Sunday, October 13, 2019

38. Getting to know our patients

If you are going to be of any help at all to another human being, as we as acupuncturists surely hope to be, then we have to make every effort to get to know who the person is who is coming to us for help.  And getting to know somebody is certainly not as easy as it may sound.  For each of us can present different faces to the world, having learnt during our life to adapt ourselves to the different people we encounter.  The practice room represents an unknown world, and at first patients will be unsure both about the treatment being offered and the person offering this treatment.  Practitioners, too, meeting an unfamiliar person, will have their own concerns to face in adapting to what is to them also a new situation. 

All this represents different kinds of challenges.  Patients are being asked to reveal something of themselves to a stranger about whose capacity for empathy and ability to put them at their ease they are initially unsure of. They will be asking themselves whether the practitioner is a safe person to whom to show any vulnerabilities, those which all of us may wish to hide from others, but which reveal the true nature of why we are seeking help.  The practitioner, too, will be trying to adapt to the many different ways patients present themselves in the unfamiliar situation they find themselves in.

There is a great skill in helping a patient overcome their natural reticence at opening themselves up to another person.  We have to learn ways of convincing our patients that we are a safe repository for self-exposure of this kind.  We need to know what kind of a relationship with their practitioner our patients feels comfortable with, since for each person this differs.  Some, with a trust in human nature, will assume that anybody in the guise of practitioner will be worthy of this trust.  Others, at the other end of the spectrum, will take much longer and request much greater evidence from their practitioner that the practice room is a safe place before lowering their defences.

The initial encounters between patient and practitioner are therefore delicate affairs, requiring great sensitivity on the practitioner’s part to all the little signs we give out indicating where others must tread warily when they approach us.  If practitioners do not pick up such signals, we are very likely to act too clumsily and effectively silence our patient.  Here, as with all things, a knowledge of the elements comes to the practitioner’s aid.  For each element demands a different approach from us.  And as we get better and better at analyzing the complex nature of each approach, this will give us increased insight into what may well be our patient’s element.

 

 

 

 

 

 

 

 

Saturday, October 5, 2019

37. We must beware of becoming too comfortable in our work

All of us five element acupuncturists can fall into bad habits over the years, risking becoming careless in what we do.  One such pitfall is that we may become a little bit too comfortable in our work, not challenging ourselves as much as should do.  We may start to forget that each time we see our patient we see a slightly different person who is altered by the passage of time.  The patient before us is not the same person we saw at the last treatment.  We have to understand the need to see them with fresh eyes, requiring possibly a different approach from us.

It is indeed very difficult to retain a freshness of approach to our patients if they have been coming to us for a long time.   Often we are only too pleased to welcome patients we think are doing well, because we feel they are unlikely to challenge us by presenting us with new problems.  These are patients whose treatment we assume to know in advance.  Here we can be at risk of falling into rather too well-worn a rut if we are not careful, thinking that our patients will be as they were before.  Perhaps unconsciously we ignore the possibility that they may have changed in some way, since changes require us to make more effort.  It is much easier, we may think, to continue doing what we have done so apparently satisfactorily before.

And then we may not see, or choose not to see, something in our patient which should be pointing us in a new direction.  A long- term patient of mine, whose treatment I regarded as being simple to plan ahead for, turned up for one appointment not as I expected her to be.  If I had not been alert, I could easily have overlooked the slight change I perceived in her.  She herself volunteered nothing until I probed a little more and discovered that quite a disturbing event had happened to her, which totally changed the direction of the treatment I was intending to give.  Looking back on this afterwards I realized that I had been in danger of assuming in advance that I would find her as I had done before, and might perhaps have ignored the pointer alerting me to a need to re-evaluate the treatment I was intending to give her, which was now no longer appropriate.  We must never assume that we know our patient’s needs of today, since yesterday may have changed them.

 

 

 

Saturday, September 28, 2019

36. The three levels of the human being

I remember one very important day during my training under JR Worsley at Leamington 30 years ago.  We were learning about Aggressive Energy, and JR was explaining to us why it was so essential to insert the needles very shallowly into the Associated Effect Points on the back (back shu points) so that each needle barely penetrated the skin.  What I remember most clearly was the diagram he drew to illustrate this, simply a small block of three parallel lines one above the other, with a needle just nicking the top line but not penetrating below to the other two lines.  He said that this illustrated the three levels of body, mind and spirit.  The superficial level was represented by the line at the top into which the needle was inserted.  The bottom line was the level of the spirit, and the line between these two represented the mind, the intermediary between the body on the surface and the spirit in the depths.  For the purposes of the AE drain, the needle inserted at the physical level would draw any Aggressive Energy from the spirit up through the intermediary, the mental level, and then out from the body, the physical level, at the top.  This would appear as red markings around the needle as the Aggressive Energy drained away slowly to the outside air.  If the needle was inserted too deeply, any Aggressive Energy was pushed further inside, causing greater harm as it invaded the spirit.

This picture of the three levels of the human being has stayed with me since then, providing an excellent illustration of the emphasis in five element acupuncture on the importance of treating the deep (the spirit) and through this also treating the physical.  Many therapies, including different branches of acupuncture, concentrate treatment at the superficial level, the physical, and ignore its connections with what lies deep within us.  But the two levels, with the mental acting as intermediary between them, cannot be detached from one another in this way.  If we ignore the deep, it will call out more and more insistently for our attention, often doing this through the increased severity of physical symptoms.  We ignore at our peril what is deep within us, our souls, and do our patients a grave disservice if we concentrate too much of our treatment on the superficial.

To understand what lies deep within a patient’s spirit also demands compassion from us as practitioners.  Only with compassion can patients allow themselves to open up this deepest, and thus most vulnerable, part of themselves, their soul.

 

 

 

 

 

 

 

Sunday, September 22, 2019

35. One of the many challenges of being a five element acupuncturist

We must never be too quick to say “I know this patient’s element is obviously Fire (or Wood or Earth or Metal or Water)”.  There is nothing “obvious” at all about the way in which an element presents itself to us.  We may learn to recognize its presence more and more clearly with time, but we should always keep a healthy small (or large) question-mark hanging over it, reminding us that elements can hide themselves so subtly behind manifestations of other elements that they still have the power to surprise us, as they do me even after all these years.

If the presence of an element were so simple to detect, we would all be brilliant five element acupuncturists early on in our career, but human beings are much more complex than we think.  So we should never underestimate the time it will take us to find the one element buried deep within the circle of all the elements which gives each of us our individual stamp of uniqueness.

Pride, as they say, comes before a fall, and never is this truer when trying to diagnose an element.  We risk much if we think our understanding of the elements is greater than it truly is.

In any case, the secret of good five element acupuncture is not simply managing to diagnose the right element, despite this being what many practitioners think.  Instead it is learning to respond appropriately to that particular element’s needs.  Even if we diagnose the right element, do we know how to respond to its needs in a way which makes the patient feel that they have been heard as they want to be heard?  If that understanding is not there, treatment will rest on fallow ground, however much it may be focused upon the right element.

Supposing, for example, that we diagnose a patient’s element, correctly, as Metal, but respond to it in a way which would be more appropriate to an Earth patient, offering a kind of “Oh dear, Oh dear, you poor thing” kind of response, we will find that our Metal patient soon backs away and decides not to continue treatment.  Our element may be Earth and it may be natural for us, mistakenly, to offer to all our patients what we ourselves feel most comfortable with.  Unfortunately, however, we have to learn to feel comfortable in the company of elements not our own.  To surround Metal, for example, with a kind of enveloping sympathy is not what it wants.  It will feel suffocated by it, its Lung unable to breathe.  Instead we must learn to offer the space it always wants to place between itself and others.

And the same holds true for how we need to approach our interactions with the other elements.  As far as possible, then, we must learn to suppress the needs of our own element and think ourselves into those of the element we have chosen to treat.  This is not an easy task, and one that it takes some skill and much practice to acquire.

 

 

 

Friday, September 13, 2019

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.

 

 

 

Saturday, September 7, 2019

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.

 

 

 

Saturday, August 31, 2019

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.