I have written this blog in answer to a query from somebody commenting on my blog of 23 June in my sister blog http://www.five-element-treatments.blogspot.com/, but I think it is important enough to include here in this blog. I was asked how I had diagnosed a Husband-Wife imbalance just by looking at the patient. What did I observe that made me diagnose H/W? I give my answer below. It is a very detailed answer because the question fired me to think carefully what a H/W imbalance means, and touches upon what is a very complex and profound area, that of pulse diagnosis.
We are told to diagnose a H/W through the pulses, with the pulses of the right side, the “husband’s” side being qualitatively stronger than those of the left, “the wife’s”. Diagnosis from pulses alone presupposes that our pulse-taking is sensitive enough to feel what may be an extremely subtle difference. I have often said, and will go on repeating, that it is foolish to rely entirely on our pulse-taking in making a diagnosis, since it is a very great skill accurately to interpret what the pulses are telling us, acquired only after years of practice. To understand this, but certainly not to be too daunted by this, it is essential that we remember at all times what we are attempting to assess at those 6 positions at each wrist that we gently palpate to give us a pulse-reading of the 12 officials forming the five elements.
We should think of the 12 pulses as access points to the elements. They can be palpated most clearly where the blood flow is at its strongest and nearest the surface. Since time immemorial in traditional Chinese medicine, and in modern times in Western medicine, too, the most easily accessible point has been accepted as being over the radial artery at the wrist. It is important to visualize the pattern the 12 pulses form on any pulse chart, and here we should divide them into 6, since at each position there are two, one at the superficial level and one at the deep level. (I know that different diagrams of the pulses have been drawn up over the centuries showing an intermediate position, which would in effect make 18 possible pulses, and also different pulse positions, particularly in relation to one of the pulses on the right side (the five element Outer Fire pulses), but I am writing here only about the order of the pulses which five element acupuncturists use.)
In effect, the understanding that the five elements will reveal the state of their health in body and soul at a tiny site like this, less than a couple of inches (oh how I still love my old form of measurement!) (a few cms) in length, is awe-inspiring and still blows my mind. It means, in effect, that the work of all the elements acting together is creating the blood flow at every point in the body, not just at the wrist, but that it can be detected most easily where the arterial blood is closest to the surface. (Pulses can also be palpated at the ankle or over the carotid artery in the neck where there are equally strong pulsations, but the wrist is used for reasons of easy access.) It is important always to remember the order of the pulses, and here not just the order on each hand but the order of both hands taken together. If we hold the hands together facing upwards (do this now if you are reading this), imagine that you are drawing a line which starts at the pulses nearest the wrist on the left hand, moves down to the two other pulse positions on the left wrist and then passes over to the pulses on the right hand, continuing down to the third position on the right before looping back over again to the first pulses of the left hand again, forming a continuous figure of eight. In effect, we are tracing the order of the elements backwards, from Inner Fire (Heart/Small Intestine), back to Wood and Water, back across to the right wrist to Metal, Earth and Outer Fire (Heart Protector/Three Heater), before looping back to the inner side of Fire again and so on.
We are taught to palpate the pulses in this way, first left-hand pulses starting with the first position over the Heart/Small Intestine aspect of Fire and then right-hand pulses starting with the Metal pulses. This is a simple way of reading the pulses, and emphasizes the importance of the Heart pulse as being the first pulse we palpate, but in doing this we tend to forget the actual order of the elements, even if we were ever aware that the pulses represent this, which many of us are not. It is only in helping us make a Husband-Wife diagnosis (and that of an Entry-Exit block) that it is so imperative to think of this order to understand what our pulses are telling us.
We know that the flow of energy moves along the Sheng cycle from Fire to Earth to Metal etc. We know also that we correct a H/W by needling the following points: Bl 67, Ki 7, Liv 4, Ki 3, SI 4, Ht 7. This order of points does the following: First it reconnects the mother element, Metal (a right-hand pulse) with its child, Water (a lef-hand pulse), then, by needling Liv 4, it draws energy from the Metal element (right-hand pulse) across the Ke cycle to the Wood element (mother element to grandchild element) (left-hand pulse), then by needling Ki 3 it does the same from Earth across the Ke cycle to Water, and finally it reinforces the Heart by needling the source points of Inner Fire, finishing with Ht 7.
In effect, by diagnosing an excess of energy in the right-hand pulses and a frightening depletion of energy in the left-hand pulses, the classic diagnosis of H/W, the pulses are telling us that there is a potential breakdown between the elements, and in particular between the point at which energy from Metal passes over to its child, Water. It isn’t a complete breakdown, because that means death, but it is sufficiently serious for us to regard a H/W imbalance as a dangerous condition because it is depleting the energy flowing to the Heart. It is therefore interesting to see how often the pulses leap back into balance immediately Metal is reconnected more stronly to Water, i.e, after needling Bl 67, Ki 7. It is therefore a good idea to read the pulses after you have needled these two points to see if you can detect the immediate sign of relief as the energy flow starts to re-establish itself, and the Heart can begin to relax.
With all this in mind (and I am sure anybody not a five element acupuncturist reading this will have given up well before now!), I will go back to the question which has prompted this exposition of what a H/W imbalance actually represents. If it reveals a serious weakening of the flow of energy from mother to child element around the complete cycle of the five elements, which it does, then this serious weakening must somehow show itself not only on the pulses but in the way a patient presents themselves, which it does. Patients will look despairing, as if they have given up hope (the Heart almost giving in). As well as showing this despair, they will surprisingly often say things which help our diagnosis, such as, “I don’t think I can go on” or “I feel like giving up”. They may look as if they are too weak to talk, just wanting to lie there passive with their eyes closed.
H/W can appear suddenly, as though the Heart all at once can take no more, unlike imbalances such as Aggressive Energy which appear slowly over time, so the change in a patient from one treatment to the next can be very obvious. In the case of the patient I was writing about, he came into the room looking so very different from how he had left me the week before, that the change was dramatic enough for me to suspect H/W even before I took his pulses.
Finally, I repeat my mantra, “never rely on pulses alone to tell you what is going on”. Use all your senses and all your feelings and any other diagnostic information to help you diagnostically, such as a patient rubbing their eyes in the case of a SI-Bl block or the onset of hay-fever in the case of a Co-St block, since our pulse-taking (mine included) may not be sensitive enough to do the diagnosis on its own.