see that the Flexner Report had a mercenary agenda akin to the playbook for imperialism. It was an attempt to couch the elimination of perennial forms of medicine in the name of progress. Progress was grossly tied to capitalism and the evolution of a medicine that required many inputs of fossil fuel-based chemical compounds as opposed to plant materials, that were hugely more expensive than natural medicines, treated only symptomatically except for a few wonder drugs and curative or preventive techniques, and held surgery as the top of the chain of interventions. An entire system of research at the new medical schools (many of which were or became public non-profit institutions) led to production of medical products by for-profit companies. The public who were told they could not understand the complexity of it all accepted this new medicine as progress, but it is ultimately a renewed form of imperialism.

Humans, being what they are, once again fought back. Guess what: We’re still here.  Although Flexner called all of the extant systems of medicine at the time non-conformist and medical sects (this is where the term “alternative medicine” came from), by the 1960s, my generation (thank you very much) evolved new philosophical views regarding biomedical reductionism, and new views on the place of the patient in medical treatment and even in medical development. Medical holism led to intense debates/disputes even within biomedicine. The increasing use of “alternative medicine” was driven mainly by the public but also by the biomedical industry. The term “CAM” came about—“complementary and alternative medicine” was a new word mainly concocted by biomedicine to place alternative medicine in its proper place (that is, as a subsidiary of biomedicine to be used alongside of but not as an alternative to biomedical interventions).

Postmodernism, feminism, and environmentalism also greatly contributed to changes in beliefs about what characterized the existence of truth, objectivity, determinacy, causality, and impartial observation. Individuality, complexity, and personal experience played a role in integrating into the social construction of curricula and values, especially when it came to health, belief, science, and medicine. We’re still in it—a massive rethinking of the meaning of life and how we want to live it.

NCCAM (National Center for Complementary and Alternative Medicine) was founded in 1991—a landmark event. People from various traditions of medicine, many from Bastyr University, approached Tom Harkin (Senator of Iowa) and Jesse Helms (Senator of Utah, where there is a large herbal industry influenced by Mormons) to lobby the legislature mandating some form a public funded process by which research could be done in alternative forms of medicine. Medical providers who were legally allowed to practice could finally have proof of efficacy. This proof would also allow those providers to utilize medical insurance third-party reimbursement for their services, making them more accessible by the public who wanted them. 

NCCAM was instituted under the NIH and originally called the “OCAM” (Office of the Center for Alternative Medicine). Then it became NCCAM. And most recently, it became the NCCIH (National Commission of Complementary and Integrative Health). Each step in the change of nomenclature has moved the Center away from utilizing the term “alternative”. 

Integrated or not, what do you want for our medicine and profession?

Embedded in my arguments is a critique of scientific materialism, which I assert as a failure of imagination. In discussing medicine and imagination, I am not suggesting that medicine is false. Rather, my intention is to blur the boundaries between the real and un-real, and to view medical practice as a perceptual, rather than literalist, happening.

In Asian medical practice, we encounter these epistemological issues every day. Physicians in any system (Chinese, Tibetan, Indian, etc.) will invariably arrive at different diagnoses for the same patient. Different practitioners of the same medicine will each imagine a unique treatment, even in a diagnostic consensus. For some practitioners, this subjective variability is unsettling because it implies a fluid epistemology. The idea that for something to be true it must be objective and unchanging is the naive realism of empirical knowing. I argue that these concrete forms of “knowing” are not more real than the differential diagnoses of Asian medical practice.

I. Imagining Medicine

Medicine arises from our collective imagination. Medicine contains no objective truth—only a subjective value. Its province is the clinic, a topography whose features depend on polis and psyche, person and place. Medicine is who we are and what we envision, our gaze and our grasping. There is no medicine without the imaginal, no therapy without the mundus imaginalis.

Medicine is an artificium, a making of art, its practitioners artists and artisans. They hold the careful craft of theory in their hands, carrying the delicate instrument of healing. Clinic is thus a form of theatre, an open space of viewing, in which a play is acted upon the image of the patient, whose story gives us the primary myth of the bedside art.

In the West, medicine has suffered its miscarriage, its aesthetic lost in the materiality of examination and the mundanity of datum. The Western gaze has turned to the microscopic, not the microcosmic. Its scope perceives the minute constituents yet fails the whole in every part. We have lost our imagination to an indelible scrutiny of reductions, our spirit nothing more than irreducible particles, the imaginal dead in the scientific. Such a gaze can only regard what is visible; the smallest objective unit becomes the component rather than the constellation.

Without imagination, we are left to the devices of linear thinking and physical causality. Eastern medical traditions appear as nothing more than primitive archaisms, pre-scientific and pre-rational enterprises, old-world ideas outdated with every advance of objective knowledge.

The susceptibility of the East to the West is due to a failure of imagination, a perceptual loss replaced by the empirical call of progress. Westernization has devoured the imagination of the old world to erect a stage for its own standing, towering high above history. But we will miss the mark if we idealize the East over the West. Only understanding can build a bridge across continental divides and develop a diverse biome of knowledge. We need the pragmatism of medical pluralism, not the naiveté of “integrative” medicine but a co-existence and co-mingling that gives habitation for a manifold imagination.

II. The Locus of Imagination

The birth of the clinic is the death of medical perception.1 We need not clinics in the conventional sense, white-walled and white-coated, hanging in the stale sanitized airs of surgical steel. Such laboratories of inspection are mere arenas of experimentation with the body-as-object, subjected to trial and tribulation. The clinic has become so mechanistic that its procedures are performable by lifeless entities whose accuracy and precision become the displaced values we no longer even hope to attain.

Nature is in the bottle; the sample is in the test tube, stored behind the closed walls of inspection. We grow animals for organs for a cure. But nothing can fulfill our organic loss, now so masked from the natural airs. Even our failures have no tragedy. Loss or gain, a statistic, peer-reviewed for publication.

The orangutan who applies a paste to his wounds surprises the medical mind whose suppositions of sentience are worthlessly opaque.2 We are the injury against a natural intelligence, and our cure is traumatic, agape at the ape who lives the laws of nature without any data at all. What sort of sickness has possessed us? The orangutan is cornered against all odds, habitat destroyed by machines for profit, while their intelligence is admired from the distance of the next news cycle. There is no remedy for our abstraction, its discontent has become the seed of civilization, now flowering unseeded under a manufactured light.

The orangutan teaches us that the medical imagination belongs to nature itself. The orangutan’s intuition is not reducible to biological instinct or cranial anatomy. The orangutan’s medicine belongs to intuition and imagination in a world of relatedness—not constructed but perceived and construed. Healing is intrinsic to life, not only in the instincts of biology but through the insights of the heart.

“In the ancient world the organ of perception was the heart . . . The heart’s way of perceiving is both a sensing and imagining. To sense penetratingly we must imagine, and to imagine accurately we must sense”.3 In the heart, we discover medicine as aisthesis, an aesthetic response of sensation and imagination. The pulsing beneath our fingers, the palpatory sensibility, the color, sound, odor, and emotion—impressions translated into treatments.

To move with the heart toward the world shifts psychotherapy from conceiving itself as a science to imagining itself more like an aesthetic activity. If unconsciousness can be redefined as insensitivity and the unconscious as the anesthetic, then training for psychotherapy requires sophistication of perception.4

We can substitute “medicine” for “psychotherapy” in the above quotation and discover the same meaning. “The awakened heart is the locus of imagining”, l’immagine del cuor.5 The heart is the mythical emperor enthroned in the chest, the supreme controller of perception, the utmost source of imagination. Thus, imagination abides in the heart, suspended in the center like an inverted lotus bud, flowering in place. Diagnosis requires the sensitivity of refined perceptions, twelve organs at our fingertips. Medicine is thus a visionary practice, calling us to imagine the invisible and feel and shape the unseen contours of soma and psyche.

The true clinic is not a location but a space, a container for the emergence of the unconscious—not necessarily for analysis or even diagnosis, but for giving form to an invisible cache of meaning through shared perception. The clinical imagination is the vessel of therapy, the alchemical encounter and cauldron of change. Thus, medicine necessitates a “poetic basis of mind”.6 From a poetic basis of mind, we craft in hand and speech a poiesis of healing.

III. The Rebirth of the Clinic

Tests, trials, and case studies create the illusion and goal of an objective diagnosis. Our imagings have no imagination. They show us a vacant physiology of functional parts and organic failures of nerve, waiting for repair in a mechanic’s clinical garage. The colonoscopy of culture gives us nothing more than a post-clinical bag for our wastes. Tests, trials, and case studies are the products of industrial aphantasia and the bleak antiseptic rooms it operates within.

No form of calculated veracity can stabilize the therapeutic ground from subjective variability. Medicine engenders a surrealism that consistently blurs the lines of treatment and blends the shape of bodies. There is no likelihood or probability that is meaningful, yet every therapeutic act is suffused with meaning. Our theories are open to interpretation and available to imagination.

The myopia of medical realism renders the most ghastly pallor in a sanatorium of sensation. Only imagination gives color to the monochrome world, where plays of light embed our grasp within its folds. The clinic, a room with time and space for the soul and spirit, a human prism within a sphere of many angles.

The death of the clinic is the rebirth of imagination, of clinic as theatre, a symbolic unfolding and aesthetic enactment, a prophetic dream that vividly re-imagines the patient and their cure. Clinic as theatre opens the landscape of diagnostic and therapeutic possibilities, where every diagnosis is accurate and every intervention efficacious. We are the instruments of change who need no further assessment. Diagnosis thus becomes an intersubjective perception, a sensation of resonance, a wordless understanding. “An image is not what one sees, but the way in which one sees”.7

Born again, the clinic engenders immediacy and immanence, the nexus of medicine and imagination, seeking neither diagnosis nor prognosis but the present image, which itself contains the multitudes of time and space in a perfect summary.

IV. Medical Perception in the Art of Picasso

In the Head of the Medical Student, Picasso paints the pupil with an oblong face. One eye is closed and black, the other remains open and white. This dichotomy pictures a dual perception—one eye sees in dreams, the other sees in waking. From the dreaming eye, tears flow in lines, while the other half is dry. The figure is given a single ear on the dreaming side, where the student listens to the imagination. The student’s face is a highlighted contrast between light and dark, waking and dreaming, reality and imagination. The painting was a preparatory sketch for Picasso’s famous work, Les Demoiselles d'Avignon, a painting that depicts five prostitutes of which two are masked.

In a study preceding the artwork, the medical student is depicted entering from the left, brown-suited and holding a textbook. A sailor is depicted at the center of the composition. The sailor represents the libido, perceiving women through lust as objects of desire. The medical student, however, holds a different gaze: he sees the women analytically and anatomically.

In the final image, the two men are absent, and only women hold the perceptual gaze. Art critics interpret the two masked women as Picasso’s fear of contracting syphilis, as he was known to frequent the brothels. There is a tension between the three prostitutes on the left and the fear of infection on the right. Painted before the advent of antibiotics, Picasso’s concern appears historical. The medical student is absent, but his gaze remains in the perceptual context of imaginary disease.

Picasso’s paternal uncle, Dr. Salvador Ruiz, was a physician. He gave financial support for Picasso’s enrollment at the Instituto da Guarda. The director of the institute, Dr. Ramon Perez Couteles, was also a physician. Picasso was known to suffer from aural migraines, since termed “Pablo Picasso syndrome”—the suggestion being that Picasso’s surrealist cubism was the result of migraine-driven distortions. However, such a view would pathologize Picasso’s art and reduce its imaginative qualities to nothing more than sickness itself. We can surmise that Picasso’s concerns are more complex than either his migraine or his relationships. His paintings imagine the subject in reminiscences of the real world, blurring the lines and shapes of perceptual knowing. The Head of the Medical Student is an intimate portrait of the medical imagination, standing between worlds, listening and feeling the duality of perception and conception. In the original sketch, the student’s gaze is self-contained—it has no object of analysis. The purity of the subject stands naked, without ornament, and even without body. We have only the sensorium of the head and the blue subtlety of the heart.

V. Esoteric and Empirical Anatomy in Asian Medicine

In the Tibetan medical tradition, we encounter the historical intersection of imagination and a growing empiricism. For the Tibetans, medicine was an episteme that grew directly out of the Tantric imagination—the human body composed of unseen channels and plexuses. By the seventeenth-century, Tibetan physicians began dissecting corpses, birthing a new anatomical imagination, informed by the visible. Scholars challenged the authority of textual knowledge against a knowable empiricism, that “textual knowledge could be bettered or even contravened by empirical evidence”.8 Medical dissection failed to reveal the location of Tantric channels in the body, leading to new epistemological issues in Tibetan medical knowledge.

One example is a disagreement on the number of bones: the seventeenth-century physician, Darmo, counted 365 bones in the dissected body, but the classical source-text of the Four Treatises counts 360. “Much of South Asian medicine seems to have agreed that the number of bones in the human body is 360, but the great Ayurvedic classic Suśruta avers instead that there are 300”.9 This debate illustrates the critical disagreement between traditional and empirical schools of thought—“360” is nine multiplied by twelve, its imagines the human body as a reflection of the cosmos, specifically the solar cycle of twelve months in a year.

In another example, the Four Treatises differentiates the location of the Heart by gender: the Heart is said to tip to the right in women. As a result, the Heart pulse is read on opposite sides for men and women. The Four Treatises states:

First check the [male] patient’s left arm with the physicians right [hand]:
Under the index finger, check the heart and small intestine channels
Under the middle finger, the spleen and stomach channels
Under the ring finger, the left kidney and samse[‘u].10

Thus far, the pulse positions mostly mirror the Chinese pulse system, with the exception of the spleen and stomach channels which are placed on the patient’s right arm and palpated with the physicians left middle finger. Chinese texts place the Liver / Gallbladder on the patient’s left middle position, which the Tibetans place on the patient’s right middle position. The text continues:

For females reverse the index fingers and the two channels [that they examine] from right to left.
Why? While the lungs and heart are not on the right or left sides,
The tip of the heart faces [differently in males and females] in that way
[one to the right, one to the left].
The rest of the foregoing [instructions] are the same, since the locations are [similarly] disposed [in males and females].11

The idea presented here is that the heart tips toward the right in female anatomy. Therefore, the physician should read the heart pulse on the right hand of a female patient, but in the traditional left position for a male patient.12 Such notions are hardly verifiable with literalist anatomy, because they do not reflect empirical notions. The tipping of the heart is a reflection of the Tibetan cultural imagination, especially as codified in Tantric anatomical doctrines. In the Tibetan yogic tradition of Dzogchen, for example, we find similar variations in pranayama instructions, where the Tantric anatomy of men and women is differentiated. We see this Tantric differentiation at play in Zurkhawa’s justification:

Each pair of solid and hollow organs are connected to light and shade,
since the hollow organs follow on the solid ones.
The way these abide is evident and then not evident
like the inside and outside of the curve of a rainbow.
The reversing of method and primal awareness with respect to the
heart tip
is due to the power of roma.13

Zurkhawa’s explanation is archetypally classical: the heart tips to the right in women because the roma channel is dominant in them. The roma channel is identical to the pingala nadi of Indian yoga. The roma channel runs parallel to the right side of the spine, opens into the right nostril, and conducts the fire element. In Tantric systems, women are regarded as fire / sun / compassion, and men as water / moon / wisdom. Thus, the tipping of the heart and its transference in medical pulse diagnosis evidences the Tantric imagination of Tibetan medical theory.

In Chinese medicine, the movement toward rational empiricism was heralded with the birth of the Han Dynasty classics, textual sources that remain at the heart of the tradition. By the time of the Nei Jing, the Chinese medical epistemic had consciously moved away from demonological notions of health and disease and toward an observable hermeneutic of systematic correspondences.14 The idea that Heaven and Earth are in correspondence with each other brought medicine into a naturalistic domain that was evident instead of concealed.

The Chinese medical tradition now stands, much like the Tibetan medical tradition, between the lines of esoteric and empirical anatomies. For example, the classical concept of the Triple Burner is given in the Nan Jing as an “organ with a name but no form”.15 Physicians will never find the Triple Burner in the dissected corpse, but it remains an important physiological concept in the Chinese medical imagination. Does the apparent absence of meridians, qi, and the Triple Burner in a cadaver imply that these concepts are un-real forms of magical thinking?

Modern research attempts to graft these invisible notions into the concretism of empirical anatomy. Meridians are reduced to afferent and efferent nerve pathways, Tibetan channels to the cardiovascular system, qi to the piezoelectricity of the fascia, the Triple Burner to the interstitium. When cadavers became the subject of medical perception, its locus became the dead instead of the living. Literalism has displaced the medical imagination and sublimated its concern from an irreducible eros of life to a morbid fascination with the instinct of death.

From formless physiologies to symbolic anatomies, our imagination forges a new craft and ethic of medical perception. Medicine has more to do with a participation mystique than a matter of method. Medical meaning is archaeological and anthropological, historical and cultural. Imagination is the perception of the real, the true, and the beautiful. In its hands, we craft every kind of beauty, justice, and destiny—heart to heart.

I. Cannabis and Humanity

Fire and flower are the archetypal basis of civilization. We are domesticated by fire, and we domesticated flower. Our vitality is projected into the flame of nature, held in our navel, crafted in our hands. The green fuse is the fire in the flower, the blossom held in the eye of forms. We keep the fire and fertilize the flower, until it feeds us again and again. Flower is the archetype of all materia medica, the upward growth and shooting nectar of nature’s body-form. Fire is the archetype of all change, the horizontal center of ingestion and change, the cauldron that renders toxin into medicine. Fire is the medicatrix, flower is the medicant.

Medicine began in nature, with fire at side, flower in hand. Therapy began with cooking, the intentional fire, the sacrifice for power, the extraction of essence. It has never been the thing-in-itself that we are after, not noumenon but phenomenon. The medicant is not a thing, but an emergence. Thus, medicine has no objectivity, even while it apprehends a world of forms for its uses. The meaning of the medicant is its spontaneity, its reflection of time and place, of climate and season, of substance and quality. We need the medicant born of fire, living in the medicatrix. If medicine began in nature, then its sacrament is visionary. Our substance is a metaphor we ingest, an image we imbibe, an archetype we inhabit.

Human beings have co-evolved with fire and flower. Our bodies are forged by fire, our mind altered by flower. Co-evolution is a biological concept that describes reciprocal evolutionary changes engendered via interspecies relationships. According to ethnobotanists, humans and cannabis have co-evolved over millions of years. One aspect of the human-cannabis relationship becomes obvious when we examine the active constituents of cannabis: cannabinoids. Cannabis and mammals are the only species in the natural world that produce cannabinoids. The cannabinoids produced by cannabis are termed phytocannabinoids while the cannabinoids produced by mammals are termed endocannabinoids. Cannabinoid receptors (CB1 and CB2) pervade the human nervous system, connective tissue, glands, and organs? A receptor is, as the name implies, an interfacing mechanism. Cannabinoid receptors do not exist merely for endocannabinoids—they lock-and-key with phytocannabinoids.

Cannabis is the primeval flower emerging at the red dawn of civilization. Thus, it becomes impossible to speak of cannabis in isolation, as object, as substance, as thing-in-itself. We can only seek to understand the human-cannabis relationship, historically and presently. The origins of cannabis have been placed in the general region of Central Asia, but in the recent publication of Cannabis in Asia (2019), the authors present fossil and archaeobotanical evidence for cannabis in the Tibetan Plateau, roughly 28 million years ago.1 We know that cannabis originated in the old world a long time ago, and that humans have been interacting with it all the while. Today, we can hardly see cannabis for what it is—it hides in politics and stigma. Drug, that awful pejorative, a useless substance that only addicts its user to the empty and shallow habit of high and low. The only acceptable drug is the one produced and prescribed, the consumable official “medicine”, socio-politically acceptable, but which too often leaves us withered and empty.

We have to deal with the question head-on: is cannabis a drug? It depends on what we mean by drug. If we mean drug pejoratively, as in “narcotic”, then no, cannabis is not a drug. If we mean a substance with observable physiological effects, then yes, cannabis is a drug. “Drug” ultimately fails us as an apt definition of cannabis. Is a drug any substance with an effect or is a drug defined by its medicinal effect? Where do we draw the line between medicinal effect and toxic effect? What is medicinal in one moment can easily toxify in another, depending on who is ingesting it, why they are ingesting it, and in what dose they are ingesting it. The Greek word, pharmakon, is more suitable for our purposes. Pharmakon means “remedy, poison, and scapegoat”. Within pharmakon is the union of contradictory realities—substances are not classifiable into binary categories of medicine or poison, and the most powerful medicinal substances are poisonous. Cannabis is nectar, poison, and scapegoat—it provides, it toxifies, and it endures the stigmas alloyed upon it.

Nature has become anathema. We cannot take nature as a whole, we only want plants for what we can isolate from them. We would rather re-create and chemically synthesize in white laboratories what is naturally made in the fires of the Earth, for profits and patents. Even while cannabis remains federally illegal in the United States, it holds pharmaceutical interest and synthetic cannabinoid medicines are already being produced. Doctors can give these chemical pills to their patients without concern, but if a doctor handed them a joint to smoke, they become deceivers and drug dealers, the serpent in the garden again, bringing our Eden to ruin. We cannot accept what nature gives—we are its takers, weapon in hand. We repress what we cannot understand, and the legal history of cannabis in the United States is inextricable from racism. “Reefer madness” is prejudice in another guise, xenophobia in another context, racism masked as anti-drug propaganda. We ban nature in order to control it, to divide it into jurisdictions, provinces, contexts of appropriateness, legality, and criminality. In all of this, we are Prometheus with stolen fire in hand, forever guilty of our crimes.

The trouble with cannabis is its mind-altering effects. Cannabis can lift our mood, clear the clouds of angst, and re-ignite our creative instincts—effects that are viewed by the establishment as nothing more than intoxication. The root of intoxication is the medieval Latin intoxicare, “to poison”. Why does culture view euphoria as pathological and toxic? And what exactly is sobriety? Are we prejudiced against sobriety or against changes in consciousness? Why can’t we not be sober? The yogis, saints, and sages have spoken of religious and spiritual life in ecstatic language. Sufi poets compare their exalted states of being to a state of drunkenness. Spiritual life is also anathema, unless it is sold as a “New Age”—no drink, only water. But we are not only washed in the purity of water, we are also baptized by fire.

Fire is the maker of change, its flowery fusion is an opus contra naturum. Fire is the determining principle. In Āyurveda and Tibetan medicine, mercury is regarded as the poison of poisons. Fire transforms poison into nectar; fire burns the poisonous mercury to an ashen state of nectarous purity. Therefore, once mercury has been alchemically transformed, it becomes the king of medicines. We take the gift of the gods and we offer it back to them in a ritual fire, our soma thrown into the agni, our consciousness transformed into ecstasy. Thus, the question is not of substance, but of fire and its use.

II. Fuel and Flower

When we think of cannabis, we mostly think of its psychoactive inflorescences. Yet, not all cannabis is psychoactive. Cannabis has been used historically as a multi-purpose and renewable resource, at once fiber and food, fuel and flower.

Cannabis was among our earliest cultivated plants, and for centuries it ranked as one of our most important agricultural crops. For more than 7,000 years, Cannabis was utilized to produce necessities of life such as fiber, fabric, food, lighting oil, and medicine, and it has become one of the most widely cultivated plants in the world.2

In Cannabis, Clarke and Merlin explore an ethnobotanical perspective of cannabis, noting its varied use throughout time and across cultures. All parts of the cannabis plant were utilized as a resource: the stalk provides fiber for fabric and rope, the seeds provide oil, and the flowers provide medicine. Cannabis has been used throughout Eurasia for its psychoactive properties, for ritual and recreation. But Clarke and Merlin also note the extensive use of non-psychoactive cannabis in shamanic rituals across the Eurasian continent:

Hemp smoke is still used among some cultures to fumigate and purify, hemp cordage is used by some to tie and protect souls, hemp cloth provides a bridge or gateway for the spirits during some healing practices, and hemp clothing is still used as the final attire of the corpse piety in some areas of the world.3

Such non-psychoactive ritual uses of cannabis suggest a larger relevance for the plant beyond its effects. Cannabis as provider is an archetype of sustenance, a symbol of the Great Mother. Cannabis is soma, the flower in the fire, a rope between worlds, a smoke offering to the gods. The search for soma is in vain, as there is no single plant that is the soma of the Vedas. The Vedic concept of soma is an archetype of essence and sustenance. There may not be a single soma plant, but many plants and substances are soma-genic. Cannabis is similar to the cow whose milk provides butter and ghee and whose dung provides fuel and dwelling. The Vedic fire-ritual requires the cow’s dung for its fuel, and the cow’s essences for its offerings. Cannabis and cow are both soma—they provide the essential material for the ritual offering, the fuse for the fire.

Cannabis as Herb and Deity

“The essence of all beings is Earth. The essence of the Earth is Water. The essence of Water is plants. The essence of plants is the human being”. (Chandogya Upanishad 1.1.2)

In Indian culture, plants are seen as the dwelling places of gods and goddesses. These deities are the spirit of the plant, the archetype living within it, the symbol communicated by it. In Ayurvedic medicine, such “divine plants” are known as divyauṣadhi. Divya means “sacred” or “divine”, and oṣadhi means “herb” or “plant”. Some variants include oṣadhīśa, meaning “Moon”, the celestial ruler of the plant kingdom, and oṣadhihomna, meaning “a kind of oblation”. These linguistic connotations reveal the Indian view of plants as medicine (herb), as conduits of lunar energy (Moon), and as ritual offerings (oblation). The Moon is known as soma because it governs fluids—the ebb and flow of the ocean tides, the sap and juice of plants, the nectar and resin of flowers. In The Yoga of Herbs, Lad and Frawley offer another interpretation of oṣadhi:

The Sanskrit word for the plant osadhi means literally a receptacle or mind, dhi, in which there is burning transformation, osa.4

This definition adopts an alchemical view of plants as receptacles of cosmic energies that likewise feed an inner fire when taken internally. We do not merely ingest plants then, we offer them to the agni within, feeding the fire of vitality. If plants are alchemical agents of “burning transformation”, then they can all be understood as being psychoactive. “Psychoactive” simply means “affecting the mind”. In Asian medical systems, herbs are viewed as therapeutic catalysts for the body and mind, not one or the other. Some herbs have a stronger affinity for the mind and are employed for that purpose, but the scope of their affect remains holistic and comprehensive. What do we mean then, when we differentiate psychoactive and non-psychoactive? What makes cannabis different than tulsi?

In myth, tulsi is regarded as an earthly manifestation of the goddess by the same name. The goddess, Tulsi, is regarded as an incarnation of the goddess Lakshmi, consort of Vishnu. Similar to cannabis, every part of the tulsi plant is used. Its leaves are offered in ritual worship and it is traditionally planted in the center of a courtyard. As a deified plant, tulsi is regarded as a guardian, a provider and a protector. She guards against evil spirits, clears the air of pollutants, and emanates a sāttvic quality. Indians often grow tulsi indoors for these reasons as well.

Cannabis is associated with the goddess Kālī and the god Śiva, the wrathful deities of alchemical transformation. Cannabis gains association with Śiva through a variation of the Purānic myth of “churning the ocean” (samudra manthana):

In a Vedic account, the celestial nectar Amrita was produced when the gods and demons caused Mount Mandara to churn the primordial Sea of Milk. When something was needed to purify the nectar, Shiva created bhang (Cannabis) from his own body.5

On the holy day of Śivarātri (“the night of Śiva”), devotees celebrate and worship lord Śiva by consuming bhang, a psychoactive drink made from cannabis. Śiva is the archetype of transformation—he is the one who holds the poison in his throat without becoming poisoned. Similarly, his devotees consume cannabis as a devotional sublimation that transforms its earthly poison into divine nectar.

As Kālī, cannabis becomes the destructive goddess, a necklace of skulls strung around her neck, her teeth gnashing with blood, her feet standing on the chest of Śiva. Kālī symbolizes the death of the ego and the birth of spirituality. The forbidden fruit is a serpentine whisper, waiting for communion.

However, cannabis is not only Kālī—cannabis holds the archetype of the Goddess in all her forms. The male cannabis plant has no psychoactive properties, it is only the female flowers that are psychoactive. Thus, the Goddess becomes the archetype of “intoxication”. While we can divide cannabis plants into male and female, we also need to note the plant’s hermaphroditic tendencies. A cannabis plant can produce male pollen and female flowers at the same time. The hermaphrodite is an archetype of great psychological importance. Jung considers the hermaphrodite “a unifying symbol” that “expresses wholeness”, the hermaphrodite “is an image of the archetype of the ‘self’”. As a union of opposites, cannabis is an image of the prima materia, the undifferentiated substance which is refined into the nectar of immortality. Jung writes that the hermaphrodite “is composed of opposites and is at the same time the uniting symbol . . . It is on the one hand a fatal poison . . . on the other a panacea and a saviour”.6

We find all of these statements to be simultaneously true about cannabis: it is poison and panacea, god and goddess, giver and destroyer, devil and savior. Earlier we saw how tulsi was regarded as a guardian plant, and the same recognition is given to cannabis in the Hindu tradition:

To the Hindu the hemp plant is holy. A guardian lives in the bhang leaf . . . so the properties of the bhang plant, its powers to suppress the appetites,7 its virtue as a febrifuge, and its thought-bracing qualities show that the bhang leaf is the home of the great Yogi or brooding ascetic Mahadev [Śiva].8

III. Cannabis and Medicine: Ayurveda, Chinese Medicine, and Homeopathy

Cannabis is featured in the pharmacopeia of India, Tibet, and China, where it is largely employed in the context of herbal formulas rather than as a single herb. This fact is an oft-repeated caveat from practitioners who cast a critical eye toward the modern use of cannabis as a single herb. The function of an herbal formula is to create a synergy of effects, where the whole is greater than the sum of its parts. Formulas have internal compensations, where one herb counteracts the undesirable effect of another herb. Formula architecture is given detailed consideration, where each formula is comprised of a hierarchy of ingredients, often described in an imperial metaphor of king, queen, and minister herbs.

While Tibetan and Chinese herbal traditions rely heavily on formulas, Ayurveda frequently utilizes single herbs. An Ayurvedic practitioner may prescribe ashwagandha, tulsi, guduchi, or amla entirely on their own. Herbs that are classified as rejuvenatives (rasāyana) are commonly prescribed as single herbs. For example, shilajit (mineral pitch) is used in herbal formulas but it is more frequently prescribed as a single remedy, usually in liquid form. Rejuvenatives are rich substances that function effectively on their own, without negative side-effects.

Cannabis in Ayurveda

Cannabis is first mentioned in the Atharva Veda, a text dated between 500 CE - 1600 BCE. Cannabis is referred to as bhanga and is described as having anxiolytic effects. Cannabis is mentioned again in the Suśruta Samhita (ca. 800 CE) as a cure for mucus accompanied with diarrhea and biliary fever. The medical benefits of cannabis are mentioned in a number of later texts, including Dhanwantari nighantu, Sharagandhara Samhita, Madanapala nihagntu, Rajanighantu, Dhurtasamagama, and Bhavprakash. In folk medicine, cannabis has been used to increase endurance amidst physical labor. “For centuries, Indian foot bearers transporting goods high into the Himalaya Mountains have relied on Cannabis to relieve fatigue”.9 Cannabis juice is used to remove dandruff and parasites from hair, to alleviate earaches, and in the treatment of constipation / diarrhea. “Other significant applications include its use for relieving headaches, acute mania, whooping cough, asthma, and insomnia”. Cannabis was used by the Meena and Garasia tribal groups in the form of a paste made from cannabis leaves, applied topically on bleeding hemorrhoids.

In Ayurveda, cannabis is valued for its ability to expel negative spiritual influences. These effects are typically discussed in the context of “fever” which includes physical fevers but also “angry influences”. “If a person stricken with fever poured bhang on a Shiva lingam, ‘he was pleased, his breath cooled, and the portion of the breath in the body of the sufferer ceased to cause fever”.10 Visions of cannabis in dreams is considered an auspicious omen:

To see in a dream the leaves, plant, or water of bhang is lucky; it brings the goddess of wealth into the dreamer’s power. To see his parents worship the bhang-plant and pour bhang over Shiva’s lingam will cure the dreamer of fever. A longing for bhang foretells happiness; to see bhang drunk increases riches. No good thing can come to the man who treads under foot the holy bhang leaf.11

Cannabis is viewed as the “penicillin of Ayurvedic medicine” and has long been regarded as a panacea in India. In the Himalayan region, there is a “widespread belief . . . that a concoction of young Cannabis leaf powder and honey keeps youth, vitality and virility”. In Nepal, cannabis leaf juice is used to “heal wounds, control bleeding, and relieve stomachaches, while leaves are smoked and taken internally to relieve discomfort and inflammation”. In Nepali folk medicine, cannabis was mixed with sweets and given to children in order to sedate a child—cannabis “keeps him less active and less likely to get into trouble while [the mother] is occupied in other ways”. The pediatric use of cannabis in Nepal has been compared to the use of opium extracts for the same purpose in America: “The use of hashish is quite parallel to the use of opiates in soothing syrups given to fretful or teething babies in the nineteenth and twentieth centuries in America”.12 In Bhutan, cannabis grows in the wild and can be found growing in common areas. However, in Bhutanese culture, people do not smoke cannabis, they feed it to their pigs!13

In Nadkarni’s Indian Materia Medica, cannabis is given a thorough entry with an Ayurvedic classification and a scientific description of its constituents. The entry is listed under “Cannabis Sativa” and begins with a list of Sanskrit names for the plant: vijaya, siddhapatri, ganjika, bhanga, etc. The text describes the native habitat of cannabis as “Persia, Western and Central Asia”, noting that it is “now cultivated all over India and is found on the Western Himalayas from Kashmir to east of Assam”.14 The text states that cannabis achieves its “highest therapeutic power when grown in tropical or sub-tropical climates” where resin production is maximized.

This brings us to another modern conundrum: cannabis is mostly cultivated indoors. The ability of the plant to thrive in a wide variety of growing conditions around the world, including indoors, is a testament to its adaptogenic qualities. In Asian herbal traditions, much attention is given to where an herb is grown, its climate, its location, with planting and harvest cycles astrologically determined. Indoor cannabis benefits the grower by creating a controlled environment of growth that is not dependent upon seasonal cycles and that is largely free of pests. Indoor flower can be produced year-round and at will. In the world of recreational cannabis, indoor flower is regarded as superior quality, because the buds appear “perfect”. Craft cannabis is an indoor game. However, from a medical standpoint, outdoor-grown cannabis is far superior because it has grown under the sun, moon, and stars, rather than behind walls and under artificial lights. Even more, a medical view would give relevance to the grower’s consciousness as an influence. The legalization of cannabis in twenty-four States has at least partially released cannabis from prohibition, but it has also recognized cannabis as a cash crop, farming as a profession, and dispensaries as a business.

The text continues to describe the “action and uses in Ayurveda and Siddha” as follows (translation in parenthesis is mine): tikta rasam (bitter taste); ushna veeryam (heating potency); lagu (light); tikshanam (sharp); pachanam (digestive); produces pittam (bile); sukra sthambanam (restrains semen); aphrodisiac; grahi (absorbing fluids), grahani (preventing dysentery).15 The text stops short of a doshic analysis, but the bitter taste and heating potency along with light, sharp, digestive, and bile-promoting qualities tell us that cannabis primarily increases pitta, secondarily increases vāta, and reduces kapha. This means cannabis can be used therapeutically in cases of pitta deficiency / kapha excess. If cannabis is prescribed in the proper dosage, at the right time, and for an appropriate duration, then aforementioned conditions / patterns can be helped. However, if cannabis is mis-used, taken in too high of a dosage, or for too long a period, then these conditions / patterns will manifest even if they were absent prior to use.

Returning to the text, the final section describes the uses of cannabis in detail, differentiating between the drink, flowers, leaves, and resin:

Bhang and ganja are prescribed by Hakims and Vaidyas in bowel complaints and recommended as appetisers, as nervous stimulants and as a source of great staying-power under severe exertion or fatigue. Leaves make a good snuff for deterging the brain; their juice applied to the head removes dandruff and vermin; dropped into the ear it allays pain and destroys worms; it checks the discharge of diarrhoea and gonorrhoea. Powder of the leaves applied to fresh wounds promotes granulation; a poultice of the plant is applied to local inflammations, erysipelas, neuralgia, haemorrhoids, etc., as an anodyne or sedative . . . The concentrated resin exudate extracted from the leaves and flowering tops . . . is used to produce sleep in cases of sleeplesness, in which opium is contraindicated; it is valuable in preventing and curing sick-headaches, neuralgias, migraine (malarial and periodical), valuable in acute mania, whooping cough, asthma, dysuria and in relieving pain in dysmenorrheoea and menorrhagia and pain of the last stages of phthisis; it increases appetite. It does not produce loss of appetite or constipation like opium.16

Cannabis is also mentioned in the sixteenth-century Ayurvedic classic on herbal medicine, Bhavaprakasha, where it is listed as bhangā in an entry preceding opium. The entry is very brief and notes the following:

Bhanga removes kapha, bitter in taste, water absorbent, digestant and is light in action. It is penetrating and heat generating. It enhances Pitta, causes a state of semiunconsciousness and drowsiness, induces delirium, increases appetite.17

This passage is so similar to Nadkarni’s description that we can be certain he referenced Bhavaprakash. The text notes that cannabis powder is used as an astringent in a dosage of 250-500mg and that the juice or powder is used with aphrodisiacs for “mood elevation”. The text concludes with a commentary from the translator, Dr. Bulusu Sitaram:

The drug Bhānga entered the Ayurvedic field in around 11th cent, A.D. This drug is available in the market in three forms depending upon the part of the plant concerned. The first form Charas is a resinous substance that is collected in the early hours of the day. The second one gāñjā is the female inflorescence from the cultivated varieties. Bhāng is the collection of leaves from both male and female plants.18

In Ayurveda, cannabis is prepared and administered as a medicinal ghee. When cannabis is cooked with ghee, it is “purified” of its toxic qualities. Ayurveda favors the edible form over smoking, because when a substance passes through the digestive system, it is subjected to the body’s fire, and thus purified. Smoking bypasses the digestive system and is looked upon less favorably. Medicated ghee helps counteract the drying effects of cannabis, qualities which are exacerbated by smoking. However, edible cannabis is difficult to dose, and its effects vary greatly per individual metabolism. The Ayurvedic purification of cannabis into medical ghee is described by an Irishman, William O’Shaughnessy, after observing a practitioner named Ameer performing the procedure in Kolkata:

Four onces of siddhi [bhang] and an equal quantity of ghee are placed in an earthen or well-tinned vessel, a pint of cold water added, and the whole warmed over a charcoal fire. The mixture is constantly stirred until the water all boils away, which is known by the crackling noise of the melted butter on the sides of the vessel. The mixture is then removed from the fire, squeezed through cloth while hot, by which an oleagnious solution of the active principals and coloring matter of the hemp is obtained; and the leaves, fibers, etc., remaining on the cloth are thrown away. The green ouly solution soon concretes into a buttery mass and is then well washed by the hand with soft water, so long as the water becomes colored. The coloring matter and an extractive substance are thus removed and a very pale green mass, of the consistenty of simple ointment, remains. The washings are thrown away; Ameer says that these are intoxicating, and produce constriction of the throat, great pain and very disagreeable and dangerous symptoms.19

Cannabis in Chinese Medicine

In Chinese medicine, cannabis is known either as ma, mafen, or mabo. Textual references are ambiguous in terms of which part of the plant is being discussed. Mafen is interpreted to mean female cannabis flowers, and is the reference used in a passage from the Divine Farmer’s Classic of Materia Medica:

Flavor: acrid; balanced. Governs the five taxations and seven damages, benefits the five viscera, and descends blood and cold qi; excessive consumption causes one to see ghosts and run about frenetically. Prolonged consumption frees the spirit light and lightens the body. Another name is mabo.20

In Chinese herbal medicine, the acrid taste benefits circulation of qi and blood, but overuse of acrid substances results in dryness. Cannabis is not only acrid, but “balanced”, meaning that it also secondarily contains the other four tastes. The “five taxations” refer to pathologies caused by overwork: excessive use of the eyes injures blood, excessive lying down injures qi, excessive sitting injures flesh, excessive standing injures the bones, and excessive walking injures the sinews. The seven damages refer to the injurious effects of the seven emotions: grief, melancholy, fear, fright, anger, joy, and worry. The action of descending blood and cold qi is another way of describing free-flow of blood and qi. “Cold” naturally descends, but when it fails to descend it stagnates in a channel or invades an organ. If cold qi is helped to descend, then cold can be eliminated. The comment about excessive consumption causing hallucinations and uncontrolled behavior suggests psychoactivity and resultant mania. However, this concern seems alleviated by the idea of “prolonged consumption” which “frees the spirit light” and “lightens the body”, a comment seeming to reference Daoist alchemy.

The Divine Farmer’s Classic lists cannabis as a “first class” drug, which are non-toxic. Clarke and Merlin state that “no matter how much [first class drugs] were utilized they were believed to be harmless”. Ma fen is described in this text as a powdered preparation of female cannabis flowers, thought by the Chinese “to contain the greatest amount of yin energy”. Clarke and Merlin write that ma fen was prescribed for “loss of yin, such as in menstrual fatigue, rheumatism, malaria, beri-beri, constipation, and absentmindedness”.21

In the sixth century text, Collection of Commentaries on the Classic of the Materia Medica (Ben Cao Jing Ji Zhu), the author notes: “adepts take cannabis flower (mabo) with ginseng and know of things that have not yet come”. An adept is an alchemist, suggesting that Daoist alchemists used cannabis for divinatory purposes and/or clairvoyance. This text also describes cannabis to “relieve impediment”, a reference to “painful obstruction” (or bi) disorders which roughly correlate to arthritic conditions.

In the seventh century text, Formulas Worth a Thousand Gold by Sun Si-miao, cannabis is indicated in the treatment of “wind-withdrawal”, a traditional category of disease that encompasses mental illness and epilepsy. The seventeenth century text, Reaching the Source of Materia Medica (Ben Jing Feng Yuan) lists cannabis flower (mahua) as a treatment for itching, to expel pathological wind and blood, and for menstrual disorders due to stagnation.

Dr. Leon Hammer was a psychiatrist and acupuncturist who wrote about the connections between cannabis use and Liver pathologies, specifically Liver yang deficiency, Liver qi deficiency, and the separation of Liver yin and yang.22 This suggests that the main action of cannabis is upon the Liver. In Ayurveda, pitta means “bile” and its humoral seat is in the Liver. Thus, we can see how cannabis has an affinity with the Liver—humorally as pitta and pathologically through Liver deficiency patterns. Perhaps the most obvious sign of the cannabis-Liver relationship is the classic symptom of the “munchies”. The munchies are signaled by a marked increase in appetite, especially with a desire for fatty foods, owing to increased bile production and flow. However, if cannabis is the only impetus for this flow, then when its influence is absent, stagnation results: stimulus ends in deficiency. Cannabis temporarily smooths the Liver qi resulting in a free-flowing feeling of relaxation, a release in euphoria. Liver qi stagnation is our primary cultural pathology, epitomized in the fast-paced high-stress lifestyle, the modus operandi of modernity. The cannabis-Liver relationship also explains why cannabis has been favored by creatives—artists, musicians, visionaries, writers, intellectuals.

We can also examine the pathophysiology of the Liver through the sub-doshas of pitta: alocaka pitta is the fire in the eyes, bhrajaka pitta is the fire in the skin, ranjaka pitta is the fire in the Liver, sadhaka pitta is the fire in the Heart, pachaka pitta is the fire of the Stomach. Liver pathologies can manifest in eye symptoms, skin disorders, digestive symptoms, and mental-emotional symptoms. If we correlate these with Chinese medicine, then we can see how Liver pathologies lead to patterns of Liver Fire, Heart Fire, and Stomach Fire. We can think of anger, irritability, acid reflux, skin rashes, and mania.

Cannabis and Homeopathy

Cannabis can create the very symptoms it alleviates. Such is the nature of pharmakon—it is the context of use that determines the effect. According to Paracelsus, dose is the determining factor between nectar and poison. If cannabis creates in a healthy person the very pathologies it alleviates in a sick person, then it is ripe for homeopathic examination.

In the Essence of Materia Medica, classical homeopath George Vithoulkas writes a remedy portrait of cannabis indica. He notes that cannabis is indicated in “cases where symptomatology is focused in large part on the mental and emotional planes”. Vithoulkas continues to describe two types of people for whom cannabis is an appropriate remedy:

One type is by nature a primarily emotional, ethereal person—someone who relates to things generally through the emotional realm rather than the mental. The other is primarily a mental type over stimulated in the mind, and governed by the fear of loss of control.23

We translate these types into Ayurvedic language—the emotional type corresponds to vāta and the predominance of the ether element; the mental type corresponds to pitta and the predominance of the fire element. We noted earlier that these are the two doshas that cannabis increases. “Like cures like”. Therefore, in homeopathic thinking, cannabis is appropriate for vāta and pitta people.

Vithoulkas also notes the utility of cannabis “in patients who have had a so-called ‘Bad trip’ which has left a lasting effect on the mental sphere”.24 He adds a sub-category to this, where cannabis is indicated in “people whose constitutions have broken down into a dull, hazy, scattered mental state after using many such drugs over a period of years”.25

The homeopathic prescribing of cannabis, however, looks very different from going to a local dispensary. Homeopathic remedies only contain the “essence” of the substance. By delivering the subtle energetic imprint of the substance, homeopathy uses the law of similars to create a resonance in the patient. Resonance is intelligence and regulation. Resonance is the nature of homeostasis. Pathologies are not eliminated, they are brought into a condition of resonance, and thus converted from etiological factors to balancing factors.

A homeopathic perspective of cannabis raises important considerations of its clinical use. In the Western medical context, cannabis is gaining value for its palliative effects. Palliation has its purpose, but if palliation becomes our primary clinical strategy, then we are chasing symptoms rather than treating conditions. Pain, spasms, nausea, and poor appetite can all be temporarily relieved by cannabis, but symptomatic relief is not the same as cure. According to Hering’s Law of Cure, symptomatic treatment suppresses cure. By treating the surface, we push the pathology deeper into the body. Symptoms are the body’s intelligence, communicating its distress signals. We need to listen to symptoms and understand what is causing them. If we use cannabis only for symptom relief, then its application becomes entirely allopathic, and its therapeutic value becomes reduced to nothing more than first-aid.26

On the Issue of Cultivars

Cannabis may be a single herb, but its hardly singular in function or quality. Cannabis is a genus, and within it are three recognized species: cannabis indica, cannabis sativa, and cannabis ruderalis. Only the first two produce psychoactive flowers, with the third being used for hemp production. Within the first two species—indica and sativa—we face the issue of cultivars. Cannabis is no longer simply cannabis, it has a multitude of varietals (or “strains”) that produce a diverse spectrum of effects. This makes cannabis challenging to classify.

In my view, a medical understanding of cannabis should focus on specific strains. While landrace varieties can still be found, most cannabis has been bred. This domestication of the plant coupled with breeding practices have changed the landscape of cannabis and its medical implications. Michael Pollan compares the genetic revolution of cannabis with the introduction of the China rose in Europe in 1789:

Marijuana’s genetic revolution recalls an earlier horticultural watershed: the introduction of the China rose (R. chinensis) to Europe in 1789, an event that made it possible for the first time to breed roses that would flower more than once a season. This ultimately led to the development of the ever-blooming hybrid tea rose. For both the rose and marijuana, human mobility coupled with human desire—for a rose that would rebloom in August; for sinsemilla that would grow in the north—led to the reunification of two distinct evolutionary lines for a plant that had diverged thousands of years before. In both cases, the introduction of a set of plant genes found halfway around the world created undreamed-of new possibilities.27

The undreamed-of possibilities have become the real substance of waking life, as there are currently over 700 strains of cannabis in existence. How do we begin to differentiate these strains in a clinical context? Terpenes may be one way to understand the differences between strains with a clinical sensibility. Terpenes are the primary constituents of essential oils, and cannabis is full of them. The essential oil of a plant is its soma, its nectarous sap, its essence. Therefore, by understanding terpenes, we grow to understand the subtler range of cannabis therapeutics.

Terpenes are especially abundant in aromatic plants, such as spices. My Ayurvedic teacher, Vaidya Mishra, emphasized the important of spices in one’s diet. Ayurvedic dietetics and herbal medicine make significant use of spices for their therapeutic effects. Vaidya would always say to cook with a lid on the pot to preserve the aromatics in the food. Similarly, he advised crushing spices fresh rather than buying powdered spices, because the therapeutic effect is in the aromatics.

Myrcene is an herbal aromatic found in hops, mangos, and lemongrass—substances with sour and astringent tastes. Myrcene is known for its relaxing effects and has a cooling energetic. Strains that are dominant in myrcene should be favored for its vāta and pitta pacifying effects. Strains dominant in myrcene include Blue Dream, OG Kush, Blueberry, and Northern Lights.

Pinene is an herbal aromatic found in rosemary, basil, and dill. These herbs have an affinity for clearing the mind. Pinene can clear kapha from the mind, pacify vāta in the mind, and support the intelligence of pitta. Pinene is thus tridoshic in its effects. Strains dominant in pinene will be clear-headed, anxiolytic, and have less pronounced short-term memory loss. Pine-dominant strains are less common but include landrace Jamaican varieties, Northern Lights #5, and LA Confidential.

Caryophyllene is a spicy aromatic found in black pepper, cloves, and cinnamon. In Ayurveda, black pepper is used to reduce kapha and increase pitta, and we saw earlier how cannabis has been classically understood to foster this very dynamic. Cloves are used to open the channels without aggravating pitta. Cinnamon aids digestion, enhances circulation, and clears excess kapha. Strains that are dominant in caryophyllene should be favored for its anti-inflammatory and kapha-reducing effects. The spicy and warming qualities of this terpene increase pitta, but its anti-inflammatory effects safeguard against pitta imbalance, making it especially appropriate in cases of deficient heat or low agni / high pitta conditions. Strains dominant in caryophyllene include Sour Diesel, Chemdawg, and Bubba Kush.

Limonene is a citrusy aromatic, found in citrus peels, rosemary, juniper, and peppermint. Its effect is sour, astringent, and ascending. These plants remove kapha from the head, open the nose and sinuses, and are emotionally uplifting. Limonene clears pitta but its lightening quality can aggravate vāta. In pitta and kapha predominant constitutions, the effects of limonene-dominant strains will give a calm and creative effect, but in vāta individuals, limonene strains can cause paranoia. Limonene-dominant strains include MAC, Kush Mints, Dosidos, and Banana Kush.

Terpinolene is a floral and citrusy aromatic found in nutmeg, cumin, tea tree, and lilacs. Nutmeg and cumin are revered in Ayurvedic medicine for their medicinal benefits—nutmeg is a sedative that calms vāta and promotes sleep; cumin is a carminative that aids digestion. Leafly’s chart places terpinolene at the peak of the “energizing” spectrum, but its energizing effect is closer to a calm alertness. Terpinolene-dominant strains are vāta-pacifying, providing a well-paced motivational effect. Strains dominant in terpinolene include Jack Herer, Durban Poison, Super Lemon Haze, Trainwreck, and Lilac Diesel.

Forms and Methods: Flower vs. Concentrate, Smoking vs. Vaping vs. Edibles

Cannabis comes in many forms, variances we can classify in two categories: flower or concentrate. Cannabis flower are the ripe and dried inflorescences of the female plant. Concentrates are a broader category that includes hashish and modern extraction methods. Hashish is a traditional cannabis concentrate, extracted in various ways. In Himalayan regions, ripe cannabis flowers are rubbed between the palms, leaving behind a dark resinous material called charas. Charas is typically rolled into a ball, described by connoisseur as “Nepalese Temple Ball Hash”.

Hashish is cannabis in essence form, leaving behind all plant material, and concentrating the resinous trichomes responsible for psychoactivity. Moroccan and Lebanese hash are the most common traditional forms. Rosin is a form of high-tech hashish, made by pressing flowers between 300-1000 psi.

Solvent-based extraction methods yield “honey oil” that is used to fill cartridges. Live resin is the only solvent-based method that preserves terpenes. While concentrates are purified of solvents, solvent-based extractions are less preferable to hashish forms. If we recall Nadkarni’s description, hashish (especially charas) has greater medicinal value than the flowers. Since hashish is only resin and thus free of plant matter, it produces a clean, vaporous, and incense-like smoke that is gentler on the lungs and throat than cannabis flower.

Sativa, Indica, and THC

Cannabis is sub-divided into sativa and indica varietals. Sativa plants are native to equatorial regions. The plants are very tall, have a lengthy flowering cycle, and produce thin, fluffy, and pointy flowers that give an uplifting and energizing effect. Indica plants are native to the mountainous regions of Central Asia. The plants are short and stocky, and the flowering cycle is faster than sativa plants. Indica plants produce dense flowers with soporific effects. Sativa plants have vāta and yang characteristics, indica plants have kapha and yin characteristics.

We can think of sativa / indica as up / down, but not all sativa is “up” and not all indica is “down”. Cannabis breeder, DJ Short, considers “up” and “down” to be more accurate descriptors for strain effects than the oversimplified “sativa” and “indica”. Aside from landrace strains, all cannabis represents a hybridization of sativa and indica plants, as growers bred indica plants into sativas to shorten the flowering cycle. I find it more useful to see strains in terms of directionality. In Chinese medicine, herbs are given directionality—ascending or descending. Strains that have an ascending directionality are appropriate for pitta and kapha, but contraindicated for vāta. Strains that have a descending directionality are appropriate for vāta and pitta, but contraindicated for kapha.

Lastly, we have the issue of increased potency. DJ Short notes that the strains of yesteryear had only 7% THC and were “head and shoulders above what we’re smoking now”. Today, THC levels are as high as 30%, averaging around 20%. The fact that cannabis has been bred with higher potency is voiced as a concern among critics. We need to remember that THC is only one of 100+ phytocannabinoids in cannabis. THC is regarded as the scientific cause of psychoactivity, but an herbal view appreciates the effect of cannabis as a consequence of a unique synergy—not only of compounds, but of conditions as well. Cannabinoids, terpenes, climate, grower, growing conditions, harvesting, and processing are all factors that shape cannabis, its effects, and its uses—therapeutic or otherwise. We need cannabis breeders who are growing for therapeutic purposes, who appreciate the synergy of these factors, and who will breed for medicinal cannabis, rather than high THC content.

IV. Cannabis and Spirituality

We have established cannabis as a plant of historical and modern significance, a pharmakon with established therapeutic value and clinical cautions. A medical view acknowledges a context of appropriate use, where poison can become nectar in the right place at the right time in the right person for the right purpose. But what of spirituality? Do psychoactive plants have spiritual significance? How can we understand cannabis in the context of psychedelic therapy?

Different traditions view cannabis differently. For Rastafarians, cannabis is a sacrament. For Saivites, cannabis is a gift from Śiva. For physicians, cannabis can treat certain conditions. In religious and spiritual traditions around the world, we find justification for cannabis as sacrament, as offering, as oblation, but we also find a cautionary tale.

J.R. Worsley, father of the 20th century five-element acupuncture tradition, cautioned against cannabis use. His view was resonant with the homeopathic axiom that whenever we ingest something we do not truly need, it functions as a toxin. Health is seen as a natural state and imbalance as a disruption of this condition. Treatment should represent the minimal intervention necessary to recover homeostasis. From this view, recreational cannabis would be seen as detrimental to one’s health. In Traditional Diagnosis, Worsley writes:

Given the strictures about drugs that are largely unnecessary, the same applies, with far greater emphasis, where totally unnecessary drugs are concerned. As I mentioned earlier, I have strong feelings about so-called recreational' drugs because I have often seen the terrible toll such drugs have on people. No patient should be allowed to think that he can safely take any form of non-prescribed drug, not even the so-called 'soft' ones. It is possible to tell immediately from someone's pulses if he has been taking marijuana. Its potential to create havoc is so great that it will cause greater imbalances than drinking half a bottle of whisky and smoking thirty cigarettes a day. This comes as something of a shock to people who argue that marijuana is less harmful than drinking alcohol.

While Worsley’s view is that cannabis is more harmful than alcohol, cannabis is significantly less habit-forming than alcohol and it does not impact the physiology in nearly the same way. Can we really compare alcoholics to cannabis smokers? This view is difficult to justify, but I believe Worsley is pointing to the effect of cannabis on a subtler spiritual level. Worsley continues:

If we have a patient who takes drugs, we need to know what kind, how much and how often. We must try to discover why they are being taken, just as we look for the reason behind a person's drinking heavily. No one reasonably healthy in body, mind, and spirit would touch drugs knowing the irreversible damage they can do to the officials. If the person is seeking beautiful experiences, or God, or Nirvana, we need to know why his officials28 are preventing him finding it through his own natural powers in the beautiful and bounteous world in which he lives.29

Worsley’s point is that the search for experiences via substances is the symptom of a deeper spiritual need that can only be satisfied from within, rather from without. Worsley viewed the human physiology through the classical Chinese lens, where the organs are not only functional entities, but “officials” working in hierarchical tandem to provide the being with its physical, mental, and spiritual resources. Worsley often spoke of the Heart as the “God within”, a phrase that evokes a modern term used to describe psychedelics—entheogen. “Entheogen” comes from the Greek entheos, meaning “becoming divine within”. In Worsley’s system, acupuncture is a therapeutic paradigm that restores access and connectivity in body, mind, and spirit where it has been lost, blocked, or severed for one reason or another.

We can appreciate Worsley’s view when we consider that the human body produces its own cannabinoids. Why do we need cannabinoids from cannabis when we can make our own? This view can be turned on its head to say: if cannabis and the human being both produce cannabinoids, then why not use cannabis? Do psychedelics actually give us anything that we do not already have or do they simply act as alchemical catalysts for the resources already existing within us?

Worsley’s criticism is echoed by Rudi, a teacher of Kundalini Yoga in the 60s and 70s. In his autobiography, Spiritual Cannibalism, Rudi discusses extended drug use as counter-productive to spiritual growth:

Drugs can do nothing for a student seeking spiritual growth. It is never of any benefit to use artificial means to relax or force the psychic system to open. Drugs have a purpose only under certain rare conditions; even then, natural means are usually better. Many people open to their spiritual nature during a drug experience. This is like coming to a promised land. Why risk losing it by burning out the mechanism using drugs again? The extended use of drugs has a weakening effect on the psychic system. To force the muscles open artificially weakens them and they become progressively less able to carry the force. In time the whole system becomes dependent on the artificial agent. The result can be a chronic muscular breakdown and the total muscle mechanism can be badly damaged. 

The use of artificial means in a fully developed physical system has bad results. The psychic muscular system, which is weak in function to start with, has no chance of resisting external influences. This is why drugs produce such spectacular effects and gather enthusiastic supporters. They offer an indication of the great psychic riches within a man. But why dynamite a gold mine that lies just below the surface? The slow, thorough work of a responsible and disciplined individual will produce rich rewards his whole life through. Tearing into the psychic tissue may produce a few golden nuggets, but this is only fool’s gold. 

Building and working for long-range results is not only the best way but the only way for you to achieve realization. It is to a full and happy life that you should aspire, not to thrills.30 

Rudi was speaking to students at the height of the counter-culture movement, beckoning them to real spiritual practice rather than external substitutes. Rudi does not specify which “drugs” he is referring to, but it seems clear that he is commenting on psychedelic substances. He does not completely eschew the value of such substances, but points to the value of spiritual practice for cultivating sustained conductivity of spiritual energy rather than temporary peak experiences stimulated by substances that ultimately exploit and drain the psychic mechanism.

A similar sentiment is found in Chögyam Trungpa’s disposition regarding cannabis. Trungpa famously asked his students to bring their stashes of cannabis to a gathering at his house. Students were excited, thinking they would get stoned with the Vidyadhara. But Trungpa threw their stash into his fireplace instead! This act is interpreted by his students as a symbolic burning of self-deception.31

In an account detailed by Stanislav Grof, Swami Muktananda discusses LSD and the proper sacramental use of cannabis:

Muktananda knew that I had worked with LSD and initiated a discussion about the use of psychoactive substances in spiritual practice. He expressed his belief that the experiences induced by them were closely related to those sought in Siddha Yoga. 

“I understand you have been working with LSD,” he said through his interpreter, Malti, a young Indian woman whom he many years later appointed as his successor under the name Swami Chitvilasananda. “We do something very similar here. But the difference is that, in Siddha Yoga, we teach people not only to get high, but to stay high,” he stated with confidence. “With LSD you can have great experiences, but then you come down. There are many serious spiritual seekers in India, Brahmans and yogis, who use sacred plants in their spiritual practice,” Swami Muktananda continued, “but they know how to do it properly.” 

He then talked about the need for a respectful ritual approach to cultivation, preparation, and smoking or ingesting of Indian hemp (Cannabis indica) in the form of bhang, ganja, or charas and criticized the casual and irreverent use of marijuana and hashish by the young generation in the West. “The yogis grow and harvest the plant very consciously and with great devotion,” he said. “They first soak it in water for fourteen days to get rid of all the toxic ingredients and then dry it. They put it in a chilam (a special pipe) and smoke it. And then they lie naked in the snow and ice of the Himalayas in ecstasy.” Talking about smoking the chilam and the ecstatic rapture of the yogis, Baba acted out the appropriate facial expressions, movements, and postures as if remembering what it was like.32

Swami Muktananda’s comments resonate with Rudi’s emphasis on “staying high” via genuine spiritual practice but he also adds a nuance on the value of sacramental use. It would seem that Swami Muktananda considers sacramental use compatible with spiritual practice—he at least points to an authentic tradition of it.

Adi Da, who studied with both Rudi and Swami Muktananda, is equally critical of using psychedelics on the spiritual path:

Marijuana and the hallucinogenic drugs (LSD, mescaline, etc.) may provoke illusions of bliss, heightened energy, and psychic expansion, but they actually, or by reaction, contract the entire nervous system and severely distort the natural alignment of the physical body to the etheric and astral dimensions. They lead to the dominance of the psychic over the truly spiritual (or self-transcending) disposition—thus promoting a craving for "visions" and other psychic and mental distractions, rather than allowing the natural disposition of Love-Communion with the All-Pervading and Transcendental Divine Reality.33 

From a spiritual perspective, the sacred flowers are found in the chakras of the human body, and their soma is released in yogic practice. In Indian yoga, the chakras are described as lotus flowers. In the Narayana Sooktam, the Heart is described as union of fire and flower, itself an inverted lotus bud, the seat of spiritual fire. Thus, there is no edible deity, only an in-dwelling source and substance. Adi Da elaborates on the nature of “true soma” being native to the body-mind:

Just as today certain rejuvenating herbs are fairly commonly known, herbs were also used in the ancient cultures in conjunction with symbols and archetypes and religious observances.

Modern researchers are trying to discover what the ancient herbs might have been. One of the famous herbs, or "Edible Deities," of ancient times was called "soma." There are a number of plants and mushrooms that have tentatively been identified as this soma. But the true soma is not anything external to the body-mind, not a plant or a mushroom or an elixir or one's own urine. The true soma is like the true practice—it is native to the body-mind. It is a substance secreted in the brain core by the glandular centers associated with the pituitary gland when the body is in a purified, harmonious condition, and its energies are rightly polarized.

This nectar pervades the entire body and enlivens it, but it also tends to pass out of the body through grosser activities that eliminate the Life-Force. Among the activities of the usual body-mind that tend to eliminate the Life-Force are emotional reactivity, eating, overeating, and degenerative habits of all kinds, including conventional sexuality.

The Hatha Yoga Pradipika and other similar yogic texts speak of the soma as "the nectar of the moon." By pressing the tongue up through the roof of the palate and closing off the passage in the head above the sinuses and above the mouth, and entering into meditation, the yogis prevent the nectar of the moon from burning up in the "sun," which is the lower body or digestive region, the digestive fire of the navel.34

Adi Da’s commentary likens soma to a yogic substance that corresponds to the “higher chemistry” of the endocrine system. He criticizes the search for the “edible deity”, soma as object, consumable sanctity, the displaced Mother.

The true “soma” is not something that you can eat. Of course, there are good things to eat and do. But the true "soma" is the transforming internal secretion of the whole body in its natural state. The secret is to get the whole bodily being into its natural state, in which it is naturally secreting all those substances that rejuvenate it, enliven it, keep it psychically awakened and aware in the fullest possible sense.3536

Our true sustenance is not edible or external—it is internal and imbibed with breath and fire, flowering in secret a golden dawn.

IV. Toward a Green Age

Red fire, green fuse. Will the force that drives the flower drive a green age? Cannabis re-ignites interest in herself, time and time again. Cannabis becomes an archetype of psychological femininity, an offering from Mother Earth, an image of sustenance and sustainability, the fostering of an ecology. Exploited, she takes her wrath upon us; abused, she strings our heads around her neck; worshipped, she becomes the sacramental communion. Cannabis is a message from the old world to its offspring. Cannabis should inspire an interest in the therapeutic value of plant medicines and the worth in all that is green and grows. We need not the primal trust of Eden, we need a garden of consciousness, of intentional fire and organic flower.

This essay was written in the early days of the COVID-19 pandemic, exploring the relationship between epidemics and war. Given the horrors of the ongoing warfare in Ukraine and now in Gaza, the shared context of epidemics and war felt like a timely topic to consider further. I have since revised the essay significantly, in expansion of the original themes and in light of current events.

Epidemic diseases are a multi-faceted phenomenon that have plagued humanity for thousands of years; shaping history, medicine, and culture in its movements. In this five-part essay, we will explore the historical origins of epidemic diseases in agrarian contexts, a timeline of epidemic diseases from 430 B.C.E. into the present, the connection between epidemics and war, Chinese and Tibetan etiologies of epidemic disease, and a vision for a healthy and peaceful future.

I. Etymology, Agriculture, and the Emergence of Community
The word epidemic traces its etymology to two Greek words—epi meaning “upon” and dēmos meaning “the people”. The Greek epidēmios means “prevalent” and the later evolute epidēmia means “prevalence of disease”. The New Oxford Dictionary defines epidemic as, “a widespread occurrence of an infectious disease in a community at a particular time”. When an epidemic spreads across regional borders and becomes an international phenomenon, it is known as a pandemic—from the Greek pandēmos (pan means “all” and dēmos means “people”).

In all the aforementioned meanings, “community” emerges as a theme. There can be no epidemic outbreak without a community of people—and the origins of human community traces to the beginning of agrarian life. According to anthropologists, contagious diseases existed during the early hunter-gather period of human evolution, but these diseases never reached epidemic proportions due to their nomadic lifestyle. Historians postulate that epidemic diseases formed alongside communities, which began in earnest with the advent of agriculture roughly 10,000 years ago.

Jared Diamond, an American scientist and professor, considers agriculture to be “the worst mistake in the history of the human race”.12 In an essay bearing this title, Diamond echoes the idea that necessity is the mother of invention, positing that hunter-gatherers began farming in order to feed a growing population. Diamond notes that agriculture had dire consequences on human health, resulting in “malnutrition, starvation, and epidemic diseases”.3 In particular, Diamond states that farming led to a less varied diet, compromising nutrition via dependence on starchy crops that were limited in number—the result being malnutrition and starvation when crops failed. Diamond is clear that increasing population numbers and resultant urbanization led to the formation of epidemic diseases that were absent during the nomadic lifestyle of hunter-gatherers. Diamond writes:

. . . the mere fact that agriculture encouraged people to clump together in crowded societies, many of which then carried on trade with other crowded societies, led to the spread of parasites and infectious disease. (Some archaeologists think it was crowding, rather than agriculture, that promoted disease, but this is a chicken-and-egg argument, because crowding encourages agriculture and vice versa.) Epidemics couldn't take hold when populations were scattered in small bands that constantly shifted camp. Tuberculosis and diarrheal disease had to await the rise of farming, measles and bubonic plague the appearance of large cities.4

Diamond also notes the socio-political impact of agriculture: class divisions. The arising of class divisions is the seed of war, and we will soon see that war and epidemics are inextricably linked. Diamond reaches a similar conclusion:

Archaeologists studying the rise of farming have reconstructed a crucial stage at which we made the worst mistake in human history. Forced to choose between limiting population or trying to increase food production, we chose the latter and ended up with starvation, warfare, and tyranny.5

II. A Timeline of Epidemics: 430 B.C.E. to 2023
The first record of a pandemic dates to 430 B.C.E. in Athens, Greece during the Peloponessian War. The epidemic disease (now speculated to have been typhoid fever) crossed the borders of Libya, Egypt, and Ethiopia during the Spartan seige—leading to defeat in Athens and the death of two-thirds of the population.6

The next record of a pandemic occurs 594 years later in 165 A.D. with the Antonine Plague. Speculated to be an early occurrence of smallpox, the disease spread from the Huns to the Germans and finally to the Romans during the Roman seige of Seleucia. Returning troops spread the disease throughout the Roman Empire, marking the onset of a plague that would last until 180 A.D. Here, we see again the origin of an epidemic in the context of warfare. In 166 A.D., one year into the Plague, marked the beginning of the Marcomannic Wars—a period of warfare that would last until 180 A.D., the concluding year of the Plague. An estimated 7-8 million people died during the Antonine Plague, including Roman Emperor Marcus Aurelius in 180 A.D.

The coming centuries saw the occurrence of two more plagues—the Cyprian Plague of 250 A.D. and the Scythian plague of 541 A.D. Remarkably, there is no record of epidemic outbreak until the 11th century leprosy pandemic. From here, we see a trend of epidemic outbreaks every 100-200 years into the present century—the Black Death of 1350; the transmission of smallpox, measles, and bubonic plague by Spanish Invaders in the Caribbean; the near extinction of the Taino people upon the arrival of Christopher Columbus; the fall of the Aztec Empire in 1520 due to an epidemic of smallpox; and the Great Plague of London in 1665.

There is a notable rise in the frequency of epidemic outbreaks in the 19th, 20th, and 21st centuries, with multiple outbreaks occurring in the course of a single century. The 19th century alone saw four epidemic outbreaks—the first Cholera pandemic of 1817, the third Plague pandemic of 1855, the Fiji measles pandemic of 1875, and the Russian Flu of 1889. The 20th century saw the Spanish Flu of 1918, the Asian Flu of 1957, and the ongoing HIV/AIDS pandemic that was first classified in 1981. This brings us to our present era, the 21st century, which has seen two epidemics in 23 years—the SARS pandemic of 2003 and the ongoing COVID-19 pandemic of 2019.7

So far, we have seen how epidemics have influenced human history, from the advent of agriculture to the politics of warfare. The last 100 years alone have been devastated by four different epidemics, a current pandemic, and an increasing likelihood of experiencing more epidemic outbreaks as time goes on. The reasons for this are multitudinous: agriculture not only created a context for contagious transmission via increasing populations, it had an ecological impact that reached a fever-pitch in the modern era with monocropping, the creation of GMOs, and the extensive use of chemical pesticides in farming. These practices are justified as a means to secure food supply and combat starvation. Technological advances have led to concerning developments in this regard, with un-sustainable farming practices becoming a major cause of climate change. Ecological disturbance and chemical proliferation are, in fact, two of the primary etiological factors of epidemic diseases in Asian medical systems, connections we will now explore.

III. Yi: Epidemics, War, and Medicine
In an essay published in the early days of the COVID-19 pandemic, Liu Lihong reflected on the linguistic links between medicine, war, and epidemic disease. In doing so, he demonstrated the connection between these three realities and how this understanding is reflected in the pictographic language of classical Chinese. Lihong writes: 

The Chinese character for epidemic (yi 疫) consists of the components 疒and 殳. According to the dictionary Definitions of Simple and Complex Pictograms, this character represents a combination of components that respectively indicate the meaning and sound of the word. The component 疒, pronounced ne by itself and signifying disease, expresses the general meaning of the word, while殳, an abbreviated version of the character 役 yi  for war, primarily serves to express the phonetics of the word for epidemic, but also expresses more specific layers of the term’s meaning. We can see, therefore, that at least during the period preceding the Eastern Han, epidemic outbreaks were linked to war.8

Lihong continues: 

Since all good examples tend to come in pairs, the traditional version of the character 醫 for medicine also includes the component 殳. The fact that the characters yi 醫 for medicine and yi 疫 for epidemic are pronounced the same, moreover, demonstrates that the business of dealing with epidemics has been front and center on the stage of medical activity since antiquity! We therefore should keep unpacking the reasons why in the light of present circumstances we find ourselves willing to learn from this historical playbook. While the component 彳has been abbreviated in both instances where the character 役 (yi) for war is included in the pictograms for medicine (yi) and epidemic disease (yi), and while modern reasons for high population density have changed, many relevant things remain for us to contemplate here.9

Lihong’s insights are valuable for understanding the complex dynamics of epidemic disease. For one, we can see that epidemics are not novel occurrences, but have occupied medical thought for thousands of years. In addition, Lihong highlights the interdependent nature of epidemics, war, and medicine. Reflecting on the impact of epidemics in the late Eastern Han dynasty, Lihong notes:

The waning years of the Eastern Han dynasty were the setting for repeated natural disasters and epidemics. Of the ten epidemic outbreaks recorded in the chapter “Record of the Five Phase Elements” (Wuxing zhi) in The Record of the Later Han (Hou Hanshu), most of them occurred after the year 119 CE and fall into Xu Shen’s lifetime. The duration and human death toll of the epidemic events that occurred during the Jian’an period (196-219) were especially severe. Chancellor Cao Cao (c.155-220) described the gravity of this situation in his prose poem “Passing the Dead” (Haoli xing): “The armor of marauding soldiers remains in place, unwashed and growing nits, while people lie dead by the tens of thousands. Skeletons litter the landscape, and no cock crows for a thousand miles. Only one in a hundred still lives—just thinking of this scene breaks my heart!” Although these lines describe the misery of warfare, the end result is no different than that caused by an epidemic.10

Peter Perdue, a professor of history at Yale University, penned an interesting article at the outset of the pandemic that also notes the resonance between pandemics and war. Perdue writes: 

Empires are big and microbes small, but both have shaped history by conquering territories and bodies, leaving death, disease, and devastation in their wake. Yet humans have survived many such onslaughts and brought, at hard-won cost, peace, knowledge, and protection . . . Pandemics, like wars, are ruthless auditors that test the resilience of national and international orders. Some regimes use them for domination; others find in them an opportunity for collaboration.11

What exactly is the connection between epidemic disease and war? On a physical level, warfare clearly promotes the spread of epidemic disease, where invasions cross borders and infect diverse populations. In terms of consequence, epidemics and war both devastate the populations they affect. Epidemics and war share the vector of rebellion and confrontation, combat and death—invasive influences that foster the fight for survival. Yet, epidemics and war are, in some sense, un-natural. That is to say, they are born of conditions that are disharmonious (or unrighteous) in nature, a topic discussed at length in the Tibetan medical tantras.

IV. Etiologies of Epidemic Disease in Tibetan Medicine
Tibetan medical tantras describe the etiology of epidemic disease in prophetic terms as a decline in righteousness that marks a degenerative age. The following passage in the Tibetan medical tantras details the cause of epidemic diseases: 

The causes and conditions that originated the disease called rim [infectious disease] occurred at the beginning of the final cycle of the ten five-hundred year cycles, whereby the desires of humankind led to much transgressive behavior; rampant murders of one’s own vajra siblings spread amongst ngakpa communities; monastics engaged in bitter quarrels within their sangha; extremists committing harm to others; and groups taking vows to war and slaughter many. At that time, the mamos and [wrathful and deceptive] dakinis were enraged and the breath of disease manifested immense variegated clouds and gave rise to epidemic infectious disease, dysenteric conditions, pulmonary infections, contagious ulcerative illnesses, smallpox and other pustule-forming diseases.12

This striking passage from the tantras describes a polarized world at conflict with itself, where even spiritual brethren fight among themselves. Spiritual practitioners and monastics are considered the keepers and exemplars of peace in the world. Yet, the passage states that they are committing “rampant murders” of their “own vajra siblings” and that monastics are “engaged in bitter quarrels”. Further, we see the description of an environment full of extremism and war. The passage states that these dark conditions enrage the wrathful dakinis who then exhale the vapor of infectious disease—a poetic and ecological metaphor for the airborne transmission of contagious pathogens via spiritual provocation.

In the Tibetan worldview, the integrity of the natural world is animated by various unseen beings—nature spirits who function as guardians and protectors of the ecological landscape.13 On the surface, such descriptions may seem magical, mythical, and demonological. However, whether we choose to believe in a world literally imbued with subtle spirits or not, the fundamental message is the same: human-caused disruption of the balance of the natural world results in the formation of infection disease, a pathology provoked as a self-correcting response from nature itself. the passage is saying that the ignorant and dark actions of human beings have disrupted the balance of the natural world, resulting in the formation of infectious disease.  

In another passage on epidemic etiology, the Tibetan medical tantras identify chemicals and biological warfare as causes of epidemic outbreaks: 

The mamo and wrathful dakinis strike down with epidemics of vicious disease. Ill-intended extremists create compounded chemicals and substances. At this time, it is critical to protect oneself and others.14

Modern epidemiology agrees with this understanding, identifying exposure to chemicals and radioactive materials as a cause of epidemic outbreaks.15 This passage gives credence to the possibility of a “lab leak” theory on the origins of COVID-19, a theory that has gained credence in recent time. New evidence is suggestive of the animal origins of COVID-19, but there is as yet no conclusive theory on the origins of SARS-COV-2.16

During the early days of the pandemic, two Tibetan doctors (Drs. Lobgsang Dhondup and Tashi Rabten) spoke of the greed-fueled killing of animals as a root-cause of epidemics:

The root cause of these epidemics is greed. The insatiable desire to eat varieties of foods that we should not eat, to kill animals mindlessly, destroy the environment [for personal gain], and amass consumption[insatiably]. We have created severe imbalance in our world, and our ethics and compassion have deteriorated.17

Lihong discusses three etiologies of epidemics in Chinese medicine that mirror the Tibetan medical understanding: (1) the presence of a pathogen (2) unseasonal qi (3) constitutional deficiency.  The first cause is well-understood in modern medicine as an infectious microbe causing the disease—in the case of COVID-19, the microbe is identified as “SARS-COV-2”. The second cause may seem obscure but is observed by us all as we note the extremes of climate change concurrent with the pandemic. The third cause, constitutional deficiency, is another way of describing susceptibility. Without susceptibility, viral microbes cannot take root in a human host and cause subsequent spread of epidemic proportions.

The Ling Shu offers an interesting perspective on susceptibility, stating a core dictum of Chinese medicine, “If righteous qi is strong on the inside pathogenic influences cannot invade from the outside”. Cultivating righteous qi, or the natural equilibrium of the body-system, is the very nature of resilience (or “immunity”). This truth is potently illustrated in the current pandemic where we see an uneven distribution of infectious possibility. One member of a household will contract COVID-19 while other members are inexplicably spared, highlighting the fact that not all persons are automatically infected upon exposure to the pathogen. The righteous movement of life-energy is maintained through proper diet and lifestyle practices, and even more importantly, by attending to our mental and spiritual health.

The following passage from the Tibetan medical tantras summarizes the causative factors of unseasonal qi and constitutional deficiency: 

Other causes also comprise changes in the seasons that are in excess, deficiency or adversity to the norm; exhaustion due to excess physical exertion; contagious transmission of illness; contact with toxins and poisons; extreme rage and fear; severe mental distress; and excess attachment and greed. It also includes consumption of unsuitable or contaminated foods that cause infectious disease (rim).18

Contaminated and unsuitable foods give credence to the origins of SARS-COV-2 in the wild animal market of Wuhan. However, whether COVID-19 was caused by food or a lab leak, the root-cause remains a disturbance of the natural order caused by human behavior. In this regard, our individual and collective dietary and environmental practices deserve significant attention in the prevention of future epidemics.

Seasonal disturbances can be seen in the proliferation of natural disasters in the wake of climate change. Climatologists note that increasing global surface temperatures are leading to an increase in drought conditions and storm intensity.19 On this topic, Lihong notes: 

. . . the World Meteorological Organization has reported that on February 9 of this year the record for temperatures measured on Seymour Island near the South Pole was broken by a thermal reading of 20.75 degrees Celsius (70 degrees Fahrenheit)—precisely the time when COVID-19 was spreading most rapidly throughout China. While we do not yet have enough data to understand how it all hangs together, we can say with certainty that climate change is causing the overall temperature on our planet to rise, thus contributing to the causation of “unseasonal energetics.”20

“Unseasonal qi”, or “seasons that are in excess, deficiency, or adversity to the norm”, is an easily overlooked cause of infectious disease. Seasonal disturbances indicate an imbalance at a macrocosmic level that will invariably be reflected in the microcosm—a principal reason why the health of our planet has profound consequences for the health of all who depend upon it. “Unseasonal qi” is one of the means whereby certain microbes proliferate and become pathogenic. We live in natural harmony with countless microbes that pervade the environment and reside within our bodies. In fact, these microbes are essential for our health and well-being. As the late Tibetan scholar-physician, Jampa Trinlé, summarizes:

There are 84,000 sinbu [microorganisms] that reside as coemergent in the body and, in a balanced state, provide strength and radiance to the body, enhancing longevity as well as protecting vitality and sensory organs. They facilitate the capacity for dexterity. In imbalance, they produce diseases of various types.21

Thus, the presence of microbes is not, in and of itself, the issue. However, the relative deficiency and excess of microbial activity in the body creates conditions of imbalance, an arena of health that is gaining traction in modern medicine’s understanding of the intestinal biome and the nature of the gut-brain axis. From this, we can see how unseasonal qi increases pathogenic vectors of all kinds and on all scales by disturbing the delicate balance of a diverse ecosystem—within and without.

Having explored traditional etiologies of epidemics, we will turn our attention to the treatment strategies these causative factors suggest.

V. Clinical Paradigms for Epidemic Diseases: Punitive and Unitive Measures
In modern times, the basic treatment approach to epidemic diseases has been akin to a declaration of war upon pathogenic microbes, in which the pathogen is seen as the enemy to be exterminated at all costs. Upon successful extermination, health is supposedly restored. Vaccination is one of the methodologies of this paradigm, in which ongoing immunizations are required to maintain the supposed eradication of epidemic diseases.22 Given the connections between war and epidemics, it should come as no surprise that a treatment methodology has been born from the political landscape of warfare. Yet, history has proven that fighting fire with fire has never yielded peace.

The psychological orientation at the root of this clinical approach is perhaps best expressed in an aphorism from the Brihadāranyaka Upanishad, expounded upon by Adi Da Samraj, a contemporary Spiritual Master: 

In one of the Upanishads, it is said that wherever there is an “other”, fear arises. As soon as “difference” is presumed, as soon as separateness is presumed, as soon as an opponent is presumed, there is fear—or the disposition of separativeness, of self-protectiveness, of self-division. The non-presumption of an “other” is the essential principle that will liberate humankind. Wherever no “other” is presumed, Truth awakens.23 

If we understand the true nature of epidemic disease, then we recognize that pathogenic microbes are not an “other”, but a disharmony in the natural system. Thus, a systems-based approach of cooperation with nature is needed, rather than engaging in a search to merely exterminate a perceived invader. This is not to imply that strong measures do not have relevance in acute situations, but it is to say that the long-term resolution of epidemic diseases requires a holistic approach and understanding.

In Not-Two Is Peace, Adi Da speaks of the self-correcting nature of systems: 

Unless they are specifically prevented from doing so, all systems will spontaneously righten themselves. The universe is a self-organizing, self-correcting, and self-rightening process. All systems are self-organizing, self-correcting, and self-rightening—unless something interferes with the self-organizing, self-correcting, and self-rightening process.24 

Rather than declare war on disease, we should look to restore peace within the natural order in which we inhere. Only in this way can we collectively cut the roots of epidemic disease and prevent their future recurrence. Disease is not rightfully the enemy, but a distress signal from a holistic system that needs to self-righten. 

As for a clinical paradigm, Lihong calls for unitive rather than punitive measures in response to the pandemic: 

If considered from the angle of unity consciousness versus the punishment of other, I have offered my thoughts on how Chinese medicine is an art that proffers unity enhancing measures (shangli) while Western medicine favors punitive strategies (shangxing) for quite some time now. The rectification of self, in this light, belongs to the way of promoting unity, while the rectification of others (i.e., the seeking of causal factors that lie outside of our self) belong to the way of retribution. Plans for the eradication of the virus, or vaccination against the virus, all belong to the way of retribution and punitive strategies, and rightfully so! A world in chaos needs to employ severe measures, indeed. However, if real peace and healing is our long-term goal, we must promote unity and apply punitive measures simultaneously, even adopt the way of unity as our main approach.25

Lihong’s perspective reminded me of a passage in the Ling Shu, where Huang Di and Qi Bo engage in an interesting dialogue on the nature of needles: 

Huang Di: For me the small needles are insignificant items. Now you say that above they are united with heaven, below they are united with the earth, and in the middle they are united with mankind. To me this seems to greatly exaggerate their significance! I wish to be informed of the underlying reason.

Qi Bo: Is there anything bigger than heaven? Now, what is bigger than the needles? Only the five weapons. The five weapons are prepared to kill. They are not employed to keep [someone] alive. Furthermore now, mankind! The most precious item between heaven and earth. How could it be neglected? Now, to cure the [diseases] of humans, only the needles are to be applied. Now, when the needles are compared with the five weapons, which turns out to be less significant?26

This classical dialogue represents the transition from punitive to unitive strategies—from destructive weapons of war to instruments of healing, illustrating the role of medicine in the transformation of would-be-punitive measures into unity-enhancing modalities. The practice of medicine has been traditionally regarded as a means for restoring peace and “doing no harm”. Epidemics are an urgent sign and signal that unrighteousness is prevailing and undermining the integrity of our systems. From here, unity is the only true progress beyond the dualisms of war and peace. Yet, unity is a present-time living discovery, not only a future-minded goal. On this point, Adi Da maintains that unity has an a priori nature, a point he elaborates: 

Unity cannot be achieved by combining opposites. Unity is the prior condition, the condition that is always already the case. Prior unity makes all opposites obsolete. Therefore, it is prior unity that must be enacted, rather than any continuation of the pattern of oppositions . . . The principle of prior unity applies to all human endeavor, even to the integrity of a human body or a human personality. Unity is not the result of a play of opposites. Unity is the prior condition . . . Wherever action is done in opposition to whatever force or entity is considered to be the opponent, wherever there is even a strategy relative to an opponent, the effort will fail. Some kinds of changes may be brought about—but, ultimately, everything stays the same, because the principle is one of division to begin with . . . Thus, it is oppositions that are preventing the self-organizing process from happening.27

The question is, what do unitive measures look like? A unitive measure is any treatment modality that enhances communication and balance within an existing system by cooperating with the natural laws of that system, in contrast to the extermination-approach enacted toward a perceived pathogenic enemy. Unitive measures place trust in the integrity of the system and the observation that a balanced system naturally eliminates pathology. Punitive measures, on the other hand, do not believe in any kind of systemic unity, rather human beings are viewed only as an aggregate of isolates subject to manipulation from the outside in order to be healthy. This represents an abstracting of nature into the ontological category of “thing” rather than “living process”.

In Chinese and Tibetan medical systems, treatment strategies for epidemics are largely herbal in nature. There is a treasure trove of herbal formulas for many types of contagious diseases, including epidemics, in the annals of Asian medicine. Since Asian medical systems focus on describing the nature of illnesses, all epidemic diseases can be seen in relationship to an established context of pathogenesis. This is how old traditions can still help us heal the ills of the modern day.

In addition to herbal medicine, modalities such as acupuncture, moxibustion,28 and cleansing therapies29 are employed in the treatment of epidemics, alongside dietary and lifestyle recommendations. Beyond this, Tibetan Medicine advises human beings to transcend the poisons of greed, attachment, and rage; to eat appropriate and uncontaminated foods, to avoid contact with environmental and chemical toxins, and to lead an ethical life of love and compassion for the natural world and everyone within it. Such is a truly peaceable and preventative approach to managing epidemic diseases.

Postscript January 2024: Wars in Ukraine and Gaza
Since the original writing of this essay in 2021, the world has witnessed the tragic outbreak of two wars: the Russia-Ukraine War (2022) and the Israel-Gaza War (2023). Unfortunately, these events represent a return to archaic ideologies of tribalism, nationalism, racism, and even genocide.

Communicable diseases have been an existing concern in pre-war Ukraine, a concern that is only growing since the Russian invasion of February 2022. Ukraine is currently regarded by some as being in “epidemic danger”, with the potential of spread across borders being quite high.30 The situation in Gaza is developing in a similar fashion.

The World Health Organization has warned that more will die from illness in Gaza than the war itself. This is a somewhat surprising statement, given the scores of people who have already died from Israel’s brutal warfare. War has destroyed the healthcare infrastructure in Gaza and shelters with overcrowding are increasing the likelihood of an epidemic emergence.31

These events represent a regression in human evolution and culture, a devolution that will cause history to repeat itself, as the adage goes. At the risk of sounding morbid, it seems we are on a fast track to seeing more epidemics and pandemics as time goes on. However, on a hopeful note, the possibility for change and regeneration is ever-present—it remains to be chosen.

For those unfamiliar with J.R. Worsley, he is regarded as an influential figure in the transmission of classical acupuncture from East to West and the father of modern “five-element acupuncture”. I see Worsley as a transitional figure who bridged Eastern and Western traditions and who is, therefore, part of the heritage of all Western practitioners of acupuncture.

September 14, 2023 marks the 100th birthday of J.R. Worsley (1923 - 2003). In commemoration of this milestone, I offer this tribute to J.R. Worsley and his lineage of classical five-element acupuncture.  

Worsley learned the system of five-element acupuncture in the 1950s in Taiwan, Singapore, and Korea. With the permission of his teachers—Master Hsui and Master Ono, Worsley began teaching acupuncture in the U.K. In 1971, and eventually began to teach in the U.S.A.

Worsley had a remarkable gift for integrating and transmitting the teachings of acupuncture with depth and clarity. He taught in a classroom setting, yet his teaching approach did not rely on textbooks or amassing intellectual knowledge. Worsley championed the oral tradition of transmitting the teachings directly from person to person in direct relationship through observation and clinical training. In doing so, Worsley demonstrated the values of lineage, and emphasized that he taught exactly what his teachers had taught him.

A visionary who embodied his own teachings, Worsley described five-element acupuncture as a “way of life”—a system of medicine based entirely on observable natural laws. He taught that nature is our greatest teacher and that a practitioner should be an “instrument of nature”. He explained diagnosis as the perception of nature’s cues and treatment as a process of “assisting nature”. Worsley articulated a profound understanding of disease as an interruption in the natural cycle of health—and medicine, therefore, as an intervention that empowers nature’s self-correcting intelligence. 

Worsley often spoke of the “uniqueness of the individual” and cautioned against the pitfalls of “typing”, or putting people into conceptual boxes. Worsley’s emphasis accords with the Ayurvedic understanding that a patient’s imbalance can only be diagnosed when seen in the context of their true nature. Even more, I have appreciated Worsley’s point that a patient’s imbalance is not an identity and in no way defines who they are. The imbalance is precisely who the patient is not. This is a crucial nuance that is often misunderstood or altogether missed in healthcare environments, especially when relying on constitutional rubrics as a means of diagnosis. 

Worsley’s ability to bring esoteric concepts into clinical expression is one of his gifts to the world. This is evident in many aspects of his teachings, including his focus on the “spirit of the points”—an elucidation of the profound meanings embedded in acupuncture point names, pictographic characters, and ancient cultural context. In a time when acupuncture point meaning has been reduced merely to symptom indications, Worsley’s insight is critical to ponder if one wishes to harness the power and depth of classical acupuncture. Worsley’s emphasis on acupuncture point names rather than “indications” is also seen in the work of Sun Simiao, the famous Tang dynasty scholar-physician who noted that the power of acupuncture points is hidden in their names. 

One of the most important and interesting aspects of Worsley’s teachings is his explanation of the nature of the five elements. Worsley taught that as soon as one of the five elements is imbalanced, all five elements are necessarily imbalanced, since they co-exist in a cyclical and interdependent relationship. For this reason, Worsley taught the need to ascertain what he called the “causative factor” of disease—the single element that is the root-cause of imbalance. 

Some have argued that Worsley’s teaching of a single element as the “causative factor” (or “C.F.”) is not found anywhere in classical texts and is , therefore, his own invention. However, in my understanding, Worsley’s “causative factor” teaching accords perfectly well with five-element theory, which states that an imbalance in one element will imbalance each successive element in turn via the Law of Mother-Child.  In any case, the idea that a textual basis for a medical concept must exist for it to be considered valid is itself a misplaced assertion. 

My Ayurvedic teacher, Vaidya R.K. Mishra, taught numerous clinical concepts that were not found in classical texts, including many marma points that extended beyond the 107 points described in Sushruta’s Samhita. Vaidya Mishra was a scholar of the classics and would often recite verses of the Caraka Samhita from memory in his discourses. Yet, he often transmitted significant and detailed Ayurvedic knowledge that was uniquely preserved in his family lineage through oral tradition. Worsley’s teachings likewise are entirely consistent with the tradition of Asian medicine, a tradition that owes its origins to the episteme of oral tradition as a valued means of knowledge-transmission.

Asian medical traditions have been effectively shaped by significant individuals as well as individual texts. This is why the corpus of classical source-texts are typically traced to a single individual’s revelatory recordings. In Ayurveda, the Caraka Samhita is considered the primary source-text and is held to be the work of the physician-sage, Caraka. Similarly, the Sushruta Samhita—considered one of the first treatises on surgery—was written by the physician Sushruta. Another important text, the Astanga Hridaya (largely a commentary on the works of Caraka and Sushruta), was written by the scholar Vagbhata. Similarly, the Four Medical Tantras of Tibetan Medicine (Gyüshi) trace authorship to Yuthok Yontan Gonpo, even while its contents display knowledge of numerous medical systems extending beyond the borders of Tibet.

 Of course, authorship questions abound, including the question of whether any of these authors were historical individuals or merely mythical persons—not to mention the fact that many of these texts have undergone revisions over the centuries. This is to say, individual authors are not truly seen as the sole source of medical knowledge but rather as collectors of wisdom, the scribes who first committed the vastness of oral tradition to textual form and whose exegeses have formed the basis of medical knowledge for millennia. Therefore, oral tradition remains the primary meaning-force and context of the textual corpus of traditional Asian medical systems. Although medical traditions naturally develop as a consequence of time, culture, and context, J.R. Worsley strikes me as an individual of similar stature to Caraka and Sushruta, of all the great physicians who have shaped and clarified medical knowledge through their realization. 

Some may think of a physician today as a person of technical competence, but the Asian medical classics characterize a superior practitioner as one who possesses a moral disposition and whose inner knowing transforms the lives of others. The word “physician” derives from the Latin physica, which means “things relating to nature”. In this literal sense, a “physician” sees to the natural order in others. Certainly, J.R. Worsley was one of the exceptional examples of a true physician in our age, a generous spirit who shared his healing gifts and lived for the sake of helping others even into his last days. 

Before his passing in 2003, J.R. Worsley designated his beloved wife, Judy Becker Worsley, herself a deeply dedicated student and practitioner, to succeed him as Master of the five-element lineage. Worsley also designated the Worsley Institute as the home of his teachings into the future.

I offer a deep bow of gratitude to J.R. Worsley for bringing forward the spirit of healing in our time and to Judy Becker Worsley for preserving these gifts with clarity, grace, and gravitas. 

In closing, I leave you with two of my favorite quotes from J.R. Worsley: 

We must strive to see people not only as they present themselves in illness, but more importantly as they would be in perfect health and balance, in full discovery of their true nature, unique in body, mind and spirit”.  

Instead of asking, What kind of symptoms does this person have? Five-Element Acupuncture asks, What kind of person has these symptoms, and why?

The eight extraordinary vessels are a mysterious aspect of Chinese energetic anatomy. In the context of acupuncture, the twelve primary meridians are undeniably the therapeutic focus. However, many practitioners have brought attention to the therapeutic value of the eight vessels throughout history and into the modern day.

The eight extra vessels differ from the meridians in some ways. The eight vessels are seen as force-fields rather than distinct pathways. The eight vessels are connected to the process of conception and thus they are often seen as an embryological layer of qi. As the “foundation” of the twelve meridians, the eight vessels have been described in English as “reservoirs” of qi. This understanding comes in part from the Nan Jing:

The main channels are like irrigation ditches, and the extraordinary channels are like lakes and marshes. When the vessels of the main channels are swollen and abundant, they overflow into the extraordinary channels. Thus it was that Qin Yue-Ren compared it to when the “rain pours down from heaven, the irrigation ditches overflow, the rain floods rush wildly, flowing into the lakes and marshes.[1]  

The Nan Jing describes the extraordinary vessels as “lakes and marshes” and the primary meridians as “irrigation ditches”. The phrase “irrigation ditch” technically refers to a man-made channel that drains water, typically for agricultural purposes. Given the agrarian context of Chinese medicine, the metaphor of an irrigation ditch may indeed be one intended implication. However, an irrigation ditch is not necessarily man-made, despite the nomenclature. Nature also carves its own ditches, especially in places where the flow of water is especially strong. Waterfalls eventually carve a channel into the mountains they ripple from and are capable of carving canyons. Therefore, an irrigation ditch could also be seen as a natural feature––the consequence of flowing water.

The comparison between the meridians and irrigation ditches has visual value as well. A ditch is a clear pathway like a channel, a line of natural momentum. There are different types of flow as well––streams become rivers and rivers become seas. This must be why the Nan Jing gives watery descriptions of the five-element points with the categories of jing (well), ying (spring), shu (stream), jing (river), and he (sea).  

Returning to the extraordinary vessels, the Nan Jing gives us the metaphor of “lakes and marshes”. Lakes and marshes are examples of wetlands––defined as places where water naturally collects and releases. However, the extraordinary vessels are commonly likened to “reservoirs” in English. Reservoirs are another man-made process that attempts to replace or compensate for an otherwise naturally occurring process. The extraordinary vessels––as a system that holds and releases qi––is the intended meaning, regardless of the language used. If we follow the Nan Jing’s language (albeit in translation) of “lakes and marshes” we derive a deeper range of meaning than “reservoir” implies. Thus, we can effectively replace the idea of the extraordinary vessels as “reservoirs” with the natural image of wetlands, bringing us closer to a truly natural and ecological understanding, within and without. 

This brings us to the question of whether qi only flows into the vessels from the meridians or whether qi from the vessels flows into the meridians. The idea that the extraordinary vessels absorb the overflow of qi from the primary channels is clearly rooted in the Nan Jing’s topography. Rain falls from heaven into the irrigation ditches (primary meridians) and the excess flows into the lakes and marshes (extraordinary vessels). The Nan Jing does not go on to state that the qi collected in the vessels flows back into the meridians in times of deficiency, though this idea is found among practitioners.

One such example is in the European five-element tradition as taught by J.R. Worsley. In Worsley’s tradition, only two of the extraordinary vessels are applied in treatment: the Conception Vessel and the Governing Vessel. In the context of treatment, points on these channels are used to bring a deeper level of energetic support to the primary meridians. Worsley taught that these vessels should be used to nourish the meridian system when it is deficient overall. He also gave the stipulation that one should not draw upon the vessels unless the patient’s pulses were already relatively balanced, to avoid magnifying the imbalance. Thus, Worsley’s application of extraordinary vessel theory infers a mutual flow of qi between the meridians and vessels.

A more explicit example of this understanding is found in Li Shi-Zhen’s Exposition on the Eight Extraordinary Channels. Li re-works a passage from the Nan Jing to imply a mutual flow of qi between vessels and meridians, stating:

The overflow of qi from the channels and networks] enters the extraordinary vessels providing reciprocal irrigation, internally warming the viscera and receptacles, and externally moistening the interstices.[2]

This statement is a fundamental theoretical shift in Li Shi-Zhen’s exposition on the vessels and more profoundly establishes the eight vessels in a dynamic relationship with the twelve meridians.

Returning to wetlands, we see how the concept of reciprocal flow is a natural principle of circulation. Wetlands have been described as natural sponges that absorb excess water and then gradually release it to the surface, much as the vessels absorb excess from the meridians and release it back into the network as needed. This establishes the vessels not merely as reservoirs but as a dynamic process that maintains a fundamental level of homeostasis in the human being. Wetlands are essential to a healthy ecosystem, just as the extraordinary vessels are essential to the health of the twelve meridians and the human being as a whole.

 References
[1] Chace, C., & Shima, M. (2010). An Exposition on the Eight Extraordinary Vessels: Acupuncture, Alchemy and Herbal Medicine (p. 22). Eastland Press.
[2] Ibid, p. 19.

The White Beryl (Vaidurya Karpo) is a seminal text on Tibetan divination, composed by Sangye Gyatso in the 17th century. Tibetan astrology and divination shares the paradigm of five-element (wu xing) theory with the Chinese, while the pharmacology of Tibetan medicine features the fiv

e-element (pancamahābhūta) theory of the Indians. The co-existence of two distinct five-element paradigms with context-specific application is unique to the medicine and astrology of the Tibetan plateau.

Khenpo Troru Tsenam, root teacher of my Tibetan medicine teacher, Dr. Phuntsog Wangmo, considers the Indian and Chinese five-element theories to be “complementary” rather than contradictory. He describes the Indian five elements as having a “compositional” emphasis and the Chinese five elements as having a “dynamic” emphasis:

In Tibetan Medicine, one finds both Asian systems of these famous "five elements": 

·      The Indian system, in which they appear primarily as the 5 fundamental components of all relative phenomena, corresponding to what, on one level, we would currently call matter, bonding, thermodynamics, kinesis and space. 

·      The Chinese system, in which they appear in a more dynamic sense, corresponding to four general phases of all life cycles and an underlying ground state, i.e. initial growth, maturation, decomposition and resorption into the whole, that is taking place on all sorts of levels and over all sorts of timescales, from the molecular right up to the duration of a human life.

These two systems are not contradictory but complementary. Both are employed extensively in Tibetan medicine. Pulse palpation, for instance, is very much concerned with attuning to the immediate state of the body and so uses the dynamic form of the elements. The pharmaceutical theory of TTM [Traditional Tibetan Medicine] however is more concerned with the more constant therapeutic properties of its materia medica, and hence resorts more to the compositional aspects of the 5 elements. 

The conscious clinical application of both five-element theories in Tibetan medicine has always fascinated me. Rinpoche’s observation not only distinguishes the philosophical basis of both theories, but establishes their temporal relevance: the dynamic form of the elements is relevant to the energy of the present-time and the compositional nature of the elements is relevant in ascertaining the qualities of substances.

As Rinpoche notes, the primary the application of Chinese five-element theory is in Tibetan pulse diagnosis, especially in the “seasonal pulses”. The most extensive discussions and applications of Chinese five-element theory is found in Tibetan astrology and divination texts. One such text, the White Beryl of Sangye Gyatso, features the following descriptions of the five elements which should be of interest to students of Tibetan and Chinese medical traditions alike:

Wood (shing): Symbolised by a green tree and numerically represented by the number one, the wood element emerges naturally in an upright manner. Its function is one of lightness and mobility, inherent in a diet of fruit and cooked vegetables, while within the body it is represented by the blood-vessels, nerves and liver. It causes velar and guttural sounds to be articulated, and is characterised by bald-headedness and goitre. In cases of ill-health an imbalance of wood is indicated by plague-causing spirits (gnyan) and malign goblins (the'u-brang), and by paralysis of the nervous system. Socially, wood relates to the priestly class, the kingly type, and paternal uncles. It is located in the east of the turtle divination chart, along with the trigram Zin, the tiger and hare signs, Jupiter and the six easterhn constellations. If the hour of a person's birth is governed by the wood destiny element, it is predicted that he or she will be an aristrocrat, though possibly without heirs; tall in stature, long-haired, and with enemies in the west and friends in the east.

 Fire (me): Symbolised by a red triangular flame and presented by the number four, the fire element emerges naturally in a flickering blazing manner. Its function is one of combustion, inherent in a diet of cooked meat, blood and the flesh of an animal's head, while within the body it is represented by the metabolism and the heart. It causes dental sounds to be articulated, and is characterised by matted hair or dreadlocks and swollen glands. In cases of ill-health an imbalance of fire is indicated by hanting spirits (bstan) and the ghosts of murder victims (gre-bo), and by fevers and headaches. Socially, fire relates to the mercantile class, to women and children, or mothers with daughters. It is located in the south of the turtle divination chart, along with the trigram Li, the horse and snake signs, the Sun and the six southern constellations. If the hour of a person's birth is governed by the fire destiny element, it is predicted that he or she will be of a Buddhist or potter's family background, but harassed due to a blood feud, short-tempered, virtuous, tall in stature, prone to many ups and downs, conciliatory, and ruddy complexioned.

Earth (sa): Symbolised by a yellow square and numerically represented by the number two, the earth element emerges naturally in a static manner. Its function is one of heaviness and solidity, inherent in a diet of bread and the flresh of an animal's limbs, while within the body it is represented by the muscle tissue and the spleen. It causes nasal sounds to be articulated, and is characterised by fringed hair and a decrepit posture. In cases of ill-health an imbalance of earth is indicated by spirit lords of the soil and demons of the countryside (yul-'dre), as well as by lethargy and asphyxia. Socially, earth relates to the ruling class, to Buddhist monks, and to maternal ancestors or matters concerning land and houses. It is located in the intermediate directions of the turtle divination chart, along with the trigrams Khon, Khen, Gin, and Zon, the ox, sheep, dog, and dragon signs, Saturn and the four intermediate constellations. If the hour of a person's birth is governed by the earth destiny element, it is predicted that he or she will be of a mantrin or nun's family, but the locality will be afflicted by the spirit lords of the soil.

Iron (lcags): Symbolised by a white semi-circle or blade and numerically represented by the number five, the iron element emerges naturally with sharp edges. Its function is one of sharpness or incision, inherent in a diet of dairy products and flesh from an animal's ribs, while within the body it is represented by the bone tissue and the lungs. It causes vocalic sounds to be articulated, and is charaterised by shaven heads and moles. In cases of ill-health an imbalance of iron is indicated by king spirits (rgyal-po) and Pehar, as well as by colic and bone ailments. Socially, iron relates to outcasts, to children, maternal relatives and protector deities. It is located in the west of the turtle divination chart, along with the trigram Dva, the bird and monkey signs, Venus and the six western constellations. If the hour of a person's birth is governed by the iron destiny element, it is predicted that he or she will be a fair-complexioned villager in whose family a blood feur has occurred, noisy, tall and unrestrained in speech.

Water (chu): Symbolised by a blue circle and numerically represented by the number three, the water element emerges naturally in a flowing manner. Its function is one of mollification, inherent in a diet of liquid refreshments including wine and water, while within the body it is represented by the blood, serum and kidneys. It causes labial sounds to be articulated, and is charaterised by hair on the occiput and a cleft palate. In cases of ill-health an imbalance of water is indicated by serpentine spirits (nāga) and imprecatory goddesses (ma-mo), as well as by cold diseases and ailments of the lower part of the body. Socially, water relates to the laboring classes, to Bon-po priests, sisters and female in-laws. It is located in the north of the turtle divination chart, along with the trigram Kham, the mouse and pigs signs, Moon, Mercury and the sixth northern constellations. If the hour of a person's birth is governed by the water destiny element, it is predicted that he or she will be of dark complexion, of a Bon-po or village family background, loud-voiced, whimsical, and lacking in reliable supporters.

The oldest Asian medical traditions are rooted in a worldview that recognizes the human being and the universe as a unified interdependent process. A fundamental etiological paradigm across these systems is the notion of disease as an “interruption” or “disconnection” from the larger functional, energetic, and spiritual context of our existence. It is for this reason that Ayurveda, Tibetan Medicine, and Chinese Medicine emphasize the need to live in harmony with the natural world and its cyclical laws. If we live in step with the rhythms of nature, we will remain in the flow of the universal life-force, and remain resilient. This understanding readily translates into dietary and lifestyle principles such as a seasonal and locally-sourced diet and a daily routine aligned to the cycles of day and night. While the three aforementioned systems share this understanding, they vary slightly in their application of these principles. 

II.

For example, Ayurveda and Chinese Medicine offer differing perspectives on when to eat the largest meal of the day. According to Ayurveda, our digestive fire (agni) moves in tandem with the cycles of the Sun. The Sun reaches its peak at noon and so does our digestive power. Given this, Ayurveda advises that we eat our largest meal between the hours of 11am-1pm. I remember my teacher, Vaidya Mishra, saying that the digestive fire is like a low flame in the morning, but as the day (and Sunlight) progresses, the digestive flame increases enabling us to process more food, before waning again as dusk approaches. 

Chinese Medicine also bases its lifestyle principles on the solar cycle of day and night, commonly known as the “Chinese clock” or “Meridian clock”. This biorhythmic clock divides the 24hr cycle of day and night into 12 divisions spanning two hours each. Each of the twelve meridians experiences peak energetic activity during a two-hour segment. The clock also maps the progression of the five phase-elements, with each consecutive 4hr division belonging to a single phase-element.

Within this schema, the Stomach meridian reaches its peak during the hours of 7-9am, followed by the Spleen from 9-11am.  From the perspective of Chinese Medicine, during these hours the Stomach is more equipped than at any other time of day to receive and digest food. Once it does, the Spleen is able to transform and transport the energy derived from food throughout the whole system. If we eat too lightly in the morning, our energy levels will be compromised for the entire day and we might experience an afternoon crash. This is why breakfast is given unique importance in Chinese Medicine.

How to reconcile these views? Ayurveda and Chinese Medicine both share the same fundamental philosophy of unity and balance in the microcosm-macrocosm dynamic. Ayurveda and Chinese Medicine both classify the Stomach within the Earth element. And both systems agree that the solar peak occurs at noon. In the Chinese clock, noon is the mid-point of Heart’s hours (11am - 1pm). The Heart is associated with the Fire element and occupies the unique status of being the “Supreme Controller”. We see a similar emphasis in Ayurveda’s designation of agni as the root-intelligence of the body system. Despite this convergence, Chinese Medicine does not advocate we eat our biggest meal of the day during the solar peak. I believe some insight can be gained into this when we consider how energetic cycles wax, peak, and wane.  

The paradox is that the apex of energy is the beginning of its declination. Therefore, the solar peak functions as a pivot. The apex of the Summer Solstice marks the beginning of the Sun’s waning cycle. However, during Spring, the solar energy is waxing and moving toward its maximum. In Vedic astrology, the Sun is considered exalted in the sign of Aries—the zero-point of the zodiac which coincides with the Spring equinox. The Sun is not exalted in Cancer, the sign it occupies at the Summer Solstice. In my view, the Chinese recommendation to eat the biggest meal at breakfast accords with the understanding that the solar energy is stronger on the arc toward the apex rather than at the apex itself.

III.

Coincidentally, we need to remember the difference between clock time and solar time. Clock time is a stable unit of measurement that roughly coincides with the solar cycle, but not entirely. The modern adoption of daylight savings time complicates the issue, as does geographical location and seasonal variations. The time cycles referred to in traditional medicine are not “clock time” but solar time which describes the actual movement of the Sun in relationship to the Earth. Therefore, solar noon is not necessarily “12pm”, but is rather an astronomical reality when the Sun is directly overhead, otherwise known as “true noon”. In Hawaiian tradition, the solar peak is known as “lahaina” and is considered an auspicious time for certain rituals. Consider the very real difference between this and the convention of “12pm”. While we must live with the conventions of clock time, it is very important that we consider the realities of solar time as the true biorhythm informing our life. In clinical practice, practitioners have to be careful not to make meridian associations with the patient’s report (especially in regards to what time they wake up in the middle of the night or when their symptoms worsen). If we take clock time as the reality, we will often associate the wrong meridian with the patient’s symptoms. We need to convert the reported clock time to “meridian time”. This also applies, most importantly, to biorhythmic-based treatments (such as horary treatments in acupuncture). 

IV.

Ultimately, it is difficult to reconcile the contrasting views of Ayurveda and Chinese Medicine on this topic. In many ways, their views coincide, and in other ways they diverge. Neither one is more “correct” than the other. I have tested both approaches and know what works better for me, but that is how it is for me and not necessarily someone else. Those who want to follow the meridian clock approach should make sure they are actually eating between 7-9am solar time. For one following the Ayurvedic approach, eating while the Sun is still waxing towards its maximum, sometime between 11am-noon solar time (rather than at noon or after noon, when the Sun is beginning to wane) is recommended. It is worth noting that, in Tibetan Medicine, the Chinese approach of eating a large breakfast is adopted. Given the Tibetan’s significant incorporation of Ayurvedic and Chinese medical theories into their system, they were undoubtedly aware of both paradigms. I remember Menpa Wangmo saying the traditional recommendation is to eat breakfast like a king, lunch like a prince, and dinner like a pauper.

These biorhythmic considerations are becoming more of a challenge to implement amidst modern conventions. Society prefers a fixed measure of time around which to organize productivity, instead of following the natural cycle. Consider if our days were actually longer in Spring and Summer, and we worked more during the yang period of the year. If we work during the yang period of the year, we will have enough to store when the days shorten in Winter. Then we will have earned a much deserved rest. We would rejuvenate in the Winter and be prepared when Spring arrives again. Admittedly, such notions seem unattainable today, but that does not mean we should forget their value. Life becomes rich and simple when we realize that to heal is to live in the natural order, amidst the mysterious elegance of life’s radiant power.

I.

During the time I was a student at the Shang Shung School of Tibetan Medicine, I encountered a copy of the Mirror of Beryl in the school library. The Mirror of Beryl is a 17th century text on the history of Tibetan Medicine, written by the great scholar-physician Desi Sangye Gyatso. In this work, Gyatso traces the philosophical and cultural influences on Tibetan Medicine through India, China, and Central Asia. It is a comprehensive work that illustrates the status of Tibetan Medicine as the global medical system of its time.

In the introduction to this publication, I came across the following quote:

A passage from a work called Weapons of Fearlessness, cited in Mirror of Beryl, talks of three great medical systems, and that ignorance of any one of them would exclude one from being counted among the great physicians.

—Introduction to Mirror of Beryl, p. 2

This passage is the first reference I had found that directly encouraged the study of Indian, Chinese, and Tibetan medical systems. As neighboring cultures, there is ample evidence of cross-cultural exchange between these countries in the domains of philosophy, medicine, arts, etc. The desire to integrate neighboring streams of knowledge illustrates the disposition of the great scholar-physicians of the past who synthesized these various influences into the Tibetan medical system practiced today. Tibetans, in particular, have championed an integrative approach to medicine.

As for the beginning of the appearance of medicine in Tibet, to begin with there were just some bits of knowledge about nutrition. Later the Chinese consort, brought the [text] called The Great Medical Treatise [Sman dpyad chen mo], which was translated by the monks (ho shang) Mahadeva and Dharmakosa. Then, three doctors were invited, from India – Bharadvāja, from China – Hen-weng-hang-de and from Khrom of Stag-gzigs, Galenos. They translated much from their individual schools. Jointly they compiled the seven-volume text called the Weapon of the Fearless [Mi ’jigs pa’i mtshon cha]. 4

In the 7th-8th century, the Tibetan king invited physicians from neighboring countries to exchange medical knowledge. Later, in the 17th century, Desi Sangye Gyatso invited scholars and practitioners from Europe and Asia to Tibet for a grand conference in which medical knowledge was exchanged. The famous Greek physician, Galen, also resided in the Tibetan courts. Thus, even Greek humoralism was integrated into the Tibetan system alongside Ayurvedic tridosha and Chinese zang-fu theory. The Tibetans were not shy of these facts either. The title of the Root Tantra is written in both Tibetan and Sanskrit, a way of paying homage to the Ayurvedic classic, Astanga Hridayam, which was highly influential in Tibetan medical thinking. The Tibetans were the great preservers of the existing medical knowledge of the time.

Today, Tibetan culture has been threatened since the Communist Revolution of 1959. A holistic and indigenous culture which once stood at the roof of the world has been collapsing under authoritarianism and intolerance. The fate of Tibet speaks to the fate of holism, tradition, and universality altogether. As a result, modern practitioners of Tibetan medicine are seemingly less enthused about the cross-cultural influences on their medicine, and with good reason. Tibet is often reduced to a mere synthesis of the political and cultural superpowers that surround it, particularly India and China. Tibetan medicine is typically seen as a form of Ayurveda mixed with Chinese medicine, rather than a system with indigenous roots. My teacher, Dr. Wangmo, and her teacher, Namkhai Norbu, often highlighted the uniquely Tibetan aspects of their medical tradition. Norbu points to the origins of Tibetan medicine nearly 4,000 years ago in the ancient kingdom of Shang Shung and supports his claim with historical, linguistic, and archaeological evidence (see Zhang Zhung: A History of Tibet). Further, a close study of the Four Tantras of Tibetan Medicine reveals an abundance of theoretical and clinical principles drawn from the native Bön tradition that have no parallel in Ayurvedic or Chinese medicine. In some cases, the nomenclature for some materia medica is still in the original language of the Shang Shung Kingdom. Given all of this, I find it ironic that Tibetan Medicine—the great integrator of Indian, Chinese, Greek, Persio-Arabic, and Mongolian systems—has found itself subordinated to Ayurveda and Chinese Medicine and even reduced to a mere synthesis of these two traditions.

When I graduated from Shang Shung, Dr. Wangmo addressed the class of graduates with parting words of wisdom. With great emotion, she admonished us to always remember and champion that the root of Tibetan Medicine is in Tibet.

II.

I am often asked why I pursued a study of all three systems (Ayurveda, Tibetan Medicine, and Chinese Medicine). However, it was never my overt intention to study all three systems. Rather, my medical path unfolded organically and intuitively, as I followed one thread to the next in my pursuit of a greater understanding. Now I see that my path was, in fact, rather traditional in nature.

The study of these three systems is itself paradoxical and full of contradictions that take years to resolve within oneself. As a path of study and practice, it is not one I would recommend for the faint of heart. But for those interested in challenging and broadening their perspectives, it is incredibly valuable. Initially, I found many resonances between the systems, and there can be no doubt to their common philosophical ground and orientation. But the more I studied, the more I discovered vast differences. This has required me to integrate three similar but entirely distinct approaches—at first intellectually and then in application.

Those who are familiar with the study of languages will be able to relate to my experience. A language has its own conventions but also carries within itself a unique worldview. Medicine is very much a language, a means for describing the world, according to the culture within which it arose. In clinical practice, it is challenging to hold three languages in one’s mind and hope to achieve good results. It is more important to integrate these languages as different modes of truth, discovering the universal they point to while still remaining capable of drawing upon their distinctiveness at will. In practice, each system has its strengths. There are times when an Ayurvedic diagnosis feels natural and fitting to describe what I am seeing. But I may take a Tibetan herbal approach in treatment. At other times, a Chinese or Tibetan medical diagnosis feels more fitting and accurate.

In my experience, these three systems have deep cultural and theoretical relationships. Each system has helped me to appreciate and better understand the other. Even if one does not choose to study all three systems in depth, I do feel it is very enriching to have a basic exposure to all three of the great medical systems.

This is my graduate thesis for Ayurvedic medicine, originally published by the California College of Ayurveda. Portions of this text have also been published in Healing The Thyroid by Marianne Teitelbaum.

I. Introduction

Ayurveda is a 5,000-year-old system of medicine, rooted in the ancient Indian scriptures known …

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