It's never a good idea to try to persuade a patient to continue treatment

I never think it is right for me to answer questions from practitioners who ask me for help in trying to diagnose a patient’s element or what specific treatment to give.  I can only do this when I am actually there with the patient in the practice room.  On the other hand, there are general questions about five element practice which I find useful to answer, and which often stimulate me into writing a blog.  Into this category falls something which a practitioner, Caline Chew from Singapore, has just emailed me about.  I cannot help her with specific questions about the treatment of her patients, but she finished her email as follows:  “…..I don’t know how I can convince (my patient) to stay on the treatment.”

I always say that treatment can only be successful when both patient and practitioner are equally involved, 50% the patient and 50% the practitioner.  It is therefore good to remember that we can never help a patient who is reluctant to receive treatment.  As soon as we sense this, we need to stop what we are doing and address the issue.  Dealing with a patient who openly doubts the effectiveness of our treatment is always disturbing for any practitioner, nor can we do good work if we are not sure what is going on in the practice room.

One of the tips I learnt many years ago from JR Worsley, which I have followed successfully ever since in all cases where my relationship to my patient is under some strain, is always to be honest with the patient, and tell them as soon as I sense that there is a problem.  You need to be brave enough to ask them whether they, too, feel that this is so.  I always preface what I say with the words, “I feel that ….”  Saying this removes any risk of the patient feeling that we are blaming them for what is not right, and gives them the courage to be open with us.  I am then often surprised by my patients’ answers, which may be quite different from what I have imagined.  This frankness between us goes a long way to solve some of the tricky patient/practitioner issues which complicate our work.

So this is the advice I am going to give Caline, with the hope that it will help restore a good relationship with her patient.  I hope, too, that this will clear up some of her own doubts about what she is doing.

 

More on what makes the Earth element angry

Here are two observations about what I wrote in my last blog by two of my Earth practitioner friends, one living in Beijing and the other in London.  Both comments have helped me to understand Earth a little better.

My Chinese friend wrote:  “Thank you for sending me your new blogs, I learned a lot about what makes Fire angry. And about what makes Earth angry, I agree with you when you say that “Earth can show its anger when it feels that somebody is not paying enough attention to what it wants to say, or interrupts it in mid-sentence.” But I think “angry” might be a little bit too strong here from my point of view, because I would only feel a bit unhappy about that, and if that’s something I really want to express, I will try to find another chance to tell the practitioner about it. But I will get angry if I tell the practitioner something that really makes me upset or sad or worried, and the practitioner shows no understanding but says something like ”that’s nothing, I don't know why you…”, I may even stop getting treatment from him or her. And in everyday life, I think Earth may get angry when it feels that somebody it really cares about is not paying enough attention to its devotion, or even worse, totally denying it.”

And when asked what would make her angry, my English friend told me: “It would take a lot to make me angry.”


After publishing this blog, this friend added the following to her comments: 

 

"Just to add to mine.... when I get angry about something I feel that I have to express myself over a period of time to different people until I have reached the point that I can let go of it. I guess this is my Earth processing.  And having space and time to mull it over. Also by talking about it over and over it is my way of being understood and heard."

 

 

What do the different elements get angry about?

I always like looking at the ways the different elements express their emotions, and  my last blog (14 August) has made me think about how each element expresses its anger. 

When we express emotions other than the one our particular element imprints us with, these other emotions will always be coloured a little by the specific emotion which has our guardian element’s stamp upon it.  If I take the example of Metal, then Metal’s expression of anger will always be tinged with Metal’s own emotional needs, one of which is its demand for others to respect it.  What makes Metal most angry, therefore, are likely to be those things which impact negatively upon its sense of self-respect, or, by extension, upon the self-respect of others around it.  I have seen Metal people becoming extremely angry, and to me quite frighteningly so, when somebody has ridiculed them openly in front of other people.

Earth can show its anger when it feels that somebody is not paying enough attention to what it wants to say, or interrupts it in mid-sentence.  Its need is not so much a craving for sympathy, but a craving for understanding in its widest sense.  It wants to be given the space and time to express exactly how it feels, and becomes irritated if it is not allowed to do this.  This is something that I, as a rather over-hasty Fire person, have sometimes been guilty of doing, at my Earth patients’ cost. 

I have found Water’s expression of anger to be more hidden, but like Metal’s it can be quite frightening to witness.  It can appear out of the blue (what a Water-like phrase!), like a tornado erupting suddenly out of a clear sky.  Water needs to be constantly on the move, and its sudden expression of anger can be its response to feeling that something is blocking its path.  Behind this outburst of anger lies all the power which Water exerts on all it does.

There is then the Wood element’s own expression of anger.  This is an element most at ease within a given structure and with order in its life.  It is when structure and order are under threat that its dominant emotion of anger will show its stress.   It is easy for us to see an exaggerated example of this in the shouting and fighting to be observed in drunken people on the streets at night.  There is, however, the flipside to this, which is often forgotten, and which often leads us to misdiagnose the Wood element.  This is the suppressed expression of this emotion which we call lack of anger.  Here the voice can speak in an exaggerated whisper instead of a shout, and there may be a marked inability to express anger where anger would be a balanced reaction to some external event. 

Lastly, how do I think Fire tends to express its anger?  I should know, because I am, after all, Fire, but there is always the complication with Fire that, unlike any other element, it has two sides to it, which I have called Inner and Outer Fire.  I have always felt that in some ways this double-sided element could really be described as harbouring two elements, making a total of six in all.  I remember saying this to JR Worsley one day, and was rather delighted when he nodded.  Of course the two sides share Fire’s sensory signatures of colour, sound and smell, but their emotional approach to life is very different.  I can really only speak at first-hand for Inner Fire, although having observed Outer Fire for many years I have learnt to understand some of its qualities as I have those of the other elements.

I know what makes me angry, and that is any injustice meted out to other people, not so much injustice of which I am the object.  I like to fight my battles more on behalf of others than on behalf of myself, and feel deeply, and thus become very angry, when others are wronged.  In my experience Outer Fire’s anger is more directed at feeling that they have been the victim of some injustice.  Both sides of Fire, though, will not harbour grudges for long for they tend to feel that difficulties in any of their relationships with others may somehow be their fault.  Their anger is therefore likely to simmer down quite quickly, once they acknowledge their own role in whatever initially angered them. 

These are my thoughts on the different expressions of anger which each of the five elements may show.    

Don't shut the elements up into too small boxes

In our attempt to pin down some of the characteristics of the five elements to help us with our diagnostic skills, there is always a danger that we apply the very broad definitions we have learnt for each element in too rigid a way.  General descriptions, such as that Fire’s emotion is joy, or Earth’s colour is yellow, are all well and good as starting points to help us understand the differences between the elements, but we have to be careful not to regard them as fixed categories.  Instead we should see them as providing us with broad outlines into which we will gradually learn to fit our growing understanding of the elements.  In each of us as unique human beings they meld together to form something far less clear-cut.

Of the four sensory signatures of colour, sound, smell and emotion I always think the most accessible initially are the emotional signs.  The others are likely to be more difficult for us to detect, since our senses tend to become blunted as we grow.  Our emotional sensitivity, however, has to continue to be sufficiently acute throughout life to guide us through the intricacies of human relationships, and this is why we may often concentrate our diagnostic antennae more upon how a patient makes us feel emotionally than upon whether we can detect a specific smell or colour.  With time, of course, our other senses grow sharp enough to help us with our diagnosis, but even now, after 40 years of practice, I find that my first impression of a patient is based upon their emotional impact upon me.  Subsequently, I will draw upon information my other senses give me to add to this. 

At least that is true for me, but may not of course be the same for other five element practitioners.  One of my fellow students at our Leamington College, for example, had a very acute sense of smell, and used his ability to pinpoint a five element smell as the basis for his diagnosis.  Presumably painters must have an acute ability to see colour, and musicians an equally highly-developed sensitivity to sound.  I am neither a painter nor a musician, so I tend to fall back on what I feel is my most developed sensory skill, which is that of recognizing the emotional signals directed at me by my patients. 

Here, too, though, we must beware of relying too heavily upon boxing the elements into too rigid categories.  Something like this is always likely to happen as a result of being told that a particular emotion is assigned to each element.  If we take Wood, for example, whose emotion is described as anger, it becomes all too easy to think that any expression of anger must point to this element, whereas experience will gradually help us understand that each element can express anger in its own way, since every person, whatever their element, has a liver and a gall-bladder, which are Wood’s organs within us.  For example, I am of the Fire element, but can all too often explode with anger, but for very different reasons from those which my Wood or Water friends will express.  Earth’s sense of fear differs from that of Water, Wood, Metal or Fire, just as Metal’s expression of joy differs from that of each of the other elements.

These thoughts have been stimulated by another email from my very “curious” French acupuncture friend, Pierre.  Here are his latest questions to me:

“Which element is the most connected with curiosity? And particularly in the sense of discovery and novelty?

 

Which one wants to look for efficiency first? Wood?

 

Do Earth people have trouble moving, i.e. travelling, exploring?”

 

Based on what I have written above, I think that Pierre’s problem is that he still tends to think that any human characteristic, such as curiosity or efficiency, must be a quality of a particular element, rather than being a common human quality which each different element will express in its own particular way.  My answer to Pierre is therefore that all elements can be “connected with curiosity”, or “a sense of discovery and novelty”, just as all can “want to look for efficiency” in addition to the Wood element, (I, as Fire, certainly do!), and not only Earth people have “trouble moving”.  The crucial thing for us five element acupuncturists is to determine the specific way in which they are expressing these general human tendencies.

The significance of a CV/GV (Ren Mai/Du Mai) block

A CV/GV block is the deepest block of all Entry-Exit blocks, indicating that there has been some disturbance to the central line of energy passing up and down the back and front of the body.  The two pathways of Conception and Governor Vessels link together to create a great circle of energy within which we are enclosed, body and soul.  These central meridians provide the source of all the energies of the other 12 meridians which branch off from them.  They together form two great streams in the ocean of life which feed 12 subsidiary tributaries, each of which then has its own function in maintaining the cohesion and health of the whole.  Any impediment to the smooth flow around this central circle of energy must then necessarily have a great effect upon the ability of all the 12 officials to function as they should.  

I remember JR Worsley telling us that when there is a CV/GV block, a patient “lingers miserably”, whilst with a Husband/Wife imbalance they feel as though they can’t go on and just want to give up.  I think the idea of “lingering miserably” expresses well the debilitating loss of energy this block causes in a person.  From the point of view of our pulse readings, we know that all the pulses should be indicating great weakness, revealing an overall lack of energy in all the elements.  When I think the block is there, I therefore always ask my patients whether they feel exhausted most of the time, reflecting this general depletion in their energy, and inevitably they always do.  This is another guide to help me  with my diagnosis.

Since all the elements are under stress, the symptoms shown can vary greatly, depending upon which element or elements are most affected.  The elements will show that they are suffering in different ways, and a patient will often talk about all kinds of niggling symptoms which indicate an attack upon one or more elements.  In particular, the block can often appear after a Caesarian birth, where a large incision will have been made right across the CV line.  I have found it is worth needling the points to clear this block in any patient who has had this surgery, as well as in women trying to conceive, where one of the impediments to conception is often a weakness in the flow of energy along the CV meridian.  The same can also be true for men as well as woman.  The health and nature of the sperm can be affected by blocked energy along the CV meridian or between CV and GV.

Persistent problems which treatment of the elements seems unable to shift may also be caused by a CV/GV block.  For example, this may be one of the reasons why a person cannot lose weight despite being very careful with their diet, since the sluggishness of the overall level of energy throughout the meridian system slows down their elements’ ability to process food and eliminate waste material, leading to its being hoarded as fat in the body.  It is always worth considering this block, even if your fingers cannot detect an overall picture of empty pulses, whenever a symptom persists unchanged despite all the elemental treatment you give your patient. 

The importance of ensuring an interrupted flow of energy through CV and GV was brought home to me when JR Worsley told us that if the points used to clear this block were on the hand, we would do them on all our patients.  Because of their position and practitioners’ reluctance to use them routinely, the block is sadly much under-diagnosed, to the detriment of patients’ health.

 

More on Entry-Exit blocks

In my last blog (25 July) I said that I am never happy simply relying on my pulse readings to detect the appearance of blocks.  To supplement what I think the pulses are telling me, over the years I have therefore drawn up my own list of signs, both physical and emotional, which alert me to the possibility that they may be there.   

Entry-Exit blocks form the largest group of blocks.  I have always thought that they should really be called Exit-Entry blocks, because they occur between the exit points of one meridian on the Wei cycle of energy and the entry point of its adjacent meridian, for example between X (LI) 20 and XI (St) 1.  They are a sign of an over-accumulation of energy at the exit point of the first meridian leading to depletion of energy at the entry point of the following meridian, with the pulses of the Exit point having relatively excess energy compared with the pulse on the next Entry point.  In the example of a X- XI block, for some reason the Large Intestine has become unable to pass some of its energy on to the Stomach, or the Stomach has become too weak to accept it.

One of the advantages of the five element numbering of meridians i that the numerical order we use makes it easy to list the blocks.  These consist of the following blocks: II – III (SI – Bl), IV – V (Ki – HP), VI – VII (TH – GB), VIII – IX (Liv – Lu), X – XI (LI – St) and XII – I (Sp – Ht).  The remaining Entry-Exit block is that between CV and GV (Du Mai and Ren Mai), which stands somewhat apart, as being the most significant block of all.  I will write about this in another blog.

A frequently found block is a II – III (SI - Bl) block between Inner Fire and the Water element, treated by needling II 19 and III 1. Here physical symptoms can sometimes be very obvious, with patients pinching the corners of their eyes to get rid of some irritation, or rubbing itchy ears.  At the deeper level, the block can be found at a time when a person is struggling to sort out their life, often appearing as treatment progresses, and patients are aware that changes need to be made, which put a strain on the Small Intestine, the official most involved with working out such changes.

This is a block often found in children.  Their frequent ear-aches and hearing troubles can be seen in five element terms as signs of the stress life places upon a child’s Small Intestine, as it tries to make sense of all the confusing signals pouring into its ears from the world outside.  Western medicine treats these ear problems by inserting grommets.  We do it, much less drastically, by needling II 19 and III 1.  In a similar fashion, much of the disturbing increase in the prescription of steroid inhalers for young children affected by asthma could well be reduced by treating their X – XI (LI – St) blocks to counter the increasing levels of environmental and emotional pollution they are exposed to which is being inhaled by a child’s Lung official. 

All these blocks are at the exit point of one element and the entry point of the next element.  I have wondered how often there may also be blocks within an element, in other words between its yin and yang officials, which are more difficult to detect from a pulse reading.  I remember JR Worsley saying that after a little treatment an element’s yin and yang officials become strong enough to share their energy, and at no time during the many hours I spent observing him with patients do I recall him diagnosing a block of this kind within an element.  I have however myself once found a IX – X block between the Lung and the Large Intestine within the Metal element in a patient who had just had colostomy surgery. There was a very marked discrepancy between the two pulses, and I successfully cleared this block by needling IX 7, the exit point on the Lung, and X 4, the entry point on the Large Intestine.  But this was the only time in my many years of practice where I found a sufficiently noticeable block within an element. 

When trying to diagnose an Entry-Exit block, I always like to have in mind the physical area of the body where the entry and exit points are located, and, at a deeper level, look to see whether the patient is showing any emotional signs indicating some disturbance of the officials concerned.  In the case of a X - XI block, for example, the position of X 20 at the side of the nose and of XI 1 just below the eye indicates a blockage of energy running up the nose towards the eye.  It is easy to see that this may well cause, and does often cause, symptoms such as hay fever, sinusitis or conjunctivitis.  At a deeper level, this block can also be seen as a manifestation of the difficulty the Metal element’s LI official may be experiencing in letting go for some reason, and the resultant difficulty of the Earth element’s Stomach official to process what is coming to it.  This imbalance between the two linked elements may also reveal itself in changes in some of the sensory signals they show, such as a very marked change of colour or emotion.  For example, I have detected an VIII – IX (Liv – Lu) block in patients well before taking a pulse reading, because a patient who has previously been very mild and gentle suddenly turns up for treatment telling me how angry he feels with the world. 

It is important to remember, too, that Entry-Exit blocks are not related to a particular element, and can appear in people of any element.  They can therefore not be used to help us diagnose a person’s element.

Finally, I have noticed that people have what I call their “favourite” blocks, ones that recur at intervals.  Mine happens to be a II – III (SI - Bl) block, other people’s might be a XII – 1 (Sp - Ht) block or a VIII – IX  (Li - Lu) block.  These blocks recur only very infrequently, perhaps once in 6 months or a year, and are a sign of some individual weakness in the balance of the elements within us.

My next blog will be about the deepest block all, that between CV and GV (Ren Mai and Du Mai).