81. Necessary short-cuts to a five-element diagnosis

I have been thinking a little more about the lack of five element teachers, which I mentioned in my last blog (no.80). There is always a problem venturing in the footsteps of a proven master.  Jung had difficulty in emerging from under the great shadow which  his master, Freud, had cast over him.  All JR Worsley's successors have to deal with the same problem.  Those who learnt directly from JR Worsley himself, and the following generations who were taught by this first cohort, have a natural reluctance to claim to "do a JR" when diagnosing patients, particularly in front of a class of students.  This term was a shorthand for being able to do what he told us was his ability to diagnose colour and smell as he came into the practice room, and follow this up in a very few minutes with sound and emotion as soon as the patient had responded to his questions.

 

Because we have been asked to diagnose hundreds of Chinese practitioners and patients on our seminars over in China, I realise that I am getting much better at making quick decisions about the elements I am seeing.  I have had to be, in view of the time constraints we are working under - perhaps only a morning to make over 150 diagnoses.  But then I have always emphasized that this is completely the wrong way to make a good diagnosis.  I should be sitting down alone with each of these 150 people in a practice room, and giving them all the attention and time that carrying out a good TD (Traditional Diagnosis) demands.  But as the saying goes, "needs must when the devil (here simply the time available) drives"!  If we (and that includes my five element companions, Guy Caplan and Mei Long) were not to do this, none of these enthusiastic five element practitioners and students would ever have the slightest inkling of their own element, something I consider essential for any five element acupuncturist.  And we know that we are always very bad at diagnosing our own element, for all sorts of reasons, often choosing an element which we long to be!

 

I have therefore had to learn to do the best that I can, calling these initial diagnoses simply our first hypothesis about the element, to be amended as we get to see things more clearly in the light of how treatment on that element has or has not brought about any changes.  Luckily during these seminars in China we see everybody for a full week, and so have many opportunities of observing closely those whose diagnoses we are unsure about, and then changing these where necessary accordingly.  As I said before, Chinese acupuncturists, probably because of our emphasis on the provisional nature of our initial diagnosis, are quite happy to have their elements changed, happier, I think, than their European counterparts, certainly their British.

 

Also, if we see examples of possession in the group (surprisingly often, perhaps for cultural reasons), we make sure all these patients are treated before we leave, as this is not a simple treatment for apprentice five element practitioners either to diagnose or to recognize when it has been cleared.

 

I know that my own 40 or so years of five element studies have helped me pinpoint the elements more quickly, and, I hope, more accurately, but I do wish that more of all those competent five element acupuncturists out there would take a leaf from my book and venture out into teaching.  I always remember one of my wise teachers, Dr Oskar Adler, master musician, teacher of the violin to the composer Schoenberg, and astrologer, author of some fascinating books on astrology, writing how important it was for everybody to pass on whatever they have learnt.  In a lovely quote, he said, "What would have happened if Mozart had not written down his music?".  And Mozart, after all, was almost hounded to his death through poverty and many of his manuscripts only survived by accident.  Think!  We might not now have his Magic Flute or Marriage of Figaro, or hear his sublime piano concertos!

 

So any of you experienced five element acupuncturists out there, please take courage in your hands and offer up to the next generation whatever you have learnt from your own practice.  Only in this way will any discipline survive, and particularly such a rare discipline as five element acupuncture.

 

80. The certainty of uncertainty

 Oh, how we would all like to be 100% certain about things.  In five element terms this would mean that with sufficient experience we would be absolutely sure of a patient's guardian element, leaving no room for doubt.  But that is not how things are, nor should we hope that this is how they should be.  Instead we must learn to accept what I like to call the certainty of uncertainty underlying all human activities, including our diagnosis of a patient's element.

 I am strongly reminded of this truth now because of something which has happened whilst Guy and I are helping put together the latest of a series of courses for Chinese five element practitioners.  In previous courses we have looked at videos of patients and made preliminary diagnoses of their elements.  For this course we are being sent further videos of patients we have previously diagnosed after they have received further treatment either on the new element we diagnosed or on the original element we confirmed as being the correct one.  We are focusing on helping develop practitioners' relationships with their patients and improving their ability to observe the often subtle changes in patients which indicate that they are treating the right element.  

 

All five element practitioners have to be honest enough to admit when our diagnosis is not yet the right one.  This thought is at the forefront of my mind at the moment because I have just been sent some more videos of a patient we diagnosed a few months ago which have made me alter my original diagnosis.  The patient does not seem to be showing any of the changes I expected to see after some treatments on the new element.  After seeing more videos of her, I am now much more confident of her being of another element.   

 

Here indeed is a real lesson in humility.  We are using these videos as teaching material for perhaps some hundreds of five element practitioners in China.  There is now no doubt in my mind that we need to change our diagnosis, and it would be wrong to continue with my original diagnosis.  How do I make this change  in diagnosis without undermining my students' trust in what I am teaching them?  This is a dilemma all five element teachers have to face.

 

This is where my thoughts turned to something I read in Professor Liu Lihong's book, Classical Chinese Medicine, which so impressed me with his understanding of the need for humility in all that we do.  He said that we will all start any discipline by getting things about 10% right, and gradually increase this with practice to 40%, then 50 or 60%, but we never reach 100%.  Traditional Chinese medicine is a discipline based on practitioners' subjective experience, unlike Western medicine, which prides itself somewhat naively on believing that it bases itself on objective criteria. As five element acupuncturists, on the other hand, we welcome the fact that the relationship between patient and practitioner forms a crucial part of all treatment.   There is therefore every reason for us to accept the very human uncertainties which are an essential ingredient of what each practitioner brings to his/her practice.   

 

So I will be using our approach to diagnosing and treating this patient as a prime example of good five element practice.  I hope that showing fledgling five element acupuncturists that my ready acknowledgement that I needed to change my original diagnosis will encourage them to retain sufficient humility in their own practices. They therefore need not be afraid to admit when they don't get things right straightaway, and allow themselves not to be undermined by this fact.

 

I often think that this fear of what may be seen as showing fallibility in front of their students by not wishing to reveal that they are uncertain of their elemental diagnoses may be one of the reasons why so few good and experienced five element acupuncturists wish to venture into the world of teaching.  This is one of my sadnesses, for it is reducing the flow of five element teachers to a tiny trickle.  As one of my students said to me many years ago: "If JR is the only person to be 100% sure of his diagnosis, how will I ever get to that point?"  To which I would give the answer JR Worsley gave to a class of us when I was a student at Leamington:  "If you had all practised for 40 years, as I have, you would all see the elements as clearly as I do.  So just wait!"  

 

Five element teachers have to have enough self-confidence not to mind telling their students that they, too, are human enough to change their minds, as I am about to do on my latest video recording for my students in China.

 

In my own teaching I have always emphasized that my first diagnosis of a person's element is a provisional one, a hypothesis which subsequent treatment is there to prove or to amend.  Chinese students seem to be quite happy with this and don't appear to be thrown when I change my mind later.  But being human, which means that I do after all want to show that as an experienced practitioner of many years' standing I know what I am doing, I still find it difficult when, as now, I have to announce publicly that I got it wrong!

  

79. A potential horror story, with a happier ending (I hope)

One of my lovely sons, after much encouragement on his side and much resistance on mine, persuaded me that it was high time to exchange my old pc computer for an iMac.  And bless him, he actually got it delivered to my home to prevent me from changing my mind.  It lay under my desk in its box for a month or so, until my idleness during lockdown made me unpack it and install it with the help of my son's long-distance instructions.  To my relief, he arranged things so that at all times he could see what was going on on my computer, and help me start learning how to use it.  I tried very hard not to give way to my usual panic at learning about any new piece of equipment, so am now fairly at ease with it, although occasionally casting a sad eye back to what I could do on my much simpler pc.

 

Gradually over the next few months I have learnt a complicated new computer language, with many false steps and many odd deletions.  But no false stop and no deletion was as bad as what I did last week.  By some mischance, instead of merely deleting one name from a folder on which I invited people to have access to one of the video series I have recorded for China, I apparently deleted all the 20 video recordings (about 30 hours in total).  Despite frantic calls to my son to see whether I could retrieve them they have apparently disappeared for good from my computer.  They include the videos in which I record my life as a five element acupuncturist, from my first days at acupuncture college to my last visit to China, a time which coincides with the growth of five element acupuncture.

 

At first somewhat disturbed at having destroyed so many recordings about my life, I now realise that it has given me a chance to look at that life from a different viewpoint a few months further on, when I am a little older and the world has turned on, too, in many ways which have been so difficult.  All this, Brexit, Covid, Afghanistan, global warming, all these traumas we are going through have impacted upon me, and like all things, have affected the way I, and the elements that form me, particularly my Fire Element, with its dominant Small Intestine official, have had to learn to adapt.  So I am trying to see this as an opportunity to look at my life again from a different perspective. 

Happy update a week later!

 

Good news!  I have managed to retrieve all the video recordings I thought I had deleted in error.  I had the happy idea to ask my Chinese friends whether they could post the videos I had originally sent them back to me, thinking this might be a bit unlikely but worth a try.  And now here they all are back at home on my computer.

 

But I'm still going to record some more thoughts about My Life as a Five Element Acupuncturist to add to the original series.

 

 

78. Welcome to my 8th book!

Unexpectedly I was approached by my Chinese publisher who asked me whether I would be happy if he published another book of mine, this one intended just for the Chinese market.  As readers of this blog know, I have been sending teaching videos recorded on my sofa at home to create various series of online seminars for Chinese five element acupuncturists.  The latest, to be made available on subscription in a few months' time, describes my life as a five element acupuncturist from my earliest days as a student under JR Worsley to now, as the lead tutor for the five element programmes being run all over China.  What I did not know until I received this request was that these recordings, which I thought simply had Mandarin subtitles added, have been translated in their entirety.  It is this translation that the publisher wants to make available in book form with the title of "Learning five element acupuncture with Nora". 

Of course I agreed to this unexpected offer, who would not?  Perhaps at some point in the future somebody will want to publish an English version!

 

This will become my 8th book, and has prompted me to look at the other seven books I have written, and see what I think about them now.  I have talked before about the need for each of us to leave behind a legacy of our life.  It does not matter whether this is a private legacy, one known only to oneself and perhaps a few people close to us, or one on the public stage, known to a wider audience.  I wonder where I would place myself on this scale.  In the world of five element acupuncture I am quite a well-known figure, particularly now in China, but in the acupuncture world as a whole I think I only occupy a very peripheral role.  And this does not worry me, for my greatest concern has always been to ensure that five element acupuncture survives, not to have my own contribution to its survival recognized 

 

I don't often write about my books, thinking each one should promote itself on its own, but perhaps now is the time to grade them according to how I value them.  Far ahead of the field, perhaps almost out of touch with the others, is what I call my magnum opus, my most favourite of all, my Keepers of the Soul.  Funnily enough this was my first book, written in the full flush of the excitement of my discovery of five element acupuncture.   I have been told that it is a difficult read, perhaps because, coming as I do from a rather literary background, I am very conscious of the need for my writing to reflect the beauty of words.  In the pursuit of exactly the right cadence to what I wish to express, I make few concessions to my readers, for which I make no apologies. After all, if they don't like what I write, they only have to put the book aside. 

 

My other books all express my thoughts about the practice of five element acupuncture in different ways, two, Blogging a Five Element Life and On Being a Five Element Acupuncturist, offering a selection of my blogs over the years.  The Simple Guide to Five Element Acupuncture was originally intended for acupuncture patients, but has proved to be a useful introduction for anybody interested in learning more about the five element approach to life.  The Handbook of Five Element Practice is a practice manual for acupuncture students and was the first of my books to be translated into Mandarin.  It has proved so popular over there, with more than 45,000 (yes, thousand!) copies sold in the past 10 years that the publisher tells me that it is the highest selling book on acupuncture in China.  Its popularity reflects the great interest in learning about a branch of acupuncture up till then almost completely unknown in China.

 

So on now to my 8th book.  Will it be my last, or will more of what I talk about in the series of videos I continue to record prompt me or my Chinese publisher to propose a 9th book?

77. The Metal phase of my life

I think I must now be very much in the Metal phase of my life, and I am increasingly aware of time passing.  With my love of the elements, I have reduced the seven stages of life Shakespeare tells us about in As You Like It to five, each represented by one of the elements, with Water, ever-ambiguous and mysterious, straddling both the end and the beginning of life to create an unbroken circle.  In my picture of the elements forming life's cycle, Metal lurks there almost at its end, its autumn, and at my age, now in my mid-80's, I accept that this is the stage I am at.

I feel we are living through strange times, evoking yet another Shakespearian thought, for many of us feel, with Hamlet, that "the time is out of joint".  Covid, global warming and Brexit are combining to make me assess my life anew - and this includes my approach to my five element practice and teaching.  I am treating very few people now, first forced into this by Covid restrictions and then at last accepting that the time has come for me to concentrate whatever energy is left to me on what I consider the most valuable thing for me to do.  It's important for me to know that whatever legacy I leave behind represents the best that I can offer those coming after me.  To my surprise, lockdown has given me new teaching tools to use to do this which I never suspected were there.  Things literally fell into my lap one day when I was trying to familiarize myself with my new i-Pad when it struck me that one way of occupying myself whilst I was prevented from carrying on my teaching in China would be to spend some time learning how to record myself teaching online.  My blog of 6 June: Continuing teaching during lockdown describes how I learnt how to do this.

 

Not only has recording the 100 or more videos occupied my time usefully, but it has also given me the opportunity to think my thoughts through more thoroughly, and particularly work out new ways of helping students from a distance.  With Guy and Mei I have now completed several series of video seminars, and we are about to embark on some new seminars, both online in China, and potentially in person in a chateau in the French Loire valley, once Covid travel restrictions permit this.

 

So in this most contemplative phase of my life, in the autumn of my days, I think I am fulfilling the needs of the Metal element within me to clear away the garbage and pass on as much of the true essence of my understanding of five element acupuncture as I can.  

 

 

 

76. Some of the reasons why it takes courage to be a five element acupuncturist

 It is only recently that I have realised how much courage it requires of any therapist to enter the emotional and, as acupuncturists, also the physical space of another human being.  This is all the more so if the conditions under which we practise make the kind of close relationship of patient and practitioner almost impossible.  Here in the West at least we live in a world very familiar with the one-to-one relationships which form part of all psychotherapeutic encounters, amongst which I count five element acupuncture.  I found that this was not the pattern yet in China, where it is rarely practicable to find the space or have the time to treat individual patients to foster the close relationships necessary for a good five element practice 

  I only became aware of some of the difficulties those training to become five element acupuncturists encountered in China after a few visits there, and I therefore did not realise how much Chinese practice conditions differed from what I was used to in this country.  This meant that what I was recommending for my budding five element practitioners was simply something they could not do.  Patients and practitioners alike were then accustomed to view acupuncture as a kind of adjunct to orthodox Western medicine, regarding it as just another form of physically-based therapy, concerned only with helping to treat physical symptoms.  The concept of dealing with patients' deeper emotional levels was a totally alien one, so much so that I remember one Chinese practitioner saying sadly, "I really don't know how to start talking to my patients about their problems as you do."

 

There was the additional problem, still experienced even now by most Chinese five element acupuncturists, and one touched upon by my French acupuncturist friend, Pierre, (see my recent blog of 18 June 2021).  This relates to the thorny question of who is paying for treatment, and what such payments cover.  Where the state or medical insurance includes some cover for acupuncture treatment, how many treatments does that include, and perhaps also for what conditions?  This is an area of practice with which I am unfamiliar, since most of my years of practice have been at a time when patients could not yet take out any medical insurance to cover acupuncture treatment, and therefore took it for granted that they would be paying for treatment themselves.  This had the effect of keeping fees as low as possible to be affordable to as many people as possible, with most acupuncturists having a sliding scale of fees, which could be adapted to help the less well-off.  

 

In his email to me, Pierre writes:   

"In France, we have " la sécurité sociale", that allows people to consult a physician for free. We pay but afterwards we are reimbursed by the social security. So French people are really not accustomed to pay for their health without reimbursement.  And when they come to acupuncture (they know that this practice is out of the reimbursements of the social security) then they want the treatment to be as short as possible because they don't want to pay too much for that. 

I realize that is may be a very different thing between France and England. 

This is a very bad thing, that the government here in France has accustomed people to a false free health care. Acupuncture for them is a short treatment. Totally different from psychotherapy for which they agree in relation to long-term treatment." 

 

Pierre is therefore treating patients with a clock ticking away over his head, not an easy situation to deal with.  To some extent, though, the same can be said of every practice situation which I have had to deal with during my years of practice.  Even though my patients were not relying on outside help to pay for their treatments, they and I were always very conscious of the cost of the kind of long-term treatment a good five element practice demands.  Because I was very aware of this, I gradually worked out how to counter patients' natural concern about the cost of treatment by addressing the issue right at the start of treatment. I found that by doing this I avoided the kind of problem Pierre has to deal with.

 

What I did was make sure during my first interaction with a new patient that they understood what I hoped five element acupuncture could do for them, emphasizing that it dealt with the whole person (hence the use of holistic (from the Greek work meaning "whole") to describe it, as compared with orthodox Western medicine which tended to deal only with physical problems.  I would make sure that a new patient was aware of the reach of five element acupuncture from the start of their treatment, by saying things like, "I'm interested in hearing about any physical problems you have, but these may be related to other issues.  For instance, a stiff neck may be caused by somebody you know being literally a pain in the neck, or a sore knee because you may feel like kicking somebody."  These comments may sound a bit flippant, and often made the patient laugh, but I could immediately detect the change in tone as patients were quick to acknowledge the relevance of what I was saying.

 

I would also tell them that the initial stage of treatment would require 5 - 6 weekly treatments before they might feel any benefit.  Any longstanding problems might take longer than that to be helped, but treatment would be spaced out gradually from weekly to monthly and longer as soon as they felt any improvement.  I emphasized that, unlike psychotherapy, where patients often have to commit in advance to as long as a year's weekly treatments, they would be free to stop treatment at any point if they felt it was not helping them.  Interestingly no patients I addressed like this ever did stop treatment, and many were content to continue as my patients over many years at ever longer intervals.

 

 

75. We should never assume that we 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.