61. The Metal element 2: Some of the difficulties in diagnosing and treating Metal patients

I have always found Metal people to be the easiest patients to treat, provided (and this is an important proviso) that I am quick to diagnose that Metal is really their element. I have therefore had to work out my own ways of pinpointing specific Metal characteristics which help me with my diagnosis.  A person’s first impression upon us is always very revealing, particularly if we can catch a glimpse of some similarity with how we have previously reacted to somebody else, and perhaps revealingly so if the person we are reminded of is a patient whose element we are sure of.  This makes life much easier for us, of course.  A very clear comparison of the similarities between our reactions to the two people is very helpful.  Less helpful is what happens more often, which is that some little quirk in appearance or behaviour, something like the way they move their mouth as they smile or talk, or the way they look at us, sets off a vague memory of somebody else we know who smiles, talks or moves in a similar way.  We may not immediately track back to work out who this is, and it may take us a few hours or even longer to pinpoint the person we are thinking of, but once traced this is a nearly infallible way of finding an elemental signature to help us.

There is an added factor to making a diagnosis when we treat a Metal patient, which is that the relationship between patient and practitioner is always a very delicate one, but with Metal it is especially so.  I have sometimes described it as one where I have to tread lightly, as though on glass.  Metal is the most sensitive of all elements in detecting a slight of any kind directed towards it, and will harbour the memory of it for a long time.  It regards anything as a slight as something which implies some criticism of its behaviour.  Buried deep within Metal is a search for perfection, and this is what lies behind all that it does, as it tries to weigh up what is right and good and to discard what is wrong.  This, of course, includes judging its own actions.  It is prepared to do this itself, but allows no-one else the right to do this.  Any criticism will therefore imply a negative judgement and will be resisted.  No element wants to be taken as seriously as Metal.  To mock it or make it feel unworthy in any way is to lose any respect it has for us as a person and even more so for us as its practitioner.  This is why the first interactions with a Metal patient are so crucial, and can be very tricky if we do not pick up on a patient’s need to be allowed to do things their own way with as little interference as possible from others, and thus from us as their practitioner.

One of the pointers to the Metal element is the strong feeling that I have to tread warily in what I do and say.  This is my particular reaction to sensing the space that Metal people like to keep between themselves and others, even between those to whom they are emotionally most closely related.  I feel under inspection, being observed almost dispassionately, as though I am being assessed from a distance.  This is something Metal is likely to do to everybody who approaches it, and also does to itself, since it is the harshest self-critic of any element, constantly judging its own actions.  If it feels that I am not offering it what it thinks I should, I will be dismissed as having no further use.  This will translate itself into a Metal patient abruptly deciding to discontinue treatment.  On the other hand, once it has accepted that what I am offering as a practitioner is something it can value, it will be remarkably easy to treat.  It is no coincidence, I feel, that when I was palpating the wrist of one of my Metal patients to locate the position of the Metal source points, he told me quietly, “That feels very pertinent to me,” as though such a sensitive response to my touch had activated some reaction which he recognized as profound even before the point was needled.

I have noted over the years that many practitioners including myself fail to recognize the signatures of the Metal element for some reason which I have found difficult to decipher.  It may well be associated with its yin qualities, which it shares with the other yin element, Water, for what is yin is inward-looking, unwilling to reveal itself, quite unlike the outward-looking qualities of the two very yang elements, Wood and Fire.  Neither of these hesitates to express openly what it feels, whereas the two purely yin elements tend to be more comfortable keeping their feelings in the shadows, as though unwilling to reveal their true nature.  In other words we are always slightly uncertain where Metal and Water people are positioning themselves, unlike Wood and Fire who are so unmistakably there in front of us.  Earth, of course, being a combination of both yin and yang, can be both very visible, as though partly living life above-ground and partly more hidden, as though below-ground, as befits the rather ambiguous intermediate position it takes up.

It is therefore all too easy to mistake the face Metal turns towards the world as revealing what is truly going on below the surface, which I feel helps explain why practitioners may find Metal difficult to diagnose.  We are not quite sure whether what we are seeing is revealing how Metal really feels and acts.  One of the ways I have learnt to deal with this is by understanding that Metal, whose function is to assess the true nature of things, must rely on itself to do this, not ask for help from others.  Metal people may listen to what others advise, but will then take this advice quietly away inside themselves to mull over it, and decide whether it is sufficiently or insufficiently valid to take or reject. 

I learnt this lesson quite early on in my practice, when I happened to be treating a Metal patient immediately after an Earth patient.  The Earth patient was very happy to discuss openly what she was concerned about.  This was something which had been occupying her during many of our previous sessions, and was continuing to do so now.  On the other hand, when I afterwards went in to see the Metal patient, who had told me at the last session that he had some difficult decisions to take in his life, he said without prompting, “I’ve decided what I will do,”, and that was that.  I felt that he had come to this decision by himself, presumably, I hoped, after feeling the benefit of the treatment which he had just received, and there was now no further need to discuss it.  Nor did I feel he would welcome my questioning him further.  He had moved on in that quiet but determined way that Metal has.

 

 

  

60. Our individual take on the elements

One of the problems we have when teaching five element acupuncture is how to introduce students to the concept of the elements and the individual characteristics by which we learn to recognize them in human beings.  To do this we have to draw on some of the descriptions which have been attributed to them over the years, best illustrated at a very early age by those set out in the Suwen.  We have all learnt, for example, that the colour associated with Fire is red, and Metal’s emotion is grief, and this has been repeated numerous times since then in lectures and books, such as mine.  The problem here is that these descriptions can soon, perhaps all too soon, develop into stereotypes, and stereotypes which risk taking no account of the more fluid, often quite blurred outlines with which the elements reveal themselves to us, and which we have to learn to work with.  Human beings do not fit into fixed frameworks like this, much as we would sometimes like them to.

This certainly doesn’t make for an easy life as a five element acupuncturist, because the elements appear in so many different guises.  We are formed of a unique combination of all five elements, requiring us to sift through all sorts of gradations of colour, sound, smell and emotion which these imprint upon us.  This means that what we eventually may decide is the weeping voice of a Metal patient may be overlaid by quite a lot of singing or laughing, tempting us initially to think the patient’s element may be Earth or Fire.  The subtle interactions of all the sensory signs the elements place on us may appear to overshadow those of the dominant guardian element, and have eventually to be discarded before we reach below them to those which represent our element’s true imprint upon us.  This makes a five element diagnosis into a form of sifting process which requires time and patience, rather than the moment of intuitive recognition that some people like to feel it should be.

This is why the different characteristics the elements show will also be experienced differently by us in ways which reflect the influences our particular guardian element has upon us.  We will each have our own individual approach to other people, coloured not only by the needs and responses of our guardian element, but also by our life experiences.  From the point of view of being a five element acupuncturist, this means that we develop our own individual take on the elements.    

The crucial thing here is that each of us will react in quite different ways to observing the elements’ presence in our patients, because our responses to the elements in their different manifestations will be unique.  My appreciation of a patient’s cheerfulness, which I may ascribe to the Fire element, may well differ from a fellow acupuncturist’s, who may see this patient as being of another element, because he or she experiences a person’s expressions of joy differently.  Here a practitioner’s own element will often be a determining factor, which is why it is so important that each practitioner is constantly aware of how much their own element may be colouring their perceptions of the elements in their patients.   

We must not be frightened of acknowledging that we will inevitably have our own individual take on the elements which may well differ from that of our fellow acupuncturists.  What is important is that we gradually hone our understanding of these elemental manifestations down to some common descriptions of the individual elements which practical experience has taught us to be true, and which we then learn to use as part of our individual diagnostic templates.  The important thing here is to base our understanding on solid evidence from our own practice.  If the result of the treatments I have given a particular patient has confirmed that this patient is of the Water element, this is one step further along the path to recognizing this element’s particular sensory signatures in future patients.  I can then add the characteristics of this particular patient to the template I am drawing up for the Water element, now based on further evidence from my practice. This is how we gradually build up our understanding of the manifestations of each element patient by patient slowly over the years.

I always say that it requires courage to be a five element acupuncturist, since we have nothing but our own personal reactions to the different elements to help us towards a diagnosis.  We may initially base our diagnostic decisions on some of the stereotypes pointed out to us by more experienced practitioners, but in the final analysis we have to be brave enough eventually to develop our own take on the different elements.

59. The Metal element 1: General characteristics of the Metal element

Metal people have a much greater sense of stillness about them than other elements.  There can be a complete absence of movement when they lie on the couch, for example, almost as though they are like those stone effigies of knights lying in their tombs in cathedrals.  This is not a suppression of movement, as there might be with Water, as it tries to hold itself back, but a feeling of withdrawal and detachment from what is going on.

They make very steady and acute eye contact, and it is to the eyes that we are drawn, rather than to the mouth, as we are with Earth.  Whilst looking directly at us, and obviously seeing us very keenly, they appear at the same time to be looking past and through us, as though searching for something beyond us.  It is in their eyes that the sense of grief underlying this element is revealed.

Grief is an emotion which separates us from other people.  We are each alone as we grieve, the very opposite of how we feel when we express Fire’s joy or Earth’s sympathy, where we welcome others to us.  We might think that Metal only grieves for a death, but there are many other kinds of losses we can feel.  Its grief can stem from the actual loss of a person, but it can also grieve for what can be as acute, or even more acute, than a loss, which is an absence, a person who is not there for them, either physically or emotionally, such as an emotionally distant parent.  It can also mourn all that it will never have and all that was never there.  It can grieve for the things it has never done and will now never do, for what it has never known and for what it will now never know, for the losses it will never make up and the joys it will now never experience.  These are some of the losses which Metal, of all the elements, can experience the most profoundly.

I think the following is a beautiful description of the loneliness of grief, the feeling of isolation we all feel when we experience loss. It comes from a book by the American writer, Francine Prose, called Goldengrove, which is all about how a young girl copes with the death of her sister.

“So many of (those trying to offer comfort) said the same things that I might have thought that there was common ground, if I hadn’t known that I was alone on an iceberg split off from a glacier….. When they wept, I cried, too, and for a moment I almost believed that my iceberg might have room for another person.” 

I have also been helped in my understanding of the Metal element from the time when I unexpectedly experienced the emotion grief in an intense form for one day.  I woke one day feeling unutterably sad. Though I racked my brains I could find no reason for this. Nothing was then happening which could be causing me the kind of sense of deep loss I was experiencing, nor could I pin it down to any recent event which might have occurred around this time of the year. I looked at the season I was in, and it was not autumn, Metal’s season, when we might all feel a little melancholic at the imminent death of the year. Nor did the date have any particular resonance for me, as I fretted away at my memory. So where had this overwhelming, all-permeating feeling of sadness come from? 

The feeling lasted just that one day. By the evening it was fading, and by the morning it had gone completely, never to this day to re-appear. At one level it puzzles me that I should have been so shot through with such an unfamiliar emotion, one that even in times of deepest distress at some real loss in my life I had so far never experienced. Its very unfamiliarity was disturbing, for it propelled me into unfamiliar emotional territory. I felt cut off, alienated from my surroundings, and unwilling or unable to share my thoughts with anybody else. I felt as if I was wandering alone like a shadow amongst strangers, unapproachable, as though nobody could reach me beneath this mantle of grief that I was enveloped in, like a garment I could not take off.

The memory of this strange day has faded, but its significance has not, because at some time during it I found myself saying to myself, “so this is what it is like to be Metal. This is what Metal people must be feeling at every moment of their lives.” Was this realization the reason I was asked to experience such an unsettling day? Now I like to think it was, for that journey on to what I like to think is Metal’s territory and my identification, however briefly, with the emotional terrain upon which Metal lives its life, have given me deep, personal insights into this element which I think I could have gained in no other way. These have stayed with me ever since, and guide me with a surer hand to my diagnosis of Metal in other people.

When trying to work out whether a voice has the weeping tones of Metal, it is worth closing your eyes and just listening.  Somehow when we listen in the ordinary way, watching the person talking, I find that we can overlook the quiet, yin, falling quality in a Metal voice.  Listened to by itself without any input from our eyes, it becomes surprisingly flat and low, and draws us downwards.  This is exactly the opposite of the yang, rising tones of Wood and Fire.

When trying to work out whether somebody is Metal, it is worth watching how the person is making you feel.  Are you finding that you are somehow careful in what you say, as though choosing your words carefully in case you may be criticized?  Metal judges;  that is its role, to weigh the good and the bad, and discard the bad.  It therefore cannot help itself from judging us, and we can feel this as implied criticism, although it may not be intended as such.  It is, of course, above all critical of itself, but will not take lightly anybody criticizing it.  You can laugh with Metal, it can laugh at itself (it can have a very acute, sharp sense of humour), but you can never laugh at it without finding that it withdraws completely from you.  In the case of a patient, this may be the reason why they decide to stop treatment, because they will experience your laughing at them as you as their practitioner judging them to be in some way inadequate, and this they cannot allow.

 

58. The Earth element 5: Lying in the bath

I had an insight into the Earth element as a result of some observations I made whilst having my bath.   I was lying in the bath, slowly letting the bathwater drain out.  As it drained away, I started to feel my body grow heavier, moving from a point where I had been totally unaware of its weight to a feeling of increasing heaviness as parts of me emerged above water, until, with the bath now empty of water, I felt as though my body had become a dead weight whose heaviness seemed to be pinning me down. I was made aware of the considerable effort it required to unpeel myself from the floor of the bath, and was astonished by the force of the gravity which had seized hold of my body as the water sucked away from it. Why had I never noticed this before?

Once upright, normality returned, as all the mechanisms which we learn as a child to enable us to stand clicked into place. By the time my feet were on the bathmat my body no longer felt heavy, and it took me some effort to remember how difficult the transition from weightlessness to weight had been.

Those few minutes in the bath have helped me understand how Earth people can feel, for they live their lives in an endless balancing-act between the desire to remain safely tethered to the ground and the need for their Spleen to help move them forward.  And thus for the few moments as one foot after another leaves the ground they can in principle be vulnerable to falling over. When out of balance, this desire for security can outweigh the need for movement, and suck them down into the earth as though they are stuck in damp clay. Or the opposite may happen, and this damp clay turn instead into dry sand which allows no foothold.

This is how I see the two extremes of the Earth element out of balance: the one as though they are stuck fast in oozing mud, the other as though they are trying to keep their footing on ever-shifting sand. Between these two extremes lies stable Earth, with its feet firmly planted on the ground, and yet with sufficient balance to move securely forward when movement is required.

You may find that your next bath can be a lesson which teaches you as much as a whole lecture on the Earth element!