34. Giving advice to patients

I recently received an email from a Chinese acupuncturist asking how she can improve the skills needed to help her patients cope with their problems. She writes, “How to interact with our patients is very subtle and skilful, and a very challenging task for us practitioners.  I really wish I could do better on this, but I don’t know how I could improve… (Their) problems are so tricky that I always have no suggestion to give.  I even sometimes don’t know how to comfort them when they are sad.  I wish I could say something to make them feel better!”

I am sure that every practitioner can relate to what she says, for these are issues we have all struggled with in our practices, and no doubt continue to struggle with.  There is no one approach that will suit all practitioners, because we will each have worked out our own way of dealing with our patients.  As with everything we do, our own guardian element will shape our interactions with our patients and determine the nature of these interactions.  Some practitioners will be much more hands-on in their approach than others (perhaps those with Fire as their element), whilst others will be much less so, giving their patients more room to breathe as it were (perhaps those with Metal as their element).  No particular approach is better than any other, provided that the practitioner is aware at all times of how far what they are doing and saying matches their patient’s needs.

Of course this is where experience comes to our aid.  If I think back on the years of my practice, I realise that there were many occasions when my own very hands-on approach disturbed some of my patients, where allowing a little more space between us would have given them the time they needed to work out their own solutions to their problems.  As with any profession, we can only learn by hit-and-miss, and only experience will teach us how much advice it is helpful to give our patients, and what kind of advice this should be.   We always have to be careful not to assume anything about our patients.

Finally, it is helpful to remember that we are not there to solve our patients’ problems;  only they can do that.  Our help must focus on offering treatments which bring greater balance to their elements, and then allow these to do the work.

 

 

 

33. Unravelling the puzzle of point locations a little

For many years I was completely unaware of the fact that different branches of acupuncture used anatomical locations for some of their points which differed from the ones I had been taught.  The first five or more years of my practice were spent in a complete five element bubble, since at that time JR Worsley’s college at Leamington was the largest college, and many of us who trained there were completely unaware of the existence of other schools of acupuncture.  I know I certainly was, until rumours started to spread around the acupuncture community that acupuncturists who had visited China were bringing back with them another form of acupuncture which appeared not so much to complement what we had learned, but to cast doubt in the minds of some five element acupuncturists about the validity of what they were practising.  This was first brought home to me when standing in a lunch queue at an acupuncture event and being told by a fellow acupuncturist, with some disdain in her voice, “JR has a very odd way with moxibustion”, followed by, “You don’t still only do five element acupuncture, do you?”

I always find it interesting when I observe how often people are only too happy to grab hold of anything which might seem to undermine some practice or concept which holds a dominant position, almost as though they cannot wait to mock what before they expressed admiration for, or indeed, as in the case of many five element acupuncturists, actually used for years in their practice.  This happens all too often, particularly where somebody has been pre-eminent in one discipline.  Perhaps it is then only natural that those sheltering in the shadow of such a person may start to feel increasingly disempowered, and look for ways of asserting their own independence of thought.  This happened most famously with Carl Jung’s abandonment of his admiration for his mentor, Sigmund Freud, and the same thing happened in this country when JR Worsley’s legacy to acupuncture started being mocked in the way I encountered.

In a very short space of time this was followed by a growing onslaught by the acupuncture world in general on the right of five element acupuncture to be considered as a stand-alone discipline.  I have written a lot about the difficulties I, as a devoted five element acupuncturist, have encountered in defence of my practice over the years, but in this blog I want to look at how influences from China have apparently changed this country’s approach to the location of certain points, and how far this is still something five element acupuncture needs to take into account.

The subtle undermining of an accepted five element tradition extended also to the area of point location, where people started discussing whether the five element locations used, based on a long-established tradition going back through to JR Worsley’s teachers, Jacques Lavier and We Wei Ping, came up against the locations modern Chinese acupuncture was now deciding for us, and which have come to replace those in many British acupuncture colleges.  I am certain no historian of acupuncture, nor have I, any way of knowing whether the point locations which have gradually superseded some of those used in five element acupuncture have clinical validity or not.  And this is the only factor in the debate about different point locations which I feel needs to be taken into account.  If I needle a point in my well-practised five element location will a point at a slightly different location used in modern Chinese acupuncture, and following hard on its heels, modern British acupuncture, have the same clinical effect?

We sometimes think that acupuncture does not lend itself to “evidence-based research” in quite the same way as scientifically-based therapies, because it does not seem possible in a holistic discipline such as ours, and similarly in any of the different forms of psychotherapy, to obtain sufficient objective evidence of the efficacy of any clinical procedure which cannot be measured by some physical instrument.  But I think my many years of practice have provided me with just as much evidence that the points I use in treatment have actually brought about material changes in my patients, and ones which are perceptible to others, provided that their senses are sufficiently honed to perceive sensory and emotional changes.

When a patient says, as one of my patients did, that “the treatment you gave me a few days ago really made me feel I could face life again,” is that not evidence of the efficacy of the particular treatment, made possible by needling specific acupuncture points?  The problem is that a reader of this blog only has my word for this, and if I were to invite observers into my practice room during the treatment, might the presence of unfamiliar faces affect the patient’s response to the treatment, and perhaps nullify it?  I do, though, have what I like to call one objective proof of the location of one of the disputed locations of an acupuncture point as a result of a moving encounter I had when consulting JR Worsley about one of my patients.

This point is the one on the Kidney meridian which in the five element point numbering is IV (Ki) 7.  As any five element acupuncturist knows, this is one of the first points in the combination of six points, needled bilaterally, used to clear one of the most serious energy blocks recognized in five element acupuncture, that of a Husband/Wife imbalance.  IV 7 is a tonification point, drawing energy from Water’s mother element, Metal, and in the five element location is at 3 ACI (cun) from the prominence of the medial malleolus.  We were taught to needle all six points before taking the pulses to see whether we had cleared the block, in effect checking whether the patient’s Heart energy - (I (Ht)7 is the last point in the procedure - was recovering sufficiently to combat the spiritual despair which is one of the main indicators of this block. 

 had taken a patient to see JR Worsley, and he had diagnosed a H/W block, leaving me to carry out the treatment.  As this was early on in my acupuncture career, it took me some time to mark up the points, particularly those on the Kidney meridian which require much careful measuring of the leg, so when JR returned I had only had time to needle the first two points, III (Bl) 67 and IV (Ki) 7.  Before I had told him that I had not completed the whole procedure, he took the pulses, nodded at me, and said, “That’s cleared.  Good.”  It was then that I realised that the re-establishment of a strong connection between the Metal and Water elements through the tonification points must have been sufficient to clear the block.  From then on I have always checked the pulses at this early stage in the procedure just to see if this often happens, which I find it does.  Each time, though, I go on to carry out the full procedure because I recognize that needling the remaining points strengthens the connection between the elements which a H/W imbalance shows has been weakened.

From this, and from my own experiences, corroborated by my years of clearing many H/W blocks, I know that the tonification point on the Kidney meridian is where we locate it in five element acupuncture, at 3 ACI (cun) from the level of the medial malleolus.  The Kidney source point, IV (Ki) 3, too, which also forms part of the H/W procedure, is at a different location from the more recently accepted location.  I therefore recommend any practitioner trying to clear a H/W block to adopt the five element anatomical location of these two points. I like to think that I am stepping in the footsteps of an acupuncture master in using the points exactly where he told us they were, and feel that something of the energy I felt passing from him through to the patients I brought to him for consultation is transferring itself a little to me as I needle the points where he told us to find them.

 

 

 

32. A meditation on the spirits of acupuncture points

(Article prompted by a request for me to write more about the spirit of points from Seán O’Neill of the College of Five Element Acupuncture (CoFEA) in Dublin, Ireland)

One of the conventions of five element acupuncture is that points are said to have their own “spirit”, a quality intrinsic to them which we can tap into when deciding which particular point to select.  According to this convention, a particular action is ascribed to a point. This is a nebulous, very vague term, and I have never felt that much thought has been given as to what it actually means.  Nor is there any consensus about how a point has acquired a particular description.  The assumption behind the term is that when we decide to use this point, we do so on the basis that we think the action traditionally ascribed to this point is one that we feel our patient needs.

 

This raises the question as to when and by whom the qualities were ascribed to individual points.  In my case, I was fortunate to be part of one of the last cohorts of acupuncturists whose teacher was the great master of five element acupuncture, JR Worsley.  I would listen avidly in class when he would suggest particular points to be used for patients we would see in the college clinic, and write down what he told us.  I still have my notes taken at the time, which have acted since then as welcome signposts in the often bewildering landscape of the traditionally 365 or so points available for us to select from.

 

I remember one awesome day with JR during the Masters programme I completed with him (the last he was to take), when he took up his famous brown point reference chart which lists the names and functions of all the points, and read slowly through the list, from Heart 1 to Governor Vessel 28, spelling out the name of each point with love in his voice, as though these were his beloved friends.  About some points he said very little, about others, quite a lot, and this is when I realised that he had acquired some esoteric knowledge conveyed to him no doubt through his own acupuncture masters, but which I would never aspire to.  On the other hand, I have used my time as teacher to pass on my own understanding of the points I use to the students I have taught, based very much on what JR told us, but also on my own experiences.  And this is how the inheritance of a lineage moves on from generation to generation.

 

The problem I have with the term “the spirit of a point”  is that it can all too easily be assumed that a point can have a quality which is almost objectively established, much like that attributed to the action of a specific drug.  It does not take account of the individual practitioner’s understanding of why he/she feels this particular point should be selected for this treatment.  An objectively ascribed function of a point should be regarded as an alien concept to us five element acupuncturists, where each treatment we select is based upon our subjective evaluation of our patients’ needs, guided through the prism of our understanding of the elements and their officials.  Professor Liu Lihong in his book Classical Chinese Medicine emphasizes the contrast between the Western medical approach and that of traditional Chinese medicine by saying that “Western medicine is biased towards objectivity”, whereas Chinese medicine “places great emphasis on the subjective experience”. Each acupuncture treatment is therefore seen as drawing upon some subjective quality in both the patient and practitioner rather than on a fixed quality within a point which remains constant whenever this point is used.

 

This has made me look carefully at what actually happens at the site of an acupuncture point, something we rarely think about.  Each point can be seen as representing a slight opening along the pathway of a meridian.  This is where an acupuncture needle can be inserted which by its action can alter the flow of energy along that meridian in some way.  Each point is one of the many places where the energy passing along a meridian makes itself available to outside intervention, in the case of acupuncture through the insertion of a needle.  It is therefore where what is within us can react to influences acting upon us from outside.  It is also where what might be called intrinsic to the point, its particular quality, meets something coming towards it which the spirit of the acupuncturist brings to the action of selecting and needling this particular point.  To this must be added a further component, which is what the spirit of the patient preparing him/herself to receive this treatment also brings to the needle’s action.

 

It is good to look what happens at the interface between a patient, his/her practitioner and the needle which acts as the conduit between patient and practitioner.  Each of us can be seen as a distillation of the combined energies of the elements within us which emanate from us both as a shield and an invitation when we encounter another person.  In return, we receive from this other person a flood of different energies as though summoned by each of us when we encounter somebody else.  When we look at this interaction in terms of acupuncture treatment, the needle becomes the physical point of contact between two people, the practitioner and the patient. 

 

In Lingshu chapter 9 it says, “The needle is inserted in the surface area and remains a while, manipulated with delicacy and at the surface, in order to move the spirits.” In this context, in their examination of the patient- practitioner relationship, Father Larre and Elisabeth Rochat de la Vallée add their own explanation in an article in the Review of Traditional Acupuncture.  They say that “the most important thing for healing is the relationship of the practitioner, the spirits and the patient.” 

 

We therefore have three components which, when acting together, contribute to the success of treatment: the selected point itself, with any particular qualities associated with it, the practitioner and the patient. In talking about the spirit of a point, though, we often focus only on what is considered to be the characteristic of the point itself, either forgetting altogether those two other aspects associated with any treatment, or regarding them as not as important.  It seems to me obvious that the spirits of both practitioner and patient also play an important role in endowing a treatment with a specific quality.  In fact, it is only when the three act in tandem and in harmony with each other that the “spirits” will move, as we hope they will.

 

Here I am always reminded of an occasion many years ago when a young acupuncturist friend of mine complained to me one day, “How come I use the same points as you do, but don’t get the same results?”  Thinking about this, I realised that the reason must have lain in my friend’s doubts about what five element acupuncture could do.  These were the early days of TCM’s onslaught upon the practice of five element acupuncture in this country, when people began to be persuaded that five element acupuncture would only work if it incorporated TCM into its treatment protocols.  My friend was beset by doubts about his five element practice, since he worked with a group of other acupuncturists who were telling him that five element acupuncture “had had its day”.  Eventually, he abandoned five element acupuncture altogether, and moved to a TCM-based practice.  I therefore assumed that the uncertainty he had about the efficacy of the five element protocols he was using was conveying itself both to the needles themselves and presumably, also, to his attitude to his practice, and robbing his five element treatments of the absolute certainty which I had then, and have maintained in my many years since then, that a pure five element acupuncture treatment offers a profound form of healing.

 

The great majority of points lie along meridians associated with one of the five elements.  The greatest influence acting upon a point must therefore be the fact that each of these points takes on some of the qualities of a particular element.  Any point along the two Earth officials, Spleen and Stomach, for example, reflect some of the Earth element’s fundamental functions, each point, from Spleen 1–21 to Stomach 1– 45 (a total of 66 points in all) bearing the stamp of this element.  

 

At the most fundamental level, any point which lies on a meridian associated with one of the five elements receives some of its “spirit” from the properties of that element.  To help them in their point selection, therefore, practitioners have to steep themselves in their understanding of the elements and their officials.  Because all our efforts are directed at establishing which of the five elements is what I call the guardian element (the element of the causative factor of disease, the CF), much of what might seem the difficult work of point selection is made very simple once we are sure we are directing our treatment at the right element.  For all we need then do is concentrate upon choosing points on one or other of that element’s officials, or on both of the officials, and the element will then take over responsibility, with little nudges from us as treatment progresses.   Every one of these points is able to express the “spirit” of its element.  To stop us novice acupuncturists from being too daunted at the wide array of points available to us, JR would always remind us that good treatment could simply consist in needling an element’s source points time and time again.  This would produce the same result as choosing more complex treatments, but “it may only take a little longer”.  The purity of five element treatments was one of the main reasons by JR would say that five element acupuncture is such a simple discipline, “any child would understand it”.

 

In addition to a point’s association with a particular element and official, there is a further layer which contributes to point selection, and that is that certain points have been given specific functions in relation to the element to which they belong.  The most common of these functions is that associated with the group of points clustered around the arm and leg which we call command points.  These include what are called tonification, sedation and horary points, plus five individual element points.  Thus the Water officials, Kidney and Bladder, each have a Wood point, a Fire point, an Earth point, a Metal point and a Water point, creating an inner five element circle within each official.  These element points are like a reflection in miniature of the large five element circle.  Some points also have other functions when they form part of a sequence of points used in specific treatment protocols, such as those used for clearing Aggressive Energy, Possession, Entry/Exit blocks or a Husband/Wife imbalance.

 

In selecting which of the element’s points we should use at any treatment, we can also draw on our interpretation of the names the points have been given over the centuries, another profound and often confusing area of point selection.  A point’s name is very evocative, awakening in each one of us very different feelings, and finding personal echoes because of our particular life experiences.  There are many ways in which it will be up to each practitioner to choose a description which seems to him/her to best respond to their patient’s needs at any particular time.  For this reason, no two practitioners are likely to make the same choice of points for the same patient, though both may be making appropriate choices.

 

The trouble is that it is natural for people to like certainty.  Even the most experienced five element acupuncturist likes to have a handle to hold on to by being told that a point has a certain action, since this helps to give some fixed signposts in the often bewildering area of point selection.  Because there is so much that is indefinable in our work, any little pointer which helps us towards making a point selection may be too quickly snatched at.  I remember how eagerly as students we would seize on any description of a point’s action as though giving us a secure footing in the very mysterious world of point selection.  It requires some courage to accept that our own subjective input into point selection is a crucial component in the success of any treatment.  But then I have always said that five element acupuncture, with its emphasis on the importance of the practitioner’s input, is not for the faint-hearted.

 

I have concluded that the concentrated focus of a practitioner upon what he/she intends to be the outcome of the proposed treatment forms part of the treatment, if not its most important part, as though the practitioner’s energy directed at achieving the outcome of the treatment he/she is intending to give is itself something which adds to the depth and success of the treatment.  The spirit a practitioner brings to needling any acupuncture point is a function of a very complex interweaving of past experiences, the relationship of patient to practitioner, as well as something inherent within the point, at a deep level coming from its association with the functions of a particular element.  All this weaves together a web of personal associations which will differ for each practitioner.  Every time I needle Liver 14, Gate of Hope, I instil into this point all my belief as to why I think this patient is of the Wood element, plus all my years of delving into the mysterious world of the Wood element, and its Liver official in particular, and why I think it is good today to use this point to offer hope to my patient.

 

As a final illustration of the power of the interactions of the spirits of practitioner, patient and point is a moving occasion that occurred very early on in my practice when as a newly-qualified acupuncturist I found myself trying to decide whether I could detect a Husband/Wife imbalance in my patient.  Still somewhat unsure whether I was interpreting the patient’s pulse picture correctly, I started to mark up the sequence of points to clear the H/W, working rather slowly as I wasn’t sure that this was the treatment I needed to do.  As I marked the first few points on the foot (Bl 67, Ki 7),  my patient suddenly said, “That’s a rather frightening thing that Husband/Wife imbalance your Professor Worsley writes about.”  I had lent my patient a book by JR in which he described this imbalance, but she had never mentioned until this moment that she had actually read it.  I sent thanks up to heaven for this encouragement, and with a lighter heart continued clearing the H/W block which I felt her words had confirmed for me.  This was a moving example of the spirits of patient, practitioner and point combining to create a successful treatment.

 

Since traditional Chinese medicine places great emphasis on the subjective experience, as Professor Liu Lihong points out, there is nothing more subjective than an individual practitioner’s assessment of why he/she feels the patient needs a particular point or points on that particular day.  Each point becomes as though impregnated with our own personal narrative, which our use over the years has added to it.  I revel in the fact that every time I select a point, I bring to my selection the understanding of the particular element or official associated with that point which I have gained from my experience as practitioner over the years.  

31. Further insights into the Metal element

Every day I receive confirmation that the elements do indeed imprint a personal stamp upon each one of us in the shape of one of the five elements.  It is both exhilarating and humbling to receive these continuing proofs of the truth of what I practise.  I received one such confirmation at a fellow acupuncturist’s practice some time ago, when I was asked to help a patient of hers.

A few years ago this patient had suddenly begun to experience severe pains down his body, accompanied by strange involuntary jerking movements of his left leg.   I asked him whether he had been suffering from any particular stresses at the time the pains started, perhaps something which he might experience as a shock to the system.  “No“, he said, but then I noticed his eyes suddenly filling with great sadness.  “Is his element Metal then?”, I began to ask myself, as I saw this look of grief.  We are always being given pointers to the elements if we are sensitive enough to notice them, however slight they may be, little gifts of help.  And then came another gift.  He was silent for quite a while as I took his pulses, and then, out of the silence, unexpectedly said quietly, “I always wished I had had some relationship with my father.”  Aha, I thought, who but Metal would say this?  For of course Metal has a particular association with the father.

Metal is the “if only” element, the element that looks back into the past, and often thinks more about this past than about the present.  So here was a double pointer to Metal, the grief in the eyes and the immediate connection with a father who, though still living, is as though lost to him.

So I continued with my questioning, guiding it now along a path that my experience tells me that Metal will accept.  It wants to be left alone to make its own connections and assess for itself what is relevant or irrelevant.  So I suggested lightly that maybe something had indeed happened around the time all this pain appeared. “Maybe some stress at home or at work, perhaps?  But only you will know what that might be.”  And I added, “Perhaps the involuntary jerking of your leg is because you want to kick somebody!”  We both laughed, and then he was given his first treatment on Metal, just the source points, and I left him with this rather light, almost joking remark hanging in the air.

A few hours later he phoned, and wanted to tell us both something he had never told anybody else before.  Two years ago his wife had had an affair with his best friend which had devastated him.  They had worked through this now, but he could not forgive his friend, and never wanted to see him again – another great loss in his life.  I suspect that now that he has admitted to his anger, he will no longer unconsciously need to kick out, either at his wife, or more likely at his friend, as good treatment focused on his Metal element helps him gradually heal.

This was further evidence for me that we need only lightly suggest something to Metal, and then stand back to allow them space to work out their own solutions, since Metal is so acute and quick at making connections for itself.

How much we achieved in such a short time!

I’m sure five element acupuncturists reading this will expect me to write about any other signs of Metal I noticed in terms of the other sensory signs.  His emotion I have talked about;  his colour was not very clearly what I associate with Metal.  I couldn’t detect any smell at all, but the sound of his voice was very flat, very yin, dragging me down with it.  This is the sound which I associate with Metal’s weeping tone.  

 

 

30. Further insights into the ways in which I communicate with the different elements

I learnt something new about my relationship to the Metal element as a result of treating one of my Metal patients.  At one point during the treatment I found that I was talking too much, and noticed that my patient only seemed to talk after prompting from me.  The two-way communication I was engaged in appeared to be heavily weighted towards one side, where I was doing the talking, whilst the other side, my patient, was mostly doing the listening.

This set me wondering afterwards how far this was in general true of my interaction with Metal, and I decided that it was.  I then looked at my interactions with all Metal people, and found that as a general rule it is as though Metal needs to wait to hear what I have to say before entering the conversation.  I interpret this as a sign that Metal wants to assess the quality of what I am saying before deciding whether and how to take part in a dialogue with me. 

I have now gone on to look at where my interactions with Metal might differ from those with patients of the other elements.  The most obvious difference here is in the case of Fire, because, unlike Metal, it is generally unhappy with the kind of silence Metal feels at home with.  A Fire patient is likely to be the one to start talking even as they come into the practice room, although, being a Fire practitioner myself, the chances are that they will have to be very quick of tongue to outpace my own need to speak to them!

Earth, too, is one of the elements most consistently engaged in speech, a sign of its need to make the listener understand what is going on for them.  Conversations with Earth patients may sometimes be more in the nature of a monologue than a dialogue unless the practitioner steers the talk carefully.  Wood may also need no prompting to talk if it has something it needs to say, and wants to make sure the practitioner  is listening to what they are being told.  Again, here, speech can descend into a monologue if the practitioner loses control.

Finally, my verbal interactions with Water patients always seem to have a very distinctive character of their own, which makes of them not so much a dialogue where one person talks, then listens whilst the other person talks, but a conversation where both talk at the same time in a kind of concerted murmur.  It is as though the sound of the words, rather than the meaning of the words, is more important, offering the kind of reassurance that Water is not alone which it craves in order to still its fear.

Of course, all these observations are based on the fact that my own reaction to everybody I come into contact with will be strongly coloured by my own Fire element.  In trying to look at their own experiences with patients, each practitioner must therefore take into account how far their own guardian element shapes the way they interact with their patients and their patients interact with them. 

I am now determined to watch myself more closely to see whether my own talking in the practice room is an appropriate response to the needs of my patient rather than an inappropriate response to my own needs.

 

 

29. The voices of the different elements

As an insight into the way different elements talk, I am reminded of something a friend of mine said to me one day.  She told me that she often thought that “silence is golden”, and was surprised when I said that on the contrary I regarded “speech as golden”.  Silence was certainly not for me, and was not something I regarded as being as admirable a quality as my friend obviously did.  This proved another lesson for me in helping me understand the different priorities different elements have.  Silence for her was an admirable quality, whereas it is slightly threatening to me, a silent space which always tempts me to fill it with words.

Why do I, as a Fire person, think speech is golden?  I think it is because the words we utter can be seen as small connections we make with the person we are talking to, each an attempt to set up a tiny relationship.  There are, of course, many ways of talking, many of them certainly not with Fire’s aim of using its words as a way of initiating a relationship with the person spoken to.  

The ways in which each element wants to communicate with others differ, as do all their individual qualities.  Understanding such differences and working out how to respond to the needs they reveal is one of the lessons all five element acupuncturists have to learn.  Each element therefore has a distinctive way of speaking, and as five element acupuncturists we are taught to listen for tone of voice as one of the sensory signs by which we recognise the elements.  As with the other three sensory signs, smell, colour and emotion, we tend to think that we recognise a sensory signal merely by using the appropriate sense organ, in this case by listening.  But there is more to speech than the mere sounds we utter as words.  In addition to the tone of voice in which we hear the words, we need to look at how the words are spoken, as well as the body language which accompanies them and expresses their meaning.  No diagnosis of the element behind the words can be complete unless all these factors are taken into consideration.

There is an additional important factor here.  When we feel we have to rely simply on the sharpness of our hearing, we may feel helpless if we cannot yet distinguish the different tones of voice, something which it takes many years to master (so students, take heart – we have all had to learn this the hard way!).  If we can add to this some visual input, by looking at how the words are spoken and watching the body language, we have more in our sensory armoury to call upon.  This is something that is particularly important for me as I am now very hard of hearing and don’t trust my ears as I once did.  I have therefore started to develop additional distinguishing marks which I can add to tone of voice to help me recognize the elements.  I noted, for example, that Fire people tended to lean forwards towards the person they are talking to, making me wonder whether this was indeed a characteristic peculiar to all Fire.  I then started to observe myself talking, and noticed that I, too, move forward towards my listener, as though trying to engage more closely with them and add something personal to the communication.

I have now started to look more closely at the movements the other elements make as they speak, and have so far discovered the following, though I have still much work to do to define these characteristics further and with greater reliability.  Metal, as is to be expected, tends to remain remarkably still as it talks.  Earth enunciates its words very clearly and obviously enjoys the process of speaking as though, I like to think, it enjoys the moment at which a word is uttered, then swallowed, and the thought behind it digested, much in the way we enjoy the taste of food as we digest it.   Its way of talking is comfortable and soothing, reflecting the singsong quality characteristic of its speech.  This can make it the easiest on the ear to listen to.                

Water’s speech, on the other hand, tends to be more rapid and jerky.  Its body moves as it speaks, with none of the stillness behind Metal’s words or the comfortable feeling underlying Earth’s.  Its characteristic tone of voice gives it a droning-like quality of speech which can be difficult to listen to, and unsettles the listener, without their knowing quite why, a characteristic typical of Water.  It is very penetrating, almost like something drilling away at your ears.  Water in nature can grind away slowly but inexorably, drip by drip, so that even hard rock has to give way and mould itself to this almost invisible force. 

I met a friend in the street recently who I know to be Water.  What struck me most was a kind of uneasiness which the encounter stirred in me.  We had known each other a long time, and yet I could not feel at ease with him, and as he walked away what stayed with me for a long time afterwards was the sound of his voice, that groaning tone typical of Water, which seemed to bore away inside my head.  For a long time I went on hearing this sound, and I realised that this was another example of Water’s persistence, its ability to carry on come what may, revealed here in the tone of its voice. 

Finally, there is Wood, where the emphasis behind the words, that of telling somebody something with a kind of internal punch, can often be spoken with tight lips, as though the words are being held back from bursting forth.  We have no trouble in knowing where Wood’s forceful voice is issuing from.  It is coming right at us from there in front of us, symbolically hitting us in the face.  It is very penetrating, but less like Water’s drill, rather more like a hammer.  Wood people make their presence felt more openly than Water’s;  their voice, by far the most consistently emphatic of all the elements’ voices, comes straight towards us. Forceful as Water’s tone of voice is, it does not strike us as a series of finger jabs demanding the listener’s attention as does Wood’s voice, but as a rather monotonous mosquito-like drone circling round and through us, difficult to locate.  Wood’s words, on the other hand, often fall on our ears like miniature hammer blows, each word clearly enunciated as though each has a force of its own.

Wood always wants to “tell” rather than to communicate.  To tell somebody something is just as much a way of ordering things, this time through the structure of words, and we know that Wood wants order above all.  Wood’s telling can be described more as making a statement rather than taking the form of a discussion with others.  It wants to impart something to us, rather than enter into a dialogue with us, which is what Fire will do.  The emphatic tones with which it talks to us are its way of insisting that we hear what it is saying.  One of the ways we were told would help us recognize Wood people was to think we could visualize them as illustrating what they wanted to say by pointing a finger at us in time with their words, in effect saying, “You must listen to this.  This is what I am telling you“, much like a teacher in class.  To tap a finger down emphatically as they try to get a point across to their listener is very typical of Wood speech.

The words Wood utters can be experienced almost like some physical push if they are spoken with sufficient emphasis, and it is this emphasis which characterizes what we call its shouting voice.  The voice does not need to shout, though.  Clearly enunciated words, quietly spoken, with each syllable differentiated, can have the same effect upon us as words shouted at us.  Hissing can then be as powerful as shouting, if not more so, because of the unexpected venom which may hide behind its quieter tones.

Wood’s talking differs from Fire’s whose communications turn into a two-sided affair, moving from one person to another and back again.  Wood’s is in one direction only, towards the person spoken to, with far less emphasis upon the need for the words being returned to it by the person spoken to, or, if Wood is very unbalanced, with no attention at all paid to the need for discussion with the other person.  The image I have of Wood’s speech is to think of it like a tennis player practising alone by hitting a ball against a wall, where I see Fire as taking part in a game of two players, one on each side of the net, hitting a ball of words to one another across the net.

I learnt most about the different qualities of the elemental voices from an exercise I carried out with a class of students.  Each of us would read the same passage from a book whilst the rest of us listened with our eyes closed.  What surprised me was how different voices sounded to me when I wasn’t watching the person speak.  I knew each of the speakers well, but their disembodied voices, separated from any visual clues gained from looking at them as they spoke, revealed qualities I had previously been unaware of.  The voices that surprised me the most were the Earth voices.  I had not previously realised how seductive a typical Earth lilt is, and how its speech appears to flow so easily, almost without interruption, drawing me towards it.  I was lulled by its sing-song quality, which sounded almost like the singing of a soothing lullaby to me.  Thinking about it afterwards, I interpreted this as evidence of Earth’s desire to enunciate clearly what it wants its hearers to understand so that it can make sure that they do really understand and that what they are saying is truly being heard.  After all, the more clearly speech is formulated, the more clearly does what Earth is trying to convey come across to the listener.

Fire’s voice, too, surprised me, but in a quite different way.  I had not realised so clearly as I did after this exercise that there is a jerkiness to Fire’s speech quite absent from Earth’s.  Again, thinking as I did of how Wood’s and Water’s voices mirror what happens in nature, Fire’s voice, too, has some resemblance to the flickering and unsteady movement of something like a bonfire burning.  The most emphatic example of this is seen in Inner Fire’s speech, where the Small Intestine can be audibly heard striving to sort its words out as it talks, so that there will be many spurts and hesitations as it tries to get its thoughts into some order.

Of all the voices, Fire’s is the least like Metal’s, for Metal shows no hesitancy or unevenness.  Rather, it comes across as steady and clear, a true reflection of how Metal’s thoughts are always attempts to maintain the clarity it admires above all.  Appropriately for such a yin element, its voice has a quiet, low timbre to it, where the voices of Wood and Fire, more strongly yang, seem to lift their listeners.  It is this yin quality which is so typical of Metal’s voice, as it draws us down and down, as nature does in autumn.

Again, as with all the different characteristics of the elements, we have to practise listening to voices and learn slowly to interpret what our reactions to each are.  We have to ask ourselves what kind of a force do they exert upon us.  Is it a hidden, more oblique one (more typical of Water), or a direct, open full-frontal one (more typical of Wood)?  I am saying “more typical” because hidden within all the different elemental voices will be echoes of the other elements, which may confuse us if we forget how far elemental signatures meld with each other, just as the elements within us constantly interrelate.