by Malia Kirby

A few months ago, Shawn wrote an excellent post on needle technique (How to Needle Like a Mosquito...Without Sucking) and discussed the need to be present while locating points and performing assorted techniques. The question is, how do you know when you're truly present or if you're just shining yourself on?

To answer, I challenge you all with the most difficult ten second exercise that I have had given to me from one of my spiritual teachers. Are you ready? Are you sure? Well, brace yourself, because here it is:

Every time you walk through a doorway, stop before walking through it. Look at the doorway and notice the details. Notice the grain in the wood or reflections on the glass. Feel the ground beneath your feet. Take a deep breath, reach out for the handle, open the door, and consciously walk through the doorway.

Seems easy, right? When I was first presented with this exercise, I had been cultivating a practice of my own for a number of years and I believed that I could easily accomplish what my teacher was asking and move on to bigger, better, and more exciting things, assuming I had achieved a higher level of competence through my previous experience. Alas, I was young and arrogant, and I promptly had my hind-end served to me nicely on a spiritual platter. At the end of each day when I was to check my progress, I found myself realizing that I had been so wrapped up in my work that I had completely forgotten my assigned task. Not only had I forgotten to walk through every single door in a mindful manner, but I had also completely forgotten about the task itself!

...

Before you scoff and pass this exercise by, I challenge you to try this out for a few weeks. See if you can get through the entire exercise, every time, without forgetting on a single door. If you can, then congratulations! You, my friend, are present in the here and now. If, however, you walk through the door, sit down at your desk, review a few patient charts before they arrive for their appointments, look into current research on medical diseases, and then realize that you've completely forgotten about my little challenge, take heart. You are in good company as most of the planet will struggle with this exercise, this humble writer included.

That's all fine and dandy, but why is being present clinically significant?

Prelude
The most basic building blocks of our medicine (aka, Theory 101) come from the Huangdi Neijing Suwen, or more commonly known in English as The Yellow Emperor's Classic of Medicine. The first chapter begins with a discussion between Huang Di and his ministers regarding a shortening of the life-span in comparison to the good old days in China, where everyone supposedly lived one hundred years without aging.

Qi Bo, one of Huang Di's ministers, replied to the inquiry by stating, "In the past, people practiced the Tao, the Way of Life. They understood the principle of balance, of yin and yang, as represented by the transformation of the energies of the universe. Thus, they formulated practices such as Dao-in, an exercise combining stretching, massaging, and breathing to promote energy flow, and meditation to help maintain and harmonize themselves with the universe...They maintained well-being of body and mind; thus, it is not surprising that they lived over one hundred years.

"These days, people have changed their way of life...They do not know the secret of conserving their energy and vitality...people disregard the natural rhythm and order of the universe...so it is not surprising that they look old at fifty and die soon after." (1)

Today, we all know from archaeological record that back in Huang Di's day and previous to his time, that no one lived an extraordinarily long life in comparison to today. Quite the contrary, the life expectancy of most humans in the Paleolithic age (500,000-8,000 BCE) averaged at 19.7 years (2) and has steadily increased to the most recent US Census life expectancy at birth of 77.7 years (3). Realistically, we know that Huang Di was one of the legendary five emperors and, being a legend rather than historical fact, some of the information given therein will be inaccurate. As John Boorman so eloquently phrased it, however, "All the great legends are templates for human behavior," summing up nicely how we should look at the Neijing.

It's about your patients.
If we are to accept the basic statements of the first chapter, that living in accordance with the natural rhythms of the universe result in health and long life, then basic logic states that anyone who books an appointment for treatment is not living in harmony with the world around them. Yes, we could immediately jump into more complicated theories on how to properly harmonize the Qi, quicken the blood, and so forth, but let's pause for a moment and ponder a more basic question: is it possible to live in harmony with the world around you if you are not living in a mindful, present manner? Consider the following scenarios:

1) The woman in the office across from you has an abusive spouse/partner and refuses to leave them.

2) Your patient has an upcoming deadline at work.

What happens to the woman with the abusive spouse if she doesn't learn to read her partner's moods and be on guard for warning signs? Most likely, she'll be caught off guard and find herself the brunt of the abuse once again. Worst case scenario, she'll lose her life from the trauma if she doesn't take care of herself and leave the situation.

How about your patient with the deadline at work? What happens if she's thinking only about her project and not about whether or not she's hungry or comfortable? What if she starts skipping meals and sacrifices sleep in order to meet her deadline? Will the quality of her work be as high if she isn't taking care of herself at the same time? What about her home life? What happens when she comes home late to her family, exhausted, famished, and irritable, and takes her day out on them? Most likely, your patient won't be entirely happy with her situation and her symptoms could range from mild irritation and gastrointestinal distress, to uncontrollable rage, sky-high blood pressure, risk of a heart attack &/or stroke, muscle tension, and migraines. Either way, she's still in your office seeking help for her symptoms, most of which could be reduced through being present and practices of mindfulness.

Most of us live as slaves to the past and to the future, even though these concepts do not exist except in our own minds. According to a commentary written by David Mokotoff, MD, a neurological lecture he attended described a study showing that more than 90% of our thoughts relate to past or future events (4), not on what is in front of us at the present time. Purposefully paying attention to our present surroundings in a non-judgemental manner instead of our usual patterns of focusing on past or future events has shown to be so beneficial to our health that even the National Institutes of Health has taken notice. In fact, a simple search on mindfulness on the NIH website pulls up over 400 different results. Numerous studies have shown that actively cultivating mindfulness can significantly reduce stress levels, effectively treating symptoms of ADHD (5), improve sleep (6), and even slow the progression of HIV in infected individuals (7). Even more studies are currently ongoing on the effects of mindfulness on PTSD, musculoskeletal pain, and even hot flashes. If the results are to be believed, then this suggests that all of our patients (and ourselves, also) could benefit from being more present and mindful.

The unfortunate problem arises when your patient is so completely out of touch with their bodies and the world around them that not only are they unhealthy, they can't tell you anything clinically significant about their condition. All they can tell you is that they don't feel well, or they tell you they really only have one symptom but deny any other symptom or sign you ask about, or they tell you their Western diagnosis but can't tell you which symptoms they experience in association with it. I know that I've certainly had a number of patients who fall into this department and I'm sure I'm not alone in that. In these cases, sometimes determining an accurate pattern identification can be downright difficult and it can be frustrating when you feel as if you're simply throwing spaghetti at the wall to see what sticks. You probably will need to treat almost entirely off of what you see in the tongue and feel in the pulse in the beginning. When you find yourself having to do so, that is your red flag signifying that your patient could benefit from the challenge presented today and from incorporating the exercises in mindfulness that I will discuss in part two of this series, So You Think You're Present, Part Two: Exercises for Patients (And Practitioners).

With this, I leave you all with my original challenge in preparation for part two and I look forward to hearing how you all fare with it in the comments section. Good luck!

1. Maoshing Ni, Ph.D. The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen With Commentary. 1995. Shambhala Publications, Inc. Boston, MA.

2. Dan Usher. Political Economy. 2003. Blackwell Publishing. Oxford, UK.

3. http://www.census.gov/compendia/statab/2010/tables/10s0105.pdf

4. David Mokotoff, MD. "Why I Brought Spirituality to My Medical Practice". Integrative Medicine. Vol. 8, No. 5. Oct/Nov 2009.

5. http://jad.sagepub.com/cgi/content/abstract/11/6/737

6. http://www.ncbi.nlm.nih.gov/pubmed/18502250

7. http://www.sciencedaily.com/releases/2008/07/080724215644.htm