A Brief Review of Related Issues on the Problematic Tang Ye Jing 湯液經

The title printed on the front cover, i.e. Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction). Below the title are the five characters ‘Yi Qian Ge Juan Zhuan 一錢閣鐫傳’ (Engraved and Issued by the One-Coin Pavilion).

The title printed on the front cover, i.e. Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction). Below the title are the five characters ‘Yi Qian Ge Juan Zhuan 一錢閣鐫傳’ (Engraved and Issued by the One-Coin Pavilion).

A guest blog by Di Lu

Many scholars and practitioners of Chinese medicine now consider the Tang Ye Jing 湯液經 (Classic of Decoction) as the basic reference for Zhang Ji’s 張機 (style name: Zhongjing 仲景, c. 150-219 AD) Shang Han Lun 傷寒論 (Discourse on Cold Damage). But is such an opinion on the relationship between the two texts unquestionable?

On the Anonymous Text Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)

The Tang Ye Jing (Classic of Decoction) has long been lost since the Eastern Han Dynasty (25-220 AD). The ‘Yiwen Zhi 藝文志’ (Bibliographical Treatise) of the Han Shu 漢書 (History of the [Former/Western] Han Dynasty, c. late 1st century and early 2nd centuries AD) simply records the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction, in 32 juan 卷 [volumes], without author information), and groups it with the other ten medical works under the title of jing fang 經方 (classical prescriptions). Many later authors mentioned the bibliographic record of this text in the Han Shu (Book of Han); but none of them reported his/her reading of the text (strictly under the title of ‘Tang Ye Jing Fa’, or under a similar title [e.g. Tang Ye Jing 湯液經] but containing the same number of volumes), or introduced the content of the text.

On the Text Tang Ye Jing 湯液經 (Classic of Decoction) by Yi Yin 伊尹

At least from the Southern Song dynasty (1127-1279 AD) onward, so far as known, authors of Shi Wu Ji Yuan 事物紀原 (Origins of Things and Matters, first printed in 1197 AD), Yi Shui 醫說 (Discourse on Medicine, 1224 AD) and other works attributed the text entitled Tang Ye Jing 湯液經 (Classic of Decoction; NOTE: lacking the character fa 法) to Yi Yin 伊尹 (c. 1649- c. 1549 BC), without offering any reasons or additional information, without basing such a claim on the above bibliographic record in the Han Shu (History of the [Former/Western] Han Dynasty). But similarly, no one in pre-modern China left a bibliographic record of this text, and/or spoke of any specific content of the text. Did this Tang Ye Jing 湯液經 (Classic of Decoction) ever exist? If so, is it the same as the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)? If so, why does the above bibliographic record in the Han Shu (History of the [Former/Western] Han Dynasty) not ascribe authorship to Yi Yin?

On Yi Yin’s 伊尹 Authorship of Tang Ye 湯液 (Decoction), Tang Ye Jing 湯液經 and Tang Ye Jing Fa 湯液經法

Modern proponents of the Tang Ye Jing 湯液經 (Classic of Decoction) as the progenitor of Zhang Ji’s Shang Han Lun 傷寒論 (Discourse on Cold Damage), as mentioned above, often invoke the following words in Huangfu Mi’s 皇甫谧 (215-282 AD) preface to his own work Zhen Jiu Jia Yi Jing 鍼灸甲乙經 (Classic of Acupuncture and Moxibustion, Selected and Arranged):

Zhong Jing Lun Guang Yi Yin Tang Ye Wei Shi Shu Juan, Yong Zhi Duo Yan.

仲景論廣伊尹湯液為十數卷, 用之多驗.

[Zhang] Zhongjing expanded Yi Yin’s Decoction into more than ten volumes, which were mostly effective in practice.

Lin Yi’s 林億 (active in the 11 century AD) preface to Zhang Ji’s Shang Han Lun (Discourse on Cold Damage) adopts the above words of Huangfu Mi, and adds that ‘Zhong Jing Ben Yi Yin Zhi Fa 仲景本伊尹之法’ ([Zhang] Zhongjing’s [medical knowledge] is rooted in Yi Yin’s norms). The proponents often acquiesce in the equation of the Tang Ye 湯液 (Decoction) with the Tang Ye Jing 湯液經 (Classic of Decoction) or Tang Ye Jing Fa 湯液經法(Models of the Classic of Decoction). In this way, Tang Ye (Decoction) becomes an abbreviation of the latter text title; and Yi Yin also becomes the author of Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction).

However, Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction) consists of 32 juan 卷 (volumes); while Zhang Zhongjing’s expanded edition of Yi Yin’s Tang Ye 湯液 (Decoction) merely contain more than ten juan 卷 (volumes). How could Yi Yin’s Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction) be the same as the anonymous Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)? Why do extant editions of Zhang Ji’s preface to his own work Shang Han Lun (Discourse on Cold Damage) contain no words of the text Tang Ye 湯液 (Decoction), Tang Ye Jing 湯液經 (Classic of Decoction), or Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)?

Copyright page A, showing the book title Tang Ye Jing 湯液經 (Classic of Decoction), the words ‘Yang Shao Yi Fu Zi Kao Ci 楊紹伊夫子考次’ (Compiled by Teacher Yang Shaoyi) and ‘Di Zi Li Ding Jing Shu 弟子李鼎敬署’ (Respectfully Signed by [Yang’s] Student Li Ding).

Copyright page A, showing the book title Tang Ye Jing 湯液經 (Classic of Decoction), the words ‘Yang Shao Yi Fu Zi Kao Ci 楊紹伊夫子考次’ (Compiled by Teacher Yang Shaoyi) and ‘Di Zi Li Ding Jing Shu 弟子李鼎敬署’ (Respectfully Signed by [Yang’s] Student Li Ding).

On the Reconstruction of Yi Yin’s Tang Ye Jing 湯液經 in 1948

In 1948, Yang Shiyin’s 楊師尹 (style name: Shaoyi 紹伊, 1888-1949) reconstruction of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction), supplemented by Liu Fu 劉復 (style name: Minshu 民叔, 1897-1960), was published by Liu’s Yiqian Ge 一錢閣 (One-Coin Pavilion). This is the only reconstruction of the text Tang Ye Jing 湯液經 (Classic of Decoction), which is believed by some people to be written by Yi Yin, and/or to have truly existed and given birth to Zhang Ji’s Shang Han Lun (Discourse on Cold Damage). Its main text has 160 pages.

The book title printed on the front cover of this reconstruction is ‘Yi Yin Tang Ye Jing 伊尹湯液經’ (Yi Yin’s Classic of Decoction); while the title shown on the copyright pages and the first page of the main text is ‘Tang Ye Jing 湯液經’ (Classic of Decoction).

All images here are from the original edition (1948) of the reconstruction of the Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction) in 1948.

The 1948 reconstruction of the Tang Ye Jing 湯液經 (Classic of Decoction) now has the following two modern versions (the latter one has adjusted the original title to another):

  • Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction), in: Liu Min Shu Yi Shu He Ji 劉民叔醫書合集 (Collection of Liu Minshu’s Medical Works), Chen Guangtao et al. (eds.), Tianjin: Tianjin Kexue Jishu Chubanshe, 2011, pp. 201-345.
  • Tang Ye Jing Gou Kao 湯液經鈎考 (A Study of the Collected Text of the Classic of Decoction), Chen Juwei and Guo Yujing (eds.), Forewarded by Qiu Hao, Beijing: Xueyuan Chubanshe, 2011, Pp. 242.

Yang Shiyin’s 楊師尹 (style name: Shaoyi 紹伊) name indicates Yang’s admiration of Yi Yin. Literally, Shiyin 師尹 means imitating [Yi] Yin; and Shaoyi 紹伊 means introducing Yi [Yin]. According to Yang Shiyin’s own introductory chapter in the reconstructed text,

The first page of the main text, showing the following information: ‘Shang Yi Yin Zhu 商伊尹著’ (Written by Yi Yin of the Shang Dynasty), ‘Cheng Du Yang Shi Yin Shao Yi Kao Ci 成都楊師尹紹伊考次’ (Compiled by Yang Shiyin of Chengdu, whose style name is Shaoyi), and ‘Hua Yang Liu Fu Min Shu Bu Xiu 華陽劉復民叔補修’ (Supplemented by Liu Fu of Huayang, whose style name is Minshu).

The first page of the main text, showing the following information: ‘Shang Yi Yin Zhu 商伊尹著’ (Written by Yi Yin of the Shang Dynasty), ‘Cheng Du Yang Shi Yin Shao Yi Kao Ci 成都楊師尹紹伊考次’ (Compiled by Yang Shiyin of Chengdu, whose style name is Shaoyi), and ‘Hua Yang Liu Fu Min Shu Bu Xiu 華陽劉復民叔補修’ (Supplemented by Liu Fu of Huayang, whose style name is Minshu).

  1. the full title of the text Tang Ye 湯液 (Decoction) mentioned by Huangfu Mi should be Tang Ye Jing 湯液經 (Classic of Decoction);
  2. the author of the Tang Ye Jing 湯液經 (Classic of Decoction) was Yi Yin of the Shang dynasty (c. 1600-1046 BC);
  3. the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction, 32 volumes) was a later text composed on the basis on Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction) and containing all the content of the latter;
  4. the Tang Ye Jing 湯液經 (Classic of Decoction) still existed in the Eastern Han dynasty, and enabled Zhang Ji to read it and expand its content; Shang Han Lun (Discourse on Cold Damage) was not ‘written’ by Zhang Ji, but an expansion of the Tang Ye Jing 湯液經 (Classic of Decoction);
  5. Yang Shiyin’s reconstruction of the text Tang Ye Jing 湯液經, alleged by Yang to be comprised of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction) and extended words by Zhang Ji, was reconstructed on the basis of Wang Shuhe’s 王叔和 (c. 210-285 AD) Mai Jing 脈經 (Classic of the Pulse) and Sun Simiao’s 孫思邈 (581-682 AD) Qian Jin Yi Fang 千金翼方 (Supplement to Prescriptions Worth a Thousand Gold, c. 682) (Wang and Sun’s texts contain words from Zhang Ji’s Shang Han Lun [Discourse on Cold Damage]).

The above points are arbitrary and speculative. None of them is solidly convincing. In particular, the Mai Jing (Classic of the Pulse) adverts to neither Yi Yin nor the Tang Ye Jing 湯液經 (Classic of Decoction). And only the 26th chapter of the Qian Jin Yi Fang (Supplement to Prescriptions Worth a Thousand Gold) mentions ‘Gu Ren Yi Yin Tang Ye 古人伊尹湯液’ (the ancient man Yi Yin’s Decoction), which, however, is not connected with origins of the content of the Qian Jin Yi Fang. Moreover, as mentioned above, extant editions of Zhang Ji’s preface to his Shang Han Lun (Discourse on Cold Damage) also makes no mention of the text Tang Ye 湯液 (Decoction), Tang Ye Jing 湯液經 (Classic of Decoction), or Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction). Some scholars also treat Yang’s opinions, methodology and reconstruction with caution, as evidenced by Qiu Hao’s foreword to the Tang Ye Jing Gou Kao 湯液經鈎考 (A Study of the Collected Text of the Classic of Decoction, Chen Juwei and Guo Yujing eds., Beijing: Xueyuan Chubanshe, 2011, pp. 1-16) and Feng Shilun’s foreword to the Jie Du Yi Yin Tang Ye Jing 解讀伊尹湯液經 (Interpreting Yi Yin’s Classic of Decoction, Feng Shilun 馮世綸 ed., Beijing: Xueyuan Chubanshe, 2009, pp. i-iv).

On the Manuscript Fu Xing Jue Zang Fu Yong Yao Fa 輔行訣臟腑用藥法要 (Auxiliary Knacks of Essential Drug Usage for Viscera)

A text often associated with academic discussions of the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction) is the manuscript Fu Xing Jue Zang Fu Yong Yao Fa 輔行訣臟腑用藥法要 (Auxiliary Knacks of Essential Drug Usage for Viscera, hereinafter FXJ), which is now included in, for example, the Dun Huang Gu Yi Ji Kao Shi 敦煌古醫籍考釋 (Commentary and Research on Ancient Medical Texts Excavated in Dunhuang, Ma Jixing 馬繼興, ed., Nanchang: Jiangxi Kexue Jishu Chubanshe, 1988, pp. 115-137), Dun Huang Shi Ku Mi Cang Yi Fang 敦煌石窟秘藏醫方 (Secret Medical Prescriptions from Dunhuang Grottoes, Wang Shumin, ed., Beijing: Beijing Yike Daxue & Zhongguo Xiehe Yike Daxue Lianhe Chuban, 1998, pp. 1-28), Fu Xing Jue Zang Fu Yong Yao Fa Jiao Zhu Kao Zheng 《輔行訣臟腑用藥法要》校注考證 (Textual Studies, Collation and Annotations of the Auxiliary Knacks of Essential Drug Usage for Viscera, Wang Xuetai, ed., Beijing: Renmin Junyi Chubanshe, 2008, pp. 3-62), and Fu Xing Jue Zang Fu Yong Yao Fa Jiao Zhu Jiang Shu 《輔行訣五臟用藥法要》校注講疏 (Interpretation, Collation and Annotations of the Auxiliary Knacks of Essential Drug Usage for Viscera, Yi Zhibiao, et al., eds., Beijing: Xueyuan Chubanshe, 2009, pp. 250-307).

According to the introductory remarks on FXJ in the above modern publications, FXJ was initially preserved at the Mogao Grottoes of Dunhuang, and then flowed into the hands of a Daoist, who later sold it to the Chinese physician Zhang Wonan 張偓南 at the beginning of the Republican period (1912-1949). Zhang passed the original manuscript of FXJ down to his grandson Zhang Dachang 張大昌, also a Chinese physician. In the summer of 1966, unfortunately, the original manuscript was destroyed in the Cultural Revolution. In 1974, Zhang Dachang sent a copy of the manuscript to the Zhong Guo Zhong Yi Yan Jiu Yuan 中國中醫研究院 (China Academy of Chinese Medicine). Later, the manuscript began to receive increasing attention from historians of medicine. Until now, 21 copies of the original manuscript of FXJ, transcribed by different people in the second half of the 20th century, have been found in China and included in the Fu Xing Jue Wu Zang Yong Yao Fa Yao Chuan Cheng Ji 《輔行訣五藏[臓]用藥法要》傳承集 (Collection of the Circulated Manuscripts of the Auxiliary Knacks of Essential Drug Usage for Viscera, Beijing: Xueyuan Chubanshe, 2008, pp. 3-400).

FXJ, originally authored by Tao Hongjing 陶弘景 (456-536), is a controversial manuscript. Two historians of Chinese history, namely Zhang Zhenglang 張政烺 and Li Xueqin 李學勤, had examined FXJ, and concluded that it could not be counted as an early writing composed by Tao Hongjing, nor could it be a modern forged text. The original manuscript of FXJ is now lost; and available information on the origin of FXJ originates from Zhang Dachang, whose narrative might be unreliable (say, FXJ might be forged or might not be a manuscript from Dunhuang Grottoes). The title of FXJ also does not appear in extant records of Tao Hongjing’s writings. Some scholars treat FXJ a forged text, see, for example, Tian Yongyan 田永衍, ‘Fu Xing Jue Zang Fu Yong Yao Fa Yao Fei Cang Jing Dong Yi Shu Kao——Cong Wen Ben Xing Shi Yu Wen Xian Guan Xi Kao Cha 《輔行訣臟腑用藥法要》非藏經洞遺書考——從文本形式與文獻關係考察 (A Study of the Auxiliary Knacks of Essential Drug Usage for Viscera as a Text not from Dunhuang Grottos——From the Perspectives of Textual Forms and Relationships)’, Nan Jing Zhong Yi Yao Da Xue Xue Bao (She Hui Ke Xue Ban) 南京中醫藥大學學報(社會科學版) (Journal of Nanjing University of TCM [Social Science]), 2015, 16(4): 232-237.

FXJ mentions ‘Tang Ye Jing Fa 湯液經法’ (Models of the Classic of Decoction) three times, and claims that it was written by Yi Yin of the Shang dynasty. Because of this, some historians, such as Ma Jixing 馬繼興, consider that FXJ incorporates some words from the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction). Further, because some prescriptions recorded in FXJ (not associated with the Tang Ye Jing Fa 湯液經法 [Models of the Classic of Decoction]), bear resemblance to their counterparts in Zhang Ji’s Shang Han Lun (Discourse on Cold Damage), some historians of medicine, such as Qian Chaochen 錢超塵, think that FXJ proves Shang Han Lun (Discourse on Cold Damage) to be composed on the basis of Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction). Even if FXJ is not a forged text, such an opinion is still too arbitrary.


Concluding Remarks

Copyright page B, showing the publisher information ‘Liu Shi Yi Qian Ge Zeng Fu Zhen Juan Zhuan Chuan 劉氏一錢閣曾福臻鐫傳’ (Engraved and Issued by Zeng Fuzhen at Liu’s One-Coin Pavilion), and the information on the transcriber and the collator: ‘Di Zi Li Ding Lu Gao 弟子李鼎録稿’ (Transcribed by [Yang’s] Student Li Ding) and ‘Wu Zi Nian Dong Chu Ban Hai Men Shen Dan Jiao Zi 戊子年冬初版海門沈旦校字’ (First Published in the Winter of 1948, Collated by Shen Dan of Haimen).

Copyright page B, showing the publisher information ‘Liu Shi Yi Qian Ge Zeng Fu Zhen Juan Zhuan Chuan 劉氏一錢閣曾福臻鐫傳’ (Engraved and Issued by Zeng Fuzhen at Liu’s One-Coin Pavilion), and the information on the transcriber and the collator: ‘Di Zi Li Ding Lu Gao 弟子李鼎録稿’ (Transcribed by [Yang’s] Student Li Ding) and ‘Wu Zi Nian Dong Chu Ban Hai Men Shen Dan Jiao Zi 戊子年冬初版海門沈旦校字’ (First Published in the Winter of 1948, Collated by Shen Dan of Haimen).

After a brief review of related issues on the Tang Ye Jing 湯液經 (Classic of Decoction), we can confirm that:

  1. There had been an anonymous text entitled Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction, in 32 juan [volumes]) in the Western Han dynasty;
  2. It is unknown whether there truly existed a text written by Yi Yin of the Shang dynasty and entitled Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction);
  3. It is unknown whether the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction) was Yi Yin’s Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction);
  4. It is unknown whether Zhang Ji’s Shang Han Lun (Discourse on Cold Damage) was an expansion of Yi Yin’s Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction);
  5. Yang Shiyin’s reconstruction of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction), published in 1948, can only represent his own faith in the existence of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction).

Purple Cloud Podcast: Daoists and Doctors: Michael Stanley-Baker

In this episode Daniel interviews Michael Stanley-Baker about his in depth study of the spiritual and medical practices of the Shang Qing school of Daoism. The podcast delves into the relationship between religion and medicine, the visualisation and meditation techniques of the Shan Qing practitioners and touches on the roles of played by important figures such as Ge Hong and Tao Hong Jing. Listen to the show here!

Can use of acupuncture delay proper medical treatment?

Introduction

Even though there is room for more thorough adverse effect reporting in acupuncture trials and a need for more studies about acupuncture safety (Ng et al. 2016; Turner at al. 2011), there already exists evidence concerning the safety of acupuncture. Based on the studies (Witt et al. 2009; Kim et al. 2016; McCulloch et al. 2015; Park et al. 2014; Houzé et al. 2017), we can conclude that generally acupuncture can be seen as a relatively safe practice. The adverse effects from acupuncture are extremely rare compared to reported adverse effects from conventional medicine. The FDA Adverse Event Reporting System (FAERS) Public Dashboard reveals 906,773 serious side effect reports and 164,154 deaths from side effects or malpractice in 2017 alone. This is an unfair comparison as the patient base and seriousness of the conditions treated are often very different, but it gives us a perspective to the safety of acupuncture in comparison with many other medical treatments. And even the most serious side effects like pneumothorax from acupuncture seem to be preventable with sufficient training in acupuncture education (Kim et al. 2016).

In the acupuncture studies about patient safety, the subject has been approached from the point of safety of the treatment itself. There seems to be a lack of studies about the possibility of delayed medical treatment in cancer or other severe medical conditions due to the use of acupuncture. This essay approaches the subject with reflection on a patient case.

Case background

The author first met the patient in 2011. The patient had suffered from recurring, almost constant uveitis for 15 years. Known causes of uveitis had been previously excluded by medical doctors. The only treatment offered to the patient was ophthalmic steroids. Prolonged use of the steroids had increased her intraocular pressure causing glaucoma that threatened her diminishing vision. The ophthalmologist wanted to start a more robust and constant medication for glaucoma with a drug having the side effect of flaring of uveitis. The patient wanted to try acupuncture as an alternative.

After five sessions of acupuncture, the symptoms of uveitis had clearly decreased and she had reduced the use of corticosteroids. She had permission from the ophthalmologist to dose corticosteroids based on need. During the following months, she used them only twice when she felt any peculiar feelings in her eyes. Five months later she visited her ophthalmologist who could not see any signs of uveitis. Due to increased intraocular pressure, they had agreed for regular follow-ups. Beside one occasion in 2012, she has been without corticosteroids and free from uveitis.

In addition to uveitis, she had a medical history of back and joint pains, and Ménière’s disease.

During her initial visits to author’s clinic, she expressed her growing frustration with medicine and how she felt like a test subject. The doctors could not give a reason for her symptoms, and to her it seemed illogical to use medication causing uveitis to treat problems caused by the medication for uveitis. She also felt that some doctors she had met had been unprofessional in their behaviour. Side effects and dissatisfaction to conventional health care are among common reasons for trying acupuncture (Jakes et al., 2014).

Radical change in patient’s health

In 2015, the patient wanted to try acupuncture for fatigue. She had already visited a medical doctor through occupational health care who didn’t find anything alarming. The author performed acupuncture based partly on her previous background information and her current symptoms. Afterwards, she reported a slight initial improvement, but the exhaustion soon returned and was non-responsive to further attempts with acupuncture.

After a third acupuncture treatment she caught a flu and visited another doctor who took a chest X-ray that revealed a cancerous growth in her lungs. The patient was treated with surgical removal of the tumour. Because of inappropriate joking by the operating doctor just before the surgery, she felt mistreated again even though the surgery was successful. Soon after the surgery she contracted pneumonia. During follow-ups later on, her papers were not read properly leading to surgical marks visible in the X-ray to be mistaken as a sign of pulmonary embolism. Two months of unnecessary subcutaneous injections added to her mistrust of the whole medical profession even though the surgery itself had been successful.

During these events the patient contacted the author and told him about the correct diagnosis. She didn’t blame the author for misdiagnosis. But for the author this caused concerns and a need for reflection. How could something this serious be missed even when the cancer was advanced enough to cause serious fatigue? Could this be prevented from happening again?

Meeting in 2017

In 2017, the patient reserved time from the author because of vertigo caused by Ménière’s disease. The prescribed medication was no longer effective. During the meeting she gave a detailed account of her experience with surgery and how she felt afterwards. She was angry and frustrated and said she had little faith left for the health care system even though she had been saved by the medical procedure. During the session she gave permission for using her case as a case study. After giving the permission, she was told that the treatments would be free of charge.

Meeting her after the incident produced conflicting thoughts. Because of her past, the current condition felt more alarming. Why did her medication suddenly stop working? Was the dizziness caused by Ménière’s disease, a simple benign positional vertigo or was it something more severe? What if this was somehow connected to her previous condition? There was also curiosity and a need to ask questions about her previous health concerns that might shed some light to the author’s wrong diagnosis.

She had already seen her physician to screen out anything serious but still the situation stirred some insecurity in the author. During the discussion and diagnosis she revealed that she had recently lost her job and was now unemployed. So she was particularly happy to receive free treatments. Lack of money combined with free treatments might also increase the possibility of an already vulnerable patient to feel more dependent on the acupuncturist or it could produce a feeling of groundless gratitude. Having less money might also mean that she might be less willing to see a doctor in case the acupuncture treatment did not work, especially with her experiences with the public health care.

While describing her experiences and expressing her mistrust with the medical profession, she didn’t seem to consider the author to be part of the medical profession. In Finland, the author is a registered health care professional due to being a licensed masseur, but an acupuncturist is not an accepted health care professional nor is there any legal regulation about the profession. The professional associations are working to self-regulate the field, set educational criteria, enforce the following of ethical guidelines, and ensure that the professionals have proper insurances.

For the author, it was important to meet the patient face to face after making a wrong diagnosis. There were no signs of blaming or mistrust from the patient. Her patient records had been reviewed in 2015 and again before the appointment. There was no evidence of neglecting of symptoms, and she had already visited a medical doctor beforehand. It was crucial for the improvement of practice for the author to become more aware of possible consequences. It made the author question his own responsibilities and also the boundaries of his practice.

Analysing the case

During 2015, the author had failed to recognize lung cancer. The examination and questions asked during the visit could have been more thorough. Owing to the fact that the patient was previously known, there was a possibility of using information gathered during earlier visits. This combined with the shorter time reserved for returning patients might have made it harder to be cautious enough. The TCM diagnosis based on the discussion, pulse, and tongue during the visit revealed what is known in Chinese medicine as a deficiency of blood and a weakness of lung qi. Relying on the patient history while formulating a picture of the current situation might have affected the understanding of the real reason for exhaustion and how serious her case was. The medical expertise of the author did not enable him to recognise the underlying reason. A similar mistake was probably made by the medical doctor in occupational health care who failed to see cause for further tests. Given the patient’s earlier bad experiences with health care, she probably might not easily go back for a second opinion. In this case, it was pure luck that the patient caught the flu and was sent to x-ray.

The seriousness of the situation also raises other concerns. What if the patient had gotten better results from the acupuncture treatment? In that case, could the better results have delayed a proper diagnosis and medical treatment? And what role does the therapeutic relationship play in a possible delay of proper treatment?

There exists some evidence that acupuncture is effective in treating cancer-related fatigue (Duong et al. 2017; Zhang et al. 2018; Zick et al. 2016). These studies focus on fatigue in connection with conventional cancer treatments, but acupuncture might also diminish the fatigue caused by cancer itself. Definite scientific evidence for the effectiveness of acupuncture for cancer pain is still lacking (Wu et al. 2015), but there is reason to believe that acupuncture might provide some relief from cancer pain (Hu et al. 2016; Chiu et al. 2017). So there is a possibility that acupuncture might prolong the time before the patient goes to see a doctor. An acupuncturist might see diminished fatigue and/or pain as evidence of successful treatment, which might in reality delay proper medical treatment. However, in case of pain, the same could easily happen with self-administered and commonly available pain killers. The fatigue might also diminish with energy drinks (Warnock et al. 2017), but the effects wouldn’t probably last for long. However, it could also be possible that by visiting an acupuncturist frequently, the acupuncturist could notice if there was no response to treatment or that the results were not as long-lasting as they should be. At least the acupuncturist would notice if the condition of the patient seemed to deteriorate despite the treatments. This could easily alarm a professional acupuncturist so, in this way, the acupuncturist would provide an extra pair of eyes watching for the patient’s health. In Finland, the acupuncture associations require the signing of ethical conduct which states that all acupuncturists refer cases to medical doctors when medical treatment is needed.

A study by Shorofi and Arbon (2017) offered some reasons why patients are opting to use CAM therapies instead of medical therapies. In the study, in all the people opting for CAM therapies, the most relevant reasons for this case study were that the problem was not seen serious enough to see a doctor (21.4%), a belief that these alternative treatments have fewer side effects than conventional ones (16.9%), and dissatisfaction with conventional treatments (6.8%). Combining these percentages with those of people who felt that CAM therapies were more fitting to their personal lifestyle or philosophy (37.7%), there is some evidence of a group of people who might not prefer to see a medical doctor in the first place. The study was done among hospitalised patients in Australia, but the author is in agreement over these patient groups and confirms similar numbers based on his own patient records and experience.

In serious diseases, like cancer in this case, medical diagnosis and intervention as early as possible is paramount. The symptoms, however, can begin with only minor health complaints. The 21.4% of population who use complementary modalities consider their problems not serious enough (Shorofi and Arbon 2017), but they might still find their way to the acupuncturist who, with adequate training, could be able to recognise the severity of the symptoms and could advise the patient to see a doctor.

The example patient in this essay had a medical diagnosis from her ophthalmologist for her previous condition. But in Finnish acupuncture clinics, it is very common to meet patients with medically unexplained physical symptoms (MUPS). These patients do not have a diagnosis and often feel that in conventional medical care they are misunderstood and their symptoms are not always taken seriously (Lipsitt et al. 2015). This same patient group generally obtains poor clinical outcomes from medical practice (Lipsitt et al. 2015), which might lead them to further avoid medical doctors. Some of these patients might feel more understood by CAM practitioners in general. Depending on the type of therapy, this could partly be due to the duration of initial interview and time used during the treatment, or more cosy clinical settings. It might be the CAM practitioner who first notices that their symptoms start to change or become worse, signalling that there might be a need to see a doctor. However, if the CAM therapist fails to see the alarming signs, the patient might get non-optimal treatment and believe that he gets all the treatment he needs. This could be preventable with proper education and further cooperation with medical doctors.

An even more alarming group than the MUPS patients who often burden health care with their constant visits (Lipsitt et al. 2015), are those who feel very dissatisfied with their medical care and are avoiding seeing doctors. This group is easily left without treatment by their own choice. Some of these patients might still be willing to see an acupuncturist. In that case, more serious and easily recognised problems might become apparent and they could be referred to health care, if they can be persuaded to make an appointment. Within these patient groups, there are people who feel vulnerable and, sometimes, they do not know where they should go and which symptoms they should tell their doctors. In their case, even one bad experience with a medical doctor can lead to further aversion of medical procedures and tests. For them an acupuncturist might be seen as a neutral bridge for communication to conventional health care.

CAM modalities are also often selected because of recommendations or wanting self-control over an illness (Shorofi and Arbon 2017). Many patients from the group who feel CAM therapies are more fitting to their personal way of life may not easily visit a doctor for any minor complaints. Based on the author’s experience, the people from these groups are generally willing to see a doctor when faced with any serious conditions or when told so by an acupuncturist. The problem for these patients is to recognise what is relevant and what is serious enough. Those seeing an acupuncturist with at least a basic education of medicine, could then be told by the acupuncturist to see a doctor if needed.

Conclusions

The failure to recognise lung cancer by the author and by a medical doctor in occupational health care was a human error. The proper acupuncture studies in Finland include a minimum of 14 to 30 ECTS of medicine, depending on the year of graduation, and lung cancer is one of the most difficult forms of cancer to diagnose even for general practitioners (Rankin et al. 2017). Mistakes can happen for any medical professional and CAM practitioner alike, but delays in treatment can lead to disease progression and missed opportunities for cure in a significant subset of patients (Rankin et al. 2017). In conventional care, it is customary to refer the patient to a specialist for diagnosis in case the general practitioner suspects cancer or another more serious disease. A similar attitude is crucial for patient safety among all CAM modalities. Wide cooperation with medical doctors would ensure patient safety and could also encourage some vulnerable patient groups to visit a doctor in time. It might also provide a bridge for communication to patients with MUPS or other patient groups who may feel more understood by CAM practitioners.

Based on these reflections, the author claims that there exists a possibility for certain groups of people to be left without early recognition of serious diseases in conventional health care and in clinics offering CAM modalities. In developed Western countries, most patients already go to a medical doctor in case they suspect anything serious. Those coming to see an acupuncturist or another CAM practitioner have often already visited a medical doctor (Eisenberg et al., 2001). Those who have considered their problems too minor for needing a doctor may still try acupuncture. In case the acupuncturists suspect any more serious health concerns, the professional acupuncturists always ask the patient to visit a doctor. In Chinese medicine education, it is necessary to teach acupuncturists to become aware of their own limitations. In acupuncture education, the students need to be taught to communicate with the patients honestly, if they cannot understand the symptoms or they have any suspicions.

The ability of an acupuncturist to recognise important clues about serious health issues depends on education and clinical experience. Even though Chinese medicine courses are not meant to produce medical doctors or to teach how to make a conventional medical diagnosis, they aim at providing enough understanding when it is necessary to refer the patient to medical care. As the popularity and acceptance of acupuncture is growing fast and more and more research about its effectiveness is emerging, the acupuncturists will receive more and more patients seeking alternatives. With growing public awareness of acupuncture, there will be more and more patients coming with grave illnesses that require conventional medical treatments. The need for basic medical education and continuous education for acupuncturists cannot therefore be stressed enough.

It is also crucial for acupuncturists, and other CAM practitioners, to network themselves with medical doctors whom they can refer the patients to or ask for an opinion. Awareness of these critical situations can also be improved with open discussion and sharing experiences with other acupuncturists or practitioners of other CAM modalities.

Some patients have withheld information from their doctors about their nutraceuticals recommended by their nutritional therapists or herbs recommended by CAM practitioners. In the study by Eisenberg et al. (2001), three fifths of CAM therapy used was not disclosed to doctors. The common reason is that the doctor didn’t ask and some patients were also afraid that the doctors would not agree or understand (Eisenberg et al., 2001). This can be very dangerous considering the potential interactions (Salminen, 2018) with drugs used in cancer treatment, for example. The possibility that the patient uses some CAM modality is ever increasing. According to Eardley et al. (2012) “the prevalence of CAM use varied widely within and across the EU countries” and could be even as high as 86% of the population in some countries. The most commonly used modality is herbal medicines. If the patients sense a strong dichotomy between CAM practitioners and medical professionals, it can cause the patients to withhold vital information. It is important that acupuncturists also recognize these dangers and are able to inform their patients and form patient relationships based on trust. They need to tell their patients to inform their doctors or practitioners of other CAM modalities about any treatments they give, especially if they prescribe any medicinal herbs or products.

The acupuncturists and Chinese medicine practitioners might also hear about the use of falsified medicines that can endanger the patients (Hamilton et al. 2016) or other unregulated and possibly harmful products. The acupuncturists can report these potentially harmful products to local authorities and inform their patients about possible dangers in their use. The author believes that information about the use of unregulated or falsified medicines might be left out during visit to a doctor just as easily as the patients withheld information, such as using CAM modalities, and an acupuncturist can instruct their patients to disclose this information.

With patients having any previous dissatisfaction with medical care, extra caution should be taken. In case of any suspicious symptoms, the patients should be instructed to see a doctor, if they have not already done so, to avoid a late diagnosis of serious medical conditions. Making patients agree to see a doctor probably requires building a good therapeutic relationship. The practitioner of any CAM modality also needs to be aware in his therapeutic relationships that a patient might also easily get a wrong idea of the effectiveness. The patient in this case reserved time to check if acupuncture could help with Ménière’s disease when medicine failed. She had already had made the assumption that vertigo was because of Ménière’s disease and that acupuncture might help. Currently, there is preliminary evidence that acupuncture might work for Ménière’s disease (He et al. 2016) but her expectations were high because of the previous success with uveitis. It is sometimes almost impossible to avoid giving false hope by just agreeing to treat any less commonly treated symptoms. Not treating or overly explaining that the treatment might not work might harm the therapeutic relationship and even prevent the referral to a doctor in case it is needed.

Reflecting upon therapeutic relationships and clinical skills after this incident, the author became more aware of possible consequences of his therapeutic practice. It would be unrealistic to think that these mistakes couldn’t ever happen in the future, but there are always ways to improve the practice. He will now reserve extra time for returning patients if a few years have passed from the last session. With this he tries to ensure that he has enough time to collect information. Even in cases of seemingly minor complaints that do not respond to acupuncture treatments, the patients will from now on be routinely encouraged to see a doctor upon termination of the course of treatment. Before, the patients have already been asked to see doctor if there have been any alarming symptoms, but minor health concerns might have been previously overlooked. The author himself sees the work of an acupuncturist very tightly interwoven with the medical profession and sees further cooperation between different medical modalities as a requirement for patient safety. The author also concludes that it is unlikely that offering acupuncture would generally cause delays in diagnosis and treatment of a serious disease like cancer, but there is definitely a lack of proper studies in this area.

 

References

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Āyurveda, Modernity, and Time

Moderator’s note: Many practitioners of Asian medicine and Asian-based health modalities are grappling with questions concerning the historical roots and cultural status of their disciplines today as never before. In response, Asian Medicine Zone is launching a new series of practitioner essays exploring how changing conceptions of “tradition” and “modernity” are impacting their practice and field in the 21st century (these are organized under the tag “tradition/modernity”). If you’re interested in contributing to this seriesplease email a short description of your proposed essay to the moderators. Here, we’re pleased to share our third offering, a poetic reflection on the paradoxes involved in being an Ayurvedic educator/practitioner who’s well aware of the culturally contingent and politically contested nature of the practice.

On the morning I sat down to write this, the Nobel Foundation announced it had awarded the 2017 Prize for Biology or Physiology to the American scientists Jeffrey C. Hall, Michael Rosbash, and Michael W. Young for their work in the field of chronobiology. Over decades of meticulous lab work, the trio isolated the “period gene”, and described how the protein it encodes regulates each cell’s rhythm of vitality and rest in relation to cycles of light and dark.

The news made me smile.

After nearly 15 years of studying and practicing the narrow stream of Āyurveda to which I’ve had access – modernized, Anglicized, commodified, and merged with reconstructed European naturopathies – I’ve come to the personal conclusion that the most general gift this art form offers is insight into how human beings can heal our relationship to time.

My first Ayurvedic mentor said, “We are living in the most vāta-aggravated period in history, but we can take great comfort in the faithful stability of the solar cycle.” Using the mathematics of Jyotiṣa, he taught us the daily calculations for finding solar noon, and the precise transitions between the kapha, pitta, and vāta periods of day and night. He taught us how the stress of sundowning could be eased by meditation at dusk, about why we should avoid staying awake past the “pitta threshold” – that tripwire that gives us a second nocturnal wind, better applied to dreaming than internet browsing. He taught us how to calculate the pre-dawn moment of brahma muhurta, when the fluctuations of air and space seem to relax, and groundless anxiety can yield to expansive possibility.

The lessons communicated both primal dependability and existential maturity to an uncertain, insomniac, gaseous world. I began to feel that the “knowledge of longevity” for which Āyurveda is named is not so much about personal wellness goals as it is about making peace with time, which means making peace with change, which means making peace with death, the pole star of stress.

This core idea, fleshed out in the broad principles of dinacharya (“to follow the sun”, according to my teacher’s nirukta) has remained as stable for me as the solar cycle itself. It has survived the numerous waves of disillusionment I now see as natural to the interrogation of an unconsciously adopted religion.

My resonance with dinacharya has survived realizing that my exposure to Āyurveda has come through an alchemy of the neo-colonialism that wants to commodify it for export and the Hindutva ideology that wants to claim it as part of a saffronized patrimony. The former thinks it can be packaged and sold. The latter wants to deny that Buddhists played an essential role in its early formulation.

It has survived realizing that Āyurveda’s gender essentialism and heteronormativity – whether authentic to its historical roots or not – can be subtly oppressive to the women’s consumer market it claims to serve. (Not to mention wondering whether its obsession with human fertility is coherent in a world racing past its carrying capacity.)

It has survived realizing that modern global Āyurveda can provide sanctimonious cover for neoliberal propaganda, and contribute to the anxiety of privatized, aspirational responsibilism. Āyurveda in current practice can reinforce the punishing belief that self-care is the only care we can rely on, or that oil massage makes the world a better place, or that health is assured through kitchari and memorizing the doshic implications of red grapes versus green grapes.

It has survived watching friends from the country of the Nobel-winners use Āyurveda to faithfully but unsuccessfully manage cancer because they either distrust public medicine, don’t have health insurance, or both.

It has survived realizing the hypocrisy of Āyurveda’s marketing as a common sense, low cost, local economy wellness modality, whilst outside of low-income India it mainly flourishes as a lifestyle brand and leisure activity for the wealthy, consumable through long-distance spa vacations and carbon-heavy importation. Globalization popularizes and sells the notion of local authenticity through the process of destroying it.

It has survived realizing that Āyurveda’s premodern somatic poetry is elliptical enough to help contemplatives interrogate their internal sensations, but also vague enough to serve as a platform for Deepak Chopra to authenticate pseudoscience.

It has survived watching the rise of Baba Ramdev use Āyurveda as a tool of blood-and-soil purification: selling spiritually-inflected skin-lightening creams, or researching herbs that will cure homosexuality.

And today, it will survive both the grandiosity of biologists who have “discovered” that life has rhythm, and the patriotic fantasies of those who will claim that the “period gene” is described in the Vedas.

“Āyurveda is said to be eternally continuing because it has no beginning,” says Charaka (via Sharma). “Our understanding of Āyurveda has arisen a posteriori to Āyurveda’s eternal laws.”

I have only a dim understanding of where the cultures of Āyurveda have come from, and no real clue as to where they’re going, or how much trouble and joy they will foster. But between these mysteries lies a present, palpable phenomenon that points to the notion of “eternal law”. Even a deconstructionist such as myself can get behind it, and treasure it.

Through these histories of colonial, capitalistic and epistemological violence – histories that may cause more disease than the bacteria and viruses that Āyurveda cannot treat – the earth still turns in its measure. It faces the sun, and then faces away. The body radiates and grows dark. The identity extroverts and introverts. We wake and sleep. Dinacharya does not solve capitalism, climate crisis, or death. But it looks clearly at the rhythms of change, and perhaps relieves us of the suspicion that time is meaningless.

Modernity, Identity, and Contemporary (Non-) Buddhism

Moderator’s note: Many practitioners of Asian medicine and Asian-based health modalities are grappling with questions concerning the historical roots and cultural status of their disciplines today as never before. In response, Asian Medicine Zone is launching a new series of practitioner essays exploring how changing conceptions of “tradition” and “modernity” are impacting their practice and field in the 21st century (these are organized under the tag “tradition/modernity”). If you’re interested in contributing to this seriesplease email a short description of your proposed essay to the moderators. Here, we’re pleased to share our second offering in the series, which focuses on a reassessment of the therapeutic practices of mindfulness meditation and lifestyle coaching in light of recent scholarship and critiques of Buddhism.

I grew up firmly attached to my mother, a hippie and follower of the White Eagle Lodge, a self-described “Wisdom School for the New Age,” in the UK during the 1980s. By the time I reached adolescence, I had mediated, journeyed to power spots, been healed energetically and blessed by Indian Gurus, and taught all manner of transcendental spiritual truth. 

Buddhism caught my interest in my early teens. After several exploratory years, I joined a Tibetan Buddhist group just after turning 19. Like many other young Brits in the 1990s, my relationship with Buddhism was informed by New Age ideals, unreflective romantic orientalism, a desire to experience mysticism and escape from materialism, and a warped view of Asian Buddhists as being in possession of something inherently special. Although I didn’t recognize it then, I was clearly a product of the historical and cultural influences of the time.

Coming to understand the significance my own cultural formation as a modern Buddhist-based practitioner, psychological counselor, and life coach – and then deciding how best to respond to this – has been a lengthy process. Over time, it has revolutionized how I understand, experience, and engage with my self, my work, and my practice, both personally and professionally.  

The shift began when I first started to seriously question the cultural direction that the Western Buddhist world was heading. When I found that such inquiry was mostly met with resistance within Buddhist circles, I turned toward a wide range of scholarly and critical literatures – religious studies, Buddhist studies, cultural history, and postmodern theory – for answers. As I explored these materials, I found myself most powerfully drawn to the question of how subjectivity and selfhood in contemporary Western Buddhism is developed and maintained. 

Diving deeper into this inquiry eventually led to the conclusion that the ideas and practices that dominate Western convert Buddhist communities help shape and support identities that conform to the ideological super-structure of the larger society. Seeing this process of socially conformist identity formation more clearly shifted my personal identity as a Buddhist-based spiritual practitioner. At the same time, it generated ethical tensions for me in my professional work as a counselor and life coach who utilizes Buddhist-based to including mindfulness and meditation. As I came to see such practices as embedded in a cultural matrix that I found problematic, the question of how to resituate the therapeutic encounter in an alternative framework of meaning became paramount. 

Currently, I am exploring whether a “metamodern turn” might help resolve the philosophical and practical tensions that run between more traditional Buddhism, modern Buddhism, and the relatively unexplored terrain of post-modern Buddhism. Most pivotally, I am interested in whether some sort of metamodern reframing might serve to reinvigorate the second purpose that Buddhism has historically served: that is, the alleviation of suffering through the reduction of ignorance. 

Emergent dissonance

During my teens and early 20s, it was perfectly normal for me and my companions to carry out traditional deity practice in a Gompa one weekend and study with a New Age teacher from the States the next. We got high on the positive vibes in the process. Powerful feelings were sought, as well as mystical insights and revelatory truths. 

Although I would spend time with other Buddhist traditions such as Goenka’s Vispassana and Soto Zen, Tibetan Buddhism held the greatest appeal. I spent 15 years following the Gelugpa and Kagyu traditions intensely, as well as a neo-Shamanic group from the States on the side. During that period, I also trained as a Person-Centered Counselor, Life Coach, and Core Shamanic Counselor. All of these activities were connected by a sense of meaning and purpose that would be best defined as spiritual and salvational. 

The cracks that would eventually emerge in this identity came from my father’s influence. He was a Marxist, an intellectual and history buff, and an avowed atheist. My parents had divorced when I was one. Weekend visits to Dad’s home involved him taking me along to political protests whilst boring me with the truths of anti-capitalism. But his imprinting had an important, if delayed effect. 

As Tibetan Buddhist groups began to grow in the UK and the States, many appeared to be moving towards commercialization. At the same time, many New Age teachers were appropriating aspects of Buddhism. Fake Lamas and Gurus were discrediting themselves and their groups through inappropriate behavior. Their money-making was becoming grosser and more evident. My paternal history meant that I could not help but notice this emerging alignment with capitalist goals. 

These observations began to chip away at my romantic readings of Buddhism and the New Age. Eventually, I realized that the spiritual practices and groups I had been engaged with were not separate from the wider society, as I had believed. It seems ridiculous to say now, but I had previously seen the meditation cushion, sweat lodge, or retreat center as direct routes for escaping from the illusory material world and entering into something authentic, powerful, and more real. 

By the early 2000s, I had stopped frequenting New Age teachers entirely. As the decade rolled on, I began to slowly withdraw from Tibetan Buddhist groups, while only intermittently engaging with others. Eventually, I began working with a European Shingon teacher who I discovered via the “Buddhist Geeks” podcast. 

With the benefit of hindsight, I realized that I had come to Buddhism for a variety of reasons, many of which were simply romantic. Some, however, were less problematic. In particular, I was fascinated by the possibility of learning to better understand and address my own ignorance, and its general role in creating suffering. My pursuit of this foundationally Buddhist aspiration, however, took a nontraditional route. 

Modernism, Texts and Disruption

The first years I spent within traditional Buddhist convert groups in the UK (mainly Tibetan but also Southeast Asian and Japanese) had been marked by a lack of access to other voices that resonated with my personal concerns. I searched for, but failed to find some sort of informed, intelligent, and critical engagement with Buddhism as it was developing in the West. It seemed that my intuitions and observations were mine alone. This increasingly distanced me from Buddhist groups, as well as the materials they relied on to validate their practices. 

Were it not for the Internet, which enabled me to engage with Buddhism more critically, I would likely have abandoned it all together. Instead, I started exploring relevant academic literatures and related work online. Initially, I focused on academic books that crossed over to a general audience. Notable titles included Donald S. Lopez’s Prisoners of Shangri-La; David Loy’s The Great Awakening: a Social Theory and Non-Duality: A Study in Comparative Philosophy; Geofffrey Samuel’s Civilised Shaman; and Sam Van Sheik’s, Tibet: A History. I also perused books, articles, and podcasts by religious studies scholars such as Rita Gross and John D. Dunne, as well as non-academic writers and thinkers including Stephen Batchelor and John Peacock. 

Scholarly works that contextualized modern Buddhism, neo-shamanism, and other spiritual practices in an overarching cultural-historical framework enabled me to see how my own private, personal practice was actually, in great part, the product of Western history and the forces of modernity. David L. McMahan’s The Making of Buddhist Modernism was particularly pivotal in this regard. For me, reading this and other texts was a form of practice, as enlightening as any experience I’d had sitting on a meditation cushion or in retreat. Engaging with them burst my ideological bubble and challenged many of my remaining beliefs about Buddhism. It disrupted my sense of what it meant to be a Buddhist and spiritual person, and changed my clinical practice. 

By and large, I felt quite alone in this process. As far as I could see, there were no Buddhist teachers offering signposts for where to go next. All were firmly committed to the narratives of their traditions, or uncritically embedded in Buddhist Modernism. The prioritization of unreflectively visceral “experience” from teachers and practitioners alike seemed to be part of a more general anti-intellectualism in Dharma centers. Among those who had engaged with works detailing the historical particularity of modern Buddhism, the dominant reactions were either: 1) defending their own particular tradition, which was seen as not having fallen for such delusion; 2) rejecting Buddhism as a whole; or 3) searching for a more “authentic” form of Buddhism. 

For me, no such options were available. I wanted to engage critically with contemporary Buddhism, but not abandon it altogether. 

At this point, I wondered if a further possibility existed: Perhaps some sort of Buddhist postmodern turn? I had found the work of Heidegger, Merleau-Ponty, and other precursors of postmodern philosophy helpful in attempting to make sense of being and embodied practice from a non-Buddhist viewpoint. Now, I was motivated to explore postmodern theory more thoroughly in light of my shifting understanding of contemporary Western Buddhism and its relationship to modernity, identity, and culture. 

Here again, having access to the Internet proved invaluable in terms of researching and accessing relevant materials. That said, finding direct connections between Buddhism and postmodern thought was not easy.  By and large, I continued to grapple with the implications of my ongoing intellectual explorations for my Buddhist-based identity, thought, work, and practice on my own.  

Consequences

Gaining an understanding of the historical formation of Western Buddhism led me to radically rethink my relationship with contemporary Western spirituality as a whole. I also became deeply uncomfortable with how I used to understand therapy and my role as a therapist. I realized that I had long held a salvational vision of therapy, and had been transmitting the myths of the Buddhist modernist project unwittingly. 

I recognized that Buddhist groups have a tendency to form particular types of identities whilst inculcating specific codes of behavior, linguistic habits, and taboo areas of discussion. I also saw that these directives were almost never made explicit. If brought up in discussion, they evoked defensiveness and avoidance on the part of students and teachers alike. I came to view this phenomenon as intimately related to the creation of an ideologically shaped Buddhist identity. 

I began to frame meditation within different conceptual and perceptual frames. I stopped using Western Buddhist jargon and spiritual tropes. I came to believe that recognizing the role of modernity in forming Western Buddhism and shaping the experiences, beliefs, practices, and concepts of its practitioners was itself a powerful form of practice. Moreover, I now saw it as necessary one if Western Buddhism is to act as a genuinely liberating force.

Western Buddhist, being blind to its own influences, does not see that the language and practices of Buddhist modernism are part of an ideological apparatus that creates subjects within a discourse of pseudo-liberation. In fact, Buddhism is incapable of providing an adequate response to the complexities and implications of modernity on its own. This should not be surprising, as Buddhism was never designed for such a purpose. Tools from the Western intellectual tradition are required to respond to the challenges that Buddhist modernism presents, both for individuals and for those groups committed to a therapeutic approach to practice.

Uncovering the historical roots and cultural formation of modern Buddhism within one’s own work, life, and practice can be liberating and transformative. It can also be highly disruptive and difficult to navigate. Within Buddhist discourse, concepts such as Enlightenment, the Bodhisattva, and the Four Noble Truths act as grand narratives. In contradiction to the Buddhist notion of no-self, they provide a solid foundation for the creation of religious or spiritual identities. 

Challenging the solidity of such perceived final truths by means of cultural history and postmodern theory destabilizes sustaining ideological norms. This undermines not only the certainty of dependable, pre-existing identities, but also the pay-offs that are implicit in the promise of an end to suffering, awakening, or whatever else is currently on offer in Dharma halls or therapeutic encounters. 

The problem is that while subjectivity comes under attack in the work of postmodern thinkers such as Derrida and Foucault, postmodern theory offers no real replacement for the modernist subject. The resulting lacuna is particularly problematic for the spiritually inclined, who are drawn to practices such as Buddhism. Postmodernism provides no clear basis for new models of selfhood that are sufficiently robust to sustain any sort of meaningful practice. 

It’s no surprise that many Buddhists resist exploring the more potent insights of postmodernism. They rightly intuit that it conflicts the therapeutic, religious, and/or mystical aspirations that most commonly motivate engagement with Buddhism in the first place. Glynn (2002) goes as far as saying that subjectivity is “denatured” by postmodern thought and thus incapable of “self-actualization.” To the extent this is true (and I think it essentially is), it also undercuts the commonly made marriage between Buddhism and self-help/self-development. 

As a therapist utilizing Buddhist tools and concepts, this necessarily presents a challenge. I don’t want to encourage salvational fantasies by directing clients deeper into a culture that promulgates them via the language of True Nature, Buddha Nature, Awakened One, and so on. On the other hand, if the carrot of enlightenment is not held out, whether explicitly or implicitly, what final vision of the individual is to be held? What is the purpose of engaging in this, or any other sort of therapeutic and/or spiritual practice? 

Undermining the modernist project presents a profound challenge to Buddhist-based clinical practice. It raises questions about the use of meditation to bolster well-being, and as a tool for the development of a psychologically robust individual. Ethically, it raises questions about the purposes that Buddhist practices are being put, and their true compatibility with the liberationist aims found in much traditional Buddhism. 

Non-philosophy, non-Buddhism

I continued to explore relevant work on the Internet as such questions simmered. Eventually, I discovered the Speculative non-Buddhism (SNB) website, which had been founded in 2011 by Glenn Wallis, a former professor of religion at the University of Georgia. SNB provided precisely the sort of critical engagement with Western Buddhism, informed by a vast array of modern and postmodern theory, that I’d long been looking for. My discovery of this online hub of critical thought was extremely important for my developing relationship with Buddhism. It also further disrupted whatever certainties I had formerly held around the role of therapist. 

My initial encounter with SNB was marked by reading Tom Pepper’s 2001 essay, Buddhist Anti-Intellectualism, which hit me like an intellectual bomb. Pepper’s critique of Buddhism went well beyond anything I had heard before. His description of how Dharma centers in the West resisted Western philosophy and engaged in “spiritual snobbery” captured my own sentiments, and reinvigorated my relationship with Buddhism as a site of critique. 

Pepper argues that Western Buddhism’s anti-intellectualism is rooted in and nourished by its over-focus on “experience,” which effectively serves as a retreat from thought. While this is an understandable “reaction to the desolate landscape of post-modern thought,” Pepper argues “a more useful . . . response is to escape up, into the limits of philosophical rigor.” 

Wallis’s experimental text, Nascent Speculative Non-Buddhism (2013), leveraged another pivotal turn in my evolving relationship with Buddhism and clinical practice.  This work develops a heuristic that combines a variety of thinking tools, many of which come from Continental philosophy. Here, Wallis’s core influence is the work of François Laurelle and his concept of “non-philosophy.” By adapting it to create the concept of “non-Buddhism,” Wallis generated what is perhaps the most intriguing critique of Buddhism to emerge in this century. 

Non-philosophy is not a postmodernist concept per se. Rather, it emerges from an attempt to rethink philosophy, drawing on ideas found in Derrida and Heidegger. Laruelle posits a number of relatively simple concepts, but presents them in very complex ways. In part, this is because he is attempting to build a conversation about philosophy that does not fall into the “decisional matrix” that he identifies as being at the heart of all philosophical theory and practice. 

Laurelle’s  foundational concept is what he defines as decision: an unconditional, non-reflexive commitment to an ideology or thought-world. Laurelle notes that out of decision the world becomes the subject of philosophy, in the sense that the world is remade in the image of said philosophy through a dialectical splitting of the world, with the philosopher confusing the philosophizing image of the world for the world itself.

In transferring this concept to Buddhism, Wallis defines decision as a commitment to Buddhism as the source of truth. Buddhism provides a totalizing means of understanding the world and our selves in it, one that encompasses the whole person and their most intimate spaces of selfhood. Buddhist metaphysics provides a lens through which the world is seen and experienced. Despite Buddhist teachers’ claims to the contrary, it provides a perceptual filer. This is an important insight as it means that descriptions of experience within Buddhism are in part ideological and not pure, perfect reflections of reality. 

While drawing on postmodern thought and evidencing an acute awareness of the limits of modernity, Nascent Speculative Non-Buddhism does not embrace postmodern irony. True, it is playful and creative in its style, mirroring much of the rhetorical strategy of postmodern thinkers. But hidden within this ostensibly destructive prose is an aspiration for Buddhism to do more. There is a clear desire, dare I say hope, to find a way forward that incorporates relevant insights across ideational and geographical boundaries, and historical and cultural phases. Wallis describes today’s unprecedented opportunity to draw from this vast array as “the great feast of knowledge.”

Just as non-philosophy drags philosophy out of its own rarified sphere, robbing it of its specialness in the process, so does non-Buddhism demand that Buddhism test out its axiomatic claims in the world, beyond the gates of Buddhist ideology. This requires a meeting of minds across intellectual boundaries, a cross-cultural, cross-discipline explorative endeavor. 

Both Laruelle’s and Wallis’ work is radically democratic in that it seeks to liberate the subject from its dependency upon any totalizing system. Adapting non-philosophy to the practice of non-Buddhism supplies a creative ground for a democratized exploration of practices and thought beyond the rules, taboos and persuasive rhetoric of lineage holders and orthodoxy. 

I want to make clear that I am not arguing for the superiority of such an approach. I would simply argue that Wallis provides a novel Dharma door through his work on Buddhism by means of Laurellian thought. Seeing Buddhism as culture through the lens of non-philosophy, which itself is informed by and in conversation with the Western intellectual tradition, enables the development of form of meta-knowledge that remains tethered to Buddhist insights while dismantling Buddhist orthodoxies. 

Therapeutic Implications

Speculative non-Buddhism provided a vast array of conceptual tools for thinking about my coaching business and how it might best serve people who found mainstream Buddhism problematic and didn’t want to suspend their critical thinking skills at the Gompa door, but had no sense of where to go next. Increasingly, my clinical work specialized in critically engaging with Buddhist materials in conjunction with a similarly critical utilization concepts and practices associated with self-help, change work, maturation, personal development, waking up, gaining insight, training the mind, working with the body, and becoming more intellectually capable. 

Rather than seeing meditation as a means of connecting to the true nature of things, I viewed it one tool among others for grappling with the fact that ideological filters and decisional matrices necessarily structure and influence our understanding and experience. This perspective allowed me to reframe the therapeutic relationship as a creative dialog that allowed for a conceptual reframing not only of Buddhism, but also of the person engaging with practices such as mindfulness. 

In this sense, the Buddhist-based tool of mindfulness practice becomes a means of synergistically exploring and addressing the shared nature of subjectivity and the ideological currents that run through all spiritual practices. Therapy provides a dynamic space for thinking and experiencing beyond the decisional matrix of a given Buddhist tradition, as well as the overall cultural climate and its ideological thrust. If well realized, this process is not a means of liberation per se, but rather an act of liberation from the delusion of transcendence: In other words, a practice of immanence. 

Any system of thought and practice can steer its practitioners into a decisional matrix, and prescriptive forms of being and perceiving. From this perspective, a counseling intervention can be put into the service of liberating a client from the decisional matrix (e.g., traditional Tibetan Buddhism), whilst rendering the materials of Buddhism available as democratized resources that cease to hail the practitioner into conformist identities. This supports the client/practitioner in exiting the modernist-self and moving towards thought and insight that draw from the wider knowledge community. It offers an alternative to the more common subjective frames that encourage either retreating into pre-modernist desires and irrationality, or spinning off into postmodern cynicism and fragmentation. 

Metamodern Buddhists?

Recently, I’ve begun exploring the emerging body of work on “metamodernism” as a means of further developing and articulating my understanding of Western Buddhism(s), the purposes that meditation and mindfulness can serve, and the therapeutic act. 

Metamodernism is one among many labels that attempt to describe emergent cultural shifts that are moving beyond postmodernity in the arts and culture more widely. Vermeulen & Van den Akker and Abramson characterized it as capturing the desire to resolve the conflict between modernity and postmodernity. As a term, it has begun to appear tentatively in academic discourse, but is very much in its infancy and may never truly take off as a new marker for the current cultural zeitgeist. Nonetheless, its emergence is evidence of the need to respond to the diminished cultural status of postmodern theory, which is increasingly understood to have a very limited ability to respond helpfully to either our current cultural and artistic climate, or the religious and therapeutic landscape we inhabit. 

Metamodernism can be understood in a variety of ways. Vermeulen & Van den Akker describe it as a structure of feeling incorporating principles of multiplicity and paradox, as well as the loss of distance. Abramson sees metamodernism as the cultural milieu of the internet age, with characteristics such as collaboration and simultaneity that mirror aspects of internet culture. 

In terms of the individual, metamodernism offers a creative response to the certainties of modernity, which are no longer psychologically compelling, and the fragmented postmodern self, which undercuts purpose and meaning. Metamodernism recognizes that if the nature of the self is fluid, it still requires stable foundations in history. In contrast to postmodernism, there is a preference for the reconstruction and realignment of cultural resources, rather than purely deconstructive relationship with them. 

I believe that a metamodern paradigm might provide a means for religions to refind themselves in an appropriate relationship with the contemporary world due to its embrace of multiplicity and paradox. This is the framework that I have adopted in my therapeutic role with regard to both teaching meditation and reconfiguring spiritual concepts in interrelationship with a larger ecology of ideas, theories, and practices. Resources and relationships that I am particularly drawn to include Western psychotherapy and self-actualization, Shamanistic worldviews and their compatibility with process-relational ontology, and Buddhist concepts of emptiness, Buddha nature, and interdependence. 

All these concepts and many more can be explored critically within different systems of thought, and applied as practices within each framework for different ends. This encompassing of possibilities rooted in the material world of historic contingency and finitude reinvigorates the field of spirituality in terms of thought and practice without leaving aside intellectual engagement. 

In this context, a practice like meditation can serve multiple ends. Many people who come to my coaching practice would like to be able to embrace the irrational aspects of ceremony or deeper meditational insight without having to sign on to a preset belief system or identity. Exploring the complexity of selfhood within the context of the therapeutic relationship enables us to better understand and experience how we are individuals and collectively formed beings that are finite and rooted in history. We also gain better insight into how we are enmeshed in both individual and collective forms of ignorance, suffering and selfhood. Together, we unpack each line of inquiry that arises while drawing on a wide variety of materials and practices. 

Many of my clients might be loosely defined as a new category of practitioner, one that comes after that of “spiritual-but-not-religious.” They are basically secular. Yet, they find the rationalism, empiricism, and scientism of both atheism and secular Buddhism to be less than satisfying. And, they understand that all of these “-isms” are products of modernity. They desire a spiritual path of sorts. But, they want to remain fully aware of the problems of both religion and spirituality. They recognize that an affective practice is needed and that the term “spirituality” serves signify something of value. At the same time, they recognize that it is bogged down by a great deal of baggage. 

It could be said that we carry within us the seeds and consequences of both premodernity, modernity and postmodernity. Banishing the cultural legacy associated with one or more of these epochs can be seen as a form of denial, or an ostracism in which part of our shared selfhood is bypassed or alienated. The macro-cultural, historical phases that each of these terms designates is part of our shared human selves and history. They reference the diverse array of ideas, practices, and opportunities available as our identities and experiences of self become more fluid, yet necessarily remain rooted in our material existence and indebted to our collective past. 

Bibliography

Books 

Batchelor, Stephen. Buddhism without beliefs: a contemporary guide to awakening. Bloomsbury, 1997. 

Batchelor, Stephen. Confession of a Buddhist Athiest. Spiegel & Grau, 2010. 

Boon, Marcus and Eric Cazdyn and Timothy Morton Nothing: Three Inquiries in Buddhism (TRIOS Series) University of Chicago Press 2015.

Laruelle, François. Dictionary of Non-Philosophy. Translated by Taylor Adkins Univocal Publishing, 2013. 

Lopez, Donald S. Jr. Prisoners of Shangri-La: Tibetan Buddhism and the West. Chicago University Press, 1998. 

Loy, David. Nonduality: A study in comparative philosophy. Humanity Books, 1988.

Loy, David. The Great Awakening: A Buddhist Social Theory. Wisdom Publications, 2003. 

Lyotard, Jean-François. The Postmodern Condition: A Report on Knowledge, Manchester: University Press, 1989.

McLeod, Ken. Wake Up To Your Life. HarperOne, 2001.

McMahan, David L. The making of Buddhist Modernism. Oxford University Press, 2008.

Polt, Richard. Heidegger: an introduction. Cornell University Press, 1999.

Samuel, Geoffrey. Civilized Shamans: Buddhism in Tibetan Societies. Smithsonian University Press, 1993.

Van Schaik, Sam. Tibet: a history. Yale University Press, 2011. 

Wallis, Glenn. A Critique of Western Buddhism: Ruins of the Buddhist Real. Bloomsbury, September, 2018. 

Wallis, Glenn, and Tom Pepper and Matthias Steingass. Cruel Theory|Sublime Practice: Towards a Revaluation of Buddhism. EyeCorner Press, 2012.

Wallis, Robert J. Shamans/Neo-Shamans: Ecstasy, alternative archaeologies and contemporary pagans. Routledge, 2003.

Znamenski, Andrei, A. The Beauty of the Primitive: Shamanism and the Western Imagination. Oxford University Press, 2007. 

Websites

Abramson, Seth. “What Is Metamodernism?” Huffington Post (01/05/2017, Updated Jan 09, 2017) https://www.huffingtonpost.com/entry/what-is-metamodernism_us_586e7075e4b0a5e600a788cd

Abramson, Seth. “Metamodernism: The Basics” Huffington Post (10/13/2014, Updated Dec 12, 2014) https://www.huffingtonpost.com/seth-abramson/metamodernism-the-basics_b_5973184.html

Abramson, Seth. “Ten Basic Principles of Metamodernism” Huffington Post (04/27/2015, Updated Dec 06, 2017) https://www.huffingtonpost.com/seth-abramson/ten-key-principles-in-met_b_7143202.html

Chapman, David. “A bridge to meta-rationality vs. civilizational collapse” Meaningness (Last viewed 07/29/2018) https://meaningness.com/metablog/stem-fluidity-bridge 

Damico, Philip. “An Introduction to Metamodernism” The Metamodernist (February 18, 2017) https://themetamodernist.com/2017/02/18/an- introduction-to-metamodernism/ 

Gross, Rita M. “Buddhist History for Buddhist Practitioners” Tricycle (Fall, 2010) https://tricycle.org/magazine/buddhist-history-buddhist-practitioners/

Ivakhiv,  Adrian J. “Žižek and his Others” Immanence: ecoculture, geophilosophy, mediapolitics (UVM Blog) (November 24, 2009, last viewed 29/07/2018) http://blog.uvm.edu/aivakhiv/2009/11/24/zizek-and-his-others/ 

McLeod, Ken. Unfettered Mind: Pragmatic Buddhism. http://unfetteredmind.org/

O’Connell, Matthew. “Post-Traditional Buddhism: The Quiet Revolution?” elephant journal (November 21, 2012) https://www.elephantjournal.com/2012/11/post-traditional-buddhism-the-quiet-revolution-part-one-matthew-oconnell/

Pepper, Tom. “On Buddhist Anti-Intellectualism and the Limits of Conceptual Thought” Speculative non-Buddhism (blog) (October 2011, last viewed on 01/03/2018) /2011/10/25/buddhist-anti-intellectualism.

“Postmodernism” Apologetics Index (Last viewed July 30, 2018) http://www.apologeticsindex.org/p02.html

Sobol, Hokai. Personal website. http://www.hokai.info/

Žižek, Slavoj. “From Western Marxism to Western Buddhism” Cabinet Magazine, Issue 2 Mapping Conversations (Spring 2001) http://www.cabinetmagazine.org/issues/2/western.php

Journal articles

Brassier, Ray. “Axiomatic heresy: the non-philosophy of François Laruelle.” Radical Philosophy 121 (2003): 24-35. https://philpapers.org/rec/BRAAHT-3

Clasquin-Johnson, Michel. “Towards a metamodern academic study of religion and a more religiously informed .” HTS Teologiese Studies/Theological Studies, Vol 73, No. 3 (2017). https://hts.org.za/index.php/hts 

Glynn, Simon. “The Freedom of the Deconstructed Postmodern Subject.” Continental Philosophy Review 35: P.61-76 (2002)

Laruelle, François. “A Summary of Non-Philosophy.” The Warwick Journal of Philosophy, Pli 8 (1999): 138-148. https://plijournal.com/files/laruelle_pli_8.pdf

Vermeulen, Timotheus, and Robin van den Akker. “Notes on metamodernism.” Journal of Aesthetics & Culture Volume 2, 2010, no.1 (Published online: 25 Jan 2017). https://www.tandfonline.com/doi/abs/10.3402/jac.v2i0.5677

Wallis, Glenn.Nascent Speculative Non-Buddhism.” Journal for the Study of Religions and Ideology, vol. 12, issue 35, (Summer 2013). http://www.jsri.ro/ojs/index.php/jsri/article/view/710

Yousef, Tawfiq. “Modernism, Postmodernism, and Metamodernism: A Critique.”
International Journal of Language and Literature, Vol. 5, No. 1 (June 2017): 33-43

Events

Paul Smith, Anthony. “History of Non-Philosophy: From Philosophy I to Philosophy IV, Or What’s Behind the Move from the First Non-Philosophy to the Second” A Symposium on Non-Philosophy, University of Warwick, UK, (March 5th 2010, last viewed 07/29/2018)

Audio

Peacock, John. “Buddhism Before the Theravada.” Insight Meditation Center Audiodharama. (Septemer 3rd/4th 2011) https://www.audiodharma.org/series/207/talk/2602/

Buddhist Geeks Podcast, https://www.buddhistgeeks.org

Chapman, David. “18. On stages of maturation, Dzogchen & the future of Buddhism.” Interview by Matthew O’Connell on January 6, 2017. Imperfect Buddha Podcast:  https://soundcloud.com/post-traditional-buddhism/100-imperfect-buddha-david-chapman-on-stages-of-maturation-dzogchen-the-future-of-buddhism 

Dunne, J. “Awakening to Buddha Nature.” Upaya Zen Center (January, 2012) https://www.upaya.org/tag/awakening-to-buddha-nature/

Freinacht, Hanzi. “Metamoderna” Interview by Tom Amarque Podcast on February, 17, 2018. Audio: http://www.tom-amarque.de/lateralconversations/2018/2/17/hanzi-freinacht-metamoderna-engl

Ivakhiv, Adrian. “11. On Immanence & a world after enlightenment.” Interview by Matthew O’Connell on May, 30, 2016. Imperfect Buddha Podcast: https://soundcloud.com/post-traditional-buddhism/72-imperfect-buddha-podcast-adrian-ivakhiv-on-immanence 

Sobol, Hokai. “On Buddhism.” Interview by Matthew O’Connell on May 26, 2007. Imperfect Buddha Podcast: https://soundcloud.com/post-traditional-buddhism/113-imperfect-buddha-guest-hokai-sobol-on-buddhism

The Dharma Overground https://www.dharmaoverground.org

Wallis,  Glenn. “16. On non-Buddhism.” Interview by Matthew O’Connell on September 16, 2016.  Imperfect Buddha Podcast: https://soundcloud.com/post-traditional-buddhism/92-imperfect-buddha-podcast-glenn-wallis-on-non-buddhismpart-1

Video

Žižek, Slavoj. “The Irony of Buddhism.” Zizekian Studies Channel, Youtube (Published, August 14, 2015) https://www.youtube.com/watch?v=nfUWtuOyEvk

Zen training in the U.S.: tradition, modernity, and trauma

Mushim and son at Green Gulch Farm Zen Center in 1990 when she was a penniless single mother, following six years of monastic practice under a vow of poverty. (Photo credit: Jack Van Allen)

Moderator’s note: Many practitioners of Asian medicine and Asian-based health modalities are grappling with questions concerning the historical roots and cultural status of their disciplines today as never before. In response, Asian Medicine Zone is launching a new series of practitioner essays exploring how changing conceptions of “tradition” and “modernity” are impacting their practice and field in the 21st century (these are organized under the tag “tradition/modernity”). If you’re interested in contributing to this seriesplease email a short description of your proposed essay to the moderators. Here, we’re pleased to share our first offering, which artfully explores the encounter between traditional patriarchal authority and contemporary social justice commitments in the author’s life, practice, and community.

Having spent over 30 years of my adult life as a Buddhist practitioner in the U.S., I’m certain of only one thing, which is this: in the process of spiritual maturation, the path is not always clear and straightforward. In my personal experience as a practitioner, there’s been a lot of both/and – a particular experience can be abusive and traumatic, and it can lead to insight and breakthrough. Necessary spiritual surrender can mix potently with what Western psychology calls poor boundaries. And, it seems to me, some people will always be drawn to take paths of greater risk in varying degrees, up to so-called crazy wisdom. Others will develop by staying true to conventional mores with quiet patience.

In 1984, I was living as a renunciant under a vow of complete poverty in a Buddhist community in the United States. Our teacher, a strong-willed Asian man, resided most of the time in Canada, with periodic visits to our startup temple in the Midwest. Probably like most of our convert Buddhist community, I had moved into the temple full-time with a great deal of hope and projection that the teacher, who was described by his senior students as a Zen master and enlightened being, would be my major role model of elevated qualities of compassion and wisdom as I somehow imagined them to be.

I had immediately been appointed office manager and treasurer when I moved into the temple. I started the office with a landline phone, a cardboard box for petty cash and receipts, a checkbook, and a small wooden bench that could be used as a tiny desk if one sat cross-legged on the wooden floor. There wasn’t enough money in the bank to pay our utility bills and mortgage when I moved in, so we cut every corner and pinched every penny.

It was under these pressured circumstances that I was quietly working in the office when the “Zen master” suddenly walked in and began screaming at the top of his lungs at me for making a long- distance phone call for business reasons during a time when rates were higher. As Zen students, we were taught to “eat the blame,” so I did, and simply apologized until he went away. A few days later, having complained to the temple director who told him that the reduced rate times for calling were different in the U.S. than in Canada, he sheepishly reappeared in the office and said he hadn’t had full information. This was somewhat short of an “I’m sorry I unfairly vented my rage on you.” But it was the best I could get under the circumstances.

I couldn’t talk to anyone outside our temple system about such incidents because they would immediately say, “Why don’t you leave?” And the fact was, I was also learning a great deal. There were so many beautiful aspects of our communal temple life of meditating together and manual work, cooking and cleaning and eating together. The teacher was also immensely talented and caring in many ways. It was confusing, and in the Buddhist practice we were doing, it was okay not to know everything at once.

Traditional Zen stories and Zen lore are full of anecdotes that involve hitting and yelling and enduring unfair accusations. By the time I became a renunciant, I was an adult woman with a master’s degree. I’d been married and divorced. I had worked various jobs in the secular world. And I’d been exposed to the women’s movement and lived through the civil rights era in the U.S. I was open to going through some strong, and even traumatizing experiences for the sake of spiritual training.

Things continued to be a dynamic mess. I ended up in an Asian monastery for 8 months in 1987-88. There, my life and identity as I had known them continued to be blown up. As I said some time after I returned, I felt as though I got completely chewed up by the patriarchy.

It is also completely possible that if I had been smarter and had better boundaries, I wouldn’t have ended up as badly as I did.

But I survived. I got back to California, and, struggling continuously with extreme poverty, raised a Buddhist child, and continued my practice. I promised my son and myself that I would find a way to live in Buddhist community where power was more equally distributed, and codes of ethics and democratic structures were in place. Buddhist life might continue to be a mess. But I wanted, at minimum, a more workable mess that aligned with my cultural values. I distinctly remember thinking, upon returning to the U.S. from the Asian monastic system, “I don’t have to get my way, but I will be damned if I don’t at least get to vote. I am an American, and I want my vote!”

I didn’t want to overthink any of this. All systems and forms have limitations, and attachment creates suffering – this is a universal principle of Buddhism which I personally have never found to be untrue. That being said, the reason I began Zen meditation in the first place was because I wanted to find a situation in which I could live with other people with forms of practice that encourage well-being, kindness and justice, while at the same time providing support for Awakening. And I’ve been fortunate, because I’ve spent the last eleven years working with others to create a diverse and social justice-centered urban meditation center in Oakland, California, where I live. For me, and for many others, East Bay Meditation Center has been the intersection of Dharma practice and community-based social justice activism and awareness where I can constantly explore Liberation in ways that don’t separate the spiritual world from the real experiences of structural violence that I experience or witness every day.

As a Buddhist teacher at East Bay Meditation Center, I teach in trauma-informed ways that I have learned as a yoga student from the social justice-based Niroga Institute in Oakland, California. The traditional forms of spiritual training that require students to withstand humiliation and abuse from those above them in a hierarchical model are, I’m convinced, not essential to a 21st century Eightfold Path. Why? Because for most people, especially those in communities targeted for oppression, life is already full of traumatic humiliation and abuse. What we need are ways to become resilient, whole, and wise in seeking environmentally sustainable ways to coexist nonviolently and joyfully.

My Bodhisattva vows, the same as millions of others who have taken these vows, are “to save the many beings.” Where the rubber meets the road is that we are different from one another, love is not always the answer, and conflict is inevitable. I’m fine with this particular dynamic mess of imperfection, as long as it’s worked with in the service of systemic justice and equity.

Curing Illness with Meditation in Sixth Century China

This is a syndicated post that first appeared on BuddhistDoor
By C. Pierce Salguero

Buddhistdoor Global | 2018-06-29 |

 

Though he lived in the sixth century, Zhiyi (538–597) has a lot to teach the modern practitioner of meditation, whether Buddhist or secular. He is best known as the founding patriarch of the Tiantai school of Buddhism, widely considered to be the first native East Asian school, and thus a precursor to Chan and other later developments. Among the foundational writings of Tiantai are several treatises on meditation composed by Zhiyi.

Although it is popular to think of meditation as a solution for all kinds of illness, Zhiyi knew it was more complicated. In his Shorter Treatise on Samatha and Vipasyana (in Chinese, Xiao zhiguan), Zhiyi suggests not only that not all illnesses can or should be treated with meditation, but that meditation itself can be a cause of illness: one might be unskillful in harmonizing the mind, body, and breath, and thus fall ill. But he does advise eight different healing meditation practices.

These eight practices are divided into two categories. First are the calming meditations, or, as he calls them, employing the Chinese translation of the Sanskrit samatha, “stopping” meditations:

1. Settle the mind on the location of the illness.
2. Settle the mind on the dantian,* one inch below the navel.
3. Settle the mind on the soles of the feet.
4. Abiding calmly, remain aware that all phenomena (including the illness) are empty.

Next, Zhiyi introduces what he calls “seeing” meditations. Here he uses the Chinese translation of the Sanskrit vipashyana, although most are quite different from what contemporary meditators mean by the term vipassana. There are four practices in this category:

1. The Six Breaths, a Chinese exercise in which the practitioner makes the sounds “chui,” “hu,” “xi,” “he,” “xu,” or “si,” while exhaling in order to regulate internal processes.
2. The Twelve Respirations, which are different types of Indian breathing exercises (pranayamas) intended to regulate various symptoms of illness.
3. Visualization techniques in which one concentrates on one type of qi in order to counteract ailments caused by others. (He gives the example of concentrating on fire-like qi to cure cold in the body.)
4. Finally, Zhiyi mentions using both samatha and vipasyana together to “analyze the non-existent nature” of physical and mental illnesses, resulting in their spontaneous healing.

painting of Sramana Zhiyi, founder of the Tiantai school of Buddhism. From wikipedia.org
Painting of Master Zhiyi, founder of the Tiantai school
of Buddhism. From wikipedia.org

Lamentably, Zhiyi does not give us much detail on specifically how to practice the techniques mentioned in this particular chapter. (Zhiyi did write instructions on samatha and vipasyanameditation, much of which has been translated into English. [Chih-i 1997; Zhiyi 2009]) The most detailed descriptions he gives concern the specific medical applications of the Six Breaths and for the Twelve Resiprations.

For example, each of the Six Breaths should be used as follows:

Imagine each of the Six Breaths revolving around inside your mouth and between your lips, and then make [the sounds]. If you are in meditation, use chui when you are cold and hu when you are hot. In the treatment of illnesses, chui is for eliminating cold, hu is for eliminating heat, xi is for eliminating pain and treating wind, he is for eliminating mental troubles and also flatulence, xu is for breaking up phlegm and relieving congestion, and si is for replenishing exhaustion. If you are treating the Five Viscera, the two breaths of hu and chui can treat the heart, xu is for treating the liver, he is for treating the lungs, xi is for treating the spleen, and siis for treating the kidneys.

For the Twelve Respirations, he instructs:

Now, to explain how the Twelve Respirations relate to the treatment of symptoms: the upward respiration cures weight gain, the downward respiration cures feeling spent, the falling respiration cures emaciation, the scorching respiration cures bloating, the increasing respiration cures depletion [of the Four Elements], the dissipating respiration cures [their] excess, the warming respiration cures cold, the cooling respiration cures heat, the forceful respiration cures blockages, the retained respiration cures trembling, the harmonizing respiration completely cures disharmony of the Four Elements, and the nourishing respiration nourishes the Four Elements. One who is good at using these respirations can cure any and all afflictions—but, as you can infer from this, doing them wrong can cause even more afflictions to arise.

In closing the chapter, Zhiyi offers general reflections on the practice of healing using meditation. Advising the practitioner to become skilled in all of the eight techniques, he notes that he has only provided an overview, and that we should seek out more complete instruction. Above all, Zhiyi is emphatic that healing meditations help us cultivate various good qualities. He explicitly states that if one follows 10 “dharmas,” then one’s “treatments are guaranteed to be effective and will not be in vain:”

1. Faith in the effectiveness of the methods outlined in the text.
2. Regular practice.
3. Sustained effort.
4. Staying entirely focused on the object of the meditation one chooses.
5. Clearly discriminating the causes of illness (presumably in order to apply the correct meditation).
6. Using skill in choosing the right practice for the ailment in question.
7. Maintaining a long-term perspective and not giving up when results come slowly.
8. Knowing when to continue with a beneficial practice and when to abandon a non-beneficial one.
9. Avoiding mental distractions and moral transgressions.
10. Avoiding hindrances to practice such as pride and frustration.

Zhiyi lived in a very different religious and medical culture than we do today. Throughout the essay, we see that his notion of illness revolves around traditional Asian medical concepts, such as qi and the “five viscera” from Chinese medicine and the “four elements” from Indian classical medicine. However, it is quite possible that Zhiyi’s essay is describing contemplative techniques that can be proven to be efficacious in the modern context. At the very least, he is pointing out avenues beyond the current fixation on mindfulness meditation that merit further medical research and exploration.

* Qi or energy center.

C. Pierce Salguero is an interdisciplinary humanities scholar interested in the role of Buddhism in the cross-cultural exchange of medical ideas. He has a PhD in the history of medicine from the Johns Hopkins School of Medicine, and teaches Asian history, religion, and culture at Penn State University’s Abington College. He is the author of numerous books and articles on Buddhism and medicine, including Buddhism and Medicine: An Anthology of Premodern Sources.

References

Chih-i. 1997. Stopping and Seeing: A Comprehensive Course in Buddhist Meditation. Translated by Thomas Cleary. Boulder, CO: Shambhala Publications.

Zhiyi, Shramana. 2009. The Essentials of Buddhist Meditation. Translated by Bhikshu Dharmamitra. Seattle: Kalavinka Press.

Salguero, C. Pierce, ed. 2017. Buddhism and Medicine: An Anthology of Premodern Sources. New York City: Columbia University Press.

See more

Pierce Salguero

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Healing Experiences of Vipassanā Practitioners in Contemporary China, Case study 5

This is a case study that is part of a series of linked posts:
Introduction, case 1 | 2 | 3 | 4 | 5

Case 5: Candasaro

Before ordaining as a monk in Thailand, Candasaro had worked at a private factory as a production manager in Sichuan for over 30 years. In 2008 he started exploring Theravāda meditation by learning observing the breath[i] with Pa-Auk Sayadaw’s method at Jiju Mountain for about two months in Yunnan. He later gave up this practice as he could not see any sign[ii] emerged in his sitting. “My personality is quite fast-paced. It’s difficult to cultivate calmness.”[iii] In May 2011, he firstly learnt about the practice of dynamic movement at a ten-day retreat led by Luangpor Khamkhian Suvanno, from Thailand, in Hongzhou.[iv] During the retreat, he tasted a sense of joy[v], a positive outcome of meditation.

Candasaro found that dynamic movement suited him perfectly. He explained about the practice: “In the beginning [you] observe the movement of the body. Later [you can] observe the mind. All practices are similar. They firstly cultivate calmness by bringing awareness to one point. That is developing an ability of concentrating the mind. Without calmness, it is impossible to practice vipassanā. When you open the six sense doors, you hold one of them, like a monkey holding the main pillar. In dynamic movement, the main practice is moving the arms. In Mahāsi’s method, it is about the rising and falling of the abdomen. … I like observing the movement.”

He also practiced the dynamic movement at workplace. “While I was working at the control room, I managed the office work and communicated with my colleagues [when it was necessary]. The workload was not so heavy. There was only about one working our every day. It was relaxing.” Then in October 2011 Candasaro joined an organized trip to stay at WatPa Sukato[vi] for two months in South Thailand. This was the first time he travelled to Thailand. Located at Chaiyaphum Province, the temple covering an area of 185 acres, including a river and Phu Kong Mountain that was 470 meters above sea level. Sukato means ‘good’. Luang Phor Kham Khian Suwanno, the first abbot, shared his intention of building the temple, “Sukato is a place where people come and go for wellness, also for the beneficial impact of the environment, human being, river, forest and air. This is the wellness in coming, going and being. This wellness is born from earth, water, air and fire, not from one person alone. …There are shelter, food and friends who will teach, demonstrate, and give advice. Should one wish to stay here, his or her intention to practice dharma shall be fulfilled.”[vii]

In this huge forest temple, there were around 30 monks and 30 lay people only. As there were plenty established huts, every resident could stay in one hut.[viii] Every morning, all residents woke up at 3 o’clock in the early morning to prepare for the chanting and dhamma talk at 4 o’clock. Around 6 am, Candasaro and other monks, dressed in yellow monastic robe, formally visited villages nearby carrying their alms bowls for their daily alms round. (See Fig. 3 and Fig. 4) In Chinese Buddhist communities in China, alms round practices have been faded out for many centuries. With bare feet, the monks lined up tidily first and started walking towards one of the target villages. After entering the village, they stopped in front of a household where donors were waiting with cooked rice and food. Whenever people from households offered food to monks one by one, they would line up before the householders and chant blessing words in Pāli. All the monks went back to the monastery with the received alms. At around 7.30 am, volunteers in the monastery kitchen finished preparing the foods so that the monks and all residents could have their first meal. For monks, this was also the only meal according to their precepts.

In August 2012, he stayed there again for a month. In 2013, he decided to quit his job and receive early retired pension. He decided to ordain as a bhikkhu and settled at WatPa Sukato. He enjoyed his monastic life very much, “I don’t need to spend any money by living at a monastery. I have been working in government and business sectors for many years. I am very tired of them. And my wife agreed to that [the separation] ….  After you practice diligently, awareness lead you to have a strong sense of renunciation from the mundane world. Firstly, [it’s] renunciation; secondly, you do not attach or crave something.” (See Fig. 5)

Although Candasaro could not speak English, he had learnt some basic Thai words to communicate with Thai people for his daily basic needs. Over the past four years, he went back to China a few times to attend retreats and also invited some friends to travel to WatPa Sukato. In 2017, he returned to China and settled in Fujian Province. He started teaching dynamic meditation and led alms round in the village.

[i] Ch. guanhuxi; P. ānāpānasati.

[ii] Ch. chanxiang; P. nimitta.

[iii] Ch. ding; P. samādhi.

[iv] Luangpor Khamkhian Suvanno was a disciple of Luangpor Teean.

[v] Ch. xi; P. piti.

[vi] See “Wa-Pa-Sukato,” Tourism Authority of Thailand, https://www.tourismthailand.org/Attraction/Wat-Pa-Sukato–3354

[vii] Ibid.

[viii] Ch. gudi; P. kuṭi

Healing Experiences of Vipassanā Practitioners in Contemporary China, Case study 4

This is a case study that is part of a series of linked posts:
Introduction, case 1 | 2 | 3 | 4 | 5

Case 4: Jiang Hailong

Since May in 2006, Jiang Hailong, a forty-six-year-old civil servant from Fujian Province, had started practicing vipassanā with Goenka’s method for ten years. He attended four ten-day retreats and five eight-day satipaṭṭhāna retreats. Jiang said: “Learning vipassanā can purify the mind and cultivate wisdom. After a car accident in October 2005, I started suffering from headaches all the time. They could not be cured, although I had tried various kinds of treatment in clinics by spending a lot of money.”

Finally, he started practicing vipassanā to help relieve his physical pain in his daily life. He shared with me in a grateful tone: “I practice mindfulness every moment. From my experience, I feel pain in my head if I don’t practice. Yet with moment-to-moment awareness, the headache can be released. I can see clearly the change in the mind and the body. The whole body is composed of waves and particles. They emerge and disappear. I can see the phenomenon clearly during sitting and in my daily life. There is no concept of my arms, legs and head. They are waves only, with the vibration of particles. They arise and fall like bubbles… many bubbles …arise and fall… very quickly.”

Jiang highly recommend the teaching of Goenka. He believes that the teaching can lead to liberation of life and death. “Without awareness, I feel so painful. It is suffering. With awareness, the pain is relieved. Previously I had hatred towards the pain. Progressively the pain and hatred have faded away. A pleasant feeling even sometimes arises. Yet [I remind myself] not to attach to it.”

Jiang highlighted meditators should report to meditation teachers, who would give instructions during interview. Jiang thought that he did not practice well. He said shyly and humbly, “I have never dared to share with anyone about my practice–the experience of impermanence and not-self. But when I report to teacher, he confirmed that he could see it [in a similar way].”