Monday, August 14, 2017

Further delight of the unexpected

A reader of my past blogs may recall one entitled Hidden delights of London:  Phantom railings (3 September 2012).  Imagine my delight today, therefore, when once again passing the wall outside the British Museum about which I wrote, I could hear my footsteps creating a strident echo, as though their speed and strength was being mimicked by sounds coming from the wall.  I paused, turned back and retraced my footsteps, only for my surprise to turn into a happy recognition of the re-appearance of the musical artwork called the Phantom Railings, about which I wrote.  This time, though, the creators of this installation seem to have added a little more to it.  I gather that the sounds made by my footsteps as I pass this installation are now being streamed live and can be heard on  

I am writing this in the British Museum, and will now hurry back past the wall to delight once more in this installation, before returning home to what I hope will be a session listening to the live streaming as others make their way past the wall. The sounds my footsteps made are those which resemble the familiar sound of somebody running a stick along an iron fence.  This was in the days before the second world war demanded the removal of railings round houses and parks, so that they could be turned into armaments for the war effort.  Or at least that was what I was told when reading about the installation five years ago.  Now, though, a completely different interpretation has been put on the removal of the railings.  Far from being an attempt to help the war effort, they were, the notice on the wall states, “a democratic gesture to remove restrictions to public access to parks and gardens”, much advocated apparently by George Orwell himself.

I enjoyed my time walking up and down, creating my own symphony of sound.

Tuesday, August 8, 2017

How do we judge whether treatment is a success or a failure

I think most of us assume that a successful course of treatment should result in the patient feeling better in some way.  But in what way?  And who decides what feeling better actually represents?  In Western medical terms the successful outcome of any treatment can probably be judged as being whether the physical symptoms have improved or disappeared.  But when we view things from a less physically oriented point of view, as a five element acupuncturist or a psychotherapist would do, the role physical symptoms play in assessing the success of treatment is much less clear-cut.   

We take it for granted that we are offering treatment for soul as well as for body, and are therefore viewing things holistically, so how do we gauge how successful our treatment has been in helping our patient at the deeper level?  This is a much more difficult question to answer than merely noting that a patient is suffering from less headaches or is sleeping better, and the outcome of treatment may therefore be much more difficult to assess.  We then have to consider more complex questions, such as a patient’s own assessment of how far treatment may have helped them in changing some more intangible aspect of their life.  This could involve something like coming to terms with a past emotional trauma or having the courage to confront an unresolved issue with a partner.  Improvements in these areas of life are difficult to quantify, because they are based on much more subjective criteria, and may often at first hardly be perceived by the patient and only by a practitioner trained to notice what are often very subtle changes..

I learnt a very important lesson not long ago, which has given me a different perspective on the whole issue of what can be considered a failure of treatment.  A patient told me that he had been given my name “by a friend of mine who said you had transformed her life.”  I was puzzled, because I could hardly remember who this former patient was.  Looking up my notes afterwards, I found that she had come for just two treatments and then disappeared.  At the time I had assumed that she had not been happy with treatment, and I therefore listed her amongst those I thought I had not managed to help.  Obviously, though, this was not how the patient herself had viewed things. This taught me that we can never really know how far what we have done for our patients has helped them or not, or indeed what they themselves want from treatment.  It is therefore likely that patients and practitioners will have different criteria by which to judge the success or failure of treatment.  It also helped me understand the importance of not becoming too self-critical, a tendency I think we all have, particularly when we start in practice, because we may not be aware that our expectations are not matching those of our patient.

We must always ask ourselves whether what we assume our patient wants from treatment is actually what they are coming to us for.  Perhaps the few treatments I gave my former patient was all she felt she needed to set her life on the right path again, whilst I might have been considering a different outcome for her.  The very simple but profound treatments of the Aggressive Energy drain and an element’s source points which we start our treatments with can by themselves give a strong boost to the elements and help them regain balance.  An AE drain, for example, is a way of asking the elements whether they have been invaded by harmful negative energy, and, if so, clearing it from the body.  Addressing an element’s source points is one of the deepest and safest ways of stimulating that element’s energy.  These first treatments therefore set the tone for all subsequent treatments, and act as their firm foundation.

Perhaps for some patients, as with my former patient, this simple treatment is all they need.  Others, though, come for more than this, and may be uneasy about being left to sort out their life by themselves without ongoing support from their practitioner.  If this is so, it is a clear reminder that each of us is likely to want something uniquely different from treatment, often related to the specific needs of our element, and that it is the acupuncturist’s task to gauge these needs sensitively and try to satisfy them in the best way possible.

We can also waste a lot of time analysing each treatment in too much detail to see whether we could have done better.  Some good advice I was given early on, which I have found increasingly easy to follow the older I get, is to stop thinking about our patients the moment they leave the practice room at the end of treatment, and not continue to clutter our minds up by taking thoughts about the first patient with us into the next patient’s treatment, or home with us at the end of the day to preoccupy us later on.  Originally I thought that switching off from a patient too quickly at the end of treatment might be doing them a disservice, but I now realise that the opposite is true.  Before the start of each treatment, it is useful to give ourselves time to empty our minds of what has gone before so that our next patient receives the full attention from us that he/she needs, not the half-distracted attention somebody still preoccupied with thinking about the last patient will bring them.  And then when the patient comes back next time we are fully able to concentrate on them once again. 

It is of course natural to continue to think through the events of our day when we have finished practising, but we should try to do this at quiet times and not during the hurly-burly of the day’s activities.  Only then can we clear our minds sufficiently to help us sort out any problems we need to deal with.  All this is easier said than done, but if we are aware of some of the issues which make practising problematic for us, we are half-way to solving them.


Sunday, August 6, 2017

Usain Bolt - again

I have written about Usain Bolt and the Fire element before (see my blog of 24 August 2016), and I am delighted to be writing about him again today, the morning after he ran his last race here in London.  He didn’t win last night, but interestingly he didn’t seem to mind.  I could see him obviously enjoying to the full the love pouring towards him from the huge crowd.  This reflected what I had read in the newspaper on the morning of the race, words which so accurately describe the effect that the Fire element can have when it tries to share its joy with those around it.  Here are some of the article’s descriptions of how he affects other people:

“He is not only the face of athletics but its light-house, luring even the most casual fan to its shores.”

“..Usain really is a people person, too.  When he first went on the circuit, a decade ago, he would be in the hotel lobbies talking to people at 1am or 2am. He loves people and interacting with them.  I had to tell him to go to bed.”

And one description which makes me think Usain Bolt is Inner Fire:

“What struck me was just how willing he was in the middle of a conversation to break off and oblige a fan for a photo or an autograph, never complaining, always smiling…”

“He’s a selfless human being, one who genuinely loves to make others happy.”

All these descriptions could only be applied to Fire, I think, and in my view particularly to Inner Fire, which has a greater ability than Outer Fire to multi-task, even at the most emotionally extreme moments (such as running in the Olympics).
I know this from myself, who am Inner Fire.  Many years ago, long before I had even caught sight of an acupuncture needle or understood anything about the elements, I realised that I had this ability to do more than one thing at a time when somebody expressed amazement that I was able to switch from a very serious moment to pointing out something rather trivial happening nearby, almost as if the two events, the very serious one and the trivial one, were happening at one and the same time.  Watching Usain Bolt again, I could see that, whilst preparing for his race, he was nonetheless all the time aware of those around him and interacting with them, exchanging smiles and the odd word with whoever was next to him.  We can contrast this with the absolute and necessary self-absorption that Metal would display in a similar situation, as I have observed before.
So all hail to this most charismatic and joyous representative of the Fire element.  Feast your eyes on him wherever you can catch him on TV or social media, and you will get a lesson about one of the elements that you will never forget.  I wish it was as easy to find such outstanding examples of the other elements.

Tuesday, August 1, 2017

Horary treatments

Many things have happened during my years of practice which still make me laugh at myself, none more so than my attempts to give my patients what we call horary treatments at the right hour of the day (or night).  The word horary, used as far as I know only in the context of acupuncture now, comes from the Latin word meaning “hour”.  Horary treatments are treatments given at specific times of the day which are seen as having a particular relationship to different elements.  The 24-hour day is divided into six four-hour periods, one specific to each of the elements (two for Fire), and, within these four-hour periods two two-hour periods relating to that element’s yin and yang officials.  Thus the hours from 3 – 7am relate to the Metal element, with 3 – 5am that of the Lung, (often the time of day when people take their last breath), and 5 – 7am that of the Colon (which is why this is an excellent time to empty the bowels ready to take on food between 7 - 9am, which is the Stomach’s horary time).

Giving a patient a horary treatment, particularly in the season of that patient’s element (for example some time in the early morning between 3 – 7am in autumn for the Metal element) is considered to be the very best treatment of all.  Bearing this in mind and remembering JR Worsley’s exhortation to us not to forget horary treatments, even if they are at anti-social times, such as in the middle of the night, in the full flush of being a keen new practitioner eager to put everything that I learnt into practise, I gathered together two of my Wood patients for a horary treatment in the night, the best time being just before 1am still in the Liver’s horary time and just after 1 am just into the Gall Bladder’s horary time, carefully setting my alarm for 12.30am to be sure to wake up.  To my surprise both turned up on time, and I completed the treatment, congratulating myself on doing what a good practitioner should do, however tired I would feel the next day.

Imagine my horror then when a few months later I realised that with the greater experience I had gained since then I now recognized that neither patient was Wood.  Imagine also my confusion when another patient, who this time I was sure was Wood, and I had also scheduled to come during the night, overslept and never turned up.  Was I to phone her home, though I was reluctant to do so for fear of waking the whole household (this was the time before everybody had mobile phones by their beds), and how long should I stay up in case she arrived late?  Even when I felt I was treating the horary points at the right time during the night, did this justify the possible inconvenience which my previous sad experiences had shown me?  Finally, too, had horary treatments proved to be the uniquely excellent treatments that warranted all this trouble?

I cannot say that the results of giving horary treatments at more sociably acceptable times of the day have prompted me to consider that facing the possible hurdles of night-time treatments is worthwhile.  But I still like to remember with affection my novice practitioner’s enthusiasm.  Certainly my patients were terribly impressed that I was prepared to sacrifice a few hours’ sleep for them, which I am sure made our relationships all the closer, perhaps the best result of all.

I now think back rather sadly and with some nostalgia to a time when I so enthusiastically tried to put everything I had been taught into practice, and realise that I, older, much more hard-bitten and less idealistic, but perhaps not wiser, would be unlikely to do the same now.

Tuesday, July 25, 2017

What to charge patients

Since my formative years coincided with the birth of the NHS and free medical care for all, I feel deep in my bones that at some level all medical care, including what I offer my patients, should be free.  This has always made me feel uneasy about charging my patients, making it all the more difficult for me throughout my long practice life to know at what level to pitch my fees.  I am, after all, a freelance acupuncturist dependent on my practice income for my financial survival, unlike those working in the NHS who are employed by the state, so charge I must, but how much?  Do I add into this figure the number of years I have been treating, and do I have a standard rate for everybody? But what about those people who can quite understandably not afford the weekly fee needed for treatment?  Hidden within this, to me, vexed question of the level of fees to charge, too, is the conviction that it would be wrong to deny treatment to somebody I could help simply because they cannot afford it.

This problem has bedevilled all the years of my practice, and seems to have grown if anything more acute since my move first from my home practice to the SOFEA clinic in Camden Town, and finally on to Harley Street, of all places, to what is considered to be the pinnacle of medical practice, where I now work amongst those who are happy to charge the most exorbitant fees that I would be ashamed to charge anybody.

My arrival in Harley Street was the result of one of those chance encounters which seem to punctuate my life, and had nothing to do with a desire to work from the very heart of London’s private medical world.  If anything, I would have preferred to move my practice somewhere else, but this clinic just fell into my lap, a chance too good to miss.  I was walking along Harley Street and passed a handwritten notice in a window saying that there was a clinic room for hire.  It turned out to be an ideal place for me and for others from SOFEA, its greatest advantage being our freedom to use moxibustion without other practitioners complaining of the smell, and access to surprisingly large storage areas for the many SOFEA files which needed to be kept for the requisite minimum of seven years.  It also happened, luckily, to be only a few minutes’ walk from my new home.  But as I walk to Harley Street each day, I am aware that I am walking past many medical practices where what I have decided to charge my patients would be viewed as ridiculously low.  What would those working in these very luxurious clinics say, I think, were they to know that I continue to charge some of my longstanding patients the very reduced rates I have offered them over the years, with the occasional free treatment thrown in for good measure?

One of the reasons why the whole issue of fees has proved such a problem for me is because it has a lot to do with my assessment of my own worth, something I am unclear about.  How do I value what I do, and do I put a monetary value on this, and, if so, at what level?  What fee to charge therefore still remains a sensitive subject for me, particularly as a few days ago I happened to note from the web that a former student of mine is charging three times the rate I now charge.  Is she right to do this, and am I therefore being unprofessional not to do the same?  Or is there still some value in retaining the idea that the vocation I have chosen represents my desire to help others, rather than doing it for financial reward?

I realise I have ended up after all these years doing what a tutor during my original training told us not to do, which was to charge different levels of fees for different patients.  He said that this only led to confusion, and he was right.  “Stick to one fee and let the patients decide whether they can afford to pay it.  Don’t make their financial circumstances your concern,” he told us.  And this is what I have always found difficult.   

I have come to the conclusion that my problem with working out how much to charge touches on my dislike of meanness, and its counterweight, my desire to be generous.  I regard treating as a gift I am offering my patients.  To ask them to pay for this is in some senses much like giving somebody a present and then holding out my hand for them to pay for it.  Even though I recognise the need to make a living, to charge the high fees which some would definitely consider appropriate for my many years of practice and my level of expertise represents not the gift I would like to bestow on my patients, but smacks of meanness.  For somebody who would always prefer to give than to receive, this inevitably causes problems, still unresolved within me to this day, after so many years of practice.


Tuesday, July 18, 2017

Not yet finding the right element does not mean that the treatment you give is wrong

I was walking along thinking about the blog I have just posted Nobody likes getting things wrong (13 July), when I realised that I needed to add something to it.  If we are treating a “wrong” element, we may assume that we are doing something wrong.  But that is not what I believe.  We should not condemn any treatment we give as being wrong provided that we follow one of the basic rules of five element practice, and that is to ensure that we are not going against nature by taking more energy away from an already depleted element, or adding energy to an element already with an excess of energy. 

Our pulse-readings should tell us what to do, for they will help us assess the relative level of energy in the different pulses.  Any treatment we then give on whatever element we choose will not only not harm, but will be beneficial, because it will help balance out the different levels of energy between the five elements.  And anything which brings greater balance is to be recommended.

To all five element acupuncturists out there reading this I would therefore say “take heart”.  You can never harm a patient if you let the pulses guide you in this way even if you are unsure which element you should be concentrating your treatment upon.  Pulses alone are unlikely to pinpoint the patient’s element for you, (but you may like to take note here of Peter Eckman’s comments on my blog on Facebook about this). Using your reading of the pulses to help balance the relative strengths of the different elements one to another can help you lose some of your worry about whether the element you have chosen to treat is the “right” one or not.

Finally, in all my years of practice, no patient of mine has ever, I repeat ever, told me that any treatment I had given them had made them feel worse, except when it has temporarily exposed an underlying block, such as Husband/Wife or Entry/Exit, which the appropriate follow-up treatment successfully clears. 

I think nature is very kind.  The elements help themselves by disliking the states of imbalance which lead one element to have too much energy and another too little.  It seems that they try everything to even out any discrepancy in energy between them, which is why the treatment using energy transfers between elements is greeted with such a huge sigh of relief by all the elements.

Thursday, July 13, 2017

Nobody likes getting things wrong

One of the most difficult lessons for a five element acupuncturist is learning to train themselves not to mind when their choice of element eventually turns out not to be the “right” one. I can still remember my feeling of embarrassment when the whole of my Leamington class except for me thought a patient was quite clearly Earth, when I was sure she was Metal.  I remember cringing inside when I realised that there was something in the patient which I had not before then associated with Earth, but everybody else had, and my shame at having to admit this in front of the 20 or so of my fellow students.

I have often baulked at using the words “right” and “wrong” when talking about the elements, because these terms hide within them just this feeling I had in the class of not being good enough, or at least of not being as good as other people.  But there is definitely a “right” element, which is the patient’s element, and eventually “wrong” elements, which are the four other elements which are not this patient’s element.  We have to learn to accept, though, that discovering the right element always takes a lot of time and a lot of experience, but does not come as a result of a flash of insight in a few moments.  It helps, though, to know that the cumulative experience of years of practice undoubtedly speeds this process up.

 I have tried to think of better ways of describing an element as being either the “right” or the ”wrong” one, but have not yet come up with any satisfactory alternative.  So these descriptions may have to stay, despite making us feel just as inadequate as we felt at school when we got an answer in class wrong.  “Not yet the right element” is the nearest I have come to a possible solution, but, although it is an accurate description of the step-by-step process of diagnosis, it does not slip easily from the tongue.  Perhaps with more frequent use, though, it will gradually start to supersede the phrase “the wrong element” with all its unhappy associations.

I have often thought that this is one of the reasons why people hesitate to venture into five element acupuncture.  Other branches of acupuncture seem to display their diagnostic choices in less black and white terms, and can therefore seem to expose their practitioners less to public displays of what they may wrongly feel as their ignorance.

Significantly, though, this, to me, embarrassing lesson in not recognizing the Earth element taught me the most about Earth in the shortest time that I have ever learnt.  As JR would tell us: “You don’t learn anything if you get the element right.  It’s when you get it wrong that you learn the most.”



Friday, June 30, 2017

Meaningless mission statements

I often laugh at the slogans companies devise to advertise themselves.  Here are two I have recently seen:

In the Nat West Bank window:  We are what we do.
On the side of a van advertising building work:  Make sure the past has a future

I do wonder who thinks these things up.

In the early days of SOFEA, I was asked by somebody who was helping us with our advertising to think of something which defined what I wanted our school to represent, and I came up with a phrase which I still like:

An ancient form of healing for a modern world

I always felt it had been given JR Worsley’s blessing, because when he read it one day, I saw him nod his head and say, “That’s nice.”

I still think it is nice, and unlike some of the mission statements I see dotted around on every advertising hoarding and on the side of vehicles, I think it still means something.

Monday, June 19, 2017

The Wood element in crisis

As those who read this blog will know, I think both Theresa May and Donald Trump are Wood, and both, unfortunately for the world, appear to be incredibly rigid, unyielding Wood, more stolid oak trees than graceful willows.

I was therefore amused, as well as horrified, by reading this in the Guardian newspaper yesterday about Theresa May:

“Wooden-headedness is a source of self-deception. It is also the defining feature of Theresa May’s prime ministerial stint, and particularly of her “hard Brexit” strategy.  On Europe Mrs May appears to assess a situation in terms of preconceived fixed notions while ignoring any contrary signs.  She then acts on her delusions and does not allow herself to be deflected by facts.  While this might be a good way of winning power, it is not a good way to exercise it.”

And the piece ends with: 

“Wooden-headedness is characterised by a refusal to benefit from experience.  Why not, Mrs May, learn from one’s mistakes and change tack?"

It made me think a little more about how I perceive Wood.  Changing tack, a very nautical expression for changing the sails of a boat to move it in a different direction, is very appropriate for describing the flexibility and manoeuvrability of the Water element.  It is certainly not how I would see Wood moving.  It likes to keep to a straight line, and once on that line is determined to stay on it as it presses onwards towards the future.

We all know that Wood’s function is to do with planning and decision-making.  When in balance these plans will be appropriate and lead to good decisions.  When under stress, which Theresa May always seems to be, the plans, once made, have been rigidly adhered to, and the decisions made on the basis of these plans can easily become the wrong ones.  She has been seen to change her mind suddenly and quite erratically (from a Remainer to a hard Brexiteer in the matter of a few hours, as well as all the volte-faces she has recently made in government). 

I think her dominant Wood official is likely to be the Liver rather than the Gall Bladder.  It appears to be much easier for her to plan (the Liver’s function) than to carry out the plans (the Gall Bladder’s function) by making the right decisions.  Others may see the differences between Wood’s two officials differently.  I have always been reluctant to specify which is the dominant official within an element, because I have always regarded the elements as an almost indivisible whole, the yin and the yang within them indissolubly tied together.  There are, however, definite differences in some elements which I have found easier to see, such as the difference in the Metal element between the Lung and the Colon official (taking in and letting go).

And finally Trump as well!  I need hardly point to Trump in this context.  Enough said, as they say.


Wednesday, June 14, 2017

Interpreting the elements is always a subjective experience

I have been very interested by the comments people have posted on my recent blogs about the differences between Water and Metal.  Some have agreed with my observations, others not.  All have given me something fresh to think about.  They have made me realise that people reading what I write may be assuming that the very personal way I have learnt to interpret the elements over the years is prescriptive, and that they should see and feel things in the same way, rather than what I say reflects my own often maybe quite idiosyncratic approach to the elements.  What I mean by the word prescriptive is that it may be felt that others reading what I write should try and see the elements as it were through my eyes.  I don’t think that this is right or what I would like people to do.  Instead, it is important that everybody develops their own personal filters through which they perceive the elements.  Everything we do, think and feel reaches us only through these filters, and will be interpreted according to what they tell us individually.

What is absolutely essential, though, is that each of us, practitioners as well as anybody else interested in developing their understanding of the elements, subject this understanding to a rigorous system of control.  This is what I have been doing ever since my eyes were opened on to the landscape of the elements spread before me.  I have learnt that I must test carefully my assessment that a person I encounter might at first sight be Earth, for example, against those other people who I have previously thought might also be Earth, and then assure myself that these people have enough in common to warrant being gathered together under the heading of Earth.  Collecting together enough examples of all the elements therefore takes time, and requires a great deal of patience and self-scrutiny as we assess how accurate our diagnoses are.  Being accurate requires us to be very aware that we may often get things wrong, and then be prepared to amend our initial diagnosis.

Some people, of course, will find this the most difficult aspect of being a five element acupuncturist, because we can never really know that we have found a patient’s element until we are offered proof from the results of successful treatment.  As I have often said, what we do is not a calling for the faint-hearted, but, as I have also often added, but it is a calling which, if we persist, brings us incredibly rich rewards.