Interview by journalist Arminta Wallace with Paul McCarthy on various spects of Chinese Medicine.
Paul, let’s talk about Chinese medicine. Wouldn’t some people say that it’s weird, old, off-the-wall stuff? I mean, in the 21st century, how can it compete with MRI scans and antibiotics?
Chinese medicine is not weird or off-the wall but it is certainly old. In fact, Chinese medicine is one of the oldest, most comprehensive and coherent medical and health care systems still in practice in the world. It has sustained the health, wellbeing and longevity of the world’s longest ongoing civilisation for over 5,000 years. During that time its practitioners have recorded the results of their meticulous research and clinical experience in classical medical archives which span more than 3,000 years of written history.
Regarding the second part of your question I prefer not to perceive Chinese medicine as directly competing with Western medicine. Although Chinese medicine can be used in many cases as an alternative, it can also be used in many situations to complement Western medical treatments.
Over thousands of years Chinese medicine has developed through extensive observation and clinical testing. As a system of medical theory and practice it is quite different to – but no less valid than – Western medicine. It has its own consistent theoretical concepts, philosophy of health and disease, theory of disease aetiology and system of disease classification. It also has a coherent diagnostic and treatment framework. And its research process, which began thousands of years ago, continues today.
How did the two systems come to develop so differently?
I believe the differences between Chinese and Western medicine reflect the ways in which both cultures have evolved over millennia. In a nutshell, people from Eastern and Western cultures see and think about the world quite differently. Western medicine has developed primarily from ancient Greek culture and philosophy, while Eastern medicine evolved out of Chinese culture and the philosophy of Daoism.
The Greeks developed highly linear methods of understanding objects in isolation. This led to explanations of things in terms of properties, such as a stone possessing density and gravity. They also emphasised the notion of stasis: things do not change because they have properties, and properties cannot vary.
Chinese philosophy, by contrast, emphasised complexity, holism, resonance and flux. All things were to be understood in terms of their relationship to each other and to their general environment. The Greeks understood discrete objects in isolation; the Chinese understood objects to be part of, and inseparable from, a larger environment.
Arminta Wallace: That’s fascinating. It never occurred to me that these ancient philosophies could have a direct impact on modern medical approaches.
The Greeks put more emphasis on linearity, reductionism, objectification and rejection through contradiction whereas the Chinese emphasised circularity, holism, systems thinking and the acceptance of contradiction. The Greek (Western) mind therefore developed tendencies towards individualism, personal freedom and objective thought. They tended to examine and explain objects and their properties in isolation, whereas the Chinese (Eastern) mind tended to focus on the interconnectedness and relationships between objects and gave rise to a holistic philosophy that emphasised change and flux.
There are many medical and healthcare ramifications of these two different cognitive modes. Western medicine is based on modern biomedical science and is evidence-based, analytical and reductive by nature. This approach is very powerful in understanding the structure and function of the human body and disease-causing agents: viruses, bacteria, fungi etc. Anatomy, molecular and sub-molecular biology, histology, cytology and advances in modern genetics have given us a detailed view of the physical and biochemical structure of the body.
This model has been very successful, especially in acute life-threatening medical or surgical emergencies. Because of this success Western medicine has become the predominant medical system in the world.
Perhaps, though, the linear, analytical approach is not always the most appropriate – or most successful – one?
Western medical methodology has not been very successful in dealing with chronic diseases, because no two people are the same and medication ideally has to be individualised. The linear, analytical approach also has a weakness when it comes to understanding the holistic nature of the body. The human body is a large, complex, open system and therefore it is impossible to understand it by analysing its sub-systems alone. The sum of its parts will not add up to the whole because of the complex interdependencies that exist between its internal and external environment.
In Western medicine, especially in chronic diseases, the human body’s reaction and pathological changes are seldom taken into account. For example if a patient contracts a chronic viral infection, Western medicine tends to focus on treating or attacking the virus and does not address the changes that occur as the body reacts to this invasion.
This is a pretty crucial distinction, Paul. Before moving on to other topics, can we do a compare-and-contrast summary of the two systems?
Western medicine uses the reductive and analytical method. It looks at the structure and function of the parts. It is standardised and evidence based. It is the result of laboratory experimentations. It is strictly a science. It relies on chemical agents/drugs and medical/surgical procedures, and it manages disease.
Chinese medicine uses the inductive and holistic approach. It looks at the functions and behaviours of the system as a whole. It is the result of clinical observations developed over thousands of years of “trial and error”. It is experienced based. It uses acupuncture, nutrition, herbs and natural agents, and it works to maintain health, wellness and balance of the mind-body-spirit continuum.
Ok. So while we in the West tend to think of “medicine” primarily as a) drugs, or b) surgery, the Chinese approach incorporates many more elements. Right?
Yes. Chinese medicine incorporates a number of healing modalities including Acupuncture, Moxibustion, Herbal Medicine, Dietary Therapy, Massage, Gui Sha, Tuina, Meditation, Chinese Aromatherapy, the therapeutic use and precious and semi-precious stones, Tai Chi and many forms of Qi Gong.
I can see how dietary therapy, acupuncture and even meditation could be considered “medical” in nature. What about precious stones, though?
Well, Arminta, be mindful of the fact that Chinese medical philosophy does not consider the absence of disease to be the ideal state of health and wellbeing. According to Chinese medical theory, complete physical, emotional, intellectual, social and spiritual wellbeing is the goal to be achieved. Therefore many of the healing modalities of Chinese medicine are involved in maintaining wellness and preventing the development of imbalance or disease.
Stones are a rich and major part of Chinese medicine – in fact, the original acupuncture needles were made of stone. The insertion or the placement of stones on acupuncture points was used to engender an effect more powerful than an iron needle. Jade was considered the ultimate stone but silver, gold and crystal needles were also used.
Stones are also used to make elixirs. Certain stones will dissolve in water while others remain relatively permanent. Stone elixirs were ingested in alchemy in an attempt to prolong life and attain physical immortality, but we can use stone elixirs to treat various conditions. For example, I recently used a stone elixir of rhodonite, rhodochrosite and amethyst with acupuncture and the herb Danshen (Notoginseng) in the treatment of Atrial Fibrillation. I have also successfully used a stone elixir of black tourmaline to chelate mercury in a patient with high blood levels of mercury.
And the medical uses of aromatherapy? I’m guessing this is rather more complex than chucking a few drops of lavender oil into your bathwater.
For centuries the essential oils of aromatic plants have been used in Chinese medicine for the maintenance and restoration of health. The Shen Nong Ben Cao Jing, written around the 3rd century AD, defined parts of plants such as leaves, stems, roots, rhizomes but also their “jing essence”, which would correspond to our understanding of essential oils. Incidentally this book is the earliest classic on pharmacology still in existence. Most of the medicines recorded in it are still in use today, and their efficacy has been proved by centuries of clinical practice and modern scientific research.
Rooted in a Chinese medical and diagnostic framework and based on the energetic qualities, properties such as volatility and viscosity and – of course – the relationships between odour, taste and the five elements, specific oils were applied topically to stimulate specific acupuncture points. The selection of the oils is also based on the characteristics of the parent plant. Different oils obviously affect different energetic levels and different organs and metabolic systems.
Essential oils are a wonderful way to treat children or adults, with or without the use of acupuncture needles. The treatment is usually followed up at home by the patient, who learns some specific acupuncture points and applies the prescribed oil or combination of oils. According to our friend the Daoist Priest Jeffrey Yuen, “the essence of the plant treats the essence of the person”.
So not only do we have treatments and medications tailored to the individual, but treatments and medications which embrace the beauty and healing power of the natural world. Isn’t Tai Chi rather different, in that its origins are martial and/or militaristic?
Tai Chi Chuan was originally taught as a martial art and longevity exercise, but has evolved into a graceful, self-paced system of gentle physical exercise that is used for stress reduction and for helping a wide variety of physical, mental and emotional disorders. Tai Chi has often been described as “meditation in motion” as it promotes peace of mind through gentle movements and by balancing the mind/body/spirit continuum.
Research has shown that Tai Chi benefits such conditions as anxiety, depression and stress. It improves balance, flexibility and muscle strength, increases bone density, reduces falls in older people, improves cardiovascular fitness, relieves chronic pain, increases energy and endurance, lowers blood pressure, improves sleep quality, improves immune function and improves overall feelings of wellbeing.
How did people first hit on the idea of using needles as a healing therapy? And why did they apply them to particular places on the body?
The origins of acupuncture are unclear as they predate recorded history. There are variations of a common myth whereby some warriors wounded by arrows in battle were cured of pre-existing chronic conditions.
Many Chinese scholars believe that acupuncture was used as far back as the Stone Age. Sharp-edged stone tools from this period, described by the character “bian”, were used to puncture the skin – perhaps initially to drain abscesses. “Bian” means to use a sharp edged stone to treat disease.
In modern times the character “bi”, representing “painful obstruction”, most likely derived from the use of bian stones (“bianshi”) for the treatment of painful conditions. Later narrow snippets of animal bones were used and, later again, bamboo needles.
Wow. Everyone knows that acupuncture has a long history – but being able to trace its origins back to the Stone Age is pretty impressive. How about the written record? What does that tell us?
The oldest records of ancient acupuncture in China are found on etchings on bones and tortoise shells believed to be from around 1600 BCE. The earliest written record of acupuncture is the Chinese Text Shi Ji (Records of the Grand Historian) by Sima Qian, who was an astronomer and perhaps the first great Chinese historian.
More detailed accounts are given in the Classical Daoist text the Huangdi Neijing (Yellow Emperor’s Inner Canon), written in the 2nd century BCE. During this time stone and bone needles were replaced with metal.
Over the following centuries acupuncture continued to evolve as more channels and points were added. For example, around 260 AD, Huang Fu Mi organised all of the ancient literature into his classical text, Systematic Classics of Acupuncture Moxibustion. This influential text extended to 12 volumes and describes 349 acupuncture points.
One of my favourite texts is by Sun Simiao, who is considered by many to be the father of Chinese medicine. He wrote the Prescription with a Thousand Gold for Emergencies (650-692). This text includes data on acupuncture from various scholars. In addition, during this period acupuncture education became part of the Imperial Medical Bureau.
Paul, can you tell us a little more about the Huangdi Neijing? You feel that it’s one of the most important texts on Chinese medicine, don’t you?
Yes. This ancient medical text has been a fundamental doctrinal source for Chinese medicine for more than two thousand years – and indeed it remains so up to the present day.
It is written in a question and answer format, as a conversation between the legendary Yellow Emperor, Huangdi, and his physician, who was called Qíbó. The text is arranged in two books, the Su Wen (Simple or Basic Questions) and the Ling Shu (Spiritual Pivot). Each book has 81 chapters.
As well as being the most important ancient text in Chinese medicine, the Huangdi Neijing is also a major text on Daoist theory, lifestyle and self-cultivation. It departs from the old shamanistic beliefs that disease was caused by demonic influences. Instead, imbalances in our dietary habits, our lifestyles, our emotions, the physical and social environment in which we live, and our age are involved in the causation of disease.
According to the Neijing the universe is composed of various forces and principles, such as Yin and Yang, Qi and the Five Elements (or phases). These forces can be understood via rational means, and man can stay in balance or return to balance and health by understanding the laws of these natural forces.
Why are there two volumes of the Neijing, and how are the Su Wen and the Ling Shu different from each other?
The dialogue between Huangdi and Qíbó lays down the philosophical basis of traditional Chinese medicine, and makes this text more of a treatise on health and disease rather than a textbook of medicine. The Su Wen (Simple Questions) is timeless and deals with philosophical concepts, many of which are as relevant today as they were over 200 years ago. It introduces anatomy, aetiology of disease, pathology, differentiation of syndromes, maintenance of health and prevention of disease, treatment modalities, the principles of yin-yang, five elements, treatment, and man’s relationship with nature and the cosmos. It regards humanity as a microcosm which mirrors the larger macrocosm.
The Ling Shu’s main focus is acupuncture. It includes a description of the meridians, functions of the Zang-Fu organs, nine types of needles, needling techniques, types of Qi, and the location and function of 160 acupuncture points.
Two thousand years ago, then, the extraordinary Huangdi Neijing described some 160 acupuncture points. Has the number of points changed over time? How many points do practitioners use nowadays?
Well, during the Song Dynasty (960-1279), The Illustrated Manual on Points for Acupuncture and Moxibustion, written by the famous physician Wang Weiyi, described 657 points.
Today the number of points varies. In 1993 the World Health Organisation described 361 classical acupuncture points on the classical meridians. However, there are hundreds of additional acupuncture points – and more points are being discovered every year.
What about the term “acupuncture” itself – where did that come from? It doesn’t sound very Chinese!
“Acupuncture”, a Latinate word which derives from “acus” (needle) and “puncturu” (to puncture), was coined in the 17th century by Willem ten Rhijne. He was a Dutch ship’s surgeon who, following a tour of duty in Nagasaki, Japan, published a treatise which included a description of the use of acupuncture in arthritis. The Chinese classical term is “zhenjiu”, combining “zhen” (needle) and “jiu” (moxa, as in the herb mugwort).
While we’re on the subject of terms and concepts, Paul, could you explain what is meant by “meridians” in Chinese medicine? It’s a word I associate with geography!
Yes – when we hear the word “meridian” we initially think of imaginary lines of longitude or indeed magnetic lines in geography. In Chinese medicine the term “jing luo” is used. This has been translated as “conduits”, “channels” or, most often, “meridians”.
These meridians form an elaborate network which regulates the circulation of Qi throughout the body. In ancient times – before the onset of modern pathology, microscopes etc – Daoist scholars and doctors envisioned the meridians or channels as being similar to the streams, rivers, canals and irrigation systems which cross the landscape on their way to the ocean. The Qi flowed like the water flowed, and the acupuncture meridians were like the waterways. It was important to maintain a free flow of Qi in the channels in order to maintain wellness.
For Westerners, this is a radically new way to look at our bodies: a sort of sat-nav map of health and well-being. And the beautiful, life-affirming image of flowing water is at the heart of Chinese medicine. Can you tell us a little more about how it relates to acupuncture practice?
If the flow of water in a river becomes blocked – by a rockslide or a fallen tree trunk, for example – the area above the blockage is flooded and in excess, and the area below the blockage becomes deficient or may dry up altogether. If we go to the point of the blockage and clear away the rocks or tree trunk, the river will resume its natural flow.
Similarly, if the flow of Qi in a meridian becomes blocked – say through physical or emotional trauma or contaminated food – an imbalance of deficiency and/or excess, and/or stagnation, can occur in the body. If we insert a very fine needle into a specific point or points in order remove the blockage in the meridian, just as in the river analogy, the natural flow of Qi will be restored.
Many acupuncture points reflect this landscape analogy. On the main acupuncture channels, for example, we have five transporting points. They begin at the fingers and toes and finish at the elbows and knees. So, beginning at the tip of the finger or toe, they are called the “jing-well”, the “ying” (spring), the “shu” (stream) , the “jing-river”, and the “he” (sea) points. At the well point the flow of Qi is narrow: at the spring point the flow is larger and has more direction. At the stream point the flow has more depth and more width. The river is wider and deeper yet, and the sea points are the widest and deepest. The sea point is also where the Qi travels deep into the body and connects with the internal organs.
Just as the kind of needle and the number of points used in acupuncture have evolved and developed across time, has the understanding of meridians changed too?
Over millennia, the archetypal acupuncture meridian concept has developed into the very sophisticated multi-layered models we see today. For example there are many different needling methods besides those to clear blockages in meridians.
So, depending on the diagnosis, the site of insertion, the depth of insertion, the direction of needling and various other needling techniques will allow us to increase or reduce the flow of Qi in a meridian or transfer Qi from one meridian to another in order, at the end of the day, to rectify and rebalance the flow of Qi and bring about healing in the mind-body-spirit continuum.
There are many acupuncture meridians or channels. As far as I’m aware, the majority of acupuncture schools today only teach the Twelve Main (six yin and six yang) Meridians and the Eight Extraordinary Meridians. But a number of schools, especially those that teach from a more Classical Chinese Medicine perspective also teach the Divergent Meridians, the Sinew Meridians and the Luo Meridians.
It’s interesting that the idea of movement and flow is so closely linked to healing in Chinese medicine. In our Qi Gong class we’re sometimes invited to visualise the path our breath takes as it travels through our body. Can this kind of visualisation be used to help a particular healing process – or would this be exploiting what Western medicine would call psychosomatic connections, or the link between body and mind?
Well first of all, Arminta, we need to take a closer look at the term “psychosomatic”. In Western medicine there is a lack of consensus with regard to the meaning of this term. Numerous definitions have been advanced since the word “psychosomatic” was used at the beginning of the 19th century – I think it was around 1818 – by the German psychiatrist Johann Christian August Heinroth. Incidentally, Johann believed that the soul had primacy over the body, that the body and soul interacted in several ways, and that consequently, mental illnesses and many physical illnesses are caused by the soul.
But I digress. Medical dictionaries can often give narrow definitions of the term psychosomatic, such as “disorders in which physical symptoms are influenced by psychological factors”, or “a branch of medicine concerned with the mind-body relations”, and so on. The problem with these definitions is that they imply a dualism – although writers in this field usually affirm their anti-dualistic position and tend to stress some form of monism by arguing that the mind and body are one, or are merely separate aspects of an individual. They say that the word psychosomatic may be referred to as the “holistic” one, in the sense that it presupposes the inseparability of mind and body as well as their mutual dependence.
So here again, we need to be aware of inexact definitions, as well as those philosophical differences between Western and Chinese medical perspectives which we’ve already discussed.
When I taught psychiatry about 40 years ago, I used to emphasise to my nursing students that the term “psychosomatic” refers to a holistic healthcare perspective. This sees the individual as a bio-psychosocial being which receives, stores, processes, creates and imparts information – and gives meaning to it which, in turn, gives rise to emotional responses. These emotional responses may affect all bodily functions in both health and disease.
Of course the causes of disease are usually multifactorial. However, the relative weight of each causative factor varies from disease to disease and from person to person. So from this point of view, optimal holistic patient care requires that all of these factors be applied in clinical practice. This is obviously a wider perspective on the original use of this term. Later on, specialities such as psycho-neuro-endocrinology and psycho-neuro-immunology developed from the “psychosomatic” domain. A classical Chinese medicine perspective based on Daoist philosophy would agree with this, but would include the spiritual domain as well.
I see it as a natural manifestation of the mind/body/spirit continuum. As you probably know there are Qi Gong hospitals in China which specialise in treating cancer.
So to get back to your specific question … yes! The visualisation which you do in your Qi Gong practices engages the healing process and what Western medicine may refer to as the psychosomatic connections. I see it as a natural manifestation of the mind/body/spirit continuum. As you probably know there are Qi Gong hospitals in China which specialise in treating cancer.
I didn’t know that. Treating cancer with Qi Gong? What’s the thinking behind that?
It’s difficult to give a brief answer to this question. First of all, it is generally recognised that Qi Gong is beneficial to our health and can be used in the prevention of disease. However there is a growing interest in the efficacy of Qi Gong in the treatment of specific diseases, including cancer.
Various human and animal studies have affirmed the positive anti-cancer effect of various forms of Qi Gong such as Guo-Lin and Five-Element Qi Gong. Studies have shown that the positive effects of Qi Gong in the treatment of cancer include an improvement in patients’ DNA repair rate, an increase in Haemoglobin, White Blood Cell and Red Blood Cell counts, an increase in Immunoglobulin levels, (IgG, IgA and IgM) and Natural Killer Cells, a lower or inhibited cancer cell growth and metastatic rate – that is, the rate by which cancer spreads to other parts of the body – and an increase in survival rates. Some studies also showed a rise in the level of L-Lymphocytes. All of these changes, of course, reflect an improvement in immune function.
Bear in mind that most cancer patients experience some degree of immune deficiency, which makes it possible for cancer cells to survive and outlive normal cells in the first place. And of course chemotherapy/radiotherapy treatments tend to further damage or destroy the patient’s immune function – which, in turn, reduces the patient’s overall capacity for healing. So you can see the benefits to patients of including Qi Gong therapy as part of their overall treatment strategy.
Another interesting point to make is that Qi Gong also improves the patient’s micro-circulation: that is, the blood circulation between micro-arteries and micro-veins. It changes the viscosity of the blood, increases the elasticity of blood vessels and controls the concentration of platelets in the blood. The advantage of this is that it increases blood flow and the number of micro blood vessels, which in turn increases the oxygen, and blood supply to the cells and tissues and it strengthens the patient’s metabolism. From a Western medicine perspective it consequently maximises the efficacy of chemotherapy.
Sounds like a way for patients to take control of their own healing regime – and a very benign, non-invasive way at that.
From the patient’s point of view Qi Gong is relatively easy to do, as it involves gentle movements which give the body a chance to exercise the lymphatic system and increase oxygen consumption due to greater focus on the breathing.
This is, of course, aerobic activity without the stress on the heart that is commonly found in other exercise regimes, which tend to be very vigorous and would not be conducive to someone who is already weak with cancer. It also involves guided meditation, which has been shown, in other studies, to improve the healing process in a wide variety of illnesses.
In conclusion we can say that many studies over the past 30 years have shown that Qi Gong’s curative effect on cancer is more than a psychological or placebo effect. The research has consistently demonstrated Qi Gong’s inhibitory effect on cancer growth and metastasis in both animal and human studies. It may prevent or stop the growth of cancer and indeed enable patients’ recovery from many other diseases as well.
Do you personally treat patients with cancer? If so, which modality or modalities of Chinese medicine do you prefer to use?
This is really a very large area. As you know, cancer is not one disease but over 300 different malignancies each with its own unique histology, patho-physiology and clinical behaviour. Basically I adapt a multi-modalities approach based on what is appropriate for the particular patient. Much depends on the aetiology, type, and stage of the cancer, the Chinese medicine diagnosis, on the degree of strength and vitality of the patient, and on the patient’s willingness to “change”.
So, for example, if the patient were very weak and malnourished the treatment strategy would be to promote remission (latency) and build up his/her strength and vitality. If the patient is stronger the strategy would be to promote clearing, detoxification, and if possible elimination of the cancer.
Nothing is absolute and one must be flexible in applying what is sensible for the patient. Remember everyone is different and cancer does not need or require a “specific” treatment. I generally use a combination of acupuncture, Chinese herbal medicine and nutritional and lifestyle advice.
So, once again, we’re talking about a rounded, holistic approach but also one which is practical and tailored to the individual?
For patients who are undergoing chemotherapy, radiotherapy and other biomedical treatments, acupuncture and Chinese medicine can help reduce the severe side effects of these treatments such as severe nausea and vomiting. It also benefits the immune system, which biomedicine treatment often overwhelms, and aids in tumour reduction itself – thereby reducing the length of time the patients needs to receive chemotherapy or radiotherapy.
I invite the patient to focus more on the healing process rather than the disease process, and suggest that the consciousness and lifestyle that, in some ways, contributed to the disease process – in this case cancer – can’t be the same consciousness and lifestyle that brings about the healing process. So, crucially, an invitation to change lies at the heart of the treatment strategy.
Ah, yes. But Paul, making major changes in our lives – and, perhaps more especially, in our thought processes – is something which many of us find difficult. If not impossible! Have you any suggestions as to where we might start?
As part of the change process I would gently encourage my patients to view a set of DVDs based on the public lectures which the world-renowned Daoist Master and Priest, Jeffrey Yuen, gives on his regular teaching visits to Dublin. Topics include “The Healing Process”, “Dealing with Emotional Issues”, “Empowering the Self to Confront Illness” , “All Diseases are Rooted in the (Shen) Spirit”, and “The Six Healing Sounds” and many more.
Yes. And while we’ve been discussing some very serious topics here – and rightly so – what’s striking about Jeffrey’s approach, apart from the incredible breadth and range of his knowledge and experience, is his unfailing emphasis on humour, humanity and spontaneity.
Absolutely. I remember Jeffrey saying, ahead of another of his Dublin talks, “A Heart-Centred Approach to Wellness”, that his themes would include “gratitude and reverence … joy and laughter and fun”. He added that “every day is an opportunity for us to experience something new. To do something new with our lives”.
Well, we’ve run out of time but that’s an inspiring and enlightened point at which to conclude our interview for today, Paul! Thank you for your insights into the topics of acupuncture, Chinese medicine and Daoist philosophy.
Arminta Wallace (2015)
Irish Times Journalist.
Please click the following link if you prefer to read (and print) this article in PDF format (opens in a new tab) Obtaining and Maintaining Wellness and Optimal Immune Health during the current COVID-19 Pandemic / Feardemic Paul McCarthy Academy…
Jeffrey, once again we are really happy that you are coming to talk to the Dublin community: not just to your acupuncture students, but to everyone who is interested in exploring a Daoist approach to healing and wellness. Even so, many people may be surprised by the topic you’ve chosen for this year’s lecture: Shamanism and the Early Roots of Daoism. This might appear to be something of a departure for you – but actually it follows on from a one-year shamanism programme which you’ve been teaching in New York this year.