75. We should never assume that she know what our patients want from treatment

A French five element acupuncturist, Pierre, comes regularly to our seminars and uses the time between them to send me interesting questions about his practice.  He is tucked away in Brittany, far from any regular five element support network, and has been brave enough to study on his own.  His latest email to me deals with one of the uncertainties therapists of all kinds have to learn to face.  What do we do if we are not sure that we are helping our patients?  What if the patient's symptoms persist?  It is interesting that his email also contains part of the answer to his question without his realising it.  

 

With his permission, I will quote what he was written (and he asked me to forgive any faults in his English!):

 

"The more I treat patients with Five Element Acupuncture only, the more I feel I miss something like a deep knowledge of the spirit of the points.  The treatments I give to somebody, focused on the CF (guardian element), is often good to improve their well-being.  But too often they continue to suffer at a level that I seem not to be able to achieve. After a number of treatments, I feel like I'm going around in circles with the points I use to help them and the treatment seems to be on a plateau.  Examples : The pain (a patient) feels on the wrist doesn't really change, the weight (a patient) wants to lose doesn't really move,  the fear (a patient) has concerning his future retirement doesn't really reduce,  but they all feel better inside them with some improvements in their well-being and even in their other symptoms. 

 

How to improve a treatment with somebody beyond the treatment of the CF (guardian element) when we feel that we are on a plateau?" 

 

I can see that there may be some mismatch here between what his patients expect of their treatment and what he does.   This brings me to an important aspect of our practice.  By what criterion do we judge the success of treatment?  In a purely physically-based medical system, such as that of most orthodox Western medicine, a successful outcome is usually measured by how far one or more physical symptoms have disappeared, or at least been alleviated.  That assumes that as five element acupuncturists we are there simply to treat the physical, whilst ignoring the other, deeper levels of our being, our minds and spirits, or in general terms our emotional well-being.  We all know that a holistic therapy like five element acupuncture does not or should not confine itself to treating just the physical level, indeed often viewing this as in some senses the most superficial level.  And my French acupuncturist's patients appear to recognize what five element acupuncture has done for them at this deeper level by telling him that "they all feel better inside them with some improvements in their well-being and even in their other symptoms".

 

It seems, though, that it is the practitioner who is more concerned with assessing the effect of his treatment on his patients' physical symptoms than they are.  Perhaps to some extent we all live in a medical environment concentrating so much on treating purely physical complaints that we may overlook what to our patients may well be the most important effect of their treatment, which is the fact that they "feel better".  My advice to my French friend will be to be glad that his treatment has increased his patients' general well-being, to continue with the kinds of treatment that have already produced such good results, and, most importantly, to give himself more time for treatment to work.  He may be in too much of a hurry to judge the success of treatment simply because he is overlooking how much his treatment is already helping his patients.

 

When I was a student we had a rule of thumb which stated that it takes one month of treatment for each year that a condition has persisted.  For most patients their imbalance has lasted for many years, and a practitioner must therefore assume that things will not improve quickly (although they may!).  Often it is the practitioner who is in more of a hurry to get things moving than patients are.   

 

 

  

74. What recording my videos has taught me about myself

My preferred way of teaching is not to draft what I want to say in advance, as many people feel they need to do, but to gain inspiration from those listening to me.  I may have a topic in mind, perhaps a title for my talk, just as the title for this blog is prompting what I want to write about here, but I rarely have any idea what words are going to come from my pen (if I am writing something) or from my mouth (if I am lecturing or recording myself on video). In fact, past experience has taught me not to attempt to fit my teaching into what is, for me, the straitjacket of a prepared text.  I've tried to do this in the past, feeling that I should rein in my very impromptu lecturing style, but with no success.  Quite the opposite.  I was asked by my translator tin China to give her an outline of what I intended to say to help her prepare.  And at times I have tried to do this, only to realise how far I was diverging from what I had intended to say in order to elucidate some additional point I felt needed saying.  This acted as an inhibiting factor on me from the start, confusing my thoughts and almost bringing me to a halt.   

I always like to relate people's behaviour, here my way of teaching, back to a person's element, and I have therefore thought a great deal over the years about where this, to some people, rather odd way of delivering my lectures comes from.  I now recognize this as being an understandable product of my Fire element, and specifically, of my Inner Fire official, my Small Intestine.  It will be useful here to summarize the Small Intestine's task as part of the family of the 12 officials, for this does much to explain the way I like to teach.

The Small Intestine is known as the sorter, the official in charge of sorting the pure from the impure, and disposing of the impure through the Large Intestine, as its physical counterpart does in our body.  It is the closest official to the Heart, being the yang official tied for all eternity to the yin of the Heart, and this close relationship gives it its most important function, that of ensuring that it gets things right for the Heart.  It is there to help this Emperor of the kingdom of body, mind and soul rule with justice and fairness.  If the Small Intestine is weak and gets things wrong, it will allow impurities through which will pollute the Heart.  The need to sort things out therefore influences all that I do, including what I say and write, and how I do both.  I have to be sure that what I say at every point represents the truth of what I wish to convey.  

 

Whilst I am talking, therefore, I am at the same time checking to see that the words I am using accurately reflect what I wish to say.  If I am lecturing to a group of people, I also watch my audience carefully all the time to check whether they follow what I am saying or are puzzled by it. If they are, I then adjust what I intended to say to take account of my audience's reaction. .From the listener's viewpoint I may then appear to qualify one statement I make with other statements which I think will add to what I am saying until I am happy that I have covered all I want to talk about.  Hence my poor Chinese translators' bewilderment, as they try to follow some unexpected detours before arriving back at where they expected to be.

 

I have observed how other people approach their teaching, none more so than my fellow acupuncturist, Guy Caplan, who accompanies me to China.  He, I clearly see, prepares his talks very carefully, sticks to what he has planned in advance to say, and certainly doesn't confuse his Chinese translators, as I tend to do.  But then this is his Metal element working within him to determine his actions, so different from my Fire element, with its Small Intestine working so busily to get things right.

73. Continuing teaching during lockdown

Being unable to give any person-to-person seminars during this year of COVID has meant that I have had to come up with other ideas for continuing to help my many hundreds of Chinese five element practitioners and students from a distance.  Like many of us, I have been driven to think of ways of using social media to do this, and it was while watching one of the many online programmes which helped me while away some of the lockdown time that I realised that here was another excellent way of passing on my knowledge.  So for many months now, but only after many hours of tuition from a media-savvy son, I would sit down each day in front of my iPad and record myself for up to 10 minutes talking about whatever five element topic came into my mind as being of interest to my students.  

 

These recordings started off without much of a plan, but I soon realised that they had developed into an excellent accompaniment to my Handbook of Five Element Practice, the text which all Chinese five element students base their studies upon.  I was very pleased to hear recently that over 50,000 copies have been sold worldwide over the past 10 years, making it the most successful book on acupuncture my Chinese publisher has sold.  I thought it that was very likely, therefore, that there would be many aspiring five element practitioners who would welcome the kind of personal teaching my video recordings offer in my absence.  I arranged these video recordings around the different topics covered in the Handbook so that the complete set of more than 30 videos adds something to the text.  I sent each video over to China as I recorded it; they were then edited, Mandarin subtitles added and put online to be downloaded on subscription.  These subscriptions have proved very popular, with more than 1500 people so far enrolled.  And Guy Caplan has now added a further series of videos on ways of helping students with their CSOE (colour, sound, odour and emotion) sensory skills.

 

After completing the Handbook videos, I moved on to recording a more advanced set for practising five element acupuncturists, and followed that with a kind of online autobiography, describing my journey from my first encounter with five element acupuncture as a patient more than 30 years ago to my arrival in China.  Finally I am also now working with Guy Caplan on a series of videos about treating long-term patients, which will list the kinds of treatment we give patients who have been coming to us for many years.  

 

Novice practitioners often find the move from the well-defined early stages of treatment to the more spaced-out treatments at later stages difficult to deal with.  For these long-standing patients there is no longer any need to worry ourselves about finding the right element, since the fact that they are still coming to us after so many years of treatment is proof that they are doing well and just need some top-up treatment.  Practitioners, though, often feel that they have to ring the changes and each time should be searching around for different points to use.  This is not what is needed, and we list for each element the kind of simple treatments we continue to give our long-term patients, showing that, apart from interspersing basic element treatment with the occasional clearing of a block, the points we choose are often much the same year in year out, with the simple aim of reinforcing the patient's element.  

 

In fact, long-term treatment is in a way the easiest treatment of all.  By this time, we know all about our patients' lives, and have developed very easy, warm relationships with them.  Patients' eagerness to continue coming for treatment year after year is satisfying proof of how effective five element treatment can be.  This can provide a welcome relief from the much more complex work involved in attempting to manoeuvre a path through the undergrowth of the different elements until we find our way to the right element at the start of a patient's treatment.  So we have asked long-standing patients of each element if they are happy for us to record them talking about themselves, and tell us how their treatment has helped them in the past and is continuing to help them now.  We also list the one or two years' treatments they have recently received as further encouragement for our fellow practitioners. 

 

 

72. Another lesson about the Earth element

It still surprises me how much I learn each time I'm with another person, particularly if I am paying the kind of concentrated attention I reserve for looking at patients. Yesterday I observed something new about the way the Earth element impacts upon me.  As I watched a video of a Chinese acupuncturist's interaction with one of his patients, I learnt something about this element that I had not seen before.  The description that came to mind was that the patient made me feel surprisingly comfortable.  He was sitting back at ease in his chair with his hands loosely clasped together on his lap, and I could sense myself relaxing in response to him.  There was little of the usual feeling I have come to associate with the presence of Earth, that of something being demanded of me, a need for understanding which may have become the stereotype of my response to this element.  This patient did not make me feel that he was pulling at me in any way, and I decided that he was an example of balanced Earth, with little of the neediness I had come to associate with this element.

 

I then asked myself how I would be feeling if the patient was one of the other four elements, and I therefore looked at each in turn, starting with Wood.  I asked myself how I would feel if I was facing one of my Wood patients, and was immediately aware that I would have reacted differently, by sitting up a little straighter and leaning forward towards the patient as if to counter a slight obstacle.  This tends to be my reaction to Wood since it always has a slightly challenging effect upon me, as its strong yang energy meets my own Small Intestine's yang energy.  If the patient were Fire, this would also have had a different effect upon me, as our two Fire energies, both in some ways trying to enter into some kind of a relationship with each other, being such a familiar feeling for me, would have left me even more relaxed.

 

This is quite unlike the effect a Metal patient would have upon me, for Metal, far from wanting to enter a relationship with those it encounters, wants space between it and other people, more than either Wood, Earth or Fire do.  Like all elements, though, it makes its own demands, and when I am with Metal patients I feel that I must work out carefully how to respond in an appropriate manner to what they want of me, otherwise they will withdraw into their shell.  Finally, then, I am left with wondering how I would react if this patient were Water.  I think I would feel slightly apprehensive, this being a reflection of Water's own fear conveying itself almost unconsciously to me, and making me uneasy.  There was no such uneasiness within me as I watched this Earth patient.  

 

It is by studying carefully the subtle differences in my responses to the different elements in this way that I have learnt to improve my diagnostic skills over the years.  So I have now added this slice of fresh learning to the drawer in my filing cabinet of element examples labelled Earth.

  

71. Greater tolerance: one of the gifts of five element acupuncture

Very early on in my study of the elements I realised that I was becoming a much more tolerant person, simply because what I was learning about the elements made me understand, probably for the first time, that there were good reasons why people differed, from one another, and that I should no longer be surprised at these differences.   It was through learning about the different qualities of the elements that this was spelt out so clearly to me. If, as I learned on the first day of my acupuncture course, and believed so utterly from then on, each of us was imprinted with the mark of one of the five elements, then the particular qualities of that element gave all of us something which I like to call our elemental DNA.

 

We are often reluctant to acknowledge such innate differences, perhaps because it is easier simply to be critical of aspects in other people with which we are not familiar than it is to welcome them as signs of the richness of what we contribute to the human experience.  Even now, after all these years of acquainting myself more closely with the different expressions of the elements, I can still find myself dismissing some opinion contrary to mine as proof of a person's narrow-mindedness or even stupidity, rather than bting a legitimately held view based on another element's approach to life which inevitably differs from mine. 

 

We are conditioned to see life in all its complexities through the lens of our particular element.  However carefully we may try as five element acupuncturists to discount the distortions to our thinking this inevitably results in, we cannot totally eradicate this tendency.  I cannot stop my own Fire element colouring my interactions with the different elements in the people I meet, and even, though to a slightly lesser extent, in those of my own element.  For in the presence of another Fire person I feel myself relax a little, even if that person is a patient of mine, and this very relaxation may mean that I am not as observant as I should be in all my interactions with my Fire patients.

 

Understanding how each element shapes all that we do, from the way that we talk, the way that we make judgements, the way that we relate to other people, and even perhaps even to the kind of political party we may tend to belong to, certainly leads all of those with some knowledge of the elements to explore why other people act as they do, and try to find the reasons for this within the circle of the elements.

 

This is why JR Worsley always said that everybody who wanted to study five element acupuncture should be allowed to do so, irrespective of their academic qualifications. Nor did those wanting to study need to have as their aim the desire to practise.  It was simply enough to wish to learn more about a fascinating philosophy of life.  Initially this was my own reason for enrolling in JR Worsley's acupuncture college.  It was only after my first year of study that I realised that I was totally hooked, and began to overcome the doubts I had about my suitability to become a practitioner.  Gradually these gave way to a deep conviction that here at last I had found my true calling, a conviction which only became stronger as the years passed.

 

Five element acupuncture's ability to help each of us cope better with other people is probably the greatest gift this form of healing offers an increasingly intolerant world which often appears to be tearing itself apart.  So I urge everybody to learn as much as they can about this ancient form of healing, which is so well-suited to the needs of a modern world, for in doing so we help smooth our relationships to all around us.  And that is such a worthy aim. 

70. Updating the procedures for clearing Possession and Aggressive Energy

When teaching students I have always had to draw an imagery line between what I have learnt to do in my practice as an experienced five element practitioner and what it is advisable to tell students to do.  I am sure that many of my fellow five element acupuncturists have over the years also developed their own approaches to their practice.   

I had to consider this when writing my Handbook of Five Element Practice, which is intended for budding five element acupuncturists, and now, in its latest edition, has the addition of a Teach Yourself Manual for all those who are not able to join a college course or train with a five element acupuncturist.  In the original edition, published first more than 15 years ago, I rather blindly copied what I had been taught in my original training at JR Worsley’s Leamington College.  It was only when my own students started pointing out to me some years later that what I was teaching them in class differed in some respects from what I had written that I realised how far in my own practice I must have adapted what I had been taught without realising it.

 

This has been brought home to me very strongly recently by questions from practitioners on two different and important aspects of five element practice, both relating to clinical procedures.  The first is about the procedure for clearing possession and the second about that for an AE drain.  Both questions have made me think carefully about why I have adapted what I was taught in the way I have, and whether it is appropriate to incorporate these changes into any future teaching that I do.  Alternatively I ask myself whether there will always be some discrepancy of this kind between what an experienced practitioner does compared with what it is advisable for novice practitioners to do.

 

First, to the procedure for clearing possession.  I have been troubled for some time by the fact that in all the years during which I saw JR Worsley with patients, and he diagnosed many cases of possession, not once did he suggest that we should start treatment with EDs (External Dragons), nor, on the only occasion when he thought IDs (Internal Dragons) had not been successful, did he immediately suggest that I should move on to EDs.  And yet in his Points Book not only are the points for EDs listed, but also two sets of points for IDs, making a total of three sets of possible points.  This has always puzzled me, but I sadly never took the opportunity of my many hours following JR to ask him when we should be thinking of using EDs, nor how we should choose between the two sets of ID points.  We were told to use one set of the ID points listed, those for patients “with depression”.   Like so many things I now wish I had asked him, I wasted that opportunity, and will now never know why all three sets of points were listed.

 

Of course, other practitioners may have had different experiences when consulting JR, but I have had to base my thoughts on what I personally observed.  So why did we learn in class that if IDs did not clear possession, we should straightaway move on to EDs, when I never saw this happening in practice?

 

In fact, what I did learn from treating my patients with IDs diagnosed by JR was how quickly possession cleared with ID treatment.  Certainly it never took the 20 minutes’ wait that we had all been told might be necessary, and which I dutifully copied into my Handbook as part of the procedure.

 

Having over the years therefore observed how quickly possession clears if the needles are inserted correctly, I now tell students to leave them in for a much shorter time, about 5 minutes, if there is no effect, before tonifying the points strongly and removing them.  I find the strong tonification usually does the trick which the initial sedation may not have done, and there is rarely need to repeat the procedure. Even if I feel that sedation has cleared the block I still tonify the needles before removing them, as a fall-back procedure just in case possession is still there.  Better safe than sorry, I think to myself.

 

So when a practitioner recently pointed out that what I said about possession treatment in a video lesson I gave was different from what I had written in my Handbook, this gave me pause for thought, and made me realise that since my clinical experience had modified the procedure I had been taught as a student, it was sensible to reflect this change to my thinking in future editions of my Handbook, which I am now doing.

 

The second example of a change in clinical procedure which has been pointed out to me by a student concerns the procedure for an Aggressive Energy drain, and specifically the order in which the needles are inserted.  What I have written in my Handbook is based on what I learnt as a student.  We were told not to insert the needles in the AEPs (back shu points) of the Heart unless there is first erythema around the needles of the two points immediately above them, those of the AEPs of the Heart Protector.  Like the good student I was, I continued to do this until one day, after I had been in practice for quite a while, I thought I would speed the procedure up a little by inserting all six sets of needles including those in the Heart AEPs, which I did very carefully.  Since I noticed no ill-effects from this, I have continued to do this as a matter of course, making sure that I am particularly careful not to insert the needles too deeply into III (Bl) 15.  

 

To my surprise one day I found that erythema appeared around the Heart AEPs in one patient but not around those of the Heart Protector AEPs, something which seemed at odds with what we had been told.  This was that Aggressive Energy could only reach the Heart AEPs if it was passed through from the Heart Protector.  This made me all the more determined to needle all six sets of points.  I also found that it was only after the AE appeared on the Heart AEPs that erythema gradually emerged around the two Heart Protector needles, almost as though I had summoned Aggressive Energy to emerge by stimulating the Heart AEPs.

 

The discovery of Aggressive Energy on the Heart but not on the Heart Protector still puzzles me, but I have only found this to happen in very few cases in my many years of practice.  I therefore assume that these were very rare examples of something slightly inexplicable, or perhaps I did not position the needles correctly on the Heart Protector AEPs, and missed detecting the AE that was there.

 

I still feel it is a safer procedure to defer putting needles into the Heart AEPs until the Heart Protector is given time to reveal whether it has Aggressive Energy or not.  This is particularly the case for novice practitioners whose needling skills may not be sufficiently good to avoid inserting the needles too deeply.  After waiting a little while, it would then be perfectly safe to insert needles very shallowly in the Heart AEPs just to make sure you drain any Aggressive Energy which might happen to be there.

 

All medical traditions change and develop with time, as they benefit from the experiences of all the many practitioners who have passed through over the years and the centuries.  This is right and proper, otherwise practices would atrophy.  I myself observed the changes JR Worsley made to clinical protocols he developed during my years observing him.  It is therefore always good for practitioners to be prepared to incorporate changes in their practice if they wish to learn from those with greater experience.  The important thing here is that we should make such changes only if we are sure that any new protocols suggested to us are based on the experiences of those with clear clinical expertise.  

I am sure that five element acupuncture will continue to benefit from the adaptations future generations of acupuncturists may feel they should make to today’s practice. 

69. Five element acupuncture treatment of Long Covid symptoms

I am pre-occupied at the moment with thinking of ways in which five element acupuncture can help all those many, many people who have emerged from their bouts of COVID 19 still suffering the side-effects lumped together under the name of Long Covid.  I was prompted to think more about this by an article I have just read in the Guardian newspaper entitled "Don't be fooled.  Covid won't be cured by a wonder drug".  After looking at some traditional herbal remedies, including some from China, it comments very wisely: "It doesn't pay to rule out (remedies) just because there's no clear rationale for how they would do the job."  We could include acupuncture in the list of remedies to be considered when looking at ways of treating Long Covid.  

So how does five element acupuncture approach the treatment of the many Long Covid symptoms?  We know that these range from extreme tiredness, chest pain, heart palpitations to joint pain, nausea and high fever.  One of the things my years as five element acupuncturist has taught me is how effective we can be in treating conditions, such as these, which are described as being non-specific ailments with no obvious aetiology.  In five element terms a variety of symptoms affecting different organs must be caused by some severe attack upon the elements controlling these organs, to the extent that their ability to retain balance has been overwhelmed.  

It is likely that the elements will also have become sufficiently weakened to cause Aggressive Energy to appear, making this obviously the first treatment we should carry out.  We must also consider the possibility of having first to clear IDs, a condition that that might appear when a patient is facing a life-threatening illness.  And then we should look for any of the other major blocks to treatment, such as Husband/Wife, moving on to consider Entry/Exit blocks, starting with the major CV/GV block.  This may occur when severe illness has weakened the elements' connection to their main sources of energy the two great pathways of Conception and Governor Vessels (Ren Mai and Du Mai).  Other Entry/Exit blocks may also need to be cleared, before we move on to treat the patient's element.   I would also always think it advisable to re-check for AE at intervals after this if some of the COVID symptoms persist, because severe illness may have weakened the elements' ability to withstand stress and allow AE to creep in again.

 

I would love us to be able to offer this treatment to as many sufferers of Long Covid as we can, if only the conventional medical world would learn to accept the fundamental validity of what five element acupuncture can do.  But until this happens, all we can do is treat those patients who find their way to us, and hope that these people will spread the word to their fellow sufferers.