Accumulation/Depletion Syndrome:
The Energetic Root Of Stress And Burnout
Michael T. Greenwood, MB (MD)

ABSTRACT
The idea that acupuncturists might take on pathogenic energies from their patients may initially seem preposterous. Yet many practitioners will confirm that accumulation occurs and that it can lead gradually to stress and burnout. This article explores the phenomenon of patient-to-physician energy transfers and suggests strategies for proactive management.
KEY WORDS
Acupuncture, Biomagnetic Field, Energy Transfers, Meditation, Heart Centering, Qi Gong

INTRODUCTION
Many acupuncture practitioners are aware that the state of their own energy field can have a profound influence on their patients. Indeed, articles on this subject are appearing increasingly in the literature.¹

Perhaps less acknowledged is the influence a patient's field might have on the practitioner. We may find that we are somehow "taking on" something from our patients, or that we are mysteriously losing energy and feeling "drained." Concerns and comments about such experiences have appeared in the literature and online exchanges. In the words of Yogananda:

All actions, both positive and negative, create vibrations in the ether. These vibrations are everywhere present. When you are in the environment of these vibrations, they pass through your body, just like radio waves. If you live or associate with people who are doing wrong, you will feel the magnetic vibration of their wrongdoing, no matter how you try to avoid it.²

Compare the above to a passage from the Nei Jing:

...External evil attacks the skin to open the spaces and textures and lodge in the collateral. Having filled the collateral, the evil pours into the main channel; when the main channel is filled, the evil attacks the Fu and Zang.³

No doubt the writer of this passage was referring to the source of evil Qi as being some factor like Cold or Wind rather than patients, but there is no reason why pathogenic Qi (External Evil) could not come from anywhere in the energy field. Patients, often quite sick ones, exhibit a constant field presence around practitioners.

One way to think of this phenomenon is that it represents an energetic equivalent of the Madame Curie effect (after the researcher who accumulated radiation sickness from overexposure to uranium). While field effects from radioactivity are well recognized, physicians may be less aware of the impact of biomagnetic energy fields and practice  acupuncture without noting the issue. The subject is rarely mentioned in acupuncture circles. Accumulation of unwanted energies is a well-accepted phenomenon in other energy disciplines. For example, Pranic Healing practitioners are taught awareness of the accumulation of diseased bioplasmic matter.⁴ Therefore, acupuncture practitioners should familiarize themselves with the issue.

THE BIOMAGNETIC FIELD
The body's biomagnetic field is an infinitely complex informational interference pattern of waves and troughs, rather like the wave patterns on the surface of the ocean.^{5 I}n contrast to the material structures, fields are not restricted to physical confines, but rather stretch out indefinitely into the surrounding space. Similarly, the body's energy field is not restricted to the body but extends outward into space, a fact that has been confirmed by the superconducting interference device. Certainly, the intensity of the field falls off quite rapidly, so the bulk of the field lies close to the body, but the field itself is theoretically infinite.

Field Levels in Different Traditions

Figure 1. The Energy Field

Esoteric literature refers to several levels of the body's energy field, each one getting increasingly rarefied or subtle (Figure 1). The more rarefied the field, the more it extends out into space. At the most rarefied causal level, which might be called the "subtlest of the subtle," the field theoretically extends to infinity. Table 1 lists the energy field levels according to different traditions: Western Esoteric, Ayurveda, and Oriental Medicine. Although differences of opinion exist, there does seem to be some broad agreement across the traditions.

Level 1, the corporeal or physical body, is where conventional medicine focuses most attention. Level 2, the etheric or energy body, is an energetic double of the physical body that extends out a few inches from the surface of the body and probably corresponds to the acupuncture meridians and the Zhen Qi.⁶ Level 3 is an intermediate protective layer, a "health aura," that probably corresponds to the Wei Qi.4 Level 4, sometimes called the Astral Body, is a more rarefied energy body that interpenetrates the physical and etheric planes and extends out several feet from the body. Clairvoyants call it the aura; modern science calls it the biomagnetic field. It has been described as a cocoon-like oval of colored light that is responsive to desires and emotions.⁷ While the oval shape and subtlety of this level is reminiscent of the Extra Meridians of Oriental medicine, the emotional sensitivity of the aura suggests an association with the primary Five-Element constitutional type. Both views are probably useful; either way, the Yuan Qi is clearly involved. Level 5, the mental or noetic level, is the realm of thoughts and ideas and likely corresponds to the Oriental medicine concept of Heart-Yang. Level 6 is the subtle level, the soul or Attman, and likely corresponds to the Oriental medicine concept of Heart-Yin.⁸ Finally, Level 7 is the causal level, alternatively known as Brahman, Absolute Spirit, Sat-Chit-Ananda, or the Tao.⁹

Table 1. Field Levels
Level	Western Esoteric	Alternate Nomenclatur e	Ayurveda	Oriental Medicine
1	Material	Corporeal	Ana-Maya-Kosha	Body, Zang, and Fu
2	Etheric	Inner Aura	Prana-Maya-Kosha	Zhen Qi (Channel Qi) Channels and  Collaterals
3	Protective	Health Rays		Wei Qi (Defensive Qi)
4	Astral	Outer Aura	Mano-Maya-Kosha	Yuan Qi (Original Qi) Extra Meridians
5	Noetic	Mental	Bhuti-Maya-Kosha	Heart-Yang
6	Subtle	Atman/Soul	Ananda-Maya-Kosha	Heart-Yin
7	Causal	Brahman/God	Sat-Chit-Ananda	Tao

Table 2. Internal Dragons/External Dragons
	Internal Dragons		External Dragons
CV 14.5 (15)	Jiuwei	Wild Pigeon's Tail	GV 20	BaiHui	Hundred Meetings
ST 25	Tianshu	Heaven's axis	BL 10	Tianchu	Heaven's Pillar
ST 32	Futu	Hidden Rabbit	BL 23	Shenshu	Kidney's hollow
ST 41	Jiexi	Release Stream	BL 61	Pushen	Serve and Consult

Energy Transfer Phenomena
Virtually all hands-on disciplines in some way incorporate the idea of facilitating person-to-person energy transfer, whether they are Qi Gong, acupressure, therapeutic touch, Reiki, Pranic Healing, or any other interactional technique. Moreover, studies of healers from a variety of traditions have shown pulsed biomagnetic fields emanating from their hands, with frequencies ranging from 0.3-30 Hz and intensities running hundreds of times stronger than the body's regular field strength.¹⁰ Other studies have shown that Qi Gong masters can project heat or infrared radiation from their hands.¹¹ These studies demonstrate that energy transfers are implicit in the therapeutic relationship and that healers have the ability to augment the intensity of their own field through special techniques. Field effects are by their very nature bidirectional so that in any interaction, an exchange takes place. Awareness of the exchange may differ, the amount and quality of transfer may vary, but the very existence of such phenomena can no longer be seriously questioned.

ACUPUNCTURE
Acupuncture is a field-based intervention that mobilizes the flow of energy, influencing the field at all levels. Although needles are placed into the physical body, their influence is primarily intended to be on the Qi (levels 2, 3, 4). Heart-Yin and Heart-Yang are not beyond the influence of acupuncture, although perhaps more the purview of the hidden traditions and Five Elements.¹² Finally, the non-dual Tao forms the basis of acupuncture philosophy.

Mobilization of the patient's stagnant Qi with acupuncture creates impulses in the patient's field, which reverberate outward into the surrounding area. When patients are ill, the mobilized Qi is not likely to be a coherent biomagnetic pulse, but rather an energetic or vibrational expression of the patient's symptoms, i.e., pathogenic Qi.

Energy transfers occur on many levels. The more immediately apparent effects will be at the more superficial levels of the Zhen and Wei Qi, but there can be effects at the constitutional (Yuan Qi) level and ramifications can even penetrate as far as Heart-Yang and Heart-Yin. A practitioner may see several people a day for many years; over time, the potential energy accumulation can be significant. Yet effects can be noticed within a surprisingly short time, sometimes even after a single session.

The Impact of "Intention"
Ideally, patients' intent should be directed toward symptom integration, which means they should be learning to experientially transform/transmute, rather than remove/eradicate their pathogenic Qi. However, patients rarely have such intent when they first present to a physician because their primary desire is to somehow eliminate their symptoms. This means that generally, patients want to transfer their symptoms to whoever they believe might be willing to take them on, such as a medical practitioner. It is often an openly stated intent which, in turn, is a reflection of the various psychosomatic splits peculiar to their ego-illness gestalt; particularly the mind-body and persona-shadow splits.^13,14 Furthermore, a basic principle of energy medicine is that energy follows intent, so that the flow of Qi between the people involved in a patient-practitioner dyad is an expression of the underlying intent of the relationship.¹⁵

Intent to eliminate symptoms, especially if accepted and supported by the practitioner, may inadvertently provide a context that facilitates the transfer of pathologic Qi from patient to practitioner. In such an environment, the degree of symptom relief achieved during a particular treatment session - being a measure of the extent to which a patient's pathogenic Qi has been mobilized - may be the same extent to which the practitioner may have accumulated a pathologic energy transfer.

Not all patient-physician energy transfer effects are negative. We are all familiar with interactions that leave us feeling energized; for example, when a profound insight is realized or when we receive a heartfelt acknowledgement. Such experiences pose no problem. It is the narcissistic, demanding, or time-consuming patient who is more of a concern; and it is the consultation that leaves a "hangover" that may have delivered a pathogenic impact.

One difficulty with transfer phenomena is that it may be the most empathetic practitioners who are also the most vulnerable because their compassionate desire to relieve symptoms may subtly frame intent to take on their patients' energy. Medical training often promotes such empathetic traits (through patient-centered interview techniques, open-ended inquiry, active listening, etc), generally without simultaneously explaining energy principles or providing students with practical energy management tools.

High-Intensity Waves
Oschman talks about tsunami-type waves, or solitons, that arise spontaneously.¹⁶ These coherent, solitary waves are of similar strength as the biomagnetic pulses coming from the hands of healers. They can be felt by almost anyone, without any specific insight or meditational training, often as tingling, temperature changes (heat or cold), mental imagery, feelings, or horripilations.

Perhaps more interesting is the possibility that such high-intensity waves can coincide with mental insight, intuition, or other significant inner experience, signaling a shift from one energy level to another such as from Mind (Heart-Yang) to Heart (Heart-Yin). In such a shift, the sudden collapse from mental dynamism (Yang) to silence (Yin) may be what triggers the release of the high-intensity waveform.

High-intensity waves can also occur with depossession phenomena; for example, when the points for the 7 Internal or External Dragons are used (Table 2). The intent behind the use of the Dragons is to remove any high-intensity energies that may be clouding a patient's spirit, whether those energies were acquired internally through the impact of toxic emotions (Internal Dragons) or externally through some trauma such as a motor-vehicle collision (External Dragons).

Energy Stealing
Yet another curious concept, written about in the popular book The Celestine Prophecy, might be called energy stealing;¹⁷ when people try to project or give away unwanted energy, they usually have an associated strategy to reclaim energy they deem desirable in return.

Such a hidden strategy is commonly encountered in medical practice. Such a strategy forms the energetic basis of many chronic ailments and can expend the practitioner, who may not realize how much his/her energy is being appropriated.¹⁸

Symptoms
Symptoms can be classified according to the usual Oriental medicine principles, with its various combinations of excess or deficiency (Table 3). Excess occurs as a direct result of accumulation of pathogenic Qi, which can clog the channels and collaterals, give rise to stagnation and obstruction, and/or damage the Wei Qi. In esoteric literature, clairvoyants describe seeing such pathogenic Qi as "aka" cords, dense sticky energetic strands of energy that emanate from the etheric body, literally weighing an individual down.⁴ Over time, the accumulation, heaviness, and tethering can become sufficiently onerous for a secondary deficiency to arise. Concurrently, a primary energy deficiency can develop through repeated exposure to the energy-stealing phenomenon.

Table 3. Accumulation/Depletion Syndromes
Field Level	Excess	Deficiency
Etheric (Zhen) Qi	Myalgias, tendonitis, aching in hips and below the waist, back pain, headaches, ankle swelling or edema, epigastric tension	Fatigue, exhaustion, pain, weak digestion, diarrhea, backache, dizziness, blurred vision, palpitations
Protective (Wei) Qi		Frequent infections, coughs, colds
Astral  (Yuan) Qi	Constitutional off balance according to elemental typology, e.g., Wood = irritability	Constitutional deficiency, rapid aging, degenerative or neurological disease
Noetic (Heart-Yang)	Anxiety, insomnia, mental fogginess, obsessive-compul sive states	Confusion, poor concentration, indecisiveness, forgetfulness
Subtle (Heart-Yin)	Manic-depression, psychosis	Anxiety/depression, loss of Spirit

Symptoms of excess can include headaches, heaviness, swelling, epigastric tension, back pain, irritability, and achy/stiff muscles. Overuse syndromes and tendonitis are common. For example, repeated muscle testing can lead to a stubborn epicondylitis. Similarly, those who use their hands doing massage, acupressure, or Reiki may notice aching in the joints of the fingers, wrists, and elbows. One common accumulation syndrome involves an aching and heaviness in the pelvic girdle, hips, and legs as Damp energies build up from the floor, leaving a practitioner literally wading in pathogenic Qi. Excess mental activity might manifest as anxiety, insomnia, mental fogginess, obsessive/compulsive behaviors, and cynicism about practicing medicine. A misted heart could present as manic-depression or psychosis.

Symptoms of deficiency include the obvious ones of fatigue and exhaustion. Specific deficiencies might include poor digestion and loose stools from Spleen deficiency; frequent infections, coughs, and colds from Lung deficiency and/or weakened Wei Qi; palpitations from Heart deficiency; back pain from Kidney deficiency; or dizziness and blurred vision from Blood deficiency. A deficiency at the mental level might manifest as confusion, indecisiveness, poor concentration, and forgetfulness. Penetration to the subtle level might present as anxiety, depression, and loss of spirit. More long-term deficiencies will gradually deplete the Jing, leading to accelerated aging or even degenerative and neurological conditions.

Many of these symptoms are often attributed to "stress." But from an energy perspective, stress and burnout are simply the generally accepted labels for what might better be understood as the consequence of accumulating pathogenic Qi, meaning that there might be more creative management options than taking a forced holiday or in the extreme situation, quitting work altogether.

Management Strategies
The Objective Strategy
This consists of shoring up the ego's boundaries and making them less penetrable by outside energies. One method of accomplishing this is by maintaining objectivity, keeping an emotional distance, and hiding personal vulnerability. Such a defense works well and is the primary tool used in conventional practice. Since objectivity is the industry standard, this strategy is generally performed unconsciously and often justified as good professional behavior. Nonetheless, it remains an energy strategy, one in which the practitioner's intent is firmly set on turning away all potential energy transfers, i.e., the practitioner intends defense through objectivity and detachment. But when it comes to acupuncture, there can be a price to pay if excessive detachment leans toward emotional coldness. Without the connection afforded by an open energetic exchange, intuition may become compromised and acupuncture reduced to a technical procedure.¹⁹

The Subjective Strategy
The subjective strategy involves cultivating a deliberately increasing transparency to the flow of energy in and around the body; after all, nothing can get stuck if there is nothing for anything to stick to.

Once again in the words of Yogananda:

...When you are calm, irritating vibrations cannot disturb you. They get at you when you are cranky and nervous, but the minute you become calm and strong in mind again, they cannot touch you.²

Qi Gong
One difficulty is that increased transparency rarely comes naturally and usually requires cultivation through meditation practice. Centuries ago in China, the ancient Taoist masters discovered ways of maintaining good health through the practices that have given rise to the modern arts of acupuncture, Qi Gong, Tai Qi, and herbal medicine.²⁰ Qi Gong is a whole discipline in itself with a large body of literature behind it.²¹ Taken as a whole, one could understand the various postures and movements of Qi Gong as ways of achieving a quiet focused mind, opening the Heart center, building personal Qi through activating the Ming Men, moving stagnant Qi, and developing extraordinary powers (Siddhis) such as the ability to "see" acupuncture points and the ability to direct Qi externally.²² Written material is no substitute for actual experience but for the purposes of this article, I briefly discuss 2 practices I have found helpful. The first (Heart Centering) involves developing a new expanded center of awareness from where to engage patients in the acupuncture ritual. The second (dynamic meditation) involves developing the skill of moving accumulating energy so that it does not clog up the channels.

Heart Centering
Regular meditation leads increasingly to a tranquil Shen.²³ It gradually settles an agitated mind into the Heart center and facilitates awareness of the minute currents of energy in the body. Furthermore, because the Heart-centered state is associated with a coupling or entrainment of a variety of biological rhythms, an internal energetic coherence develops that can spread out and have a noticeable effect on patients.²⁴ It is this centered and coherent state that forms the basis of the high-intensity biomagnetic pulses emanating from the hands of healers. Those who cultivate a Heart-centered state will often find that their presence becomes a more potent healing factor than any specific point protocol they might use.

A specific meditational practice designed to cultivate the ability to transmute pathogenic Qi can be found in the Buddhist practice of tonglen, meaning "taking and sending," in which the practitioner intentionally takes external negativity which might be illness, suffering, or something else-into the Heart center and breathes out love and compassion.²⁵ However, because acupuncture practitioners are continually taking in their patients' energies, they need only activate the second half of the exercise to complete the practice. By attending to Heart centering, the practitioner simply recognizes what is already there and gives it space to move or change. In this way, he/she develops the dual skills of not holding on to and transmuting pathogenic Qi with compassionate presence.

Dynamic Meditation
Dynamic meditation allows the practitioner to let accumulated or stagnant energies move and integrate with the overall energy circulation. Performed in conjunction with Heart centering, the combination of activity and silence forms an energetic Yin-Yang pair that allows the practitioner to become a conduit for the flow of Yuan Qi. Dynamic meditation can be facilitated by simple intention introduced during regular meditational practice. Nothing needs to change except that the meditator sets up a prior intent to allow spontaneous physical or emotional movement while in a Heart-centered state and then witness any arising phenomena without interference.

An Integrated Strategy
Practitioners should have access to both objective and subjective strategies and be able to use either as they see fit in their appropriate time and place. Every situation is unique. There are times when the objective strategy is called for and times when the subjective strategy might be more appropriate. The astute practitioner should not drop his/her guard prematurely nor maintain an objective stance beyond its usefulness.

In Oriental medicine, an integrated strategy involves the creative use of Wood energies to maintain a balance between what we want to radiate out (Fire) and what we want to allow in (Metal) to our energetic space.26 In time, the opening and closing of the Heart's gates, represented symbolically by PC 6 (Neiguan) and TH 5 (Waiguan), becomes spontaneous and appropriate to every situation.

Specific Strategies

• Clean the treatment room energetically. May be accomplished through opening the windows and letting fresh air in, stagnant air out. More specific techniques might include smudging, candle or incense burning, background music or mantras, and Reiki. (Some of these may not be appropriate in a physician's office.)
• Cleanse with water. Wash hands between patients, or shower after a particularly difficult session. A vase of water can be kept in the treatment room to absorb pathogenic energy and should be changed regularly. Salt water is particularly cleansing and can be kept in a spray bottle to clean and sensitize the hands between clients. Salted baths or ocean swimming where available can be an effective adjunct.
• Exercise. Being physically fit and healthy does not have to involve extreme measures and can be as little as a 20- to 30-minute daily walk.
• Meditate. Moving meditations such as "spontaneous dynamic," Yoga, Tai Qi, Qi Gong, and quiet meditations that provide Heart centering are all useful. Practitioners should try a variety of disciplines and find what works best for them.
• Percussion. Areas of the body that have accumulated pathogenic energy may feel stiff, achy, or heavy. It is helpful to go over these areas with fairly rigorous cupped-hand percussion. This can be done prior to exercise or as an adjunct to meditation. Percussion frees up stuck energy and dislodges aka cords and thus, helps to mobilize the stagnant Qi.
• Ear acupuncture. Scanning and treating the ear with a microcurrent stimulator can be a quick way to access dynamic activity and mobilize accumulated energy. Deeper breathing during stimulation of painful points facilitates dynamism by activating the Zong (Chest) Qi.

CASE HISTORIES
Post-Injury Back Pain
A 35-year-old man had low back pain following a car crash. During acupuncture (which included the External Dragons), his body kept want-ing to go into the position of the crash. During one session, I enabled the patient to relive the crash while he regressed through the experience. There was vigorous vibration in both his legs which I could feel vibrating into my feet and spine. After that session, I experienced back pain for 3 days.

Post-Injury Headaches
A 45-year-old woman with a Wood constitution had a car crash 5 years previously in which she fractured her left femur. Although surgical stabilization was successful, postoperatively, she complained of severe headaches, became uncharacteristically belligerent and demanding, and began overusing narcotics. At presentation, she was self-injecting meperidine, 100 mg, up to 10 vials per day.

Acupuncture included the internal Dragons and harmonization of the Jue Yin-Shao Yang axis with points LV 3, GB 40, ST 36, LI 4, KI 6, and GB 20. After a heated exchange regarding the patient's addictive behavior, I subsequently experienced agitation and during sleep, strange phenomena. The next day the patient told me she had decided to stop all narcotics. She experienced no adverse effects or withdrawal phenomena.

Back Pain and Parotid Tumor
A 55-year-old woman with a previously excised malignant parotid tumor presented with back and right foot pain not attributable to metastatic disease. Of a Metal constitutional type, the patient admitted to great difficulty letting go because it reminded her of impending doom. After initially focusing on the Tai-Yang pathways, I later switched to a more constitutional treatment including but not limited to LU 9 (Deep Abyss). During one session, the patient's breathing calmed down and she went into complete breath suspension for a couple of minutes. Then I felt a distinct horripilation. Later, when she returned to rational consciousness, the back pain was gone.

CONCLUSION
Pathogenic energy accumulation of one kind or another is perhaps an inevitable sequela of acupuncture practice. Though often classified under the broad rubric of stress, the phenomenon can also provide practitioners with an opportunity to awaken a deeper understanding of energy dynamics and even learn how to take advantage of such phenomena to boost the strength of their own Qi. By paying close attention to the direct experience of accumulating energy, the physician may gradually master techniques designed to keep the body energetically clean which will keep him/her healthier and less liable to burnout.

Beyond better health and well-being, there are other rewards of a more profound nature. As personal transparency increases, practitioners may find the extraordinary becoming ordinary, and the apparently miraculous occurring daily. They may experience the simple power of presence which can manifest itself through the acupuncture ritual as synchronistic events, insights, solitons, regressions, spontaneous remissions, and various other transpersonal phenomena.

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AUTHOR INFORMATION
Dr Michael Greenwood is Medical Director of the Victoria Pain Clinic, a residential facility in Victoria, British Columbia, Canada. Dr Greenwood specializes in chronic pain/chronic illness patients, developing techniques integrating the body, mind, and spirit.

Michael T. Greenwood, MB (MD), BChir, FCFP, CAFCI, DABMA, FAAMA, FRSA*
Victoria Pain Clinic
103-284 Helmcken Rd
Victoria, BC, Canada V9B 1T2
Phone: 250-595-1496
Fax: 250-727-7358
E-mail: michaeltgreenwood@shaw.ca

*Correspondence and reprint requests

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