New Year’s greetings to all who read this blog

I always like to take stock as the year ends and we turn towards the future. And I am doing this here for that part of my life which revolves around acupuncture.

There has, unhappily, been much to be saddened by in the acupuncture world in this country in the past few months, the saddest of all for me being the impending closure of my own college in Warwickshire, and the sudden disappearance, as though overnight, of two other colleges. Happily, though, there is much else to carry forward into the New Year;   amongst these things, to my increasing surprise, there is my blog.

Being new to the world of blogging, Youtube, Twitter and such-like before I started, I suppose I am more surprised than others might be at how far into the distant reaches of the world my blog has penetrated. At the latest count it has spread to more than 50 countries, and I still find it exciting when I see that somebody from Ghana, Guadeloupe or Kazakhstan has tapped into their computer and found me. What, I ask myself, has made them interested enough in five element acupuncture to home in on what I write? Not only does this stimulate me in sending out my thoughts, but the interest shown gives me daily confirmation that in writing about the elements I am speaking in a universal language understood by all.

And through this blog I am also seeing that more and more individual seekers after five element knowledge, a rare and growing breed, are prepared to search out teachers who answer their needs, and are finding their way to me and other five element teachers. This is the kind of teaching I love, to people who are prepared to study hard, often on their own and in their own time, to explore the elements and learn how to use this knowledge to help others. I am aware that there are many people out there who have no chance at all of finding a five element acupuncturist, let alone a training college, in their country (or even on their continent!). These are the pioneers of the future, just as JR Worsley and his many teachers before him were the pioneers of old. I hope they have the courage to explore and innovate, as he did, and I hope, too, that the people who need to will find their way to me and to other five element teachers and will ask us for whatever we can offer. I and others have plans for setting up another five element centre in addition to that in London, this time on the South Coast. I can see these becoming an increasingly important resource which all those interested in developing their five element skills can draw upon in the future.

Finally there is the excitement of seeing five element acupuncture on its journey back to China through the efforts of Mei Long and the translation of my Handbook. I will end with a lovely message Liu Lihong sent me from China. He hopes the translation of my book will get published soon, which he thinks is the most important thing of all for promoting five element acupuncture in China, and he finishes by saying, “Imagine 10,000 people out there will read this book. Even if only one of them finds the truth there it is still good news. With 20,000 readers we will at least get 2 people who want to practise it. This will be a good start already.” So I greet in my thoughts all those 20,000 people out there waiting to read my book, and I look forward to welcoming the two who Liu Lihong predicts will practise what is in it.

A Happy New Year to all my readers in all the 50 countries around the globe. Amongst the many of those in China reading this there may (who knows?) already be Liu Lihong’s two!

A labour of love completed

I have just finished translating one of Elisabeth Rochat’s works in which she examines what is written in the Chinese classics about the different meridians and their points. This time I worked on the 9 points of what she calls Heart Master (called variously also Pericardium, Circulation-Sex or, which I have always liked, Heart Protector). I have translated other things for Elisabeth to include in her Monkey Press books, but this points notebook has been the most difficult by far. First I have had to learn to understand what are very complex concepts, expressed in that most poetic of all languages, French, and then, once understood, work out a way of expressing them in the much more practical language of English. This has involved thinking myself into another idiom and another mode of thought.

Having battled with these difficulties (and at times battle was not too strong a word), I developed a kind of flow, steeping myself happily in this pool of classical thought. And then the translation went more quickly, Points 1 -3 taking what I felt was forever, whilst I seemed to race through Points 4 – 9.  I have now sent the files off to Elisabeth for her to make of them what she will. The translation is eventually going to find its way to the States, where I understand an editor and a publisher are waiting. So my work is done.

One unexpected bonus of doing this translation is that I allowed it to serve as an excuse to join the London Library, claiming to myself that I needed its vast hoard of reference books and dictionaries to complete this work, but in fact just for the pleasure of walking through stack upon stack of books which I am allowed to borrow for as long as I like. For me a luxury indeed, and my own present to myself for having helped, in my own way, to give the English-speaking world greater access to more of Elisabeth’s thoughts.

Preface to the Chinese edition of my Handbook of Five Element Practice

The translation of my Handbook is now complete, and I have been asked to write a preface for it for Chinese readers.  I give it below:

"I am very happy that this Chinese translation of my Handbook of Five Element Practice will now be available to Chinese readers.

I am particularly honoured that Master Liu has encouraged this translation, and has given this book his special blessing by offering to write an introduction.

My own journey into five element acupuncture began when I met an acupuncturist at a party in London nearly 30 years ago. I experienced so many profound changes in myself as a result of my own treatment that I decided that I wanted to study it, and was fortunate to be able to study under a great master of acupuncture, J R Worsley. And now that I have studied it and practised it for all the years since then, I have great joy in offering what I have learnt to others through my teaching. For 12 years I was the Principal of the School of Five Element Acupuncture in London, and am now continuing my work in helping others to deepen their own practice. For me, the concepts underlying my practice represent a profound understanding of the soul within each of us, and recognise how that soul influences how we cope with life and what illnesses we allow to attack us.

This Handbook is intended as a working textbook for those wishing to study and practise five element acupuncture, and who want to understand the principles upon which it is based. These principles reflect all the traditional values set out in the great classical medical and philosophical texts such as the Neijing and the Lingshu. They recognise that each one of us is a microcosm of the great Dao, and that disease of body or soul only creeps in when we do not live in accordance with the natural order.

Traditional Chinese medicine made its way to the West through many different routes, and is now flourishing over here. It is lovely to think that its journey from East to West is now coming full circle, as it travels back to its homeland, China. I am proud that this Handbook is one further step on this journey home. Let us hope that what I have written finds its way into the hearts of all those dedicating their lives to helping their patients through a deep understanding of the elements which create all living things.

I would like to congratulate Mei Long on completing the task of translating this book so quickly and so competently. I would also like to acknowledge how much five element acupuncture owes to her enthusiasm in embracing it on her arrival in Europe, and then having the courage to approach Master Liu in her desire to encourage the practice of a true form of traditional Chinese medicine in China."

Do seasonal influences play their part in Entry/Exit blocks?

A student sent me the following queries about seasonal treatment to help her in her interesting research topic. I give it below, followed by my answer to it.

“I am doing some research into Entry/Exit Blocks and in particular whether there is any link between unseasonal or changeable weather patterns in nature and the appearance of these blocks in patients. I have only a very small amount of data so far, and one or two published articles from practitioners who note that in their practice Entry/Exit blocks tend to appear in clusters at the change of season or during unseasonable or changeable weather (though not exclusively of course).

My data does actually point to a link between the two but (being a beginner in 5 Element Acupuncture) I am struggling a little to understand whether there may be a link or if it is just coincidence.

I was wondering if you had noticed any similar patterns in your own practice over the years and if so, why is this and do you have any examples? I am looking at some of the classics with regard to Wei Qi (as this is where the Blocks are felt) and how its movement is linked to nature, and to me at least it seems fairly obvious that the movement of Qi within us could be affected and "blocked" by external (macrocosmic) qi movement which goes against the normal flow of seasonal movement of Qi from Spring through the Seasons to Winter

I did ask Neil Gumenick directly, by email, about this, and he said there was absolutely no seasonal connection, but as I said earlier, in practice, it does seem to occur. Other authors I have looked at, including Jarrett, do not include seasonal change as one of the causes of Entry/Exit Blocks.”

Here is my reply:

"You’ve posed an interesting question about Entry/Exit blocks. So here are my thoughts on this, although I had not until now really considered this question in any detail, so it has set me thinking!

When I find an E/E block, as well as clearing it I always think which officials are in trouble and why this might be. Sometimes we simply don’t know, but in most cases I can work out why this particular block may have occurred at this time. I tend to think more of the psychological or physical reasons, rather than seasonal reasons, although I have thought of these, particularly if the block relates to the patient’s guardian element. For example, one of the most frequent blocks is Co/St (Co 20, St 1). If it is a Metal patient who is blocked in this way, I think of what the patient can’t let go of, or if it is an Earth patient, what the patient can’t stop thinking about or transport. But I have only thought about a seasonal connection if the patient is in their element’s season, i.e., Metal in autumn or Earth in late summer. It might cross my mind that the block has been exacerbated by the season, but I don’t tend to think of the season as causing the block. I will not think about the season at all if I find a block in a season not related to that patient’s element, i.e., a Co/St block for a Fire patient in autumn (but perhaps I should!).

But, and it’s a big but, I am sure that the extra inflow of energy to any particular element from a seasonal influence must affect in some way how those elements manifest in us, since each element will receive the influence of its particular season, just as it receives the influence of its particular time of day. That’s, after all, why we do horary and seasonal treatments. I am not sure, though, how obviously the subtle changes in the balance of the elements as they move from season to season can be detected on the pulses, for example, or even how far they will lead to an E/E block. An E/E block is a sign of a great build-up of energy in one meridian which is unable to discharge it to the next along the Wei cycle. As felt on the pulses, it is a strong build-up, and therefore it seems to me unlikely that a simple change from one season to the next will affect this enough on its own (otherwise we would have E/E blocks all round the year as season changes to season!).

So in theory it is likely that there may be a subtle influence of the season on the energies of the different elements, but in practice, in my view, it is only likely to add to an E/E block if there is already a block building up. Unfortunately for your research I don’t think we have the means of assessing whether this is so or not, so I think this may always remain a theoretical discussion, without practical proof.

I hope this explanation helps.

Did points come before meridians, or meridians before points?

I find it is interesting to speculate whether the concept of meridians came first, and then the points, as it were, popped up along them afterwards, or whether it was the other way around. Were the points there first and somebody (who?) joined them up, like some dot-to-dot picture our children trace? Historically, as I know from my translations of Elisabeth Rochat de la Vallée’s work on the points, there is disagreement as to which meridians certain points were allocated to, and uncertainty as to the lines of the meridians, which were not as firmly fixed as they are now. This would appear to indicate that points came before meridians, but there is obviously no clear answer to any of this. Speculation about this is, however, worthwhile because it prevents us from being too rigid in our thinking, and encourages us to look at things from a different angle, always a good idea if our thoughts are not to atrophy.

Points as sites of access to the deep within us

We must not think of points as they can appear on our charts, as something stuck on to the body like pins in a pin-cushion. They must be seen as sites of access to the energy along a meridian, which in turn creates the pathway which eventually passes deep inside us or comes up from deep inside from the organ in question. A point is therefore part of the structure which creates the body (and soul) over which it lies. It provides a point of entry to it and thus allows us, through the needle, to alter the structure of the body (and soul) in some way. Since all is interconnected, we must remember that no point has an intrinsic value all its own, isolated from that of the meridian from which it emerges. The power of a meridian does not therefore lie in its individual points, but in the energy relating to that meridian to which these points form different kinds of access.

Any place on our body, when pressed, stimulated or manipulated in some way, in the case of acupuncture with a needle, will produce some local effect, akin to that of our scratching an itch or rubbing a painful area, but such an effect will remain restricted to that one small site, unless it somehow taps into the larger area to which a meridian has access. Each meridian reaches down into the innermost workings of an organ and from there spreads up and out back to the surface, where we meet it at the acupuncture point we decide to needle. Each time we needle the surface in this way, then, we must remember what lies beneath, and remain aware of how deeply we can influence these depths by this action on the surface, and how the energies lying hidden in the depths can propel themselves to the surface through stimulation by the needle.

The body as map

I like to think of the body as a kind of map with the meridians as its roads. The individual acupuncture points are the landmarks placed at varying intervals along these roads, some close together, others more widely spaced apart. Some of the areas of the body more crowded with points can be regarded as our body’s villages and towns. These are the energetically bustling areas of the lower arms and lower legs, whilst those expanses punctuated only rarely by points, such as parts of the back, upper arm and upper thigh, represent the energetic equivalent of the sparsely inhabited areas of the earth, such as the deserts of Africa or the mountains of the Himalayas. To select points buried within the contours of such a widely varied landscape of the body is then the equivalent of trying to plot a course through the different regions of the globe. It is good to think of treatment and the individual point selections which go to form a treatment schedule in this way, for it is by keeping in mind the landscape of what we can regard as the human globe that we retain that sense of the whole which is essential to good practice.

Perhaps we could go further and think of each element as being one of the five continents on the human globe, with its two yin and yang officials as two countries on this continent. The routes connecting all the continents together are then formed by the meridian network, with its acupuncture points representing staging posts of various importance and size along what are effectively trade routes, the trading of different sources of energy from one area of the energy network to another. This helps us remember that any action anywhere on our body can never be regarded as an isolated action restricted to that one site of the body, but must be seen as having a domino effect, just as a single domino can topple the whole line as it responds to a knock.

I think this metaphor of the body as globe is a true one, for it not only emphasizes the interconnectedness of everything that happens on the surface of the body and deep within, but it is, importantly, also an appropriate representation of the circle of the Dao which encompasses all that is, and of the unbroken circling of the meridian network within us. Somehow the charts of the body with their seductively straight meridian lines make us forget the circular picture which is in truth how we should regard the body. The energies of the five elements do not so much weave us into the straight horizontal and vertical lines of the meridians our charts show, as draw every part of us into a circular movement, much like the 24 hours of day and night draw time into an ever-revolving circle of minutes, hours, days and years. If we can keep this sense of the circling of energy in our mind when working out our treatment protocols, this will prevent us from falling into the error of seeing treatment as forming a straight line, with only one way of getting from a to b. Rather, it should be seen as a circular action into which different practitioners will draw different treatments at different stages, but all supporting the circle of energy as a whole. Regarding treatment as something cyclical rather than linear supports my conviction that the order of point selections is not as important in the overall success of treatment as the boost to the energy given by a succession of treatments.

It is useful for each of us to develop a map of the body which is personally significant to us, and learn to accept that the selection of points we feel at ease with will always be personal to us, and need not, indeed should not, mimic another practitioner’s. We must not be frightened to own what we do in the practice room, each treatment decision we take, each way in which we treat our patients, all must have our personal stamp upon them because they arise from insights we have ourselves gained. This being so, I will be sharing with you in these blogs some of my thoughts about my own personal body map which I have developed over the years and which I hang metaphorically on the wall of my practice room to help me get my bearings.

Circles of energy

We know that the elements describe a circle creating all things, including the human body, the energies of one element feeding the next and so on in a never-ending cycle. In the body we usually see this as one over-arching circle linking one element to another in the familiar sequence of Wood-Fire-Earth-Metal-Water and back again. We know this sequence as the Sheng (Shen) cycle, the cycle of production. Within this cycle there is a further cycle which has its own sequence, that of mother to grandchild, the Ke (K’o) cycle, in the sequence of Wood-Earth-Water-Fire-Metal and back again.

Here, then, are two circles of energy within us. There is also a further circle, a smaller reflection of this five element circle, which we often forget about and therefore tend to be much less familiar with. This occurs in the order of the grouping of points we call in five element acupuncture command points, which forms one of the most important, if not the most important, group of points. Command points are on the extremities, between the elbows and fingers on the hand, and the knees and toes on the feet. They lie on the meridians of each of the 12 officials, in a specific order, one for the six yin officials and another for the six yang. Most, but not all, command points are what we call element points; this means that they have a specific relationship with one of the five elements. On each meridian there is, therefore, what is called a Wood point, a Fire point, an Earth point, a Metal point and a Water point. In addition to the element points, the command points include what is perhaps the most important point of all, those we call the source points (yuan points). Of all the command points it is the source point which offers the most central reinforcement for other treatment.

If we trace the sequence of the element points, we can see that in both yin and yang officials they follow the order of the elements, but with different starting and end points. If we move up from the extremities, all yin officials have a Wood point as their nail points and progress through the cycle of the elements to finish at a Water point at elbow and knee, whilst all the yang officials start with a Metal point and finish with an Earth point. The actual distribution of the points along the meridians between the element points differs slightly from meridian to meridian, with a few of what are called non-command points lying interspersed at differing intervals between the command points, depending on the meridian involved. This apparently random distribution of the non-command points is yet another proof of the unpredictability of anything to do with acupuncture, each meridian having a unique sequence of command and non-command points, as though deliberately designed to trip up poor students as they try to memorise them. Even now, I sometimes have to refer to my charts to remind myself of a particular order of points.

To see the line of the command points as ending at elbow and knee, with the line continuing along the meridian with non-command points as though we are tracing the meridian from its extremities up the body or from the body down to its extremities, runs counter to our view of the continuous circling of energy from element to element. Instead, it is appropriate to see a kind of connecting link drawing the energy flowing as far as the elbow and knee back round out again to the nail points and on up again following the sequence of the elements, to form a continuous cycle. Thus the Earth and Water points at elbow and knee can be considered as connecting up again with the next points along the cycle, the Metal and Wood points at fingertips and toes. We can therefore envisage all these element points as creating another unbroken circle of energy, a further but smaller circle of energy within the larger, overall circle formed by the meridian network as a whole.

There is something uniquely symbolic about this reflection of the five element circle on our limbs. No other grouping of points elsewhere on the body has such a similarly fundamental relationship to the five element circle in all its mutually supportive power, as one element follows the other in a mimicry of the larger productive five element circle. Even the Associated Effect Points (back shu points), which have a specific relationship to one element each, do not lie along the back in the five element sequence, being linked in a much weaker way with the points of the other elements, since the ones lying above and below them do not follow the five element order. This helps us understand the importance of the command points in connecting our energies to the cycle of the elements. When using a command point of one element we should therefore remember that we are, in effect, drawing to some extent upon energy flowing within a complete cycle of the elements.

Each person is “a house with four rooms”

I have just bought the second volume of the autobiography of the lovely writer, Rumer Godden, who lived most of her life in India. It is called A House with Four Rooms. I quote her dedication at the front of the book:

”There is an Indian proverb or axiom that says that everyone is a house with four rooms, a physical, a mental, an emotional and a spiritual. Most of us tend to live in one room most of the time but, unless we go into every room every day, even if only to keep it aired, we are not a complete person.”

Mid-August Lunch (Pranzo di Ferragosto)

I have a friend, Susan, to thank for pointing me towards this lovely film about a middle-aged son, his aged mother and an unexpected houseful of similarly aged women over the weekend of this holiday. It is a tender and true film, which made me laugh, smile and cry a bit, but more importantly helped restore my faith in what a skilled writer and film director can do with the simplest material.

Like my little circular box (see previous blog), it continues to make me smile as I write about it. And this is all the more important, as I find that there have been very few other things in the wider world outside which make me smile at the moment.

The pleasure of beautiful things

Yesterday I bought a little circular box which I had seen in the window of a local charity shop and fallen in love with. I was told it was carved out of rhinoceros horn, but I don’t know whether that is true or whether it is merely imitation plastic. In any case, if it is made of horn, I hope that the rhinoceros from which it came died of natural causes and was not one of the poor animals now hunted by poachers for just such a piece of horn.

The box is about 3 ins in diameter and about 1½ ins high, and has a little hinged lid with a little carved knob on top. Its tiny brass hinges and the brass studs around its base point to its being quite old. I can’t see a modern trinket-maker spending the kind of time needed to work these into the side panels. And it is also carefully lined with slightly worn black velvet which could again indicate an object made at a time when craftsmanship was more readily available and cheaper than now. It is a kind of mottled brown in colour, shot through with cream, and the small panels of its base could indeed come from something circular, such as a horn. I will not know what it is really made of, and when it is likely to have been made, until I give it to a friend of mine who haunts the Victoria and Albert Museum and knows all about these kinds of things.

I have put it on a low table on which I gather precious things I take pleasure in looking at. Here it is joined by a tiny green malachite elephant, said to come from the Congo, and a small replica of the Degas dancer, stretching her hands behind her and pointing her toes. I smile whenever I look at my little box. At a penny a smile, it is surely worth the few pounds I paid for it.

“Don’t get attached to your giving”

Behind many of our fears as practitioners may lie the concern that a patient who is not perhaps getting what he/she wants from treatment, or whose treatment is not progressing as quickly as they had hoped, may decide that they do not want to continue treatment. We must not allow this fear to dictate the course of treatment. We should always let them to leave with as little feeling of disappointment or doubts about our own performance as possible, and learn to move on quickly.

It often happens that we never know why a patient stops coming to see us. Some few tell us why they are stopping, but many others, usually the majority, simply disappear, probably because they are too embarrassed to tell us why they are stopping. And this can happen after many months or even years of being our patients. The hardest to take are those long-standing patients of ours who either decide to move to another practitioner or stop having treatment of any kind without informing us. These we may never hear of again, and, human curiosity being what it is, we would dearly like to know what is going on in their lives, but may never do so, except by chance. As I heard a very wise Tibetan master, Sogyal Rinpoche, saying: “Don’t get attached to your giving”, one of the hardest lessons we have to learn.

Sometimes we hear news of our patient indirectly through somebody else. One such occasion, which I treasure for teaching me a lot about the effect of even a few treatments, occurred recently. A new patient of mine said that he had heard of me through a good friend of his who had had treatment from me, and who had told him that this treatment “had transformed her life”. I struggled to remember who the patient was, but looking back through my notes realised that she had come to see me for precisely three treatments many years ago, and then stopped coming. Without hearing what her friend told me, I would have qualified her treatment as a failure, as I did at the time. So we never really know what effect our treatments, and perhaps more importantly our presence and approach, can have. And this episode taught me not to underestimate the power of the interaction between the patient and me, nor of the power of those first few treatments in which the elements are addressed so directly and so vigorously for the first time, particularly through the initial cleansing treatment (AE drain) we give. Sometimes for some patients all that is needed is to point the elements in the right direction through these first simple, but pure, treatments, and leave the elements to continue on the path towards restored health through their own efforts as it were. Other patients may need our support for longer.

It is of course obvious that the nature of the relationship we enter into with our patients is crucial to the success of treatment. Of course a patient will have personal preferences which may have nothing to do with a practitioner’s competence, and we have to accept that. A patient must feel at ease with their practitioner, as one of the essential prerequisites for successful treatment. If this relationship is for some reason not right, patients will be reluctant to continue treatment, and the treatment itself will rest on very shaky foundations. The kind of uncertainties an uneasy relationship brings with it can lead the elements to hide or distort themselves, as though a screen has been thrown up between us, and the hesitancies which such unease can create in us as practitioners can confuse our perceptions of how to interpret what we see. We may ourselves be anxious and overlook anxiety in our patient, for example, or irritated and interpret through our own angry eyes our patient’s emotion as anger.

The lines of communication flowing between the patient and us and between us and the patient need to be as uncluttered as possible, so that the messages passing along these lines are interpreted according to their true meanings rather than being distorted by kinks somewhere along the way.

A practitioner’s intention

Each practitioner in their own way influences the course of treatment not merely by their selection of the treatment itself but by their very presence and the nature of this presence. This is the quality which should make the insertion of a needle into an acupuncture point so much more than that needed to obtain a blood sample from a hypodermic needle. For, enclosed as it were within the physical action of penetrating the skin with the needle, there should be some inner quality transmitted by the practitioner’s spirit into the heart of the action which transforms this action from a mere physical process into something akin to what is imparted by a caress.

And that is not too emotive a description of what we do, for at a deep level where the practitioner attempts to engage the patient’s spirit, he/she must do that with the kind of gentle warmth we impart to those we love. At the heart of all acupuncture treatment at the level of which I am talking lies love, the warmth of one human being for another, allied here to the desire to help another, which is a practitioner’s role. Though the needle is solid, unlike a hypodermic needle, in one way it should be regarded as hollow, offering a channel through which the practitioner passes something more elusive and intangible than a physical substance. Within this lie such ephemeral gifts as the practitioner’s experience. This will include the confidence he/she will impart born of this experience, which will include an understanding of the transformation the action residing within points can bring about in a patient.

It is therefore vital to understand that the actual insertion of the needle is only a very small part of the process by which the energy to which the point has access is stirred, in much the same way as the manner in which we touch a child can comfort or frighten it. If we are unaware of this, we become mechanical acupuncturists, going through standard rituals, and our needle is then little more than a more delicate hypodermic needle inserted at a physical level to carry out a specific physical action. But, as I argue strongly, what we do must always have within it something of the spirit, and thus the selection of an acupuncture point and its needling must also always be bathed in just such a spirit. So when I select a point I will already have endowed it with something from my spirit which breathes into it my own understanding of why I have chosen it for this particular patient and for this particular treatment, and when I lift the needle what I intend this point to do for my patient flows from me into the needle.

It is difficult to define the elusive nature of the quality we bring with us into the practice room, which is why one person using the same points for the same treatment as another practitioner may have a completely different effect. There is no doubt that the more focused the practitioner is, the more effective treatment becomes. Another acupuncturist once told me that he was surprised that he did not get the same results from treatment as I did, although he was trained in the same discipline and used the same points for the same reasons. This initially puzzled me, until I realised that, at heart, he had doubts about the efficacy of what he was doing, whereas I did not.

It is important that we do not think that this area of our practice, that in which a practitioner can summon to treatment some quality of understanding they have gained from their experience, is only accessible to the experienced practitioner and might make it difficult for a novice practitioner to carry out good treatment. This is far from the case. It is merely that it is important that a practitioner from the earliest days is made aware of this important facet of their practice, and is thus open to harnessing whatever experience they slowly acquire to guide their treatments in the right way. We can focus our intention to achieve whatever we hope to achieve from the first few hesitant steps we take in practice through to those more confident steps experience helps us to take. Merely being aware that a practitioner brings something all their own to the insertion of the needle which can endow that insertion with something much deeper is the first step in this direction.

Point names, and how far they help us in point selection

The individual site we know of as a point has been endowed since the earliest days with a (nearly) unique Chinese name about whose meaning there is much learned debate in those circles which boast a knowledge of ancient Chinese. It might be considered simple to use a point’s name as the basis for treatment, without reference either to the meridian on which it lies or to its anatomical position. This represents to me a crude form of point selection, if used as the main basis for selecting what treatment to offer, for it is to take a point out of the context of the body as an interconnecting globe of energy pathways.

Since I have started translating Elisabeth Rochat de la Vallée’s work on Chinese point names, I have become increasingly aware of the complex issues surrounding the meaning of point names discussed in the many classical texts she examines. This has helped me recognise that there are wide variations in meanings attributed in these texts to the same point names. They also show many differences not only as to where some points are located, but also on which meridian they are to be placed.

If there is so much debate in the classical texts, it is understandable how much all of this shades over into the even more complex area of the translation of names into other languages. Linguistic purists may complain that the English (or French or German or Japanese) words may eventually bear little or no relation to the original Chinese character upon which they are supposedly based, but such changes are inevitable, given the journey from culture to culture and from language to language that these names have made. This being so, I think, for my part, that a study of the original Chinese characters, fascinating and illuminating though this is, may well best be left to the historian and the linguist, if I, as a practising acupuncturist, am not to be overwhelmed. What I feel is the most important to me clinically is the rationale underlying my point selection, and how far some idea of the meaning of a point’s name helps me in this choice.

Every practitioner will have absorbed a number of points into their practice which they feel comfortable to use, and it is likely that this list will contain points with which we have grown familiar because of their use in the tradition we have inherited. The important thing here is that we develop an understanding of our own concept of the meridian network, with an internal logic we can justify to ourselves as we choose individual points. We must place our point selection in the widest context possible, and develop our own rationale for the points we select. Nor must we forget how many layers of learning seep into us from all the many different people we have learned from, who are trained in the discipline which shapes the branch of acupuncture we inherit. All these different pathways of learning, including what personal interpretation we make of a point's name, together go to form a kind of individual acupuncture heritage, and coalesce to form the understanding we have of what points to choose, making point selection always into a very personal journey of adventure.

The important thing here is to be prepared at any stage to widen both our repertoire of points and our perceptions as to when to use a point. I have often found that another practitioner will mention to me a point they use which may be one that I have never thought of using, or one that has somehow dropped off my radar. Adding this point to those I select from then reinvigorates me, refreshing my practice, much as if I am putting new flowers into my practice room. Our practice needs constant stimulation with new ideas of this kind if it is not to grow stale. This is one of the reasons why I like writing about acupuncture, because thinking about what I want to write makes me examine every aspect of my practice with a fresh eye, as though coming new to it.

Seasonal treatment

I have a reader of this blog, Sean, to thank for prompting me to write the following, in answer to his question about my treatment of a Wood patient: “I’d like to know why you choose AEPs of Wood, especially for an autumn seasonal treatment.”

The error here is in thinking that I was giving “autumn seasonal treatment” to this Wood patient. The only seasonal treatment I do is treating a patient’s guardian element in the season of that element, and with its own element points (for example, St 36 and Sp 3 (Earth points within the Earth officials) in late summer for an Earth patient). No other points, including therefore AEPs, have any connection with seasonal treatments, except of course that any treatment we do in an element's season will have that little extra effect because it is drawing on nature's contribution to that element.

I know some people give seasonal treatment for patients of other elements apart from the element whose season they are in. In other words, for a Fire patient they may give a Metal seasonal treatment, LI 1 and Lu 8. I do not do that, as I see it as unnecessarily moving away from the patient’s own element. An element in balance should be able to deal with any seasonal changes through strengthening treatment on its own points. But the guardian element is always under greater strain than any other element, and will feel this load particularly in its own season. This is why we try to help it by doubling up the support we are offering, in other words by adding more Metal to Metal in autumn, or more Wood to Wood in spring, which is what we are doing when we do seasonal treatments.

All this applies, of course, to horary treatments as well (treating a Water patient with Bl 66 and Ki 10 in Water time, between 3 and 7 pm). And to be able to do a seasonal treatment in horary time is said to be the best treatment of all (you are in effect trebling the amount of help you are giving an element). For logistical reasons, this is difficult to do for some elements (Wood and Metal in particular), since patients would have to come to our practices in the night. JR encouraged us to arrange for several patients to come together during these anti-social hours, which, as a good pupil, I started doing, until I realised that a few patients who had loyally turned up between 11 and 3 in the night for their Wood horary treatments turned out, with more treatment, not to be Wood after all! I have since, for obvious reasons, not least my own health, discontinued this practice.

The cumulative effect of points

It is good to understand the difficulty of assessing exactly what effect one point has rather than that of an accumulation of points added to the effect over time. A point might, in principle, I assume, prove its efficacy not immediately but after some time, as change can occur slowly. Since our patients on the whole continue their treatment with us from week to week, they will have further points needled which may have added to the effect of what we can call that original point, cancelled it or given it a completely different emphasis, so that it is no longer possible to assess exactly which point did what when. Certainly even if it were only the first point that has this future effect, we will never be able to isolate this for all the above reasons, so unless we are simply to needle one point once and await its effect, without adding any further points for a sufficiently long time to give us some certainty of whether it has had an effect or not, we can never know in absolute terms what the effect of that one point on that one patient at that one time is.

Does it matter? Well, yes, it does, but only if we are trying to assess the value of individual points in isolation and to test the accuracy of the information, all generally anecdotal and handed down, by word of mouth or hearsay, or from traditional sources which have grown up around that point and give it a weight and substance that we have no way at all of assessing. I am, however, emphasizing the cumulative importance of treatment rather than that of an individual point. The long-term effects of points used together, either in combination in the same treatment or in sequence as part of a pattern of treatment, will be observable over time and can thus be attributed, one can assume, to the cumulative effect of all the points that have been needled so far. We will never know whether it is indeed only one amongst many that has been effective, or whether it is the whole lot of them combined, or whether it is any combination of some of them, with some remaining ineffective, as another evidence of the dead wood I mentioned. But at least we can gain confirmation or not about the cumulative effect of the points we have so far needled.

Think element, not points

When we approach treatment, our mantra should always be: Think element, not points. We know that we treat by needling a series of points, but we must think of these points not as individual stitches in a garment, but as shaping the garment as a whole. It has always surprised me how much attention practitioners seem to pay to individual points, whilst placing very much in a subsidiary role the element upon whose meridians these points lie, of which they form only a small part.

I am convinced of the cumulative nature of working upon an element, rather than the need to rely upon the individual action of specific points. In my view it is therefore never just one individual point which does the trick, and turns the tide of treatment as it were. Rather, there is a gradual accumulation of effect, as the selection of different points on that meridian/element adds layer upon layer to the element’s effectiveness in redressing a patient’s imbalances. There may come a tipping-point as a result of one treatment, where ill-health turns at last to good health, but it is created, not by the points selected for that particular treatment, but as a result of having, with each preceding treatment, through the selection of one point or a series of points after another, placed weight upon weight on the side of the scales of health labelled balance.

The greater the over-emphasis on points to the detriment of the subtleties of the elemental and meridian networks to which they belong, the more practitioners are reluctant to engage with the elements at the deep level such a relationship calls for. This deep level of understanding helps remove the emphasis on individual points, replacing it instead with what I regard as a much simpler scenario. Here the power of each element and of its servants, its two yin and yang officials, remains always to the fore, with correspondingly less emphasis placed on deciding which of its points to select to harness its energy. All points belonging to an element enhance in different ways that element’s energy, each becoming one of the many doorways through which this energy can be directed. This is why it is possible for practitioners to choose quite different points on the same meridian and yet lead to a similar level of improvement in the patient.

If the effectiveness of treatment lies in the cumulative effect of selecting points on the same element rather than in selecting a succession of unrelated, individual points, it is then very much a matter for individual practitioners’ preferences which points relating to that element are selected at which stage of treatment. These selections are usually based on the protocols used in the particular branch of acupuncture in which they have been trained or by the individual teachers who have passed on their knowledge to them, and they will therefore vary from school to school and from practitioner to practitioner.

My calming routine

I have developed a kind of calming routine as soon as I experience the tension of not knowing which element to concentrate upon. If I am unable to home in on any particular dominant sensory or emotional signal coming from one element above all the others, I will experience that all-too familiar feeling of slight panic at not knowing what to do next, which all five element acupuncturists will, if they are honest, often feel. I then move into a routine which I have devised for myself in which I slow down what I am doing, and try to put myself back in the position I was in when I first met the patient. In other words I try to see the patient with completely fresh eyes once again. To do this I may concentrate on one of the sensory signals, voice, for example, and just engage in some conversation, not primarily to hear what the patient is saying, but how they are saying it. Or I may make a deliberate effort to smell, maybe by moving the blanket away to get closer to the body. I may also take this as an opportunity to look again at my notes. Doing this helps to insert a pause in what I am doing, since I have to page through the file and there has to be silence whilst I am reading. The patient, lying quietly there, is not aware of any hesitation in me, seeing only that I am absorbed in reading my notes and therefore is more likely than not to be pleased that I am taking so much time and care over them rather than, as I might worry, becoming impatient.

In fact the cultivation of periods of silence when nothing is happening except in the practitioner’s mind is a good practice to follow. It allows the patient to relax and the practitioner to think unhurriedly. One of the problems we may all have is in believing that we must always be doing something in the practice room, as though action is always a sign that we know what we are doing. If we don’t know what to do, because we are not reading the signals coming from the patient clearly enough to work out what treatment we need to do, we must give ourselves time to think, without feeling that our silence will be interpreted as incompetence by the patient.

I have always been quite happy, too, with admitting to a patient whose treatment appears not to be progressing that, as I have learnt to put it, “there is something here which I don’t understand”, and asking them whether they are happy to give me the time to work this out. No patient has ever been anything but delighted that I am prepared to give them so much of my time, and all have been happy to agree to coming more frequently for treatment if I think this is necessary, until I have worked out the direction I want treatment to take. For it is unprofessional if, knowing that we are unsure where treatment is going, we then agree not to see the patient for quite a long time, say a month ahead. This only delays the time we will take to get our treatment focused properly, and does nothing but increase the level of our uncertainty, since we have too much time to worry over our patient, with no feedback from seeing them to help us.

We should instead openly discuss our uncertainty to the patient, and ask them to give us the time to work out what we need to do. In such a situation it is essential that we see the patient as frequently as possible, because this gives us the opportunity of looking at them afresh and with these new eyes seeing the elements within them more clearly. Nor should we worry, as some of us do, about our patient’s finances here. We should leave it to them to say whether what may be an unexpected return to frequent treatments is making things financially difficult for them and, if so, perhaps we should consider reducing our fees for a short time. In the long run this saves patients both time and ultimately money since the frequency of treatment now will reduce the overall time the patient needs to come for treatment.

Uncertainties surrounding diagnosis in five element acupuncture

I have been reminded recently of an important fact about the realities of being a five element acupuncturist. An experienced practitioner of many years’ standing told me that what he finds difficult about five element acupuncture is that its practitioners often appear to change their minds as to their patients’ guardian elements, starting, say with working on the Metal element, and after some, or even many, treatments moving away on to Earth. He could not, he said, work in a discipline which offered him so little diagnostic certainty, and he was surprised that I did not find this as disturbing as he did. Instead, as I pointed out, I find it exhilarating that my discipline is open to accepting in this way the complexities, and perhaps ultimate unknowability, of a human being. When I asked him exactly what certainties his own practice gave him, we together eventually attributed this to the fact that his practice concentrated almost exclusively upon focusing his diagnosis upon physical criteria, for which he had learnt specific standardized treatment which hardly varied from patient to patient. Where, for example, did the patient experience pain? If in the knee, then he had a fixed protocol of points to deal with this, which came from his knowledge of the meridian pathways affected, and included additional treatments, such as ear acupuncture or cupping, which he had learnt specifically addressed physical problems.

When asked how he would deal with a patient telling him that he was finding it difficult coping with life, he fell silent and then admitted that, apart from offering some generalized sedative treatment to calm the patient, this was an area of his practice that he did not venture into. This was evidence to me of the different emphases different traditions place on specific aspects of a patient’s well-being. The central pillar of all five element practice is formed by those areas of what, in Western thought, we would call psychology. The same does not hold true for all other forms of acupuncture. This may also be one of the reasons why five element acupuncture appears to prompt much heated debate as to its validity and arouse a surprising degree of hostility for a branch of acupuncture which is so completely rooted in the deep spiritual traditions of the east upon which all acupuncture is based. You have only to read the classics, such as the Nei Jing, to appreciate how strongly bathed in the spirit were the traditions from which all acupuncture emerged. There was never a split between body and soul as there is on the whole in Western medicine, where psychology and physical medical practices lie far apart, and sadly, too, as there appears to be in modern Chinese acupuncture. To a five element acupuncturist, where no such split exists, or should exist, the emphasis upon a diagnosis based predominately upon physical symptoms therefore represents an oddity, only to be explained by an over-reliance on what appears to be physically there, to the detriment of what cannot be seen.

It may well be that a society over-dependent on the physically observable since the rise of science, and thus symbolically prizing the microscope over the touch of the hand or the glance of the eye, has forgotten how far the microscope only reveals, as it were, the physical dimension of things, but can never, unlike the human touch, reach their ephemeral hidden core. It is here that five element acupuncture approaches the realms of psychotherapy, the treatment of the soul, and where those who find such an approach either perplexing or disturbing may label it, as one practitioner, firmly embedded within the “acupuncture treats the physical” school, did, as “too airy-fairy for me”. If airy-fairy means spiritual, well then I would agree that this is a fairly accurate description, but without the overtone of disparagement attached to this remark. It is the “airy-fairyness” of what I do that fascinates me, because I regard the intangible inner core each human being possesses as dictating the health of the whole structure of body and soul and, in its response to treatment directed at it, creating the conditions which allow the health of the whole edifice to be restored.

But the practitioner who was disturbed by not being able to “know” with certainty what element a person is highlighted a valid point which deserves to be addressed. If the elements within us are such subtle manifestations that they are difficult to detect even for those with experience, how far does that invalidate the discipline of five element acupuncture as a whole, and, as corollary to this, what particular difficulties does this present to an inexperienced acupuncturist? Far from invalidating it, I believe it strengthens its right to call itself a true discipline, for it acknowledges all those areas which lie at the heart of human life and give them meaning. As to the problems it presents for a newly qualified acupuncturist, the lesson, here, is to remain aware of the uncertainties our practice arouses in all of us, experienced and less experienced alike, and not to deny their existence or belittle the problems they cause. If uncertainty is accepted as being a necessary component of all healing practices, which I believe it must be, since with such practices we are dealing with the complexities of the human being, we can each in our own way learn techniques for dealing with this, and thus lessen our fears.

My next blog will describe a method I have developed to help me cope better with the uncertainties of practice.

A lineage is a line

Below I give the text of a comment I have just left on the five element site 5e_acup.

"Having at long last joined this group, I am only just getting to grips with how to read what is in it, but I have managed to read the last messages, and the many comments they express. You have listed many important questions, Michael, and there are many other queries, all of which deserve exploring. Here, though, are my thoughts on some of what I have so far read.

A lineage is a line. It is never complete. It means a line of transmission, and that line starts before a master of that lineage enters the line and continues after that master has died.

I have translated Jacques Lavier’s History, doctrine and practice of Chinese acupuncture from French into English. As you know from Peter Eckman’s book, Lavier was one of the teachers of JR, Dick van Buren, Mary Austin and others. Much of what is in JR’s black book comes directly from the appendix of Jacques Lavier’s book, and presumably Lavier in his turn took his information from some of the masters with whom he studied in the Far East. JR is therefore one in an awesomely long lineage going right back to the pre-Christian era, and hoorah for that.

There is no doubt that JR developed his thoughts during a lifetime’s practice. I witnessed some of these developments. He undoubtedly dropped much of the more symptomatic acupuncture which fills the black book and to an extent also what is listed at the back of his Meridian and Points book. For example, when discussing possession, I never heard him suggest we select different ID points for patients “with depression” or “without depression”. With my first clinical patient as a student at JR’s college, I found weak pulses on both Metal and what I call Outer Fire (Three Heater and Heart Protector). The patient was a Fire CF. I was told to tonify both Metal and Fire. I was also taught sedation as well as tonification techniques as a matter of course. In the years of my observation of many hundreds of patients with JR, he never (not once!) suggested that we sedate a patient. The clearing of AE and removal of all the other blocks, such as Possession, Husband/Wife and Entry/Exit, all reduce the build-up of excess energy between different elements. These must have been improvements to practice which JR developed over time.

A lineage dies out if it is not fertilized by new thoughts in this way. It is the duty of those taught by a master to develop his teachings otherwise they become as sterile as some of the discussions and questions flying around now. JR very rarely answered the many sort of questions that are asked. As I heard him say once, in one of those profound and cryptic utterances with which masters like to puzzle their pupils, but which force us to go away and think, “If you have to ask that question, you won’t understand the answer.”

I don’t like all these boxes people forever seem to be trying to enclose five element acupuncture in, and boxes with abbreviations to capital letters I like even less, as though a particular branch of acupuncture is being given a trade-mark which, God forbid, somebody else will be forbidden to use. Will somebody take me to court because I always put needles into the Heart AEPs from the start (but with extreme care), because I have found AE on Heart and not on Heart Protector? Shock, horror, to those of us, who were taught as I was, only to put needles in the Heart AEPs if there is AE on Heart Protector. I have also found that by putting the needles in the Heart AEPs, AE then emerges afterwards on the Heart Protector needles! That is something new that I have learnt and which I now teach others to do. Have I thereby deviated from the lineage to which JR belonged? I don’t think so. I see it as developing that lineage and keeping it alive.

And one way in which I hope I am helping to keep the lineage alive is through my practice and through my writing, in particular of my blog, which I find is fertilizing my thoughts at an unexpectedly deep level. I like to think that I am encouraging others coming after me to go on exploring and through their own practice developing new ways of practising. As JR said, “if you had all had 40 years of practice as I have, you would be able to do what I am doing”. That may, or may not be true, for mastery is given to only a rare few, but the thought behind his words is that of a true teacher to a pupil. It is to go out there and do better than me."

Famous people I think are Water

I think the following people are of the Water element:

David Beckham
Judi Dench
Rowan Atkinson
Gordon Brown
George Osborne
Michael Schumacher
Bob Geldof
Martin Johnson
Cherie Blair
Richard Nixon


Tips to look out for:

Water people tend to make us feel uneasy, even if they themselves look quite calm. They can have a kind of frozen stillness, which can leap into action if they feel threatened, such as when something unexpected happens. Then their eyes are the give-away. Water eyes are always wary, watching everything carefully, and ready to swivel away to look at anything unexpected which might be happening to the side or behind them. They can suddenly look startled, even though the rest of the face can remain surprisingly still.

I see Water’s colour as being of two kinds. There can be a very dark shadow over the whole face, in men often accompanied by the typical blue shadow which Richard Nixon showed, particularly when he was under threat politically. You can then think of the whole face as being dark, even though when you look closely it doesn’t look so dark. Then there is the other kind of Water colour, when it has a kind of translucence, so that other colours show through it. I like to think that the dark-blueish colour is the Kidney, the more hidden, deep yin, and the translucent, lighter colour is the Bladder, the more outward-facing, yang part of Water.

I have grown increasingly better at detecting a Water smell. It can be very obvious indeed if there is great imbalance, when the smell of stagnant urine can be quite clear. At a more balanced level, I have found that when I am standing at the couch, what comes up to me is a feeling that I am literally near water in some way, as though near a pond or a bathful of water, and it feels as though there is dampness around. This is when the smell just wafts upwards to my nose. This is certainly not an unpleasant smell at all, which the word “putrid” seems to indicate, but instead just a rather pleasant dampish smell.

I find the sound of the voice makes me feel a little tired if I listen to it for a long time. It is a droning sound, which seems to hammer away at me, but in a more hidden, less direct way than the force in Wood’s voice. Listen to Bob Geldof or Gordon Brown talking (extracts on U-tube are an excellent way of doing this), and this drone, like a bee buzzing away at us, becomes very clear.

But, above all, feel how you feel in the presence of a person, and ask yourself whether you are the person who is feeling a kind of uneasy fear, and, if so, whether this is the fear in the other person, well-hidden, as Water always tries to hide its fear, transferring itself to you. Water is often mis-diagnosed, as it is very adept at hiding itself behind other elements. When I think I can see many different elements in one of my patients, then I have found it is often Water that is the element underlying them all.

How nice to feel this blog is finding its way to China!

This follows on from my blogs of June 1st and August 2nd:

Two very heartening developments, which help to offset my deep sadness and uneasiness about the future of traditional acupuncture in this country in view of the closure of LCTA in London and the impending closure of CTA in Warwick.

Mei, who is translating my Handbook of Five Element Practice into Chinese, tells me that Liu had emailed her to say that “he hopes the translation of your book will be finished and get published soon, which he thinks is the most important thing of all for promoting five element acupuncture in China.” He told her: ”Imagine 10,000 people out there read this book, even if only one of them finds the truth there, it is still good news. With 20,000 readers, we will at least get 2 people who want to practise it. Then we get a good start already.”

And I have just received the following further communication from Mei: “I’ve emailed some of your blog articles and your new blog (Nora’s five element treatments) to the students of Liu, who find them absolutely valuable. I think your teachings are exactly what they need so dearly. So your tele-education on 5 element acupuncture is on its way in China.”

The load of keeping a spiritual tradition alive within the core of acupuncture practice has been very heavy for me at times, sometimes, it has felt, overwhelmingly so. These encouraging communications from within the heart of Chinese medicine in China itself help lighten this load. Though it sometimes feels as if a door is closing in our faces here in the West through over-regulation and mistaken attempts to fit into an orthodox Western medical framework, it is good to know that another door is opening elsewhere. And where more important than in China!

A reader’s comments on my blogs on Metal and the elements within

“I am finding your snippets on the different elements useful and it really helps cut out a lot of judgemental biases that creep in while dealing with people. A friend of mine is is Metal and I have always found it hard to prevent irritation and resentment creeping up because of:
a) a feeling that our whole family is being constantly judged;
b) her laughing at some aspects of things but immediately becoming defensive or evasive if any of us is critical.

Initially I thought it was a cultural difference, but now I realize it is something that is a part of her and she doesn't mean any harm and this helps me tremendously.

A couple of other points (perhaps reminders) that I found useful were:
a) the elements are often coloured by other elements: There are times when I glimpse two elements strongly, shifting with each other, and at one time I think this must be the main element in play and at other times I feel it is the other;
b) it's helpful to consider this along with seeing what reaction the person evokes in oneself. I think this is a good way of further understanding others and oneself too, because feelings are often more informative than a certain visual cue. And I realize that in a broad way, I have a natural affinity to certain elements (or aspects of them) and a wariness of or impatience with others.”

(Reproduced here with the writer’s permission)

Famous people I think are Metal

I think the following people are of the Metal element:

Nelson Mandela
Barack Obama
Victoria Beckham
Peter Mandelson
Laurence Olivier
Daniel Day Lewis
Anthony Hopkins
Tiger Woods

Tips to look out for:

Metal people have a much greater sense of stillness about them than other elements. There can be a complete absence of movement when they lie on the couch, for example, almost as though they are like those stone effigies of knights lying in their tombs in cathedrals. This is not a suppression of movement, as there might be with Water because of it is frightened to move, but a feeling of withdrawal and detachment from what is going on.

They make very steady and acute eye contact, and it is to the eyes that we are drawn, rather than to the mouth, as we are with Earth. Whilst looking directly at us, and obviously seeing us very keenly, they appear at the same time to be looking past us and through us, as though searching for something beyond us. It is in their eyes that the sense of grief underlying this element is revealed.

When trying to work out whether a voice has the weeping tones of Metal, it is worth trying to close your eyes and just listen. Somehow when we listen in the ordinary way, watching the person talking, I find we can overlook the quiet, yin, drooping quality in a Metal voice. Listened to by itself without any input from our eyes, the voice becomes surprisingly flat and low, and draws us downwards. This is exactly the opposite of the yang, rising tones of Wood in particular, and to some extent also of Fire.

When trying to work out whether somebody is Metal, it is worth watching how the person is making you feel. Are you finding that you are somehow careful in what you say, as though choosing your words carefully in case you may be criticized? Metal judges; that is its role, to weigh the good and the bad, and discard the bad. It therefore cannot help itself from judging us, and we can feel this as implied criticism, although it may not be intended as such. It is, of course, above all critical of itself, but will not take lightly anybody criticizing it. You can laugh with Metal, it can laugh at itself (it can have a very acute, sharp sense of humour), but you can never laugh at it without finding that it withdraws completely from you (and in the case of a patient may be the reason why they decide to stop treatment).

The concept of the “elements within” that of the guardian element

At a seminar I have just given, one of the students asked me about how much attention she should pay to what we call, in five element shorthand, “the element within”. This describes the particular colouring or modification given our guardian element by another element or elements. One way of understanding what I think is a very complex concept is to see our guardian element, modified by other elements, “the elements within”, as being in elemental terms the equivalent of a person’s genetic make-up. We each have a unique elemental imprint which consists of our principal element coloured by the unique shadings this element is given by other elements.

A Wood person, for example, will, as we know, have green as their dominant colour, shouting as their dominant voice, anger as their dominant emotion and rancid as their dominant smell. But the quality of all these sensory signs which gives this Wood person the unique qualities which distinguish him or her from every other Wood person is given the element by shadings from other elements. Thus one person’s Wood characteristics may be modified by Earth, so that their colouring is a yellowish green, the voice a sing-song shouting, their emotion anger laced with sympathy and their smell a sweetish form of rancid. Similarly, another Wood person’s Wood characteristics may have a tinge of Fire in them, so that their colouring is a pinkish green, etc.

I have always pictured this as a kind of “wheels within wheels within wheels”, since the Earth within the Wood, in the first example, will itself be modified by another element, say Metal, so that the colouring becomes a more whiteish, yellowish green, and so on. This is why no one person has exactly the same tone of voice as anybody else, thus making it possible for a unique voice-print to be picked up by a mechanism activating the opening of a door.

What is important in the student’s question is, however, how far all this is significant from a clinical point of view. And since I am, above all, a practical acupuncturist, concerned predominantly with what can help me in the practice room, I feel that spending time worrying about the elements within the guardian element may well be time better spent trying to home in on the dominant element itself, since most of us, myself definitely included, find it hard enough to find what I, rather flippantly, call “the element without”.

Interesting as it is to speculate as to which imprints other elements place upon the guardian element, the important thing is to find this element, a difficult enough task! From a clinical point of view, it has little bearing on the kind of treatment we select, for it is only in very rare cases that we modify treatment in any way to take account of the element within. It may, though, have a bearing on our perception of our patient’s needs. In other words, the Wood patient in our first example may be in need of slightly more sympathy, whereas the patient in our second example may be more receptive to a bit of laughter in the practice room.

How nice to be able to write about something which is not acupuncture!

I get a delight in reading a good book or seeing a good play which is hard to describe. It’s something about being transported outside myself into another, imagined, world whose existence I totally believe in, even though it may be as alien to me as 19th century London, as in my favourite author, Charles Dickens, or Elizabethan England, as in my favourite playwright, Shakespeare. For the time of my reading or my listening I am not me, a 21st century Londoner, but a person living the life of the characters I am reading about or watching.

What greater joy, then, for me to come across a delightful book by the writer, Susan Hill, called Howards End is on the Landing – a year of reading from home. In it, she describes how she decided not to buy any new books for a year, but instead to explore the contents of her library and only read books she found there. Each chapter then covers a particular topic, such as which books she now knows she will never read, such as Cervantes’ Don Quixote or James Joyce’s Ulysses, and which have inspired her in different ways. The whole book is a charming and well-informed exploration of what makes reading so pleasurable for her, a writer.

Two other books, much weightier these, are now sitting on my coffee table, one waiting to be explored, the other into its second reading. I have just bought Neil Macgregor’s A History of the world in 100 objects, the book of the marvellous radio series of that name by the Director of the British Museum. I have vowed to read one entry a day for 100 days, and am now on to entry 3 after 3 days.

Finally, to the most extraordinary book of poetry I have ever seen, or perhaps not really a book even, more a moving homage in words and photos and collages to a brother who died young and far away from her. It is called, simply, Vox (voice in Latin) and is by a Canadian poet I had never heard of,  called Anne Carson.  She says of it that "When my brother died I made an epitaph for him in the form of a book.  This is a replica of it, as close as we could get."  It consists of one continuous page of paper, folded 100 times or more and all lying beautifully encased in a box about 8 x 2 ½ ins (24 x 6 cms for you younger people) in size. That somebody should have had the courage to do something so original and then manage to find a publisher daring enough to publish the book (New Directions in New York) is reassuring confirmation that artistic originality can still be promoted even in these days of Big Brother and the X Factor.

Famous people I think are Earth

I think the following people are of the Earth element:

Bill Clinton
Oprah Winfrey
Dawn French
David Cameron
Nigella Lawson
Kate Winslet
Joanna Lumley
Marilyn Monroe

Tips to look out for:

In my view, the part of the face which reveals Earth most clearly is the mouth.

It is always important to remember where the superficial pathway, the meridian we use for treatment, runs. In the case of the Stomach, it runs down from the eyes to both sides of the mouth, where the important point, St 4, Earth Granary, lies. It then goes over the clavicle into the stomach itself. St 4 is a lovely point literally to help Earth draw upon the harvest stored in its granary and take enough energy to swallow both its thoughts and its food better. I have needled this point on an Earth patient who was repeatedly talking about the same things only for him to fall silent as soon as the point started to do its work.

The deep pathways of both Stomach and Spleen connect to the mouth, too, with the Stomach sending a deep shoot off to (or more accurately, coming from), GV (DuMai) and the Spleen having its own deep connection passing up from its end point at Sp 21 to feed the tongue. So we can see from this why the mouth will play a significant role in defining Earth, quite apart from the fact that it is through the mouth that we feed ourselves, and Earth is all to do with feeding, both itself and others.

Since every part of us shouts out our element to those who have the eyes, ears, nose and spirit to perceive, the mouth, too, will have significance for all elements, but, from my observations, all in different ways. With Earth, it appears to express a need. In its most obvious form, I have described this need as being like a baby bird opening its mouth demanding food. People, too, can seem to be demanding food of us, and this can be what we call the appeal which is apparent in Earth, representing its need for us to give it something. When it is exaggerated, the mouth expresses this as a kind of sulky pout, one we can all recognise in Marilyn Monroe.  We can also see clear signs of this in all the pictures of Princess Diana from her famous TV interview. It is worth trying to replicate this in yourself, as if you yourself are crying out for somebody to feed you.

So if you find that somehow your eyes appear to be drawn to the mouth, this may be (only may be, I repeat) one way of perceiving Earth. A Wood mouth, too, can tell us something. Its lips tend to remain firmly, if not tightly, closed until they open to talk. It is to the eyes, rather than the mouths, of Fire, Metal and Water that we are more drawn, the eyes of Fire because they are trying to draw us into a relationship with them, the eyes of Metal because they look far beyond us into the unknown, even though they are apparently seeing us, and the eyes of Water which will dart around suddenly if they are startled.

Please remember, though, that these are not fixed rules, but only some guides which have helped me with my diagnoses in the past. You probably have quite different observations on which you base your diagnosis of an element.

The mystery of pulses

In a comment on my sister blog on five element treatments, I was asked by Sean to include pulse pictures with my treatments. I made a conscious decision not to do so for various reasons, some of which I am sure will raise eyebrows (but then a lot of what I write probably raises more eyebrows than I am aware of!). To do so, I must place pulse-taking in a five element context, and here there will inevitably be differences with the purpose and methods of pulse-taking for other systems of acupuncture.

We take pulses for the following main reasons:
At the start of treatment to assess the overall strength or weakness of a patient’s energy, and to gauge the relative balance of the elements and their officials one to another;
During and at the end of treatment: to assess change (but there are some major provisos here which I will discuss).

It is important to be aware from the start exactly what a pulse picture does not tell us.  It does not tell us what the patient’s guardian element (CF) is, sadly, some of us may think, for perhaps this would make our work easier. What it can do is indicate that treatment directed at one element has changed the balance of energy, but not whether this element is the guardian element.

We take a pulse reading at the start of treatment, at various points during treatment if we are looking for some change which will demand further treatment, such as an Entry/Exit block, and at the end of treatment. We have a blessedly simple form of pulse notation to do this, compared with the 27 notional pulses of other systems. We assess whether the energy of one element and its officials is in a state of (relative) balance, which we note as a check pulse (a tick), whether it is depleted (a minus pulses) or whether it is in excess (a plus pulse). We assess 12 pulses, two for each of the five elements, plus two further for the two Fire functions of Heart Protector (Pericardium) and Three Heater. In each case we feel the pulses at two depths, with all the 6 yang pulses at the superficial level and all the 6 yin at the deeper level.

It is rare for there to be sufficient discrepancy between the yin and yang pulses of any particular element for us to need to correct this (by taking from the relatively stronger and giving to the relatively weaker using the junction (luo) point), but it does happen. So, for all general purposes, we treat the two officials of an element as one, and usually, but not always, treat both yin and yang aspects of an element at any treatment.

This sets the scene for our pulse-taking. How then do we assess change? The major proviso here is that energy does not necessarily shift quickly after needling. It can change so markedly that our pulse reading picks it up, but it may not if change is slower and less dramatic. It can take hours, if not days, for the elements to show any improvement, and this lapse in time will be reflected in the pulses. To rely on perceiving a pulse change as evidence of good treatment is therefore not necessarily an accurate way of doing things, and to interpret no change in pulses as a sign of inadequate treatment is just as meaningless.

And this is where we need to learn to move away from a reliance on what we think the pulses are telling us to increased reliance on our observation of possible change in the patient. Does the patient look happier, quieter, pinker, less white, talk less, talk more? All these are, I believe, more reliable indicators of positive changes than any changes picked up on the pulses. And since energy continues to change long after the patient has left us, and is always completely different when they come back the next time, there seems little point in spending too much time on writing down a final pulse picture, which only gives what will be a temporary snapshot of energy in process of continuous change.

So my advice to all those struggling to feel, let alone interpret, pulses has always been to avoid over-reliance on something which is so ephemeral and delicate. Instead, use as many other powers of observation to interpret what is going on with a patient’s energy. For example, does my patient look as if they are absolutely desperate (Husband/Wife imbalance, perhaps), even if I can’t feel the left pulses as weaker than the right? Do they rub their eyes or ears, even if I can’t feel sufficient discrepancy between the pulses of SI and GB to tell me absolutely that there is an Entry/Exit block there? These are the kinds of aids I use to round out my pulse reading.

We should always remember that our fingers may be clumsy instruments for interpreting the incredibly subtle manifestations of body and soul which pulses represent

So, Sean, I hope this explains why I don’t include pulse pictures.

To tennis lovers everywhere: enjoy your tennis and learn about the elements as you do

I have had some fun watching a tennis tournament from Shanghai, and persuading myself that this is part of my CPD (continuous professional development – the buzz word at the moment). But watching sport is really one of the most productive and enjoyable ways of learning to distinguish the elements. People competing with one another show their elements in great relief, and since the cameras are always trained at close-ups of their expressions, we can see every twitch of their muscles and every expression of stress.

So what I learnt from watching tennis this week was what I diagnosed, from a distance, as being the elements of the following players:

Roger Federer and Andy Murray: Water
Rafa Nadal: Wood
Novak Djokovic: Fire (possibly Inner Fire, because his Fire is not the easier, more relaxed kind shown by Outer Fire. He seems too prickly for that.)

I think seeing the players from the point of view of the elements helps explain why Roger Federer always finds Nadal and Djokovic easier to deal with than he does Andy Murray, who seems to get under his skin (Water trying to outmanoeuvre Water). From Federer’s point of view, Water can flow over and round Wood (Nadal), and can extinguish Fire (Djokovic), but how is it to deal with its own kind, in Murray, where the slipperiness and flow which is one of Water’s characteristics meet a similar kind of ability to slip past him and win the point? This is possibly why Andy Murray has notched up more wins against him than anybody else, and won again over the weekend. From Nadal’s point of view, he can beat Federer if he is strong enough to push Water aside, but what an effort this requires, where the potential aggression of Wood meets the ultimate source of will-power in Water!

Body movements and shape also reveal a great deal. Nadal has an almost absurdly powerful body, and moves aggressively across the court using forceful blows with the racquet to power away at his opponents, whilst Federer’s body, and to a lesser extent Murray’s, flows more gracefully and the racquet movements are more fluid.  Nadal looks as if he would like to win a point quickly and brutally, Federer and Murray as though they are happy to let the point continue for some time before unleashing a killer blow.

So next time there is a tennis tournament on TV, use it to give yourself a good lesson in the elements as you watch.

Famous people I think are Fire

I think the following people are of the Fire element:

All these I think are Outer Fire:
The Dalai Lama
George Clooney
Tom Cruise
Julia Roberts
Archbishop Desmond Tutu
Boris Johnson (the Mayor of London)
Mario Sepulveda (the Chilean miner who came out from the mine full of joy and laughter)

I think these two are Inner Fire:
Tony Blair 
Nick Clegg (? I'm not yet sure about him)

I have always found the distinction between Inner Fire (SI and Ht) and Outer Fire (TH and HP) difficult, probably because I am too close to Inner Fire since that is the aspect of Fire to which I belong. This distinction is not easy to make, but other people may find it easier than I do! One way I have found to help myself is to see Inner Fire as sorting as it thinks and talks, which gives its speech a kind of hesitancy to it as it searches for the right words. Outer Fire will give itself more time to think, and, when it speaks, will speak in a more articulate way.

Tips to look out for:
Very easy, relaxed eye contact, which tries to set up a warm relationship with us immediately, and hopes that we will respond with a smile;
A movement forwards towards the speaker as they speak;
Laughing or smiling where laughter or smiles do not appear to be appropriate reactions.
A smile which lingers on the face long after the need for the smile has ended. This is most clearly shown in laugh lines on the side of the eyes which remain there even when the laughter has stopped. It should be remembered that Fire enjoys the warmth a smile gives not only to those it is smiling at but also to itself. It enjoys the act of smiling. Other elements smile for different reasons, but not to give themselves joy.

It is also worth remembering that each element projects out on to others the emotion it is itself most at ease with. Fire may therefore find happiness in creating happy feelings in others which it cannot itself feel.

All elements can show joy, smile and laugh, but we have to learn to distinguish a Wood expression of joy, an Earth expression of joy, a Metal expression of joy and a Water expression of joy from Fire’s expression of joy. Learning to understand the distinctions between an element’s expression of its emotion and the expression of that emotion by the other elements is one of the secrets to an accurate five element diagnosis.

How should we interpret patients’ reactions to treatment?

In her comment on my New Thoughts on Aggressive Energy blog (28 May 2010), Janet mentioned a negative reaction to an AE drain, and asked the interesting question as to whether acupuncture could cause “a sudden downturn in a patient’s underlying condition”. As usual, other people’s thoughts set me thinking, and here are some new thoughts of mine.

Any kind of treatment, from conventional medicine to psychotherapy to acupuncture, tries to change something, and, if effective, will change something for the better. But the processes of change in themselves can be disturbing, and often are, as body and soul have to adapt to a new condition, to a state of greater balance, which they are unused to, or have actually never experienced before. A return to balance is not achieved in some seamless transition from imbalance to balance, but usually through fits and starts, some of them challenging. We and our bodies are creatures of habit, and have grown used to the familiarity of imbalance over the years (and the onset of an imbalance can often be measured in years, not days or months). We may therefore find the changes necessary for balance to be restored as surprisingly difficult to deal with. Ultimately, however, they should be rewarding if we stick with it.

I cannot comment on any particular treatment, but in general terms I have found that what somebody may describe as a negative reaction to treatment may in the long run turn out to be a difficult first step on the path towards health. As practitioners, we have to have the patience to accept that all lasting change takes time. As patients, we have to have the patience to give our practitioner the time to help us. Most patients we see have been in and out of doctor’s surgeries for years before they come to us. Why, then, do we think we must be able to help them in a matter of weeks, as some of us in our over-eagerness do? I have found that patients are not in a hurry if we are not. A slow, steady, tortoise-like approach is what we should be aiming at, rather than one which hustles us into thinking that it only requires a few needles to overturn years of imbalance. This represents a hare-like approach, and we know who ultimately won the race!

Does it matter if a five element practitioner is not sure of their own element?

We can only be absolutely sure of our element if treatment focused upon it leads to the kind of profound transformation this element will show when its needs are addressed. But practical difficulties have to be faced here. Many people do not have access to a five element acupuncturist for geographical reasons. What are they to do? You can’t ask somebody in many of the 40-odd countries that I gather are now reading this blog to make their way to a five element acupuncturist if there is no-one within reach of where they live who practises this kind of acupuncture.

Depending on how determined a person is to learn, they may decide to travel to gain these insights. Others will have to make do with trying to work out for themselves what their own element is, and what the elements of their patients are. It is worth remembering here that even the great master of five element acupuncture, JR Worsley, started with a blank sheet as to his own and others’ elements, and only gradually worked his way towards his deep understanding of the presence of the elements in all of us. I would therefore hope that those who have to carry out their five element studies on their own have the courage to explore the world of the elements by themselves, trying to glean as much information from wherever they can. This is one of the reasons which has spurred me on to write this blog. Even though I cannot come to each of these 40 countries to offer in person my insights into the elements, I can at least try to work out ways of helping with some distance learning, as I am doing now.

So to all those many out there who are showing, to me, a surprising amount of interest in reading my blog, I would say, “Go to it and explore the world of the elements in any way you can. And if you dare to, and are qualified to do this, lift up a needle and work out your own way of practising. Even something as simple as the Aggressive Energy drain can transform a person’s life!”

Also, even if you think you don’t really what your own element is, at least you have the right to make an inspired guess. And, if you are a qualified acupuncturist, you can still help others. As long as you follow safe needling procedures, you can’t hurt anybody. The worst you can do is to leave the patient exactly as they were before you treated them. And remember, also, that treatment directed at any of the elements, even the ones which are not the guardian element, helps all the elements, for, as the Three Musketeers said (or in this case we can say the Five), “one for all and all for one”.

Famous people I think are Wood

These are some of the famous people I think are of the Wood element:
Margaret Thatcher
George Bush
Boris Becker
Wayne Rooney
Queen Elizabeth
Princess Anne
John Prescott
Peter Snow
Ann Widdecombe (now on Strictly Come Dancing)

As a reminder:
Colour of Wood is green
Sound of Wood’s voice is shouting
Smell of Wood is rancid
Emotion of Wood is anger (which I also call forcefulness)

Tips to look out for:
Tight tendons, visible on video-clips particularly around the lips and neck;
Tightly gripped lips, leading to mouth turning downwards. I suggest you try this out yourselves, and you will find that your whole face becomes rigid. It’s very tiring to hold this pose for more than a few seconds, unless, of course, it is natural to you because you are yourself Wood;
Forceful speech (telling others rather than just talking) with each word enunciated clearly. The voice does not have to be loud, as implied by the word shouting, but have a push behind it, even if the person is talking quietly;
A feeling of movement, or of suppressed movement, of energy either being released or waiting to be released.

There can, of course, also be what we call a lack of anger, as evidence of an absence or suppression of some of Wood's positive, outgoing qualities. In that case, the speech may best be described as a kind of whisper, which may have the effect of making the listener angry because they cannot hear it properly. It is worth remembering that each element projects out on to others the emotion it is itself most at ease with. Wood may therefore be happy to create a level of anger or irritation in others which it has been forced to suppress in itself.

How to learn to recognise the elements in the simplest way possible

I am exploring new ways of helping those who have an interest in learning about the elements. This includes not only those who want to learn how to practise five element acupuncture but those who are just interested in learning more about human nature. My own deepest learning about the elements started soon after I qualified, when I was asked to teach some evening classes, and found myself talking to a whole range of people, from plumbers to retired people to young, unemployed mothers. Looking back, I realise that in explaining what the elements represented for me, and trying to find examples of them in famous people the whole class were familiar with, I learnt to see the elements, not simply as a component of acupuncture treatment, but as one way of approaching the complexities of human behaviour. I have always felt that anybody interested in understanding more about human nature in all its amazing variety can benefit from learning about the elements, whether they then wish to extend this knowledge into the field of acupuncture or not.

So how can I best help people wanting to learn about the elements? One way is obviously to let people observe me or other five element practitioners in our practice room, so that we can point out exactly why we think that person is Wood and the other is Metal. But that possibility is only available to acupuncturists or acupuncture students, and then only to very few amongst these, as they have to live near a five element practitioner, or be happy for us to come to their practices wherever these may be. I do this on a regular basis.  For the person wishing to step for the first time inside the circle of the elements, and needing initially to study on their own for whatever reason, the simplest and, for me, still one of the most rewarding, ways of doing this is to sit yourself down in front of your computer screen and use U-tube or similar little five-minute snippets of interviews with people in the news, as a readily available, cheap and highly effective source of study.

This can be considered the first step in what I think can be called a form of distance-learning course on the elements, something which is so badly needed now. There are not enough courses anywhere in the world which concentrate the core of students’ studies on the elements. There are unfortunately many courses which offer a kind of add-on five element component which I believe does more harm than good in consigning five element acupuncture to a subsidiary or even inferior role. In doing this, they do it a great disservice, allowing students to think they have a training in the elements which they do not have.

To counteract this, and to help those who really want to study the elements in the way they deserve to be studied, I am preparing lists of famous people who in my view represent examples of each of the five elements. Obviously, since I have never personally met or treated any of these people, I cannot say for sure that I am always correct in these diagnoses-at-a-distance, but then nobody can absolutely guarantee that they have got it right, until changes brought about by treatment confirm the diagnosis.

Inevitably, I will be starting with Wood, which from many points of view can be considered the starting-point of the elements, the bud of life (although Water, the seedbed of life, is perhaps the real starting-point). This Wood list will be in my next blog.