Cutting diagnostic corners in China

When we were students, we were always being told that we must allow our patients plenty of time to get to know us as practitioners so that they feel safe to start talking honestly about the problems they face in life and the help that they are really asking for.  This is particularly so during our first interaction with them, which we call a Traditional Diagnosis (TD), to distinguish it from a purely Western medical diagnosis, something we were told never to hurry through. It is therefore ironic that, in China, time is the one thing we cannot ask for, since we are only there for a few days, and in those few days we are expected to achieve so much.  Indeed, it makes me sad sometimes to think how privileged our students at SOFEA were in the amount of individual time we dedicated to each of them – individual tutorials, individual supervision of their treatments – as much individual time as we felt each student needed.

If I compare this now to what we have to do in China, I am amazed that we have achieved so much based upon the little time we have to offer anything in the nature of individual tuition to the many, many students who crowd into our courses.  Nowhere am I more aware of this than in our efforts to offer each student a diagnosis of their own element as a foundation on which to build their future practice.  In England students carrying out a diagnosis are expected to spend up to two hours completing this, during which they cover a long list of questions about a patient’s physical and emotional issues, with the emphasis above all on establishing a good relationship with the patient.  But how do we condense this into what we want to offer our Chinese students, the 40-50 new ones coming to each seminar we give?

At first I thought that there was no way we could do this, but quickly realised how disappointed students were if we gave them no indication whatsoever of what their own element might be.  This started to have a negative effect on our teaching.  We would be helping them learn to diagnose the elements of the patients brought before the class, but then were doing nothing to give them any indication of their own.  And anybody who has been reading my blogs will know that I emphasize the importance of a practitioner understanding how their own element may be affecting the way they treat (see my blog of 17 October 2013 How important is it that a five element practitioner is sure of their own element?).  So we had to think of a different form of diagnosis to fit the very specific situation we were faced with. 

After a few hit-and-miss attempts at devising a way of carrying out diagnoses on as many students as possible in the extremely short time available, we now dedicate a very specific amount of time at each seminar to diagnosing, or at least attempting to diagnose, any new students coming to these seminars, as well as checking on those previously diagnosed to see whether we still agree with our original diagnosis. If we don’t, which of course happens, we are quite open about telling the group that we have changed our minds (or, more specifically, our senses have changed our minds!).  At the latest seminar a few weeks ago we diagnosed 45 practitioners in one morning, a feat which required much concentrated attention from Mei, Guy and me.

Although this is a cautionary tale of just how NOT to carry out a TD, I realise that increasingly we have become surprisingly efficient at seeing the elements in this highly pressurized situation.  We ask students to sit in groups of five in front of the class, each of them talking a little about anything they want to, and the three of us, Mei, Guy and I, observing them carefully.  After all five have spoken, we put our heads together and come up with what we call a provisional diagnosis, one that we tell them we may well change as the seminar progresses and we have more time to look at them.  It is interesting how the placing of one person next to the other often reveals very clearly their differences, showing up their elements by comparison with each other.  And we have become better and better at seeing these differences, and attributing them to one or other element.

To reinforce our diagnosis, each student is then given their first five element treatment by another participant (all of whom are qualified acupuncturists).  This consists of the Aggressive Energy drain (or, if we think this is necessary, the Dragons treatment followed by an AE drain), and finishes with the source points of the element we have diagnosed.  And then we continue to observe them carefully in class over the next few days to see whether we feel that our original diagnosis is confirmed, or not, and in particular whether it is corroborated by the effects of treatment.

This is NOT, I repeat NOT, how a five element diagnosis should be carried out, far from it.  But  “needs must….”, as they say.  I would, however, beg all five element practitioners not to skimp on the time they spend on carrying out a TD just because they are reading here what we have to do in China.  If only we had the amount of time to give our 45 new students which our patients in the UK are so lucky to be given!

"The truth is always kept in a far place"

Somebody, I don’t remember who now, gave me this lovely quotation which haunts me, though I’m not sure exactly what it means: “The truth is always kept in a far place”.  The words have a lovely ring to them, and awake in me an image of a far-distant land with at its centre a lovely picture of Truth, who I see as a graceful woman presiding over this far country.  Perhaps the reason the words affect me so much now has something to do with my latest visit to a far-distant land, that of China, for my seventh visit there a week or so ago, though why should I be thinking of truth residing there?

Probably this is because in some ways it is truth which I discover each time I return there, the truth of what I have dedicated the second half of my life to, this discipline of mine called five element acupuncture.  For each visit strengthens my conviction of the deep truths about the human condition underlying what I do.  Somehow in China these truths become ever more evident to me, because of the speed at which my Chinese students so quickly understand what I teach them and unquestioningly accept the fundamentals of five element practice as though they are absolutely self-evident to them.  It is rare for those I have taught in the UK and Europe to reach such an instinctive and profound understanding as rapidly as do the Chinese. To us Europeans they are at first in what seems to be a foreign language, which it takes us much time to understand, whilst to the Chinese they are familiar concepts underlying all their lives.

I have been privileged to be invited by Professor Liu Lihong into this (geographically) “far place” in a way which still surprises me for its rightness at this stage of my life.  Each visit to China strengthens my bonds to my students over there and reinforces my gratitude for being given such a gift.

To Professor Liu and the 80 students who sat enthralled in our classes as they gained insights into something which for them is often a new discipline of acupuncture, I send my thanks for the happy time we spent together.  And these thanks I also pass on to Long Mei and Guy Caplan who shared this seventh step on my journey to China so creatively with me.

I am sure I heard this quotation from somebody whilst I was in China last November.  Perhaps one of those reading this blog over there will tell me who it was.

The three levels of the human being: body, mind and spirit

I remember one very important day during my training under JR Worsley at Leamington 30 years ago.  We were learning about Aggressive Energy, and JR was explaining to us why it was so essential to insert the needles very shallowly into the Associated Effect Points on the back (back shu points) so that each needle barely penetrated the skin.  What I remember most clearly was the diagram he drew to illustrate this, simply a small block of three parallel lines one above the other, with a needle just nicking the top line but not penetrating below to the other two lines.  He said that this illustrated the three levels of body, mind and spirit.  The superficial level was represented by the line at the top into which the needle was inserted.  The bottom line was the level of the spirit, and the line between these two represented the mind, the intermediary between the body on the surface and the spirit in the depths.  For the purposes of the AE drain, the needle inserted at the physical level would draw any Aggressive Energy from the spirit up through the intermediary, the mental level, and then out from the body, the physical level, at the top.  This would appear as red markings around the needle as the Aggressive Energy drained away slowly to the outside air.  If the needle was inserted too deeply, any Aggressive Energy was pushed further inside, causing greater harm as it invaded the spirit.

This picture of the three levels of the human being has stayed with me since then, providing an excellent illustration of the emphasis in five element acupuncture on the importance of treating the deep (the spirit) and through this also treating the physical.  Many therapies, including different branches of acupuncture, concentrate treatment at the superficial level, the physical, and ignore its connections with what lies deep within us.  But the two levels, with the mental acting as intermediary between them, cannot be detached from one another in this way.  If we ignore the deep, it will call out more and more insistently for our attention, often doing this through the increased severity of physical symptoms.  We ignore at our peril what is deep within us, our souls, and do our patients a grave disservice if we concentrate too much of our treatment on the superficial.

This is what I want to talk about to the 80 or more acupuncturists who will be gathered together at our seminar in Nanning in 10 days’ time.  And as I have found during my six other visits there, this is one of the most important lessons that five element acupuncture can teach them.

To understand what lies deep within a patient’s spirit also demands compassion from us as practitioners.  Only with compassion can patients allow themselves to open up this deepest, and thus most vulnerable, part of themselves, their soul.

“The lost art of exchanging glances”

I am delighted to have found myself only yesterday in very exalted company, with none other than the historian Simon Schama as my companion.  In an article in the Guardian as part of the launch of a new exhibition at the National Portrait Gallery here in London, called The Face of Britain, he says:  “…society would be a better place if people, perhaps on their daily commute, actually looked at the faces of strangers”.  Anybody who has read my blogs of 24 February and 1 March will know how warmly I support what he says.

He is also very scathing about the craze for those instant self-portraits we know of as selfies (horrible word, I always think).  He says, “What we love about selfies and phones is that it’s of the moment, but the true object of art is endurance….”  “The meteorite shower of images that we contribute to and come to us every single day in every medium, especially social media, is the equivalent of white noise, and great portraits deliver the music.”

It is very comforting that I am not alone in thinking thoughts such as these.

"Step into the blank of your mind"

I love this quote which comes from a poem by somebody called Richard Wilbur:

     “As a queen sits down, knowing that a chair will be there

      As a general raises his hand and is given the field-glasses,
      Step off assuredly into the blank of your mind.
      Something will come to you.”

It represents very accurately what I often feel as I sit, pen in hand, waiting for some thought to come to me which I think is worth pursuing.  At the moment I am indeed faced with the “blank of my mind” in relationship to writing about acupuncture.  I have concluded that this may be because I am just about to set off for my seventh visit to China, and as usual my mind is preoccupied with planning what I will take with me, and, much more importantly than any clothes, what the overall aim of my time there will be.  I always like to think of a theme around which I weave what we will be teaching there.  Last time it was the importance of developing a good patient/ practitioner relationship.  This time I note that I have written something about "it requires patience to be a five element practitioner”.  This echoes one of my constantly repeated mantras:  “Don’t hurry.  Don’t worry”.

We live in a world which is obsessed with results, so that we feel pressurized “to get things right”.  In five element terms, this means “getting the element right”.  But we need to lose some of our fear of not getting things immediately right.  Today on the radio I heard a headmaster, Anthony Seldon, saying that everybody is now concentrating far too much of their attention on children’s exam results.  We should be looking at things differently.  “Don’t ask how intelligent a child is”, he said, “Ask instead how is this child intelligent?”  This is an important distinction, which also applies to acupuncture.  We should not be thinking of the disease or condition that a patient comes to us for help with, but of the patient who is suffering from this condition.  This distinguishes us as five element acupuncturists from Western medical practitioners.  It is not simply enough to say that a patient is of the Earth element, much as a patient, in Western terms, could be said to be suffering from arthritis.  Instead we should be thinking not about the arthritis but about the patient - not what is the patient suffering from, but who is the patient who is doing the suffering.

This crucial distinction emphasizes the uniqueness of each patient, rather than the common nature of the disease they are suffering from.  We are not trying to lump a group of patients together under the heading of arthritis, or in five element terms, under the heading of the Earth element, but instead are trying to see the patient as a unique example of the Earth element, requiring a unique approach to the treatment we will be offering, whilst still under the umbrella of the Earth element.

These thoughts have just come to me as I sit here pondering on my theme for the week in China.  For a few moments, then I “stepped off into the blank of my mind”, as the poet says, and something has indeed “come to me.”