Learning the skills needed to detect change

One of the skills of being a five element acupuncturist is that of learning to detect the changes in our patients as a result of treatment.  When I was a novice practitioner I had to use quite crude criteria for assessing whether my treatment was helping a patient or not. The most widely used, I admit rather shamefully now, was asking my patients themselves to tell me whether things were changing for them.  Questions like, “How are you feeling now?”, or “ Has your sleep (or any other symptoms they have told us about) improved?”  I am ashamed now of asking such questions because I realise that patients often don’t know how to reply, as I didn’t when asked by one of my practitioners whether treatment was helping me.  I felt I needed to encourage her by giving some positive response which might not be true, unsure what kind of improvement I should be experiencing, and worried, too, that she might lose interest in helping me.

A patient should never be the one to judge whether their treatment is helping them.   We should Instead develop an ability to detect often the slightest physical or emotional change as a result of treatment.  It is these which I would probably not have recognized early on in my practice.  The changes are often very subtle:  our hand held more firmly during pulse-taking, or a slightly softer outline or less tension to a face. They may talk less or more, or seem no longer to be so preoccupied with some symptom or another.  Any change, however slight, is significant confirmation that the patient’s elements are welcoming the direction of the treatment they are receiving.   

 

The flipside to this is, of course, our growing awareness when treatment is having no effect at all.  This is again a skill we need to develop.   As the years pass I have become more quickly aware that nothing has changed, acting as a warning sign that I may need to change the emphasis of my treatment to another element.  It requires some courage to admit to ourselves that we are on the wrong track, sometimes even wrongly blaming the patient for not responding to treatment as we think they should.  But if somebody comes back week after week with no evident change in themselves or their condition, we must be prepared to query our diagnosis, and be brave enough to pause and take stock.

 

I have learnt to do this by telling the patient that I am not yet satisfied with the effect of treatment, and asking them how they feel.  This is often the point where a patient will admit, with relief, that they, too, do not feel the treatment has yet helped them.  I then ask them to allow me some more time, sometimes even by coming more frequently, so that I can re-assess the treatment.  None of my patients has ever refused to do this.  Very often this honesty between us helps put our relationship on a better footing, which in turn gives me the time to work towards finding the correct guardian element: a win-win situation for us both.

Devising a new way of diagnosing the elements

One of the effects of my visits to China over the past 14 years is that they have forced me to change my approach to diagnosing the elements.  In China we were asked to help diagnose many hundreds of five element students and practitioners at each of the seminars we ran there.  The main reason for this was that I always emphasize the importance of a five element practitioner being confident of their own element, since this colours their approach to their patients. The sheer number of people wanting our help to do this therefore inevitably made it essential for us to adapt the procedure for diagnosing the elements which I had until then accepted as being the only correct one, one that I had learnt during my training and have practised ever since.

 

In my own practice I had the luxury of giving each new patient and myself the time gradually to get to know each other, and thus to develop the good relationship necessary to help me towards a diagnosis of their element.  The initial interaction could be as long as two hours, with each subsequent treatment being at least one hour.  This gave me plenty of unhurried time to work my way towards a patient’s element.  In China, on the other hand, no such luxury was possible.  We were at the most three five element practitioners, and were expected to diagnose the elements of sometimes up to more than 300 people over a mere seven days.  We could only do this by devising a different approach to diagnosis, and this in turn changed my understanding of how the elements manifest themselves when seen in groups.  This led us to develop what I regard as an effective method of diagnosing the elements of large groups of people. 

 

We modified our new approach to diagnosis slowly over the first few years of our Chinese seminars, and only developed it fully as the numbers in our seminars increased (from the initial 20 or so 14 years ago to the final 500).  To start with I kept the protocol I was familiar with in my own practice:  an hour or so quietly alone with each new patient.  This quite soon became impractical.  Initially I tried to adapt the interaction of a private diagnosis by talking to volunteer patients in front of the whole seminar as though pretending that this was in some way equivalent to a one-to-one interaction.  Apart from the fact that I always tried to avoid any very personal questions which might embarrass the person in front of the large audience, it also meant that we could diagnose far too few people.

    

I therefore had to start devising other ways of diagnosing, helped by the fact that those coming to the seminars had first to attend the preliminary seminars given by the growing group of what we call five element teachers (those Chinese practitioners who had attended many of our seminars and were themselves practising only five element acupuncture).  All attendees had therefore been given what they called a provisional diagnosis of their elements at these seminars.  This meant that we could subdivide the large group into five element groups, and use these subdivisions as a way of moving towards what could be called a group diagnosis.

 

What was so interesting was that I found that when there were several people of the same element together this seemed to exaggerate the characteristics of that element, making it appear in starker outlines.  It also revealed, again more clearly, the fact that one or more of the people who had been assigned to one element did not appear to belong to that element.  The differences between them emerged much more clearly when, for example, a Water person was amongst a group of mainly Wood people.  This became even more obvious when the very interesting element games Guy Caplan created for the different element groups showed very clearly the presence of one or more people who reacted quite differently to the instructions given to a group.  In other words, we learnt that groups of people of the same element acted in a similar way, as would be expected of that particular element.  For instance, Water huddled together, as did Earth but in a more comfortable way, Metal worked individually at the tasks Guy had set them, Fire was very conscious of being observed by video, and laughed at the camera recording their reaction, whereas Wood started to try and take individual control of the tasks, as though each wanted to be in charge.

 

The result of all these interactions between different groups of elements was that I became more than ever convinced of the truth underlying five element acupuncture,  which is that each person expresses their unique individuality through the prism of one of the elements.  And the elements appeared to reveal their characteristics even more markedly when viewed in groups.