Before a practitioner can start treating people, s/he must first find out what is wrong – as far as that is possible at all. Naturally there are many ways to do that and I am not going into the details of examination techniques. However, I am under the impression, that the Chinese with their intellectual world domination in this area have inspired many westerners in believing and practicing something that is usually “handled” (please observe the expression; there will be a few more instances of this kind of illuminating terms below) a little differently in Japan.
Since I have not had the opportunity to observe things directly in mainland China, reading through (Chinese influenced) reports, research material etc., or also material from China, I am also under the impression, that the authors gather information by taking the pulse, inspecting the tongue and some other bits of information to draw their conclusions based on the classifications the Chinese love so much and/or select the points for their treatment based on the theoretical instructions found in textbooks or the classics. It is of course laudable to know the textbooks and classics, but personally I very much doubt, they can tell you anything about any real patient. Just like the description of “pneumonia” in a textbook of medicine gives you an averaged, generalized model, but not the particular situation you encounter in patient “xxx”.
Although not all Japanese practitioners adhere to the practice I attempt to put into the words I chose below and which a patient of mine once has called “poking around”, I prefer it and believe a substantial number of other (Japanese) practitioners could offer the world here something, that may not really make the EBM enthusiasts happy, but provides a sometimes very enlightening “close encounter of the Japanese kind“.
Interface is a term usually used in relation to computer and machine technology. But I would like to express a few ideas pertaining to (physical) treatment, in particular acupuncture treatment, and borrow this expression for this particular purpose.
In the medical world it is common sense, that individual life forms, including single-celled microorganisms, plants, animals and man, have a body surface that forms the interface of this particular individual with the environment. Yet, in contrast to man-made devices, which are usually one out of a more or less large number of identical devices manufactured at a specific site with identical specifications, these life forms are always UNIQUE. Not one of these many “devices” (let’s call them units below) exactly matches any other unit, even if they are of the same species, like for example “man”.
Each individual unit is slightly different. For that reason the interface between the unit and the environment at any given moment in time is subject to a unique, highly specific set of parameters influencing both the unit and its environment. And because the specifications for each unit are unique, the interaction between the particular unit and the environment occurring at their common interface – in man the skin – also is subject to unique changes. That means, that no other unit would react in exactly the same way to a given, reproducible parameter/influence, like temperature or pressure.
In computer technology the status of the various devices and their respective hard- and software can be checked and a “digital output” of the relevant data prepared. In medicine, here I refer in particular to acupuncture, “running diagnostics” is also largely a “digital” process, because the practitioner uses his/her fingers = digits to literally READ information from the body surface of people/patients. But in contrast to this process in computer technology the diagnostic process in acupuncture exceeds the unidimensional digital level and becomes a “sensual” holistic process, in that it includes visual (inspection), audio (hearing, listening) and chemical (smell, but only RARELY taste) parameters.
In relation to the “EBM frenzy” currently almost everybody is looking for “reproducible, digital readouts” of this information: like temperature, pressure, electrical resistance etc. However, to the best of my knowledge, even if there are devices under development that may be able to test and measure some of these parameters like pressure, which would be essential for examining the pulse, these devices are still very far from reliably and meaningfully measuring the parameters they are designed for. The human touch still exceeds their capabilities.
Even if there were devices that would satisfactorily measure ONE particular parameter, a human (erratic as that may be!) practitioner would still integrate all the different modalities of into one whole (“holistic“) picture quite different from what any machine would produce. In addition, the practitioner him/herself too is a unique unit, which produces naturally a unique and not completely reproducible output. THAT is for all scientifically/technically inclined researchers believing in the holiness of EBM a horrible concept.
Now, the interface used for data collection, namely the two layers of the skin of both patient and practitioner approaching and in most instances also coming into contact with each other, are not unlike a telephone. (This is a metaphor I like to use, when I try to explain the situation to my patients and refer here only to palpation.)
On the “one hand” (please note THIS expression) the practitioner moves with his/her hand(s) over the body of the patient to collect = read the data written on the patient’s body surface. Although most patients are not really aware of them, for a practitioner with a little clinical experience there is a lot of information to read there, that will tell him/her about the past, present and future state/development(s) of the examinee. This is like listening to that person talking on the other end of a telephone.
During the treatment on the “other hand“, for which the hands do not even have to be lifted off the body = cut the connection, the same hand(s) of the practitioner provides some input for the system “patient”. That is then like responding to the person on the other end of the telephone line.
Modern telecommunication technology uses wired networks, where cables are used to connect different devices, and wireless networks using electromagnetic waves and fields. In medicine nothing substantially has changed in the technological setup of the wired and wireless networks (only our understanding of their functioning is growing) since their inception = billions of years ago. Practitioners use the hardware components for the wired networks, like nerves, muscles, bones etc. in order to receive/transmit physical stimuli/information = like nerve impulses traveling along nerves, or moxibustion induced chemical changes/substances propagated via the chemical transport system “blood”. For the wireless networks practitioners tap into energies and information in and also propagated along LAN channels that work without having their own hardware, in the field of acupuncture these are often referred to as meridians or also channels (note the similarity).
Actually, I have been called for help in my capacity as an acupuncturist via mail. However, as I said above, both patient and practitioner are unique individual units with their own unique specifications and therefore without exactly predictable reactions (to interventions). Thus, helping people over long distances is usually not working very well, because I as a practitioner have to do almost completely without data readouts from the malfunctioning unit (person). Therefore the attempts are in most cases bound to be unsuccessful.
The advice would be: get a piece of real “first-hand” human touch experience up close …… again those expressions …
The nails cut into the flesh!! The other day I was asked to “evaluate” a DVD to determine, whether its translation and eventually publication in Japan is worthwhile. While I was watching the DVD, featuring three professional therapists (all university graduates), I noted that ALL of them kept rings, watches etc. on their respective hands and at least two of the three had finger nails clearly extending beyond the finger cups. Probably I am very old-fashioned, but I learned “in school” – this in itself does not mean anything – that professionals are not supposed (I think even prohibited by (Japanese) law) to have rings, watches … anything metal … on their hands during the treatment. Personally I am very much in favor of this idea and NEVER have anything metal or otherwise hard on/at my hands. Again, when I was looking for some stuff and found on Wikipedia a picture of an acupuncture practitioner (see link). This clearly shows very long fingernails and even a mark on skin, where those finger nails have pressed into the flesh (of the patient/model).
This is UNACCEPTABLE! The practitioner is hurting the patient. Since Hippocrate’s time “Primum non nocere (first, do no harm)” is known to have utmost priority in all forms of treatment!!!
Below I list an old article of mine in Japanese / English / German about avian influenza and my personal view of the virtues of moxibustion treatment. I believe, this also applies to the current COVID pandemic.
以下のリンクをたどれば更なる情報がある。 These links lead to more information. Die folgenden Links führen zu Seiten mit weiterführenden Informationen.
Avian influenza Again, mankind faces the threat of an enemy so small, that it can be seen only under the microscope. The danger of this disease definitely cannot be taken lightly, but panicking in the face of this threat will only impair cool judgement. Currently there appears to be no “specific drug” to treat this disease. And the virus itself continously changes. If that is so, it may be a good idea at looking at available treatment forms that can look back on a tradition of several thousand years of successful treatment: moxibustion. That moxibustion “non-specifically” activates the human immune function has by now be verified beyond doubt. So, waiting to get sick and then be treated with drugs of possibly questionable safety and efficacy, does not seem very wise to me. And in addition to the already commercially available modern drugs, I have no doubt that the Chinese with their wonderful capitalistic sense of business will shortly announce the successful development and marketing of a (probably not inexpensive) Chinese medicine specifically effective for this disease. I remember that this was the case with the SARS epidemic too. Well, why not try the extremely cheap moxa therapy, that can be performed by anybody at home? This will certainly NOT generate any business, but if someone has an earnest interest in the health of the people, this is a therapy that deserves to be called to mind!
Vogelgrippe Wieder einmal sieht sich die Menschheit der Bedrohung durch einen Feind ausgesetzt der so klein ist, dass man ihn nur unter dem Mikroskop erkennen kann. Und obwohl die Gefahr beim besten Willen nicht leicht genommen werden darf, Aufregung im Angesicht dieser Gefahr kann das Urteilsvermögen beeinträchtigen. Derzeit gibt es offenbar kein “spezifisch wirksames” Wundermittel gegen diese Krankheit. Außerdem ist der Virus in der Lage sich selbst ständig zu verändern und weiterentwickeln. Wenn dem so ist, könnte es durchaus eine gute Idee sein, sich auf Therapieformen zu beziehen, die auf eine mehrere Jahrtausende überstreckende Tradition wirksamer Behandlung zurückblicken können: zum Beispiel die Moxibustion. Das die Moxibustion die menschliche Immunfunktion “nicht-spezifisch” stimuliert, ist inzwischen über jeden Zweifel erhaben nachgewiesen worden. Jetzt darauf warten, dass man krank wird, um sich dann mit modernen Medikamenten behandeln zu lassen, deren Sicherheit und Wirksamkeit nicht unbedingt erwiesen ist, scheint mir persönlich keine sehr weise Entscheidung zu sein. Außerdem würde es mich nicht wundern, wenn neben den bereits kommerziell erhältlichen modernen Medikamenten die Chinesen mit ihrem wunderbar kapitalistischen Sinn fürs Geschäft in Kürze mit einer “neu entwickelten und hochspezifisch wirksamen” (vermutlich auch nicht sehr billigen) chinesiche Medizin auf den Markt bringen. Ich kann mich daran erinnern, dass dies bei der SARS Epedemie auch so war. Nun, warum dann nicht einmal die extrem billige und dabei gleichzeitig von Jedermann zu Hause durchführbare Moxibustion ausprobieren? Dies wird mit Sicherheit NICHT geschäftlich interessant sein, aber für Alle, die ernsthaft um die Gesundheit der Menschen besorgt sind, ist dies eine Therapieform, die einmal in Erwägung gezogen werden sollte!
Ursprünglich kam ich vor 26 Jahren auf der Suche nach einem Kyudo (japanisches Bogenschießen) Lehrer nach Japan, dem ersten und einzig bestimmten Abschnitt einer geplanten Weltreise. Aus der Reise ist inzwischen ein permanenter Aufenthalt mit “Kind und Kegel” geworden.
Ein starkes, seit 15 bestehendes Interesse für orientalische Philosophie, bildete die Motivation ca. 2 Jahre nach meiner Ankunft in Japan eine 3-jährige Fachausbildung in Akupunktur, Moxibustion und Shiatsu zu absolvieren, die nach einem Staatsexamen mit dem Erwerb der entsprechenden Lizenzen (insgesamt DREI) endet, um so aus Interesse einen Beruf (ich denke da an “Berufung”) zu machen. Anschließend verbrachte ich noch vier weitere Jahre mit “praktischen Studien” in einem großen Krankenhaus und habe seit ca. 10 Jahren eine eigene sehr kleine Praxis (eine der SEHR wenigen von westlichen Ausländern geleiteten).
Die japanische Form der Akupunktur im engeren Sinne kann sich auf eine etwa 1500-jährige Tradition berufen. Trotz der relativen geographischen Nähe hat dies zu nicht unerheblichen Unterschieden in der Entwicklung in China und Japan geführt. Da die Chinesen sich jedoch wesentlich besser zu verkaufen wissen als die Japaner, wird die Welt derzeit fast ausschließlich durch chinesische Konzepte beherrscht. Dabei werden nicht selten Konzepte und Techniken als TCM (traditional Chinese medicine) ausgeben, die anderweitig entwickelt wurden. Die chinesische Akupunktur verwendet wesentlich dickere Nadeln als die Japanische und viele Ausländer, auch wenn sie körperlich größer und robuster erscheinen als Japaner, lassen sich diese dicken Nadeln nicht so gern gefallen. Daher ist es wahrscheinlich auch kein Zufall, dass meines Wissens viele (die meisten?) Akupunkteure in Deutschland Nadeln japanischer Herstellung verwenden.
Die weniger bekannte Moxibustion bedient sich eines aus Beifuß gewonnenem Fasermaterials, dass zu kleinen Kegeln gedreht und auf der Haut verbrannt wird (inzwischen gibt es offenbar auch das Verb moxen” im Deutschen). Da dies natürlich zu (erwünschten!) Verbrennungen führt, sind diverse Firmen mit tausenderlei Produkten auf den Markt gekommen, bei denen es nicht zu Verbrennungen kommt. Das ist vielleicht auch nicht schlecht, meines Erachtens nach aber nicht „richtig”. Moxibustion ist eine Neubildung aus Moxa” (japanisch für Beifuß) und combustion” und wird als solche weltweit offenbar häufiger verwendet als der entsprechende chinesische Begriff.
Bei der Akupunktur werden bekannterweise dünne Metallnadeln (japanisch meist 0,018-0,24 mm, chinesisch 0,3-0,4 mm) durch die Haut in den Körper eingeführt (nicht bei kleinen Kindern). Die Metallnadeln wirken dort auf Nerven ein, wo sie zwar auch lokale Einflüsse ausüben, die “eigentliche” Wirkung jedoch hervorgebracht wird, indem Signale zum Gehirn gesandt, dort verarbeitet und andere Signale wieder zum Körper zurückgeschickt werden. Wenn Nerven ausgeschaltet werden, zum Beispiel durch Lokalanästhetika, gibt es auch keine Wirkung mehr. Ein weithin bekannter Mechnismus besteht in einer Stimulation der Produktion körpereigener morphinähnlicher Substanzen (Endorphine etc.), die ihrerseits schmerzlindernd wirken. Meinen Patienten erkläre ich die Wirkung der Nadeln immer gern so, dass die Nadeln in der Peripherie über eine Art Telefonleitung das Gehirn anrufen und dort die zuständigen Stellen dazu auffordern, Änderungen im „Körperprogramm“, „Straßenreparaturen“ oder „Fortbildungsseminare“ durchzuführen. Dies macht es oft verständlicher, warum eine Nadel im Fuß auf den Kopf oder den Rücken wirkt.
Die Moxibustion stimuliert zwar auch die Nerven, aber der eigentlich interessante Effekt wird durch die besagten Verbrennungen hervorgerufen. Diese führen zur thermischen Zerstörung von Zellen, so dass deren Inhalt freigesetzt wird. Obwohl es sich hier um körpereigenes Material handelt, befindet sich dieses nun nicht mehr wie vorgesehen innerhalb der Zellen. Damit wird ein Teil der normalen Immunabwehr aktiviert, der für den Abbau derartiger Produkte zuständig ist. Der gesamte Prozess ist eine Serie chemischer Reaktionen von in Wasser gelösten Substanzen. Diese verbleiben natürlich nicht am Ort der Verbrennung, sondern werden über weite Strecken durch den Körper transportiert, wo sie wiederum ihre jeweiligen Wirkungen hervorrufen. Daher werden die Wirkungen der Moxa Behandlung auch nicht durch Lähmungen oder dergleichen gestört und führen sekundär zu positiven Veränderungen der Immunlage.
(Hinsichtlich weiterer Einzelheiten möchte ich auf die Fachliteratur verweisen.)
Orientalische Therapieformen werden oft als „balance medicine” bezeichnet, weil dabei angestrebt wird, angenommene oder auch tatsächlich vorhandene Ungleichgewichte zu korrigieren. Manchmal wird dieser Umstand auch, vielleicht leichter verständlich und moderner so ausgedrückt, dass die orientalische Medizin funktionelle nicht aber organische Störungen (z.B. Knochenbruch) beheben kann.
Ich bin davon überzeugt, dass es sich hier im Sinne des Wortes um ein HAND-WERK handelt. Eine Arbeit die mit den Händen durchgeführt wird und die Funktion der Hände einfach nicht durch akademische Bemühungen (Kopfarbeit) ersetzt werden kann. Wahrscheinlich werden zahlreiche großartige Akupunkteure der Welt nie bekannt werden, weil sie nie etwas schreiben. Als Therapeuten sind diese jedoch vertrauenswürdiger als die zahlreichen Akademiker, die es eher im Kopf als in den Händen haben.
In einem zukünftigen Newsletter würde ich lieber, falls Bedarf besteht, konkrete Probleme besprechen, oder kann auch außerhalb des Newsletter über meine Webseite / Mail individuelle Beratung und Hilfe (soweit möglich) anbieten (www.einklang.com).
In the not so distant past the military used scouts, sometimes also called “pathfinders” (Merriam Webster: path.find.er n (1840): one that discovers a way; esp: one that explores untraversed regions to mark out a new route — path.find.ing n or adj.), to find their way through unknown territory. Literally, these were people that could find a path not visible to anybody else. During a recent conference on translation, a certain question appeared in several different sessions: what actually is the job and/or function of a translator?
The answer to this question appears on first sight to be simple and obvious, but many of the attending translators and agencies presented widely varying definitions and concepts. This motivated me to write this little article and express an idea, I had for quite a while now. I.e., translators should also (or maybe even predominantly) be “bookfinders” in analogy to the above mentioned pathfinders. Below I will try to explain why.
I have been a translator for about 30 years and during this time spent nearly 100% of my working time with activities, involving the rendition of a certain meaning expressed in one language into another. Sometimes, in particular when the source text is of rather poor quality and/or ambiguous, this also involves a more less significant portion of text interpretation and re-writing. Nevertheless, the basic idea is always the same: change A into B. Very few, if any, people I happened to work with over the years have ever questioned or even challenged this view. This is simply considered to be the job and function of a translator.
Yet, if you are a translator for any specialized field, have a professional interest in extending your horizons, conduct a little research in your own or maybe even other fields of expertise, then you will certainly do some reading.
This puts the translator in a unique position. He/she is not only capable of professionally handling and evaluating two or more languages, but will be reading reference books on certain topics in these languages. Sometimes there are equivalents or even translations of certain valuable references, but most often not. Under these circumstances the translator can evaluate several books that might be worth translating from both linguistic and technical points of view.
I believe that a look at the currently available selection of translated books shows clearly, that the choices are definitely not always “professional”. They are made by publishers based on information and recommendations of sometimes questionable origin and mainly commercial considerations. This provides the general population with a selection of translated books influenced by a possibly biased and – naturally – profit orientated choice made by publishers. But this could also mean, that the average person has access only to a rather distorted view of the world.
Today, the internet offers access to the so-called information highway carrying more information with an incredibly short turnover time than anybody could ever handle. Yet, fast access to a terrifying amount of information could also block the view for the more distinct, practical, comprehensive and interesting information a book can provide. After all, reading should also be fun.
While access to the information highway may often prove to be very helpful, who would like to live in a house with the front door opening right onto the highway? Personally, I prefer the quiet small back roads. This is, where books come in. It takes much longer to publish a book than to publish and update a web site. Naturally, books are always somewhat “behind their time”, but that does not reduce their value.
For example, I am a native German living in Japan. I know of literally “uncountable” translations of German literature, science books etc. available in Japanese bookstores. Yet, whenever I visit Germany and wander through large bookstores, I can find at best a handful of Japanese books translated into German. A very illustrative little episode happened, when I visited the annual Tokyo International Book Fair a few years ago. There I asked a German publisher if they might be interested in the publication of translated Japanese books. The representative at that booth said: “No, why should we? Publisher XXX already has published two books.” This is hardly representative for a nation that publishes around ten thousand new books every year!
Thus, in spite of the omnipresent information highway and Japan being a superpower with a major impact on the world economy, intellectually it still remains largely uncharted territory (a sort of a black hole) for the people of other countries, because there is so little tangible (books that you can take in the hand in contrast to virtual material on the internet) information about it available. I firmly believe that the same situation also applies to quite a number of other countries.
Now, here is a field, in which translators could offer a real contribution to international understanding: selecting and recommending books worth of translation. The translator who recommends certain books might even do the entire translation. In many cases this would be not only be advantageous for the translator, but also the translation itself and thus the reader.
