Friday, July 29, 2011

Find the element, and the points will look after themselves

I am not somebody who enjoys experimenting in my acupuncture. I regard myself as a steady plodder, and like to think I work my way along paths well-trodden before me. One of the ways in which this somewhat cautious approach reveals itself is in my choice of points. I have often said that I have a very small repertoire of points, concentrating mainly on those few points which have a close and safe relationship with the element I am treating. I focus mainly on the command points,then on other points on the elements which I have gathered together over the years, on points which release energy blocks of all kind, and finally, and only then, on that difficult but important category of points which we select, as we say, “for their spirit”. It is this group which causes every acupuncturist the most trouble, since it is like opening a can of worms, as we ask ourselves which point exactly we need to use today for its spirit for this particular patient, and often can’t come up with the answer.

What I don’t usually do, though, is experiment. I have not had the habit, as other acupuncturists apparently have, of looking up the list of acupuncture points and branching out in a new direction by choosing a point I have never used, usually basing this choice on a point’s name. I have thought about this quite a lot recently, because I am at the stage in my practice where I am enjoying injecting something new into it, and what can be newer than using a point I have never used before? So, venturing on to new terrain, I have done this for one or two patients and then stood back to assess whether I have learnt anything from this experiment, and whether, more crucially, my patients, thus experimented upon, have responded in ways that differ from their responses to the more familiar kinds of treatment I have offered them before.

What I find, not unexpectedly, is that I really could not say what effect any of these new points have had, except that, as usual, my patients have continued to improve as they did before with my familiar array of points. I asked myself whether there was any sign that something new had occurred, and came up with the answer, “no”. So on a very small sample of just a few treatments, certainly, a mathematician would say, not a statistically significant number of any kind, I learnt nothing which shook my long-held belief that the fundamental nature of any five element treatment consists in addressing the element, rather than worrying about the points we use to address this element. I will always stick to my mantra, “Think element, not points”, to help me in my practice. The selection of points then always becomes secondary to the importance of selecting the right element.

So take heart all those many acupuncturists who seem to worry too much about point selection, and particularly about what exactly “selecting points for their spirit” means. All points, particularly those all-important command points, have a “spirit”.

Once you find the element, the points will look after themselves.

Sunday, July 24, 2011

Preparing to meet a new patient

I have written before about the courage it takes to be a practitioner as we prepare to confront the unknown in each new patient we meet (see my blog of 25 April 2011 on The unknowability of another human being). I am preparing myself to do just that this week when I meet a new patient for the first time.

It will be up to me to ensure that I conduct this meeting in such a way that it ends with my patient feeling that I have already helped her in some way. It should also leave me feeling, not that I must “know the patient’s element”, as though that is the be-all and end-all of this initial interaction, but that I know enough about her to make her feel happy to come back a second time.

Of course this knowledge, and all the other little bits of knowledge I will gain each time I meet her, will eventually together point me towards one element, I hope, but even if I feel confident about which element early on, that alone will never be sufficient. Just deciding on an element, however correctly we may make our diagnosis, only does so much, unless we add to it that deeper level of understanding, that “soul to soul” bit, which will give to our treatment its special flavour. And we must never forget that we can start off on what we eventually find is not the right element and yet help our patients at a deep level through our empathy with them.

Above all, I must be curious. Perhaps I am fortunate that I have always been fascinated by glimpses of other people’s lives. If I am amongst a group of people, what I most enjoy is sitting back, unobserved, and watching how they interact with one another. These interactions are endlessly fascinating, and, for a five element acupuncturist, endlessly instructive. I must bring this curiosity with me as the most important gift I will be bringing to my new patient. I need to gather all those snippets she will tell me about her loves, her longings and her disappointments, and use them to start building up a picture of her life and how she lives it now and will hope to be living it better in the future if the treatment for which she has approached me is to help her. And then I will need to look deeply into myself and examine how what she has told me, and the way in which she told me this, points me in the direction of one element.

I have learnt over the years not to be too hard on myself, and not to allow any dissatisfaction I may feel about the way I conduct this first encounter to affect me too deeply. I can only do the best I can at the time, and if I feel that I have somehow failed my patient in some way by not quite adjusting my approach sensitively enough, then there is always the next time in which to correct this. We must never ask too much of ourselves in this very delicate business of our engagement with our patients. As long as they feel we care about them, they will always come back a next time and give us another chance to get things a little more right.

Wednesday, July 13, 2011

There are 25 ways of expressing the 5 emotions

It is worth remembering that, since each of us is composed of a unique combination of all the five elements, and each element expresses every one of the five emotions, there are in effect 25 possible expressions of the different emotions. The five principal categories which tradition associates with a particular element, such as joy for Fire and fear for Water, are therefore modified when it is not a Fire person expressing joy or a Water person expressing fear. When a Metal person expresses joy or fear, those expressions of joy or fear will be shaded by grief, Metal’s dominant emotion, and therefore will express themselves in a different way from a Wood person expressing joy or fear, or a Fire or Water person expressing joy or fear.

It is therefore not simply a matter of observing joy or fear expressed to their fullest in Fire or Water people, but of having experience of observing these emotions in people who are not Fire or Water. We have to begin to differentiate the type of joy or fear being shown, however much this may be buried beneath the dominant emotion of another element. Fire or Water will show these two emotions in their purest form, since they pour out straight from the organs controlled by these two elements, whereas joy shown by an Earth person or fear shown by a Metal person will be modified by the patina of sympathy or thoughtfulness Earth throws over all it does and the patina of grief which Metal shows in all it does. In other words they will show an Earth or Metal-type joy or fear, which will be quite different from joy or fear expressed in pure form by Fire or Water.

In trying to gain a foothold in the tricky world of interpreting the emotional signatures of an element, we therefore have to look carefully at all the different possible nuances of emotional expression. We have to bring to this all the knowledge of the elements we have accumulated so far to help point us in one of the five directions. We can do this in retrospect, as it were, by looking carefully at a person whose element we are sure of, and observing how they express the emotions of the other four elements, not just their own. How, for example, does a Metal person express their anger or their sympathy, or a Wood person their grief or their fear? Such an exercise is a very useful way of expanding our library of pointers to the different elements.

Unfortunately words are inadequate tools to describe such subtle distinctions, so regretfully this blog is the only answer I can give to the request of another acupuncturist who asked if I “could perhaps say something about the different responses you have to the control of Wood and the control of Fire. I have a patient who is like a blazing log stack, a wonderful human in there but very controlling, and I can't come down on a CF”. Sorry I can’t help you more than this, Kate, except to encourage you to focus your emotional antennae a little more each time you see this patient. Something about the nature of what you see as his/her controlling character will eventually point you to one or other element (which may after all prove to be neither Wood nor Fire, just to confuse you further!). But give it time! We’re usually, if not always, in more of a hurry than our patients.

Sunday, July 10, 2011

The significance of a “Husband-Wife” imbalance and its diagnosis

I have written this blog in answer to a query from somebody commenting on my blog of 23 June in my sister blog, but I think it is important enough to include here in this blog. I was asked how I had diagnosed a Husband-Wife imbalance just by looking at the patient. What did I observe that made me diagnose H/W? I give my answer below. It is a very detailed answer because the question fired me to think carefully what a H/W imbalance means, and touches upon what is a very complex and profound area, that of pulse diagnosis.

We are told to diagnose a H/W through the pulses, with the pulses of the left side, the “husband’s” side being qualitatively stronger than those of the right, “the wife’s”. Diagnosis from pulses alone presupposes that our pulse-taking is sensitive enough to feel what may be an extremely subtle difference. I have often said, and will go on repeating, that it is foolish to rely entirely on our pulse-taking in making a diagnosis, since it is a very great skill accurately to interpret what the pulses are telling us, acquired only after years of practice. To understand this, but certainly not to be too daunted by this, it is essential that we remember at all times what we are attempting to assess at those 6 positions at each wrist that we gently palpate to give us a pulse-reading of the 12 officials forming the five elements.

We should think of the 12 pulses as access points to the elements. They can be palpated most clearly where the blood flow is at its strongest and nearest the surface. Since time immemorial in traditional Chinese medicine, and in modern times in Western medicine, too, the most easily accessible point has been accepted as being over the radial artery at the wrist. It is important to visualize the pattern the 12 pulses form on any pulse chart, and here we should divide them into 6, since at each position there are two, one at the superficial level and one at the deep level. (I know that different diagrams of the pulses have been drawn up over the centuries showing an intermediate position, which would in effect make 18 possible pulses, and also different pulse positions, particularly in relation to one of the pulses on the right side (the five element Outer Fire pulses), but I am writing here only about the order of the pulses which five element acupuncturists use.)

In effect, the understanding that the five elements will reveal the state of their health in body and soul at a tiny site like this, less than a couple of inches (oh how I still love my old form of measurement!) (a few cms) in length, is awe-inspiring and still blows my mind. It means, in effect, that the work of all the elements acting together is creating the blood flow at every point in the body, not just at the wrist, but that it can be detected most easily where the arterial blood is closest to the surface. (Pulses can also be palpated at the ankle or over the carotid artery in the neck where there are equally strong pulsations, but the wrist is used for reasons of easy access.) It is important always to remember the order of the pulses, and here not just the order on each hand but the order of both hands taken together. If we hold the hands together facing upwards (do this now if you are reading this), imagine that you are drawing a line which starts at the pulses nearest the wrist on the left hand, moves down to the two other pulse positions on the left wrist and then passes over to the pulses on the right hand, continuing down to the third position on the right before looping back over again to the first pulses of the left hand again, forming a continuous figure of eight. In effect, we are tracing the order of the elements backwards, from Inner Fire (Heart/Small Intestine), back to Wood and Water, back across to the right wrist to Metal, Earth and Outer Fire (Heart Protector/Three Heater), before looping back to the inner side of Fire again and so on.

We are taught to palpate the pulses in this way, first left-hand pulses starting with the first position over the Heart/Small Intestine aspect of Fire and then right-hand pulses starting with the Metal pulses. This is a simple way of reading the pulses, and emphasizes the importance of the Heart pulse as being the first pulse we palpate, but in doing this we tend to forget the actual order of the elements, even if we were ever aware that the pulses represent this, which many of us are not. It is only in helping us make a Husband-Wife diagnosis (and that of an Entry-Exit block) that it is so imperative to think of this order to understand what our pulses are telling us.

We know that the flow of energy moves along the Sheng cycle from Fire to Earth to Metal etc. We know also that we correct a H/W by needling the following points: Bl 67, Ki 7, Liv 4, Ki 3, SI 4, Ht 7. This order of points does the following: First it reconnects the mother element, Metal (a right-hand pulse) with its child, Water (a lef-hand pulse), then, by needling Liv 4, it draws energy from the Metal element (right-hand pulse) across the Ke cycle to the Wood element (mother element to grandchild element) (left-hand pulse), then by needling Ki 3 it does the same from Earth across the Ke cycle to Water, and finally it reinforces the Heart by needling the source points of Inner Fire, finishing with Ht 7. 

In effect, by diagnosing an excess of energy in the right-hand pulses and a frightening depletion of energy in the left-hand pulses, the classic diagnosis of H/W, the pulses are telling us that there is a potential breakdown between the elements, and in particular between the point at which energy from Metal passes over to its child, Water. It isn’t a complete breakdown, because that means death, but it is sufficiently serious for us to regard a H/W imbalance as a dangerous condition because it is depleting the energy flowing to the Heart. It is therefore interesting to see how often the pulses leap back into balance immediately Metal is reconnected more stronly to Water, i.e, after needling Bl 67, Ki 7. It is therefore a good idea to read the pulses after you have needled these two points to see if you can detect the immediate sign of relief as the energy flow starts to re-establish itself, and the Heart can begin to relax.

With all this in mind (and I am sure anybody not a five element acupuncturist reading this will have given up well before now!), I will go back to the question which has prompted this exposition of what a H/W imbalance actually represents. If it reveals a serious weakening of the flow of energy from mother to child element around the complete cycle of the five elements, which it does, then this serious weakening must somehow show itself not only on the pulses but in the way a patient presents themselves, which it does. Patients will look despairing, as if they have given up hope (the Heart almost giving in). As well as showing this despair, they will surprisingly often say things which help our diagnosis, such as, “I don’t think I can go on” or “I feel like giving up”. They may look as if they are too weak to talk, just wanting to lie there passive with their eyes closed.

H/W can appear suddenly, as though the Heart all at once can take no more, unlike imbalances such as Aggressive Energy which appear slowly over time, so the change in a patient from one treatment to the next can be very obvious. In the case of the patient I was writing about, he came into the room looking so very different from how he had left me the week before, that the change was dramatic enough for me to suspect H/W even before I took his pulses.

Finally, I repeat my mantra, “never rely on pulses alone to tell you what is going on”. Use all your senses and all your feelings and any other diagnostic information to help you diagnostically, such as a patient rubbing their eyes in the case of a SI-Bl block or the onset of hay-fever in the case of a Co-St block, since our pulse-taking (mine included) may not be sensitive enough to do the diagnosis on its own.

Thursday, July 7, 2011

Does plagiarism matter?

I have noticed that writers get extremely hot under the collar when they suspect somebody of plagiarizing their work in some way. And I always wonder why. It seems to me that all the words of all the writers we have read echo within us for a long time without our realising it, and of course this is particularly true of the oft-repeated sayings of famous writers. I don’t think any of us would now write “to be” without hearing the echo of “or not to be” in our heads. And I was pleased to read the following yesterday in a book I bought at Stratford-upon-Avon after I had watched that marvellous actor, Patrick Stewart, re-create Shylock for me in The Merchant of Venice in a totally absorbing new way.

“Scholars have long and fruitfully studied the transforming work of that (Shakeseare’s) imagination on the books that, from evidence with the plays themselves, Shakespeare must certainly have read. As a writer he rarely started from a blank slate; he characteristically took materials that had already been in circulation and infused them with his supreme creative energies. On occasion, the reworking is so precise and detailed that he must have had the book from which he was deftly borrowing directly on his writing table as his quill pen raced across the paper.” (Stephen Greenblatt, Will in the World, Pimlico 2005, p 13)

I think Shakespeare would be flattered if he had realised how deeply his words have scored us. Inevitably, then, the chances of our inadvertently including some figure of speech into our writing, some juxtaposition of colouring or shape into a painting or some musical expression into a composition, all garnered from other writers, painters or composers, are extremely high, so high indeed that I was told that Andrew Lloyd Webber is so frightened of copying somebody else’s work that he refuses to listen to other people’s music for a time as he composes. I don’t know how true this anecdote is, but it certainly illustrates the fear that we may be accused of somehow not being original.

This has never worried me, since I am always happy to acknowledge my own debt to all the many writers I have ever read. Only a few days ago I heard the cadences of William Faulkner’s idiosyncratic and beautiful prose in a sentence I wrote. I know that behind every sentence of mine lie banked up many thousands of others’ writings which have each in their differing ways created the foundation upon which I build up my own thoughts in words. I am also flattered, rather than dismayed, if I find, as I do, echoes of my own words in other people’s writings, particularly in my field of acupuncture. One such incident comes to mind. When I started my acupuncture school in the mid-90s, I coined the, to me, happy and thought-provoking phrase, “An ancient form of healing for a modern world” to describe what we did, then took it as a compliment, rather than as something worrying, when another acupuncture college a few years later used nearly the same words in their promotional material.

I think thought should be free wherever this is reasonable, not circumscribed by lawsuits and trademarks. I suppose this depends on the level and amount of copying and the purposes to which it is being put. A student cutting and pasting large chunks of other people’s writings without adding anything of their own and without acknowledgement is obviously one thing. A writer echoing a few words or cadences of speech in an entirely new creation is quite another.

Somebody recently asked me whether I had protected the translation of my Handbook in its Chinese edition with enough copyright safeguards. I have done what I have been told is sensible to do, but if by some chance some publisher somewhere, perhaps in one of the far-flung countries, such as Indonesia or Venezuela, which read my blog, decides to bring out an uncopyrighted edition of any of my books, I think that I might say, “Good luck to them”, rather than pursuing them, usually fruitlessly, with the law. At least in this way more people will read the books, and what I may lose in money (and there is little enough, if any, money to be made in publishing these days), I will gain in readers, surely the aim of all writing.

Mandarin – here I come!

The translation of my Handbook of Five Element Acupuncture into Chinese (see my blog, Meetings with remarkable people, of 16 June) is a moment of completion for me, as if my journey into five element acupuncture, started more than 25 years back, has now come full circle, very satisfyingly. All the fears I had for five element acupuncture as I closed my school some 4 years ago have, in a surprisingly different way from any that I could have imagined, proved groundless. Here now the door back to China, and with it to all those countless people who still look to China to guide them in their approach to traditional Chinese medicine, has re-opened itself to this beloved discipline of mine, and invited it back in. I feel that my work has indeed been accomplished.

But not quite yet fully! For I am invited to China once my book appears on Chinese bookshelves, and to prepare for this I feel, as a former linguist, proud of trying never to travel to a country without at least some slight knowledge of its language, that it would be discourteous of me not to learn at least the rudiments of Mandarin in order to be able to respond to what my Chinese hosts will be saying. I have always been surprised that I have delayed so long before immersing myself in the Chinese language which underpins all acupuncture in a very profound way, particularly as I am now translating Elisabeth Rochat de la Valléé’s Les 101 Notions-Clés de la Médecine Chinoise (101 Key Concepts). Perhaps it was simply a matter of never finding the time, for I tried to start several times, or because I was afraid (and still am) that my increasingly deficient hearing will not pick up the nuances of Chinese speech. But now I intend to make up for this strange omission if I can, and am about to enrol in an intensive Mandarin course. More of this anon!

Tuesday, July 5, 2011

Why are actresses called actors now?

In my last blog I wrote about a film actor and actress, and found myself irritated yet again by the, to me, utterly ridiculous convention which appeared some years back out of nowhere, and I hope may at some time in the future disappear as quickly again, that of calling actresses actors. Is this political correctness gone mad? We still distinguish a husband from a wife, a girl from a boy, a widow from a widower, a prince from a princess, so why not an actor from an actress? Of course some professions only have one word to describe both male and female practitioners, such as a barrister or a doctor, perhaps because women were only admitted later to these professions, whilst actresses belong to a long tradition. And nobody appears to have thought of calling a female barrister a barristress or a female doctor a doctress, although this is what other languages do. But why replace a perfectly good word which has been used for centuries? And in an obscure way, I find its removal to be demeaning rather than respectful to women, as though we all need to make an effort to remember gender equality.

Interestingly, the convention has not yet crept into everyday speech, where people still talk about the actress Judi Dench, but in the written press and on radio or television it has been banished to the archives, the latter obviously by BBC edict. And yet I was amused the other day to hear a journalist stumbling over himself, the word “actress” coming out unbidden, before being quickly corrected to “actor”.

Can anybody tell me when and why the change from actress to actor took place?

Postscript to this, added today, 7 July:  I have read the following in the Independent of 5 July:  "...two of Hollywood's best acresses, Helena Bonham Carter and Gillian Anderson,...."!

Sunday, July 3, 2011

The quality of tenderness

I have just seen a lovely French film, Potiche (Trophy Wife), with Catherine Deneuve and Gerard Depardieu. Watching Depardieu set me thinking again about that elusive quality called tenderness. This is a quality which this strange giant of a man (and he has now become almost gross in size) shares with another large actor, Robbie Coltrane. A friend of mine commented upon this after seeing the film. “What an attractive man Depardieu is”, she said with surprise in her voice. And I knew exactly what she meant. The tenderness shines out of his eyes, a quality of gentle loving-kindness which draws us to him. It is the eyes, those windows of our soul, which reveal the capacity of their owner’s soul to express love, and, in the case of these two actors, their eyes show it so unreservedly and warmly. It is worth going to see Potiche just for those few moments when Depardieu looks at Deneuve with love, and also for the beautiful scene in which the two of them, both middle-aged and slightly ungainly, dance gently together. This is more erotic than many much more explicit love scenes often lacking in any tenderness whatsoever.

It is a quality we need much of as acupuncturists.