Spleen 4: A patient’s comments

I love hearing how patients experience different points so I give below what an Earth patient of mine said immediately after I needled Spleen 4.

“Goodness, that’s a lovely feeling.  It feels as though there is a seeping of warm water all over my feet – like dense liquid.”

It is rare for patients to be so specific about the effect of treatment so soon after needling, although I always treasure in my own treatments the involuntary drawing up of my mouth and jaw into a smile as soon as my Small Intestine is needled, proof, if proof is needed, that Fire is indeed to do with joy.

Entry-exit blocks, and when to do them

I have written before of the lure of the entry-exit block.  I think this is because we all hope that we can achieve the often rapid easing of a painful condition that the clearing of such a block can do.  But in fact we must not let our enthusiasm for this essential area of five element practice lead us to overdiagnose blocks.

In early treatment, as with the patient in my previous blog today, A good day at the clinic, I felt there was a block between SI and Bl immediately after the AE drain, but, as you can see, I did not clear it then, but needled the source points first.  It was only after I felt the block was still there, that I cleared it.  As you can also see, I finished the treatment by returning to the source points, as we always should, but this time just doing a simple needling without doing moxa.  You don’t want to overdo things, particularly not at the first treatment.

The reason for waiting to gauge the effects of the source points is that we should try to address the element we are treating as soon as we can after the AE drain, and give it time to respond to this first treatment.  Often the balance it tries to bring to the whole cycle of the elements reduces the pressure we can feel on the pulses which makes us think there is a block there.  Even if we feel there is a Husband-Wife block after the AE drain, the same procedure holds true.  We should needle the source points first, and then decide whether the pulse picture still indicates a H/W.  Often the left-right discrepancy on the pulses disappears as the guardian element starts to take control.

So be careful not to put too much faith in your fingers’ ability to diagnose blocks, and let the elements do as much work by themselves as they can.  That does not, of course, mean that you should overlook blocks, simply wait a little to make sure that they are really there.   

A good day in the clinic

There are times when I take what five element acupuncture can do a little bit too much for granted, but then I will find myself heartened by a treatment or series of treatments which reignites my wonder at what my needles have achieved.  It also adds to my gratitude at having been given the chance quite late in my life (for I ventured into acupuncture in my mid-40s) to have found my way to a calling in which so much can be achieved with so very little - just through this comparatively tiny, one inch of flexible steel gently inserted to a comparatively very shallow depth in the skin, but able to stir the deepest depths within us all.

This has happened to me again this week, and fortunately, too, since I came back from China re-energized, only to fall foul of a bug of some kind which laid me low.  I needed a good pick-me-up and the one I am writing about today provided this so amply for me.

A new patient rang me in great distress.  He had developed excruciating lower back pain which was almost making it impossible for him to move.  It sounded as if he needed what, in other disciplines, might be called emergency treatment.  Here lies one of the traps for the unwary five element acupuncturist, because there is a myth deeply embedded in some acupuncturists’ psyche that somehow five element acupuncture cannot treat acute conditions, and that five element acupuncturists need to look to other acupuncture disciplines to supplement what they do.  This is something I have never understood, because it is belied by my many years of treating acute pain successfully using exactly the same treatment procedures as I use for any patient.  And yet all of us, even the most experienced, when faced with an acute condition may feel an impulse to forget the carefully graded steps which start every course of treatment, and think first only of which points we could use in the area of the pain to counter it.

As we all know, these first steps consist first, and above all, of what we call a TD (a Traditional Diagnosis), followed by an AE drain and the source points of the element we have chosen.  A TD should usually be as exhaustive as is necessary, firstly to set up a good relationship with our patient and then to find out as best as we may at this first encounter what is really going on in our patient’s life.  With acute pain, we may feel it better to shorten the bit of it we do face to face, only to continue it during the AE drain, an ideal time to do so for every patient.  And in this patient’s case, what I discovered was a great deal which helped explain why the backache was occurring just now, and was not just the first occurrence but a re-occurrence of one which had last occurred some 20 years earlier.  This had been when his father had died and he had blamed himself ever since for not having reconciled himself with him before he died.  Why did he think it might be recurring now, I asked him, and it turned out that his mother, too, had just died and all his feelings at this loss appeared to have brought to the surface the suppressed grief from long ago.

Reading this stated baldly like this, it might seem slightly fanciful to make these connections, but my patient certainly did not think so.  And the strong reaction to his first treatment only confirmed this, because over the next few days he experienced feelings of deep grief, which made him examine his relationships to his own children, particularly his son.  The most interesting thing from my point of view was that on his second visit a few days later he hardly mentioned his back pain, and when asked, said almost with surprise that, yes, it certainly seemed much better.  By the third treatment the pain had completely disappeared, and he felt as he said, “A completely new man”.

I hope this adds another nail to the coffin in which should lie buried the myth that five element acupuncture cannot treat acute physical symptoms.

For my acupuncture readers, I give below the very simple first three treatments I gave him, all, as you can see, directed at the Metal element.  

Treatment 1:   AE drain (a little AE on Lu and HP)

                        LI 4, Lu 9 (3∆ & needle)

                        SI 19- Bl 1 (SI-Bl block – see next blog today for explanation)

                        LI 4 – Lu 9 again (no moxa)

Treatment 2:   CV 8 (3∆ on salt)

                        LI 20 – St 1 (LI-St block)

                        Lu 8, LI 6 (3∆ & needle)

Treatment 3:   Bl 38 (42) (5∆ & needle)

                        LI 11, Lu 9 (3∆ & needle)

 

Thoughts on writing

A bit of good news.  I have just signed an agreement with my Belgian book distributors, Satas, for the French translation of my Keepers of the Soul, with the option of translating my other books in the future.  I am also in discussion with a German publisher about the possibility of translating one of my books into German.  And Mei is continuing her good work and is busy finishing her translation of the Simple Guide into Mandarin.  When the Simple Guide has been completed, I will try to encourage her to tackle the Keepers of the Soul next, which I think is by far the most interesting of my books, and one also, I know, which will be the most difficult to translate. 

A Swiss acupuncturist once asked me whether I could write in ”simpler English” so that he could read my books, and that set me pondering about my writing.  My background is what I suppose would be called literary, and my degree in Modern Languages (French, German and Italian) concentrated only on literature, and that of the highest quality (Goethe and Proust and Dante – you can’t get any higher than that!).  So I regard the written word as something very precious and to be approached with awe, and any gift I have in using it to express my thoughts as something I need to cherish.  Merely to use it much like an advertiser might do to attract a buyer affronts me.  But because words are so important to me and must represent the thoughts that inspire them as rhythmically as possible, I acknowledge that, though I hope they fit the cadences of the English language well, to try to adapt them to another language will always be difficult.

These are difficulties I am at the moment grappling with as I come near to completing my translation of Elisabeth Rochat de la Vallée’s 101 Key Concepts of Chinese Medicine. She writes in a personal, creative and very French way (sentences often tend to finish with…….), where English, so different in its emphasis, demands the more clear-cut and definite full-stop.  It has taken me the first 200 pages eventually to be happier with my own English version than I was to start with.  So I wish Mei good luck if I can persuade her to have the courage (and find the time!) to tackle my Keepers.

A puzzle

Yesterday I saw something that puzzled me and at the same time made me laugh.  If you have read my blog of 14 February you will know that I am increasingly irritated by the use of the dreaded “-ing” word in all those meaningless mission statements posted everywhere.  So I find myself looking around me as I walk along to see if there are any new examples on which to vent my anger.  Imagine, then, my surprise when I walked past a large removal van yesterday and saw, in large letters covering almost the whole side of the van, the words:  “If you can’t convince them, confuse them”.  No "-ing” word there, but I walked, on confused myself, wondering what on earth this meant.

The van was blocking a narrow road and I wondered whether the “can’t convince them” was directed at traffic wardens determined to put a parking ticket on the van.  Maybe the removal company was encouraging its drivers to confuse the traffic wardens if they weren’t convinced by arguments.  All very mysterious, and at intervals during the day I would return to the puzzle to try and work out its meaning.  And each time I did this I would start to smile, surprised at having encountered something slightly surreal on the side of a very ordinary removal van on a very ordinary street.

Has anybody reading this any suggestions as to what the writer of this message could mean?

The pluses and minuses of modern travel

Plus:  You get there quickly, and this means that you can travel to places you would never have been able to travel to before.

Minuses:  You don’t get a feeling for the vast spaces you are travelling through.  You arrive, as I did a few weeks ago in Hong Kong, tired and jet-lagged, but with no sensation of having come half-way across the world through different country after different country.  With nostalgia I remember the excitement of travelling in days long gone.  First we boarded the train at Victoria, then got off at Dover and climbed a gangplank up to the channel steamer, then got down in the marvellously different atmosphere of Calais to climb into yet another, but different kind of train, which always had those magic words “Non sporgersi….”, “Do not lean out of the window” on its windows, because windows in those days opened, and we would open them and feel the grit flying in our faces as we sped through France.

And then each station we stopped at, whether it was in France, or Holland (not called the Netherlands in those days!), or Italy or Austria, had its own special character, and people looked different, unlike the clones we have all become, since we dress the same now whether we buy our clothes in Beijing or Birmingham.  Now, though, I have to remind myself which country I am in, so depressingly similar are all the airports, selling similar clothes and similar food in similar shops and restaurants.  We have become identikit nations, with identikit architecture and identikit fashions, and we travel on identikit planes, with identikit safety instructions, or along identikit roads teeming with identikit cars.

Thank goodness human beings, though, manage to remain refreshingly unique, whatever the anonymity of their surroundings

A lesson in the spacing of treatments

I have been thinking a lot about the importance of the spacing of treatments after seeing two of my patients this week.  We know that frequent, approximately weekly, treatments are essential at the start to allow a patient’s elements gradually to regain strength and also to help us decide whether we are directing treatment at the right guardian element.  So we don’t have to think about the question of the spacing of treatment until more than about six treatments have been given.

Then, though, things start becoming a little more difficult, because we have to decide whether there has been sufficient improvement to make it sensible to space treatments a little more widely.  I usually discuss this carefully with my patients and ask them whether they feel that they can manage a wider gap between treatments.  I think this kind of discussion between us gives very useful feedback as to how patients really feel treatment is going, and gives them the opportunity to tell us if thing aren’t progressing as they would like.  We should never rely only on our own judgement of this, because many patients are reluctant to tell us how they really feel.

The important thing here is always to include patients in our deliberations about the spacing of treatment.  Later on, when we have spread treatments even further apart, I will ask patients to tell me when they feel they would like to come back for their next treatment.  And it is here that my two patients this week have taught me such a lot.  Both are very long-standing patients, one having come for at least 15 years, the other for more than 20 years, and until quite recently I would leave it to them to contact me when they felt they needed a treatment. When I look at my notes, I realise that they both tended to do this at very infrequent intervals, one perhaps once or twice a year, the other often a longer intervals.  And, then again from the notes, I notice that they would arrive very low in energy and needing at least a further 2-3 closely spaced treatments to get back on track.  One of this week’s patients, in particular, always left it far too long to get in touch with me, and would arrive very depressed and in need of a great deal of support.

About 18 months ago, I decided that I would look at things from a different angle, and instead of feeling that it would be inappropriate after so many years to suggest more frequent treatments, I would suggest that one of these patients would benefit from regular treatments every 2-3 months which we would arrange at each visit.  This he accepted readily, particularly because, finances being a problem, I offered a reduced rate for each treatment, to suit his financial pocket at the time (he is a freelance artist).  Once I had put this new regime in place, he immediately benefited from the more regular treatments, and told me this week that he was sure it was because of this that none of his physical symptoms had recurred and he had felt so well that he was able to accept more challenging work.

I then did the same with my second patient, and  she, too, this week, told me how much this regular treatment had helped the changes in her life, which she ascribed, as did my first patient, to her frequent treatments.  She now comes for a surprisingly brief booster every two months and feels her life has turned around since we have done this, mainly, I think, because the regular treatments have removed her feeling that she should be able to cope on her own.

Each patient’s needs will be different.  Some will clearly know exactly when they need a treatment, but in my experience such patients are rarer than those who are not sure themselves when they should phone us.  Most of us will wait too long before we look for help, so I see it as the practitioner’s task to decide with which patient to take a more active role in deciding when the next treatment should be and which patient we can leave to make the decision themselves.

I suspect that if I had introduced such a carefully graded plan for long-term treatment earlier on in my practice, I might have helped many more of my patients in the past.  Looking back, there are many who I think would have benefited if I had been a bit firmer and clearer about the benefits of such a plan.  So even at this late stage in my practice I find I learn new things.   

Never rely on a damaged Kindle: a footnote to my blog of 28 March All About Books

I will never, ever, again only take a Kindle with me on holiday, with no back-up from what I call real books, as I stupidly did.  When I took the Kindle out on my first evening in China, I found that it had been damaged in transit inside my cabin bag.  And that was that!

Although my Chinese hosts took it to a Kindle store to try and get it repaired, it was beyond help.  This meant that I was left for 2 weeks without a book to read.   At some level this may have been good for my soul, because it forced me to do a lot of thinking and a lot of planning of lessons for my Chinese students.  Luckily, too, I had taken some of my Mandarin studies with me and that helped save my sanity when I woke, as I inevitably did, at 5 am in the hotel room.

But it was a warning to me never again to rely only upon electronic books.  

Written before my return to London after my second visit to China

My second trip to China is now nearing its end and sitting here in the hotel room in Nanning, just gently thinking things through, I’m trying to summarize what I have taught my students and what the whole experience has taught me.

I have been listening to Mandarin spoken at full tilt and in great quantities by everybody around me, interspersed only with the pauses as the important parts were translated into English for me.  I found it interesting to note that more and more of the few simple words I had learnt at my classes in London seemed to leap out of the sentences at me, like carp leaping out of the lake I visited here.  And just for that moment the speech appeared to slow down as I recognised a word with some meaning I could attach to it, only for the remainder of the sentence to become submerged attain in an unintelligible jumble of sounds.  Although this was often confusing, as giving me only tiny glimpses of meaning, it was comforting to know that I had indeed started to learn something of the speech I heard around me.  But what a long way to go before I can engage in any real dialogue here!

At a more serious level, I come away delighted that the students have learnt so much more than at my first visit, and that we have put together some solid structures for future learning.  It is intended that I go over there twice a year, and Mei, who set in motion the whole train of five element acupuncture on its journey back to China, will probably go a further twice a year, as well as accompanying me.  Her next visit is scheduled for July, so the students will get more time to consolidate what they have just learnt before I return with her in the autumn.

The number of my students has increased by a further 5 or so, making abut 20 dedicated five element students.  There are now two main groups, one based here in Nanning and the other in Chengdu, with a lone student hoisting the five element flag in Beijing.  We will organize the website forum they have set up for me a little better, and they are arranging regular monthly meetings where they will help each other with their patients.

I call them my students, but they are all either fully practising acupuncturists or nearing qualification, so that their basic acupuncture knowledge is well established.  If anything they have a much more solid foundation than comparable practitioners here in the UK, since they are blessed from birth with a deep understanding of the elements as forming an integral part of their life, so that we already speak the same language.  This is so different from the UK, where I well remember one student, after about six months’ training, asking, “But how do we know that there really things like elements?”  Here, by contrast, the elements represent the symbols through which life expresses itself.

By the last few days of this fortnight, students had learnt some very fundamental components of five element practice, such as different needling and moxibustion techniques, how to carry out an AE drain, how to clear possession and treat a husband/wife imbalance.  Most important of all, I gave them a clear schedule of how to structure the first four treatments so that they feel confident that they know what to do at the start.

We saw together some 30 patients, and I treated at least another 25, because I gave each of the students a treatment.  I felt it was important for them to experience an AE drain and their element source points for themselves, as many of them had not had any five element treatment before.  Scheduling these treatments amidst the teaching sessions was a logistical puzzle which taxed my Small Intestine’s ability to sort to its limit, but I managed the last three treatments on almost the last day.  In doing this I only changed the element I had decided upon for one of the students, and I can only hope I am right with the others as I fly away to leave them to receive further treatment from their peers.

Each day was filled with treating patients, helping students treat patients, or helping them learn some of the five element skills they will need, such as testing for Akabane imbalance and learning how to apply moxa cones to salt for CV 8.  This proved to be an unexpected very local problem, because the climate is so damp and they usually only use rock salt, that not only did the grains of salt stick together in a tight mass but the thick grains allowed the heat through too quickly so that I’m afraid I may have burnt the first person’s umbilicus without realising it.  Being Chinese, she never complained of the pain and probably went away thinking that the pain was a necessary part of treatment.  After this we found some thinner grains of salt, and Wendy devised a way of putting rice grains in a little muslin bag to dry the salt out.

As usual, I learnt much from devising ways of teaching in such a limited and challenging timeframe.

All about books

I am off to Heathrow in a few hours for my second trip to China, and packed in my trunk are various books I am taking with me as gifts.  They make an interesting bunch, each with its own history and its own special destination.

Gift no 1:  This is for Liu Lihong, who is my host in China.  It is a copy of Elisabeth Rochat de la Vallée’s 100 Notions-Clés de la Médecine Chinoise (100 Key Concepts of Chinese Medicine), signed by Elisabeth a few days ago, specially for Liu Lihong.  As you can see, it is in French and I don’t think that Liu Lihong reads French, and therefore with it I have packed some part of the translation into English which I am doing for the edition which Sandra Hill will be publishing for Monkey Press.  I am two/thirds of the way through the book, and hope to have completed it by the end of the year, when I can hand it over to be tweaked into shape for publishing.  This is a book after Liu Lihong’s heart, as he seems to be as interested as Elisabeth is in everything which delves deeply into the classical texts.

Gift no 2:  This is for Liu Lihong’s father, who was a university teacher of English, and with whom I converse in English through sign language and the written word, as he is very deaf (and I am not much better!).  Since this is the 200^th anniversary of Charles Dickens’ birth, I thought one of Dickens’ books would be an appropriate present, and have chosen a lovely bound edition of Great Expectations.

Gift no 3:  This is for my students.  It is a secondhand copy of what we called JR Worsley’s Red Book, his book on Points and Meridians, the bible we all used, and still use, for our point location and selection.  The hardback edition has been out of print for some time, but I was fortunate to find a nearly pristine copy in the States, and just as fortunate to find a very cooperative bookseller who was happy to speed its passage across from the States in time to reach me just a few days ago.  JR signed my own copy 25 years ago, and I have photocopied his signature and pasted it to the front page of the students’ copy as visible evidence of the line of transmission stretching from JR to them, something very dear to all their hearts.

And then, in a much humbler place, I will be taking my own Kindle, reluctantly bought and even more reluctantly taken with me instead of the paper-bound books I love, but because I read so quickly and so much, and because the weight of books is always a factor when travelling, it proved a sensible buy last time I went to China.  But how pleased I was when I got back to put it aside and reach again for a proper book!