Oh, how we would all like to be 100% certain about things. In five element terms this would mean that with sufficient experience we would be absolutely sure of a patient's guardian element, leaving no room for doubt. But that is not how things are, nor should we hope that this is how they should be. Instead we must learn to accept what I like to call the certainty of uncertainty underlying all human activities, including our diagnosis of a patient's element.
I am strongly reminded of this truth now because of something which has happened whilst Guy and I are helping put together the latest of a series of courses for Chinese five element practitioners. In previous courses we have looked at videos of patients and made preliminary diagnoses of their elements. For this course we are being sent further videos of patients we have previously diagnosed after they have received further treatment either on the new element we diagnosed or on the original element we confirmed as being the correct one. We are focusing on helping develop practitioners' relationships with their patients and improving their ability to observe the often subtle changes in patients which indicate that they are treating the right element.
All five element practitioners have to be honest enough to admit when our diagnosis is not yet the right one. This thought is at the forefront of my mind at the moment because I have just been sent some more videos of a patient we diagnosed a few months ago which have made me alter my original diagnosis. The patient does not seem to be showing any of the changes I expected to see after some treatments on the new element. After seeing more videos of her, I am now much more confident of her being of another element.
Here indeed is a real lesson in humility. We are using these videos as teaching material for perhaps some hundreds of five element practitioners in China. There is now no doubt in my mind that we need to change our diagnosis, and it would be wrong to continue with my original diagnosis. How do I make this change in diagnosis without undermining my students' trust in what I am teaching them? This is a dilemma all five element teachers have to face.
This is where my thoughts turned to something I read in Professor Liu Lihong's book, Classical Chinese Medicine, which so impressed me with his understanding of the need for humility in all that we do. He said that we will all start any discipline by getting things about 10% right, and gradually increase this with practice to 40%, then 50 or 60%, but we never reach 100%. Traditional Chinese medicine is a discipline based on practitioners' subjective experience, unlike Western medicine, which prides itself somewhat naively on believing that it bases itself on objective criteria. As five element acupuncturists, on the other hand, we welcome the fact that the relationship between patient and practitioner forms a crucial part of all treatment. There is therefore every reason for us to accept the very human uncertainties which are an essential ingredient of what each practitioner brings to his/her practice.
So I will be using our approach to diagnosing and treating this patient as a prime example of good five element practice. I hope that showing fledgling five element acupuncturists that my ready acknowledgement that I needed to change my original diagnosis will encourage them to retain sufficient humility in their own practices. They therefore need not be afraid to admit when they don't get things right straightaway, and allow themselves not to be undermined by this fact.
I often think that this fear of what may be seen as showing fallibility in front of their students by not wishing to reveal that they are uncertain of their elemental diagnoses may be one of the reasons why so few good and experienced five element acupuncturists wish to venture into the world of teaching. This is one of my sadnesses, for it is reducing the flow of five element teachers to a tiny trickle. As one of my students said to me many years ago: "If JR is the only person to be 100% sure of his diagnosis, how will I ever get to that point?" To which I would give the answer JR Worsley gave to a class of us when I was a student at Leamington: "If you had all practised for 40 years, as I have, you would all see the elements as clearly as I do. So just wait!"
Five element teachers have to have enough self-confidence not to mind telling their students that they, too, are human enough to change their minds, as I am about to do on my latest video recording for my students in China.
In my own teaching I have always emphasized that my first diagnosis of a person's element is a provisional one, a hypothesis which subsequent treatment is there to prove or to amend. Chinese students seem to be quite happy with this and don't appear to be thrown when I change my mind later. But being human, which means that I do after all want to show that as an experienced practitioner of many years' standing I know what I am doing, I still find it difficult when, as now, I have to announce publicly that I got it wrong!