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
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. Liu Lihong
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.