A five element circle drawn around the world

There is always something very magical about my Chinese visits, this the seventeenth over 12 years.  My days in China always seem to feel as though time pauses when I am there, as we run our week’s seminar, and then time restarts as I get on the plane back to London.  Much of the credit is due to my hosts who welcome me each time in their hundreds as though they are greeting a beloved friend, and cocoon me within what they express as their love for me from first to last day. From the moment we arrive in Beijing we are greeted by a large group who present us with lovely bouquets, with much hugging and kissing.  And this continues until the day we leave, accompanied again by another large group, which includes both times my host of hosts, Professor Liu Lihong, the inspiration behind five element acupuncture’s so eagerly awaited return to its homeland.

 

Liu Lihong and I go back now a long way.  Many years ago I remember our looking critically at one another as Mei Long introduced us at a Rothenburg conference.  From the moment we laid eyes on one another, though, I think we both relaxed, because here were two fellow souls each in our own way determined to nurture the damaged roots of traditional Chinese medicine and restore them to the healthy condition they deserved, he through his practice of herbal medicine and I through mine of five element acupuncture.  And between us there hovered the much-loved presence of my own great master, JR Worsley, who some years ago with his usual omniscience had foreseen the return of five element acupuncture to the place of its birth, telling me, “They will want us back in China soon, Nora”, as they now do in their hundreds.

 

I come back to England, as I always seem to do, inspired by the enthusiasm and warm response to what we teach them.  At a deep level they understand what five element acupuncture is all about, since the elements are in their blood.  I hardly needed to say anything before I could feel the agreement of all the 500 people who attended this seminar.

 

I spent a very warm last evening at a simple supper with Liu Lihong and a friend, accompanied as I always am by my good friend and translator, Lynn, to help Lihong and me understand one another. (Oh! how I wish that I, as a former linguist, had had the good sense to learn Mandarin many years ago before my old ears found it too difficult).  It felt to me then, and it feels increasingly to me on my return, that together Lihong and I have drawn a five element circle around the world, with JR Worsley, smiling, there, holding out his hands to both of us.  A slightly over-impressionist image, perhaps, but one that corresponds to how I feel as I reflect on my latest trip to China.

  

Helpful hints for the novice five element acupuncturist: 3 Keep it simple

One of the mantras I can still hear my master JR Worsley telling us was: "Even a little child can understand this", and by "this", he meant the underlying principles of five element acupuncture.  One of my own mantras, following on from this, is:  "Find the element and the element will do the work".  A person's element is the imprint which nature gives each of us as the stamp of our unique individuality. By supporting this element through treatment directed at it we are helping nature do its work, with each treatment strengthening the element and allowing it to return our patients to a state of balance and harmony within themselves.

There is never any need to reach for complex point combinations.  We should rely instead on the simplest treatments, and the least number of them to help the elements.  We should also avoid over-treating our patients.  We should wait until we have proof that the element we have chosen confirms our diagnosis, before gradually spacing treatments out from one to two weeks, then to a month and eventually longer.  

It is good to understand that each time we insert a needle into an acupuncture point this can be seen as an interference with a patient's energy, and to some extent as disempowering the elements.  We should therefore interfere in the most gentle way and as least often as possible to allow the elements to regain the control over patients' energy which nature intends for them.  Unnecessary treatment encourages the elements to continue to hand over control to us rather than empowering them to do their own work.

 

And finally, always remember when in doubt choose a command point.  Unlike other points, you can use and re-use them as often as you like.

My favourite acupuncture points: Conclusion

Many people may wonder why I don't include my own descriptions of acupuncture points, but only list them.  There are many reasons why I am reluctant to do this, the main one being that I don't think that I can explain the reasons for my choice clearly in words.  I have developed these choices after many years of practice, and mainly through something I call my "feel".  I find it very difficult if not impossible to describe how today I might feel that CV 14 is a good point for one patient, whilst III 38 might be the one for another patient.

One day I decided to look back at the treatments I gave to my first patients as part of my initial training, and was amazed at just how few points there were on this list.  And they were all such simple treatments, mostly consisting of command points plus the very occasional additional point, ones we called "spirit points" (although as I often say, all points have their spirit, command points included).  Of course we always started with an AE drain, and were on the look-out for blocks.  The main emphasis of treatment was the simple requirement to confirm a patient's element and then strengthen it in any way we could by choosing points on its two meridians, or points relating to them, such as AEPs or Windows.

I have often talked about the magical day towards the end of my postgraduate study with JR Worsley when he picked up his "brown chart", the well-known bible of acupuncture points all us five element acupuncturists have at our side, and started reading out the names of one point after another, starting with the first, Heart 1, Utmost Source, and ending with GV 28, Mouth Crossing.  He did not tell us how we should use these points, except occasionally murmuring, almost to himself, "this is a lovely point", or "only the most experienced practitioners must use this point", or "this is a forbidden point to needle".  But he spoke each point's name as though he was addressing his beloved.

 

I knew I had heard a master at work, with an understanding of what points meant to him that I would never acquire, but which had touched me at different times to help illuminate my own understanding of my craft.  Perhaps, too, I like to think that he was passing on to the few of us in his class some hint of his mastery to help us develop our own approaches to the points.  Or at least that is what I like to say to myself.

The need to find our own support network

It has been increasingly clear to me how fortunate I was to receive my training as a five element acupuncturist when I did.  I was unaware of this at the time, and actually for a fairly long time afterwards, because I assumed for a long time that all acupuncture students benefited from the same training structure as I did.  I regarded this as the norm, eventually transposing this almost lock, stock and barrel to form the foundation of my own acupuncture college, the School of Five Element Acupuncture, SOFEA.  Having recognized the deep benefits of my own training at JR Worsley's Leamington College, I saw no reason whatsoever in exploring new approaches to teaching which differed from the way I had so expertly been taught.  I therefore passed through my own college's first few years without recognizing the need for deeper enquiry into the nature of the training I was offering my own students.

 

But gradually the increasing demands upon acupuncture education which the development of more stringent accreditation requirements made upon all acupuncture colleges also penetrated what I now consider my almost naive approach to setting up my own acupuncture college.  The acupuncture world as a whole was moving from being an outlier in the world of medical education to forming part of the mainstream, with all the requirements for more standardized education methods this entailed.  Whereas my own training at JR's Leamington college had a very practical emphasis, concentrating almost entirely on observing and treating as many patients as possible, often up to 20 on a clinical day, I was now expected to adapt the curriculum to conform with a less practical, more theoretical approach, more akin to a conventional university course, and therefore much less patient-orientated.

 

In the many years since then I have become aware of exactly what I and my fellow students gained and what many students of five element acupuncture throughout the world now search vainly for.  I had available to me teachers who were above all experienced practising acupuncturists, and a course which offered me the chance to steep myself in treating one patient after another under their expert supervision, over a period of something like seven years.  This covered the initial three years of my undergraduate training, plus four more years of postgraduate training, very fortunately mainly under the personal supervision of JR Worsley.  Since this included many visits not only to my own practice to be observed treating my own patients, but also many days of benefiting from observing the practice of those more experienced than me, all this combined to give me what I now realise was my own personal support network as I felt my way into being a competent five element acupuncturist.

 

When I compare this now to what a similarly enthusiastic novice five element acupuncturist is offered today in whatever country they live, I realise sadly what this novice acupuncturist has perhaps lost and which I am now trying in my small way to make up for in the way in which I teach.  This blog forms part of this, because I feel that in articulating what I see as the inevitable deficiencies of current five element training I may be able make good something of what we appear to have lost.  

 

I have often expressed my sadness at the increasing lack of experienced five element teachers.  I know that many of the older band of five element acupuncturists feel either that they no longer fit into the structure of the few acupuncture training colleges in this country, since these now feel obliged only to offer five element instruction when it is combined with modern Chinese TCM acupuncture.  Others appear to feel that there is no longer a place for them where their belief in a pure approach to five element practice is required.  Where this does not appear to be the case, luckily, is increasingly amongst the many hundreds of Chinese acupuncturists I have taught over the past ten years of my visits to China.  As of now, though, there are too few experienced Chinese five element practitioners to cover the needs of this vast territory, with just a few who have graduated to teaching concentrated in the larger cities, such as Beijing and Chengdu, whilst one or two are scattered in lonely exile in more far-flung places.  But it is precisely the needs of these hundreds of devoted five element practitioners that I am trying to address.

 

My next blog will discuss how I have had to develop my teaching methods to help support this large Chinese contingent of devoted five element practitioners. 

Helping to unlock some of the mysteries of point selection

I have often been asked why I choose a particular point or point combination, and have always found this difficult to answer, except in very few cases.  It is easy to explain the points chosen to clear a block of one kind or other, because pulse readings require them.  Apart from these, though, we are left with a whole raft of points which depend entirely upon a practitioner's choice. This is a much more esoteric area of point selection, about which much is written but very little, I feel, is really understood.  I and others living in this country may have been lucky to learn from more experienced practitioners, particularly in my case from JR Worsley, but others in other countries have not been so fortunate.  And now, as I have often lamented, there are so few good five element acupuncturists anywhere around the world that we have in some respect to wind the clock back to a time when a five element practitioner was a kind of pioneer, each of us working out our own principles of point selection.

 

I have a precious, but surprisingly small repertoire of points whose function I heard JR Worsley describe as he selected them for patients we brought to see him.  I treasure these, and use them probably with greater confidence than I do points that I have myself accumulated over the years.  In the majority of cases, though, JR would recommend points without saying anything more, leaving it to us to work out our own explanations for why he was choosing these particular points for this particular patient.  Some of us students found this absence of explanation difficult to accept, but I did not, always regarding five element practice as being based on a question of "feel" rather than on logic. I realise now how fortunate I was that I emerged from our training without feeling confused about how to select points.

 

Basically the rules we used were very simple.  The main emphasis was on points of the element we had diagnosed, particularly its command points, above all source points.  We would occasionally add what we now call a spirit point, such as Bl (III) 38 (43) or CV (Ren Mai) 8, but often not even these.  Looking back this made for very simple, but highly effective treatment.  I can't remember any of the confusion which now seems to hover around point selection. This may partly be the result of the many books which have appeared since I graduated, listing points and claiming to explain their individual function.  This is often on very flimsy evidence and with even flimsier proof that the author has gained his/her understanding of a point's function from good clinical practice.

 

It demands much of practitioners to accept that they must learn to rely on their own subjective impressions rather than open a book to search for points to select.  I would recommend that they should instead spend the time looking at their patients, and training their senses to see, hear, smell and feel, and use this information to guide them towards an element.  As I always say, it is far better to think elements than points.

  

22 - 36 The fear of not diagnosing the "right" element

A wise young man told me something very important.  He said, "We grow when we are challenged", and I often think that there is no greater challenge for a five element acupuncturist, amongst the many challenges we face, than that of learning how to deal with the natural fear we all have of not getting our diagnosis of a patient's element "right".  We each have to learn to deal with this particular fear in our own way, but what it requires of us is honesty and humility, which can be characteristics some of us may find difficult to accept as forming a necessary part of a five element acupuncturist's role.  I have observed many reactions to my students' finding that the element that they think is "obviously" Fire turns out instead to be Wood or Metal.  Their reaction is sometimes disbelief, or a need to cast doubt on even the most experienced practitioner's diagnosis rather than accept that their practice requires so much of them. In extreme cases, students or practitioners have felt compelled to move away from five element acupuncture to practising other forms of acupuncture which do not rely so heavily on our subjective senses and emotional antennae to diagnose our patients.

I have said many times that five element practitioners have to learn to accept that they are themselves, as JR Worsley so beautifully put it, instruments of nature.  Rather than relying on physical equipment to give us our diagnostic information we have to rely on ourselves, on our eyes, ears, noses and emotional antennae.  I have always found this a quite lovely aspect of my work, but some people are daunted by the need to put themselves at the forefront of practice in this way.  No physical instrument can diagnose a patient's element;  only our own senses and feelings can do that.

 

And we are all fallible human beings, each with our own particular emotional hang-ups, each of us hoping against hope that we will get that most difficult aspect of any five element practice, the accurate diagnosis of our patient's element, right.  But we must learn to say to ourselves that, if we don't get it right to start with, it does not matter, because elements are elusive things, which often hide themselves behind other elements, having learnt that life often forces them to put on masks in order to survive.

 

We have to accept that a five element practice requires us to come to terms with not getting our diagnosis right immediately, and that once we acknowledge that this is so, we will, as my young friend said, grow as a result of meeting this challenge.

 

22 - 34 What do we hope five element acupuncture can offer our patients?

There are many reasons why we find our way to a calling such as five element acupuncture, probably as many reasons as there are acupuncturists.  I have often written about my own surprising journey towards my first day sitting in JR Worsley's Leamington College hearing the magical words, the Fire element and the Heart.  That journey had started a year earlier at an encounter with an acupuncturist at a party and the subsequent overwhelming effects of the treatment I received.  So my understanding of why I eventually decided to follow the same route as my acupuncturist and study at the college he had studied at was quite clear.  My treatment had transformed my life and I wanted to be able to offer the same transformation to any future patients I might treat.

 I have always had a strong belief that each of us owes it to those around us and to the world in general to leave this world in a slightly better place than when we first entered it.  We need to feel that we have added something by our presence.  It is as though we are each given a task to do.  In five element terms I like to see this task as expressing itself through the needs and aspirations of our guardian element.  I have therefore come to see each successful treatment as in some small way forming one step along this path for each of my patients.

 

These thoughts, which have been mulling within me for many years, were originally sparked by something JR Worsley said during my undergraduate training all those years ago, and have stayed with me ever since.  He said that we should visualize how our patients would be if their element was able to express itself fully in the most creative and harmonious way.  By strengthening this element and helping it to greater balance, we are therefore making it possible for our patients to fulfil whatever destiny fate has laid down for them, as expressed through this element.  

 

I like to think that each patient leaving our practice in greater harmony within themselves is adding a tiny but important bit to the sum total of human experience, and, with it, I hope, human happiness.

 

22 - 30 The guardian official

It was during a postgraduate seminar at my Leamington college all those years ago that I for the first time dared to share my use of the term "guardian element".  Before that, I used to call it the CF, meaning the Causative Factor of disease, as most people still do.  I have always thought that the term CF has a slightly negative overtone, which JR himself did not seem to agree with.  I remember very clearly him telling us that we should always visualize our patients as expressing the most positive qualities of their element, rather than regarding this element as a symbol of their imbalances.  And I like to hear the echo of the words guardian angel behind my coining of the phrase, because this is how I think of this element.  I see it as a protective force when we live our lives wisely in tune with its demands.

 

I have now decided to add a companion phrase, and call the yin and yang officials which together create an element our guardian officials.  I am only surprised that it has taken me so many years to think of this.

 

We know that we are each marked by the characteristics of one element, and that each element is formed of the close association of one yin and one yang official.   These two officials within the element also imprint specific characteristics upon us, making some people of that element have characteristics which are more yin in nature, and others more yang, reflecting the different qualities of their particular dominant official. This distinction further defines who we are, so that a Wood person, for example, will have a closer association with the characteristic qualities of the Liver and another with those of the Gall Bladder, making either the Liver or the Gall Bladder their guardian official.  

 

It is rarely clinically necessary to diagnose this further level of differentiation.  First of all because it is difficult enough tracking down a patient's element, let alone trying to perceive even more subtle differences within an element, and secondly because we rarely need to move to this deeper level of diagnosis from the point of view of treatment, since we treat both officials equally.  It is, however, interesting to try to recognise the different qualities which one or other official gives us, since this is a way of helping us understand more about the role of the individual officials within the cycle of the elements.

 

Occasionally, we need to think more closely about this, particularly in the case of Inner Fire and its yang official, the Small Intestine.  This is because we are taught to avoid treating the Heart, the Supreme Controller, more than is necessary.  It is regarded as a sacred organ, and we should where possible avoid interfering in its functioning by treating it.  Instead we should concentrate treatment upon its close yang official, the Small Intestine, making this an exception to the general rule that we treat both official pairings equally.

 

This brings me neatly to another important question, which is how we make our choices about selecting points other than command points, those points which are often called spirit points.  As I have often written, all points should be recognized as having their own spirit, but in general parlance the term appears to be given to any point which is not a command point.  I have often thought that this is perhaps one of the most discussed, but least understood areas of five element practice, precisely because by calling some points spirit points we appear to assume that they have a more profound effect than those that are "merely" command points.  This is a misconception which bedevils five element practice.  In the right hands and with the right understanding command points can effect the most profound treatment of all, whilst spirit points, in the wrong hands and with the wrong understanding, can have very little effect at all.

 

I see non-command points as being able to offer specific qualities, often associated with the names they have been given over the centuries, which can add to what the officials on whose meridians they lie are there to offer.  Often we may use one point on one of the two guardian officials, rather than choosing points on both, as we do with command points or Associated Effect points, for example.  The selection of non-command points has often come to be regarded as a somewhat mysterious area of expertise, which I think it should not be. Different practitioners will choose different points, often having a long-term preference for a few, usually because they have learnt about them at some point from a more experienced practitioner, as I have done.  Or perhaps a fellow practitioner will tell me about a point they have used, either one I have never used, or, as happens, one I have forgotten about over the years, and I will be glad to welcome such points back into my repertoire of point selections again.  This is, after all, how we widen our range of points, although having observed JR Worsley recommending points for the many hundreds of patients I saw him with I can confirm how beautifully simple were always the treatments he recommended for our patients, suggesting the same small range of points for each element. 

22 - 20 Two important lessons JR Worsley taught me

Two important lessons JR Worsley taught me many years ago have stood me, and all those people I have passed them on to, in good stead.  They are both deceptively simple lessons, but are profound in their reach.

 

The first was when I had just started my School of Five Element Acupuncture, SOFEA, and was feeling rather overwhelmed by the task I had taken on without thinking through many of its consequences.  I remember telling JR that I thought I had been foolhardy in accepting the responsibility of teaching others when I had only been in practice myself for so few years.  And he said, "Remember, Nora, you know more than they do."  And indeed I must have done, although I hadn't put it to myself in those terms.  After all, I had then had more than 6 years' experience both learning about and practising five element acupuncture, first as a student and then as a practitioner, and the students I was expecting to teach had absolutely none.

 

So this is the advice I pass on to other prospective teachers.  As long as you never claim to know more than you do, then each person has the right, and, as I often say, the duty, to pass on the little or the great amount of their own learning to those that have less than they do.

 

I found the second piece of advice  a little more surprising, but it was even more illuminating.  I told JR that I was having problems feeling the pulses and trying to diagnose their relative weaknesses and strengths.  And he said, "I know what you mean;  that happens to me, too.  Perhaps for a month or so I am uncertain of my pulse readings, and then I realise that this is because I've moved up a further level in my pulse diagnosis."  I wasn't convinced that the same applied to me at my much lower level of practice, but it was a comfort to hear JR say that he also had doubts about his own proficiency at various points in his life.

 

Both these lessons have comforted me throughout the many years of my practice and teaching.  I hope that they encourage others in their practice as they have encouraged me in mine.

  

22-9 The importance of practitioners knowing their own element

People often think that the most important thing for five element acupuncturists to learn is gradually getting better at diagnosing their patients' elements.  This ignores the fact that we can't do this until we have familiarized ourselves as closely as possible with as many expressions of the different elements in as many people as possible, and, above all, this includes in ourselves.  I don't think this was emphasized as much as it should have been in my own training, nor, I'm afraid, in the early stages of my own teaching.  This was probably because I only slowly realized the importance of familiarizing myself with the elements at the deepest level possible in as many people as possible.  All therapists have a natural tendency to try to detach themselves from the treatment situation, acting often as if they are outsiders looking in on scenes for which they act only as observers, not participants.  This has something to do with the belief, which is still there despite many observations and much scientific evidence to the contrary, that a human being can observe another human being from the stance of an objective observer, in other words, as though from behind a screen blocking the practitioner off from the patient.

 

And this is a thoroughly false belief, and is patently untrue.  Modern physics has proved beyond doubt that there is no such thing as an objective observation.  Each observer participates in what is being observed, and to that extent affects the person or object being observed in one or more ways.

 

This is particularly true of the kind of human interactions which form an essential component of the relationships between patients and practitioner in five element acupuncture, where what we can describe as the energies of the different elements coming towards either of them from the other person are accepted as directly affecting the other person's corresponding energies. In other words, an Earth patient will inevitably respond differently to a Metal practitioner than he/she would to a Wood practitioner, just as a Water patient will respond differently to these same practitioners.

 

Unless five element practitioners are made aware of all the subtle interactions between the elements in both themselves and their patients, they may well misinterpret the nature of these interactions, and therefore often misdiagnose their patients' elements.  If, however, a practitioner is fully aware of their own guardian element, he/she will be much more successful in accurately interpreting what is occurring between the patient and themselves, leading them to diagnose the patient's element much more quickly and more accurately.  As I have always said, the dictum, "Physician, know thyself" is particularly appropriate for a five element acupuncturist.  If we understand how our own element reacts to the people it encounters, this knowledge will act as a strong foundation for our practice.

 

There are two obvious unknowns which control any relationship between two people.  These relate to how the guardian element of each interacts with the other and influences the other.  If the practitioner is at least sure of one of these unknowns, his/her own element, he/she is halfway there to building a good relationship with their patients.  It then only needs the certainty of having diagnosed a patient's element correctly to complete this necessary first step in establishing a good patient/practitioner relationship. 

 

Of course, both of these factors, a correct diagnosis of both practitioner 's and patient's elements, are difficult to establish unless there is an opportunity for students as often as possible to obtain the help of the most experienced five element practitioners around.  This is where I realise that I was particularly fortunate, as were my students, and I took as much advantage of my good fortune as I could.  For I trained at a time when JR Worsley was still teaching at his Leamington College, and also established SOFEA at a time when he was still available to give all my students the benefit of diagnosing their elements and diagnosing the elements of as many of their clinical patients as possible.  I would encourage them all to arrange to have a diagnosis from him, and would also arrange for him to come at least once a year to the school clinic to diagnose students' patients.  In doing this, I felt privileged to think that I was giving them the best opportunity I could to observe a master practitioner at work.  Looking back, I can see that there could not have been a better start to their five element practice if they chose to take advantage of it.      

22-7 How I see the future of five element acupuncture in China

One of the things I had to learn as I started teaching in China was that I had to be quick at adapting to the different conditions under which acupuncture was taught and practised in our two countries.  I made the mistake of not acquainting myself more closely with this, both before I travelled, which I could have done through my association with Mei Long, the Chinese-trained acupuncturist in the Netherlands, or soon after I arrived in China.  Perhaps beginner's luck favoured me, and perhaps, too, I would have been daunted by discovering what was often a wide gap between what I had experienced in the UK and what my Chinese students had to deal with.

I realise now, after my 10 years of experience there, that it is absolutely inevitable that, as with the development of all disciplines through the passage of time, the teachings will change as they pass through different hands.  But this will be particularly so as they pass from country to country, as five element acupuncture is doing now.  I think I see my task as ensuring that the fundamental essence of what I was taught by JR Worsley, and what I have wished to pass on through my 40 years of practice and teaching, should stay true to what I have always recognized is a profound truth about the human condition.  This was formulated more than two thousand years ago by the ancient Chinese, set out in their traditional texts, such as the Suwen, and now practised under the name of five element acupuncture.  This is now a long, unbroken tradition which continues to offer profound healing, and is particularly relevant for a 21st century which manifests deep levels of distress and conflict.

 

It therefore heartens me to discover the large numbers of Chinese acupuncturists now studying five element acupuncture.  The five element bud which I brought with me for the first time in 2011, and which started to open up with just 10 or so students, is now, 10 years on, a flourishing branch on the great tree of acupuncture.  In the last two years about 800 students a year have attending preliminary five element courses organized in 23 cities in China and Singapore, with an estimated 400 - 500 practitioners practising five element acupuncture throughout China.  I was recently told that there were now over 5000 five element students on the Tong You San He five element database.  This is heartening recompense for my 10 years' work.

 

With China's re-emergence as a dominant world power, it is also appropriate that this profound healing discipline should gain fresh impetus in the country of its origin just as its practice sadly started to fade in the West.  I like to describe my visits to China as representing hands stretched from West to East across the world.  It is lovely for me to feel that the future of five element is now safely back in the hands which first released it to the world those thousands of years ago.

 

 

84. Five element acupuncture comes full circle in China

How odd that I am now beginning to write about my life coming full circle just as I receive an update from my Chinese contacts at the Five Element Society of the Beijing Tongyou Sanhe Foundation about the number of people attending their five element preliminary courses, as well as the number of five element practitioners who have enrolled in my seminars over the 10 years I have been holding them in China.  I was prompted to ask for this information because the  Chinese publisher of my Handbook of Five Element Practice is about to publish a celebratory edition in honour of the 10th year of its publication (and presumably also of the 45,000 copies he has sold in that time).

I find that there are more than 5000 five element students and practitioners on the Society's database, and there may well be more, since the Society was only established about five years ago.  More than 800 students enrolled in five element introductory courses in both 2020 and 2021, which have been held in 23 towns, 22 around China and one in Singapore.  There must now be between 400 and 500 qualified five element acupuncturists practising in China.

 

This is a goodly number, by any measure, and particularly when set against what to me is the sad picture of five element acupuncture's position in this country and in the West as a whole. The insidious creep of other branches of acupuncture, particularly modern Chinese acupuncture (TCM), into every aspect of acupuncture, has had a depressing effect upon the teaching of five element acupuncture.  Nor did the forced closure of my School of Five Element Acupuncture (SOFEA) in 2005 help, a closure partly due to the credit crunch, but principally due to the covert and often quite overt pressure from other colleges claiming that five element acupuncture must no longer be regarded as a stand-alone discipline.  It is sad that I know now of only one or two training establishments of any kind over here who can claim to teach pure five element acupuncture without feeling themselves forced by accreditation requirements to include a more than substantial dose of TCM in their syllabus.  I find it ironic that TCM-based colleges do not have a parallel requirement to include five acupuncture in what they offer their students.  I have never understood why TCM should be considered to be a stand-alone acupuncture discipline whilst five element acupuncture is not. 

 

It is a tragedy that this country, the home of five element acupuncture under JR Worsley, who was the principal agent for the re-emergence of this ancient discipline, should, in just a few years, have concluded that five element acupuncture could no longer be regarded as a valid discipline in its own right.  And it was only by chance, or good happenstance, that I was invited to China to re-introduce it to its place of birth those 10 years ago.

 

Now, though, to my great delight, China is leading the world in promoting this branch of acupuncture.  I am honoured to have been an instrument in its route of transmission back from West to East, reversing the route taken by JR Worsley from East to West more than 50 years ago.  I am happy to witness five element acupuncture's journey coming full circle, as it blossoms once again in the country of its birth.  

 

I like to think of JR sitting up there looking down at us and smiling.  I remember him saying to us one day, "They will want it back in China soon."  And they did!

 

 

81. Necessary short-cuts to a five-element diagnosis

I have been thinking a little more about the lack of five element teachers, which I mentioned in my last blog (no.80). There is always a problem venturing in the footsteps of a proven master.  Jung had difficulty in emerging from under the great shadow which  his master, Freud, had cast over him.  All JR Worsley's successors have to deal with the same problem.  Those who learnt directly from JR Worsley himself, and the following generations who were taught by this first cohort, have a natural reluctance to claim to "do a JR" when diagnosing patients, particularly in front of a class of students.  This term was a shorthand for being able to do what he told us was his ability to diagnose colour and smell as he came into the practice room, and follow this up in a very few minutes with sound and emotion as soon as the patient had responded to his questions.

 

Because we have been asked to diagnose hundreds of Chinese practitioners and patients on our seminars over in China, I realise that I am getting much better at making quick decisions about the elements I am seeing.  I have had to be, in view of the time constraints we are working under - perhaps only a morning to make over 150 diagnoses.  But then I have always emphasized that this is completely the wrong way to make a good diagnosis.  I should be sitting down alone with each of these 150 people in a practice room, and giving them all the attention and time that carrying out a good TD (Traditional Diagnosis) demands.  But as the saying goes, "needs must when the devil (here simply the time available) drives"!  If we (and that includes my five element companions, Guy Caplan and Mei Long) were not to do this, none of these enthusiastic five element practitioners and students would ever have the slightest inkling of their own element, something I consider essential for any five element acupuncturist.  And we know that we are always very bad at diagnosing our own element, for all sorts of reasons, often choosing an element which we long to be!

 

I have therefore had to learn to do the best that I can, calling these initial diagnoses simply our first hypothesis about the element, to be amended as we get to see things more clearly in the light of how treatment on that element has or has not brought about any changes.  Luckily during these seminars in China we see everybody for a full week, and so have many opportunities of observing closely those whose diagnoses we are unsure about, and then changing these where necessary accordingly.  As I said before, Chinese acupuncturists, probably because of our emphasis on the provisional nature of our initial diagnosis, are quite happy to have their elements changed, happier, I think, than their European counterparts, certainly their British.

 

Also, if we see examples of possession in the group (surprisingly often, perhaps for cultural reasons), we make sure all these patients are treated before we leave, as this is not a simple treatment for apprentice five element practitioners either to diagnose or to recognize when it has been cleared.

 

I know that my own 40 or so years of five element studies have helped me pinpoint the elements more quickly, and, I hope, more accurately, but I do wish that more of all those competent five element acupuncturists out there would take a leaf from my book and venture out into teaching.  I always remember one of my wise teachers, Dr Oskar Adler, master musician, teacher of the violin to the composer Schoenberg, and astrologer, author of some fascinating books on astrology, writing how important it was for everybody to pass on whatever they have learnt.  In a lovely quote, he said, "What would have happened if Mozart had not written down his music?".  And Mozart, after all, was almost hounded to his death through poverty and many of his manuscripts only survived by accident.  Think!  We might not now have his Magic Flute or Marriage of Figaro, or hear his sublime piano concertos!

 

So any of you experienced five element acupuncturists out there, please take courage in your hands and offer up to the next generation whatever you have learnt from your own practice.  Only in this way will any discipline survive, and particularly such a rare discipline as five element acupuncture.

 

80. The certainty of uncertainty

 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!

  

44. Always query your diagnosis

I always like to focus our seminar days on diagnosing the elements in patients our participants want help with, or diagnosing the participants themselves who want a clearer picture of their own element.  You will note that I say “a clearer picture” rather than a definite diagnosis.  This is something I insist upon, because I am so aware that a diagnosis can initially only be a tentative hypothesis and awaits confirmation from the way in which a patient responds to treatment.  In other words, we are never sure that we have the right guardian element until that element has shown us, through its positive reaction to treatment, that this treatment is directed in the right place along the circle of the elements.

I know that hovering over all five element acupuncturists is the picture of JR Worsley interacting with a patient for a few minutes, and then turning to us with an immediate diagnosis of one element.  This picture can delude us into thinking that every diagnosis we make should be equally as fast.  But, as JR told us as students, it had taken him more than 40 years’ hard work to get to the stage he had reached.  We would all be able to do the same, he said, once we had the same number of years’ practice behind us.  So those of us with far fewer years’ experience will have to accept that tracking an element down to its source in a patient takes more than just a few minutes, and very often many more than just a few treatments.

What I tell students is that no patient minds how long this takes provided they feel our compassion for them.  A practitioner who has attended many of our seminars, has just sent me the following lovely quote:  “People don't care what you know, they want to know that you care.”  As long as we show we care, a patient will trust us to know what we are doing and allow us the time to work out gradually which element we should address with our treatment.  We must never allow ourselves to be hurried by our patients into feeling that things should be moving more quickly than they are.  One of the things we were told as students was that it takes about a month of treatment for every year of illness.  That does not mean continuous weekly treatments, but it is a helpful rule of thumb, and allows us to tailor our expectations to a more realistic level.

Once my patients have started treatment, I have noticed that very few of them, if any, seem to spend much time talking about their symptoms, but instead want to talk about their life in general.  In fact they often forget altogether why they originally came to see me, evidence that patients do indeed want “care”, and not necessarily a “cure”, although with care often comes cure, since usually the two are closely related.

13. The challenges of point selection

During our training we were introduced to the main principles of point selection, which I have always felt stood me in excellent stead, and have underpinned all my work both as practitioner and teacher since then.  Recently, though, I realised that I had taken for granted how much I had adapted these principles over the years of my practice, often without realising I was doing this.  This led me to expand what I had written in my Handbook of Five Element Acupuncture about point selection.  Originally I listed the points for only the first five treatments.  This I now extended to cover the first 15 treatments, because novice five element practitioners have told me that they would welcome further guidance.

As I looked through these treatments I began to realise how much I had adapted the point selection principles I am teaching now to take account of what I recognise to be the individual needs of my patients, so that in effect my point selection is often not truly in line with the very principles I was telling my students they should follow.  Looking in detail at each example of treatment selection, I realised that my choice of points obviously reflect my growing confidence as a practitioner.  So then I have moved on to look at how I actually decide upon a specific treatment, and what has led me to adopt an often more idiosyncratic approach to point selection.  I have taken to observing myself more closely in the practice room to try and work out the thought processes behind my selection of points for a specific patient at a specific time, and I realise that my selections have much to do with my assessment of how my patients present themselves.  As practitioners we become acutely aware of how a patient feels to us, of how the energies flowing from the patient towards us are impacting upon us, and how far this impact is resonating with what we have learnt about our responses to one or other element.

We are trained to observe our patients with all our emotional and sensory antennae on full alert, aware that we have to interpret what they are conveying to us in a remarkably short period of time between the few minutes of our initial interaction with them and the time when we lift a needle to treat.  JR Worsley would joke that you only need a few minutes to treat a patient:  one minute to decide which element is crying out for treatment, one to do the treatment and the last minute to say goodbye.  The less experienced practitioner amongst us will take far longer than this, but my own experience of more than 35 years’ practice tells me that it takes me an increasingly shorter time to decide what treatment to give.  Often I seem to register quickly that the patient may be showing signs of a Husband/Wife imbalance or there is a need for an AE drain.  I will also be quick to see when they look well and require only the slightest nudge to their element before I can send them on their way.  What I am aware of, therefore, is that I have lost much, if not all, of the worry any novice practitioner will have about trusting my senses to tell me a great deal surprisingly quickly about my patient’s needs, and this usually happens well before I have listened to what the patients have to say or have taken their pulses.  In other words, I allow my understanding of how the elements are manifesting themselves in my patients to lead me to assess quickly what impact they are having upon me, and then for me to decide what treatment is likely to be needed.

In the early years of their practice, five element practitioners need to learn the general principles which underpin point selection, but with practice each practitioner will gradually learn to allow themselves some latitude in how to apply them, as their understanding of their patients’ needs develops.  My mantra of “think elements, not points” has stayed true for me at every stage of my practice, but my experience has led me to see that “thinking elements” means that we become increasingly adept at assessing an element’s needs and thus adapting our point selection to satisfy those needs. This means that, as with all principles, we must allow ourselves a surprising degree of flexibility in adapting these principles to specific practice situations. Both as teachers and as students we have to accept that point selection, far from being a prescriptive science with rigid rules of application, is instead an art dependent on the practitioner’s ability to adapt these principles flexibly to fit a patient’s unique needs at any particular time.  Just as there is nothing rigidly fixed about how energy courses through all nature bringing life to each of us, so there must be nothing rigid in a five element practitioner’s approach to encouraging these elemental energies to greater balance through our choice of points to do this work.

As with the teaching of any skill, time and much patience is always needed for a practitioner to learn their craft and to gain enough experience to dare trust that their own level of understanding permits them to start “doing their own thing” in terms of their practice.  It has however always comforted me to know that none of my patients has ever reacted badly to any treatment I have given.  They may of course suffer the temporary discomfort caused by to the appearance of some block or other, which forms a necessary and natural part of each treatment, quickly dealt with.  The worst that can happen is for patients to experience no change at all, even after a succession of treatments, and I always see this as a failure on my part to assess their needs accurately.  Whatever points we select to treat our patients, we can be sure that a little bit of variety and possibly a bit of daring in our point selection can do no harm, and can incidentally also help to keep us on our toes.

 

 

11. Learning to build up good relationships with patients of different elements

Like all skills, we have to practise how to create a good relationship with our patients.  A successful relationship is one where we are able to match what we have to offer with what our patients need as smoothly as possible.  Here, of course, our knowledge of the elements will act as our guide, for what one person needs will differ very markedly from what somebody of a different element will need. Some people are lucky, and either by their nature or by the circumstance of their lives have an ability to empathize with other people that a fellow practitioner has first to learn, and all of us will find it easier dealing with some elements than with others.  Perhaps to some people’s surprise we are not necessarily most at our ease with those of our own element, because seeing our own needs reflected in a patient may make it difficult for us to maintain an appropriate distance.  The secret here is to recognise that we may always find certain relationships with patients of certain elements more complex and difficult than others, and remain aware of this as we engage with these patients.

I will describe some of my own reactions and difficulties with patients of certain elements. These are personal to me, and every other practitioner must study their own responses and learn from them.  But learn they must, otherwise they will not understand their patients’ needs.  More importantly their patients will not feel understood, and then their elements will take to hiding themselves away. How can a five element acupuncturist treat if we don’t know which element is crying out for help?

Nobody should think that this comes easily to any of us.  When I look back at my own practice, I can see many instances where I did not understand what a patient needed, and I offered my help in a way which was not wanted.  Inevitably it was these patients who decided quite quickly that I was not the practitioner for them.  And they were right!  How could I help somebody if I was misreading what they were asking of me?  It was as though I was talking in an emotional language foreign to these patients, or rather assuming that both of us were talking in the same language when we very obviously were not.  One way of looking at relationships with our patients is thus to see them as though they require us to learn to speak in an emotional language with which only our patient is familiar and at ease in.  We therefore need to learn to speak in a different emotional language for each patient.  And like learning any new language, this takes time and a good deal of practise.  

We all know the warm feeling we have when we have got it right with a patient.  It is those times when we know that we have not which we should accept as teaching us the most.  JR always said that it was far better if students observing him with patients did not get the elements he diagnosed right, because the only true learning is through our mistakes.

If I look at my relationship with the Wood element, as my first example, I realise that it has taken me a long time to work out a way of dealing with its strong needs.  I tend to go through almost the same pattern of behaviour each time I encounter a Wood patient.  I pass through an initial period of wanting to step away, as though shrinking from the push I feel coming towards me, then I experience a flicker of irritation, or more than a flicker, at feeling that I am being outmanoeuvred in some way, before I finally reach a more balanced stage of understanding, where I know that to help my Wood patient I have to stand firm and, as it were, counter-punch, however gently.

With all Fire patients, on the other hand, I experience first a slight feeling of relief, since I am moving on to the familiar territory of my own element, accompanied by an initial sense of relaxation.  Fire is the most articulate of all elements, enjoying speech as its way of communicating.  Since I, too, like communicating through speech, it is easy for the patient and me to fall into the habit of indulging in a kind of idle chatter with which we both feel at ease.  Experience has taught me, though, that I must issue a warning to myself to take care and not let the ease of this interaction divert from the reason why the patient is here.  I have to be aware, too, that in its need to make other people happy, Fire may also feel it should make light of its problems, and I have to be on the look-out in case I buy into the cheerful mask and ignore what lies beneath it. 

One way I have devised of helping me here is through the simple expedient of employing silence, a tool we too seldom use in the practice room.  I try consciously to quieten the emotional tone by reminding myself to fall silent.  Silence on my part gives my patient permission to stop any superficial chatter, and offers them the space to think out what they really need to tell me.   I have often found falling silent is the most difficult thing for me to do, and I have had to train myself to be on the alert against encouraging a babble of words to flood the practice room. 

Although it is easy for me to develop a very warm relationship with all my Fire patients, this ironically makes it harder to set the correct emotional tone which is helpful for my patients.  Familiarity does not breed contempt, far from it in this case, but it certainly breeds a false sense of relaxation.

The difficulties I experience with Earth patients are of a different kind from those with Wood or Fire.  I have found that the need to be nurtured which all Earth people have awakes an echo of the same need in me, because at some deep level within me I would like some of the same kind of nurturing I am being asked to offer Earth.  A few days ago, interestingly, an Earth practitioner told me that he finds his first interaction with his patients disturbing because he feels their differing needs tugging at his Earth element which is reluctant to offer what is being demanded of it.  

Once I am aware of this reaction in myself, I remind myself firmly that I am here for the patient and not for my own needs.  What Earth needs is not a blanket response of sympathy of the “Oh, you poor dear” kind, but instead it needs to be understood.  It wants to be heard, and wants to be heard to the end if possible without interruption.  Its thinking is a circular process, ending where it began and then beginning again.  If it is out of balance, it begins again with the same words and goes over the same ground, like an oxen tied to a circular grindstone, going round and round.  When it is in balance, this need to churn over the same thoughts is lessened, but never disappears completely.  Since its function is to process all things, thoughts as well as food, it has to perform this task endlessly as the other elements pass their energies to it for processing. 

If I remain clear that my Earth patients need to be allowed time to circle round a subject, even though I may have heard the same thing in the same words before, I am able to stand back and allow this circular movement to continue without getting irritated.  But being a quick thinker and talker myself, the slow chewing-of-the-cud which is Earth’s way of thinking can tend to irritate me and make me want to interrupt it if I am not careful.  So a warning sign goes off in my head with every Earth patient I treat:  Let the patient speak, Nora, and only interrupt or add your own comments when you have given your patient time to process his/her thoughts and express them fully in the way they want.

With Metal I seem to have a far less difficult relationship than with the other elements, perhaps because it demands space to be itself and allows me time to catch my breath, as it were.  No immediate reaction is demanded of me, except an acceptance that it wants to be the judge of how our relationship should develop in a way satisfactory to itself.  It is happy with space and is the most comfortable of all the elements with silence, for it needs silence in which to work out its own solutions to life’s problems.  This need for space and silence presents a great challenge to my Fire element, if I do not recognise it in time, and find myself starting to gabble to fill the silence.  With all Metal patients I have learnt, too, that I must hold back my own impulse to share my thoughts, for this can easily lead to a kind of role reversal since I find that I can often learn from Metal’s detached wisdom.

Metal patients are not, however, there to teach me, nor for me to teach them, but to find the support for their Metal energies which treatment will offer them.  With Metal I need say almost nothing and let the treatment do its work silently.  The practice of silence which Metal needs is that which respects its need to solve its own problems.  The silence which I have to encourage myself to offer Fire is different;  it is aimed at preventing it from talking so much that it forgets why it is coming for treatment.

Finally I come to the problems I may experience in dealing appropriately with my Water patients.  I do not find the demands Water makes upon me difficult to meet, although others may.  The need for a reassuring approach to still the panic which lies deep within the heart of all Water people is not something alien to me, but something I feel at ease with and able to offer without feeling in any way diminished.

My main difficulty comes from my inability to recognise the Water element in my patients quickly enough in the first place.  We all know how Water likes to disguise itself and hide, and it has taken me longer to detect its presence than that of the other elements.  Even now I have a tendency to see Water’s uneasy laughter as coming from Fire.  Its elusive nature will often make me question whether I am really in the presence of Water or not.  Once recognised, though, I feel able to offer what I think it needs, provided that I stay focused on the profound fears which lie beneath its often apparently confident surface.  This most ambitious of all elements, and the one most likely to get to the top of whatever profession it chooses, harbours a terrified underbelly.  I must never overlook its need for these hidden fears to be acknowledged by me, and for me to offer them the correct level of reassurance.