40. The positive and negative aspects of each element

I have been told that some of my Chinese students think that the Wood element has what we call a “bad press”.  They feel that we often make the kind of negative remarks about it which we apparently do not make about the other elements.  I am always surprised to hear this, because I like to think that I always emphasize that each element has both a positive and a negative side, one side which it shows when it is in balance, as opposed to the other when it is out of balance.  To me, lack of joy or excess joy, both evidence of the Fire element out of balance, for example, is just as disturbing to witness as an unbalanced expression of Wood’s emotion can be.  I have always felt that the reason why people think Wood’s imbalances are emphasized may very well lie in the word anger which is used to describe its emotion.  This has negative overtones which attach themselves to the Wood element, which the names of the emotions of the other four elements, joy, sympathy, grief and fear, do not immediately have.  This is why I always like to add a further definition of Wood’s emotion to that of anger, which is the word forcefulness.  Being forceful sounds much nicer in English than being angry, and yet anger, when expressed appropriately, is as positive an emotion as any of the other four.

It is good to look at the whole question of how each element reveals itself both in its balanced and in its unbalanced state.  First we need to define what we regard as a balanced element, and look at the way this may start to lose its balance when it is subject to too much pressure upon it.  Each element has balanced expressions of those four sensory attributes, its colour, its sound of voice, its smell and its emotion, by which it signals its control over those handed over to its protection.  (This is why I like to call this dominant element a person’s guardian element, because, like the more common expression, guardian angel, it hovers protectively over each of our lives.)  If we concentrate here on one of these qualities, an element’s emotion, then we should start by thinking about what we would describe as a balanced expression of these five emotions.  For each of us this will reflect something quite personal to us, perhaps based on our life experiences when engaging with people of different elements, but I imagine that there may well be a common quality about each emotion which we all recognise as being an expression of it when it is in balance.    

It is easiest here to use Wood as an example, because its emotion, anger, is the most visible and in-your-face of all the emotions, and therefore one that we can relate easily to, unlike the more hidden emotions of grief or fear.  I think we can all agree that it would be entirely appropriate for anybody to show their anger if, as happened to me, somebody tried to snatch the cash as I was withdrawing it from a cash machine in the street. I remember shouting at the man as he did  so, my shout alerting those around me in the queue so that he let the money drop and sprinted away.  I like to think that my anger, which had the accompanying effect of changing my voice to a shout, can be seen as being an appropriate and balanced response to the situation.

But what if, instead of this, I had cowered back and refused to engage with the incident?  Could this not have been considered an inappropriate reaction from my Wood element, as it failed to do what balanced Wood would have done?  In that case, I would have been showing a lack of anger, an inability to show anger where anger would have been appropriate.  Equally, if Wood people explode with anger inappropriately, perhaps because they are the kind of people who blow their car horns repeatedly when in a traffic jam for no obvious purpose except to let off steam, this could be described as being an expression of excess anger.  Here both lack of anger and excess anger are the two sides of the same coin, both showing the Wood element out of balance.

It is good to look now at how each of the other four emotions changes from positive to negative as it becomes unbalanced, and how we need to learn to recognize this as a way of diagnosing imbalance in our patients.  If we look at the element at the centre, Earth, it will show, in balance, the comforting qualities associated with this loving mother element, nurturing us, supporting us, ensuring that we feel grounded in all that we do.  All these attributes, however, can become liabilities if it itself starts to feel deprived of good nourishment and is unable to feed itself sufficiently, both physically and emotionally, to replenish the reserves it needs with which to feed others.  It can then react in one of two ways, either by exaggerating its particular qualities, so that we see them as expressing an unnecessary level of sympathy, of the “poor you” kind, where this would be inappropriate.  The reverse of this is when it feels it has to suppress its natural tendencies, and instead turns itself into a surprisingly hard and unforgiving element, its emotion becoming an unyielding lack of sympathy for the problems of others.   

Very different, indeed, from this example of an unbalanced element is that of Earth’s own mother element, Fire.  Unlike Wood, Fire is always likely to be viewed positively, for does not the word joy, which describes its emotion, immediately make us feel happier?  But, as we know, there can always be too much of a good thing, and exaggerated expressions of joy can overwhelm those who approach a Fire element which is out of balance, much as we might scorch ourselves if we move too near an open flame.  Other elements, particularly I expect that coolest of all elements, Metal, can feel threatened by what can seem to them to be the somewhat overpowering warmth which the Fire element in excess can spread around itself.  The opposite manifestation of unbalanced Fire, that of depleted Fire, will express itself as a lack of joy.  I have found that this form of low Fire energy can have an extremely draining effect upon those in its presence, making us feel as though all the warmth of our own heart is being drawn from us.

My response to the emptiness of Fire, which we call a lack of joy, is here very different from what I experience in the presence of Metal, where the unbalanced expression of grief, lack of grief, is where this element is unable to show grief in situations in which grief would be appropriate.  Here Metal seems to distance itself from us even more than it normally does, an extreme expression of suppressed grief making it seem totally unapproachable.  Lack of grief is the kind of emotion Metal people show who we would describe as emotionally numb or stony-faced when others around them are weeping.  It is not that such people are not experiencing grief.  It is that they are so overwhelmed by their feelings, that they are unable to express them and have learnt to suppress them.  Unbalanced Metal can also express itself as excess grief, which is when a person is unable to recover from the death of a beloved person, and may continue to mourn for many years.

The unbalanced expression of Water, our final element, is very different from that of its parent element, Metal.  Its fear, appropriate when it faces any frightening situation, becomes exaggerated when it loses its sense of proportion, and sees danger where a greater sense of balance would reassure it that all is well.  Excess fear is easier to diagnose than lack of fear, as we may not be sufficiently sensitive to detect the anxieties hidden behind a Water person’s show of apparent indifference to danger.  I remember a Water patient of mine who enjoyed putting herself into extremely risky situations (a solo parachute jump with very little prior training, for example), and seemed to enjoy the challenges she voluntarily faced, despite fearing them.  I would call this a lack of appropriate fear.

All elements can therefore exhibit a range of responses which veer from the most appropriate, and therefore the most balanced, to the unbalanced, on a scale of from a mild to an extreme expression of their emotion.  By listening carefully to how our patients describe their responses to stressful situations we can learn a great deal about the balance of the elements within them.

 

39. The transmission of a five element lineage

We are not good at lineages in the West, and we also appear to have surprisingly little respect for the expertise of others.  In fact, most of our educational system appears to be built, not so much on the idea of learning from those of greater experience than us, but more of teaching students to discover things for themselves, almost as if the hard-won knowledge of those preceding them should be discarded as somehow not so relevant.

I have spent many weeks in China since 2011, introducing five element acupuncture to what must now be many hundreds of Chinese acupuncturists, and have learnt from these visits how much respect they show the lineage of five element acupuncture which they view me as representing.  This is why, there on the wall of the Tong You San He Centre in Beijing where I teach, I am greeted - each time with a slight sense of surprise - by a large panel of photographs, the first showing my teacher, J R Worsley, followed by my own photograph and those of the two teachers who accompany me, Guy Caplan and Mei Long, who initiated my first contacts with China through Liu Lihong, the Centre’s director.  Through his writings and teachings he is the person who has done most to stimulate Chinese traditional medicine’s search for its past roots.

For the Chinese, the line of transmission extending back to the Nei Jing, and on through the centuries to reach J R Worsley, then me and beyond, represents what they feel they have lost, a direct connection to the past.  In the West, on the other hand, we seem to be, if not exactly indifferent to this, then somewhat disinterested in the routes of transmission, as though we are not ourselves quite clear what lineage we are heir to.  This probably stems from the fact that generally both in this country and in China there is little clarity about how to integrate the precepts of traditional medicine with modern attempts to draw acupuncture closer to Western medicine.

The display of photographs which confronts me each time I return to China has made me re-evaluate my own thoughts about the transmission of a lineage, and led me to a new appreciation of what has been transmitted to me.  The way the Chinese view what I bring to them makes me more aware of the precious inheritance which has been passed down to me, and which the Chinese now clamour for me to pass on to them.  Here I am, coming from a far-off land, the bearer of an unknown treasure, my knowledge of an acupuncture discipline which fascinates them.  And, most importantly, somebody with about forty years’ clinical experience, which is something they value particularly highly.  I bring them a precious gift, the transmission of what they regard as the esoteric knowledge contained within the lineage of a particular branch of five element acupuncture handed down over the centuries from master to pupil.  This has found its way through devious routes to the West and is now finding its way back to its country of origin through me, an inheritor of this lineage.  It is useful to read Peter Eckman’s In the Footsteps of the Yellow Emperor, Long River Press 2007, as the best, and in my view, so far the only, in-depth study to trace these routes of transmission.

In England we often forget how precious the legacy of the past can be, tending to take this past for granted.  To the Chinese, anything which helps them trace this past is a gift to be nurtured.  Even though all practitioners are brought up on rote-learning the Nei Jing, they are aware that they have lost many of the connections between what is in these old texts and their practice of today.  In their eyes, the branch of five element acupuncture I represent makes these connections clear to them.

To the Chinese acupuncturists that I teach, therefore, five element acupuncture embodies a spiritual tradition which they regard as lacking in much of the acupuncture now taught in China, and connects them to a past which they feel they have lost.  Its emphasis on ensuring that so much attention is paid to the spirit is something they respond warmly to.  It echoes what they have learnt from the Nei Jing, but is something which is ignored by the TCM they are taught in their acupuncture colleges.   

To witness the joy with which they greet all the five element teaching I offer them is to raise an echo within me of a similar joy that I experienced sitting on my first day in the classroom at the Leamington college all those years ago, and learning about the Fire element with the Heart at its centre.  It seemed to me then, as it still does, and does, too, to all my Chinese students, that to base an acupuncture practice upon treatment of the elements was to state a natural truth about life.  Learning from the Chinese approach to their past, I can now see more clearly than ever that I, and every other five element acupuncturist, form one link in the unending chain stretching from the earliest days of the Nei Jing down the years to today.  This path of transmission passed to the West in the 20^th century and is now coming full circle on its return to its birthplace, China, in the 21^st century.  This is indeed an inheritance to treasure.

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

 

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.

 

 

 

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.

 

 

 

 

 

 

 

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.

 

 

 

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.