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).

My approach to pulse-taking

I have been privileged to receive from Peter Eckman a draft of his latest book which is about pulses and is about to be published, like my books, by Singing Dragon Press.  I love its title, The Compleat Acupuncturist: a guide to constitutional and conditional pulse diagnosis, an echo of Isaak Walton’s The Compleat Angler (1653).  The book discusses in great detail the many, many different ways in which pulses are taken and the many, many different ways in which they are interpreted. 

This has set me thinking about my own approach to pulse-taking, best summed up, I feel, by something I said to those attending my last SOFEA clinical seminar.  In effect I told them, a bit tongue in cheek, to “forget the pulses”.  This is something I often find myself saying to practitioners in an attempt to remove some of the unnecessary burden they feel when trying to interpret pulses.  I suggest, instead, that they should concentrate on looking at the patient as a whole whose pulses are only one of many manifestations of the elements.  I always labour the point that the extreme subtlety of what these 12 pulses are telling us makes their interpretation an art which has to be honed over many years, and like all arts is a skill that is never perfected.

My approach is based upon what I was taught as an undergraduate at Leamington, where the importance of pulse-taking was never over-emphasized.  We were told simply to take as many pulses as we could (100 a month, if I remember correctly), and gradually learn to assess the strengths and weaknesses of the different pulses in relation to one another.  The aim was mainly to detect energy blocks, such as Entry-Exit blocks or those occurring in a Husband-Wife imbalance.  It was firmly drilled into us that pulses never told us what the Guardian Element (CF) was, because even if treatment was directed at the right element, it might well be this element’s pulses which showed the least response to treatment because of its role in shepherding the other elements into balance.

The famous 27 pulse qualities were only mentioned once by JR, almost as an aside, when, as part of what was apparently considered necessary to complete the syllabus, he raced through the different pulse qualities in about 15 minutes with obvious disinterest, ending with telling us, “and that’s all you need to know about the 27 pulses qualities”.  This appeared to be a doorway through which he did not think it necessary for us to pass.

Another occasion with JR had a much more profound effect on me.  I told him at one point that sometimes I felt that I couldn’t interpret anything my fingers were trying to tell me.  He said, “I know what you mean.  I will feel the same, and then perhaps a month later I will realise that my pulse-taking has moved to another level.”

These words of his hover over my fingers as I take pulses even now.  I never wait too long to try and interpret what I feel, and can even find myself talking as I take them, almost as if I want to allow my mind to do its thinking through words so that it sets my spirit free just to feel.  And then I try to add what I am feeling to what my other senses are telling me to help me interpret the signals the patients is sending me through everything they do or say.

What worries me about approaches to pulse-taking is that pulses represent one of the few aspects of five element practice where we ask for a physical response from a patient’s body.  All the other forms of diagnosis are much more ephemeral.  We can’t physically touch a smell, a sound of voice, a colour or an emotion, but we can certainly physically touch a hand to feel a pulse.  And the physical appears to provide a reassuring refuge to which we can retreat if our other senses confuse us and prove too elusive.  I have decided that this is the reason why all novice practitioners (and quite a few experienced practitioners, too!) immediately reach for the hands of the patient lying there on the couch, rather than paying attention to the patient as a whole, as though needing to anchor themselves immediately in the physical.  Sometimes I feel, rather wickedly, that this is a bit like a drowning person grasping a lifebuoy.

Except in the case of blocks, where I always try to add other information to what my fingers may be telling me, pulses play an almost subsidiary role compared with what I learn from the total picture presented by the patient.  So Peter and I, both trained in the same school, but he, unlike me, having received much more extensive training in other disciplines, have arrived at somewhat different points on the scale of the importance we attribute to what our fingers can tell us.  I am nonetheless fascinated by all those other approaches his new book covers, but which I know I may only ever appreciate in theory, not in practice.

 (See also my other two blogs on pulse-taking: The mystery of pulses, 22 October 2010, and Using our two hands, 24 February 2012)

 

 

 

Using our two hands

I have recently been thinking about the question of why some branches of acupuncture have taught their acupuncturists to use two hands to needle and to take pulses, and why others prefer just one.  In five element acupuncture, or at least certainly how I was taught all those years back at JR Worsley’s college in Leamington, we use both hands in both cases.  Thinking about why this should be so, I decided to observe myself closely during my own practice to see how I felt about what I now do so automatically, and why I find great satisfaction in using both hands.

It isn’t just because this is the way I was taught, although of course the comfort of an old habit is part of this.  The main reason, I think, is because it feels good to me to enclose the needle in both hands as I guide it to the points.  In doing this, I also maintain a comfortable contact with my patient’s body.  In taking pulses, too, both of my hands take my patient’s hand and hold it against my body.  I am using both hands to convey as sensitive and warm a touch as I can.

Pulse-taking and needling done in this way encompass something much more than just making physical contact to obtain some diagnostic information. It is possible to approach the skin with a needle without any of our fingers actually making contact with our patient’s body, and pulses can be taken in a purely physical way, as we know from our visits to a doctor’s surgery.  Here there is no intention to convey anything through touch itself, which is so different from the importance five element acupuncture places on conveying warmth and comfort through our hands.  As I observe the one-handed way of taking pulses or needling it always feels to me as if practitioners are holding the other hand well away from their patient as though to distance themselves from what they are doing.

Our hands can and should be able to convey protection, love or respect, still anger and calm fear, the five dominant emotions our treatments are trying to restore to balance.  And they should continue to do this whenever we touch our patient’s body, whether to take pulses or to needle or simply to make warm contact.

So each time I needle or take a pulse I am offering something which, though apparently purely physical in nature, becomes something much deeper if coming from my heart.  Anybody hoping to make closer contact with the elements in their patients, and at the moment practising one-handed acupuncture, may consider taking their courage literally in both hands, and decide to learn to use both as a further expression of their care for their patients.

At a slightly different level, I shudder internally as I watch people needling a II-III (SI-Bl) block or a X-XI (Co-St) block on points around the eyes without tethering the patient’s head with both hands, and making sure exactly where the eyeball is.  What if the patient jolts their head, I think – and it can happen! And the reason I have heard practitioners give for not needling these points is precisely this fear. Using both hands reassures both patients and practitioners.

We are given two hands with which to embrace people, to cook with, to use a computer with, to drive a car with, why then do we cut ourselves so unnecessarily in half when we needle and take pulses?  

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.