The simpler the better

It is interesting how often I return to the phrase “the simpler the better” when helping acupuncturists gain confidence in their five element skills.  And I keep on repeating it because, much to my continuing surprise, what I say does not appear to be actually what people want to hear.  It seems as if, instead, they prefer to believe the opposite to be true, that the more complicated things are the better.

One reason may be because people like to take pride in thinking that their discipline is a complex one requiring hard work to practise it.  To encourage its practitioners to greater levels of simplicity may appear to run directly counter to this, as though it strips away some of this pride.  It also takes courage to trust that minimum interference may mean maximum effectiveness, but there is no doubt in my mind that it does.

Nor must we think that it is easy to be simple, for this is far from the case.  Some of the most sublime music ever composed is that of Mozart’s piano concertos, where the pianist may only interject a single note as counterpoint to the orchestra.  And yet if that note were placed a bar earlier or a bar later, or at a slightly higher or lower tone, the whole perfection of the musical structure would be broken. These single notes could appear to be written by a child, and yet they are the product of the highest level of creativity.

I like to feel that we can show some of this creative ability in our own work, if, instead of bombarding the elements with a plethora of points, often picked at random from one of those books on points I dislike so much, we dare to hone our selection down to a few simple points, and end on the single note of a command point.  Treatment, like music, should then be allowed to fall silent, as we give the elements the time to carry on their healing work without further interference from us.

Our relationship to food - and what it tells us about the Earth element

I have been thinking a lot about our relationship to food in a five element context.  First, because I was asked by a fellow practitioner to help her treat an anorexic patient, and secondly, because I was made aware over this Jubilee weekend in London of my own often unbalanced relationship to the eating of chocolate.

Second things first:  I have always attributed my odd cravings around chocolate to my upbringing during the Second World War when there was no chocolate in the shops.  My family spent a major part of the war in what was then called rural Westmoreland in flight from the Blitz in London.  We rented a rat-infested little cottage by the lakeside in Bowness-on-Windermere, which had an old pre-war food kiosk in the road outside.  In its window there was a display box of what were obviously paper chocolates, getting dustier by the day over the four years we were there.  I would press my nose against the glass to look longingly at them, imagining to myself what they would taste like.  Chocolates remained rationed long after the war ended, and being from a large family, we were each only allowed one small piece once a week.  I always think that this may explain part of why chocolate is still something I yearn for, even though I can now buy as much as I like.  Interestingly I hardly ever do, but if I am given a box, I will be hard put not to eat it all one go, as though making up for all those years of deprivation.

Buried in this personal story, though, there hides a great lesson about our understanding of the element which controls our attitude to food, the Earth element, our Mother element, and the element of hearth and home, which shelters the Stomach official and all that involves our relationship to food .  And this brings me now to the anorexic patient.  Food is inevitably associated with our mothers, and therefore with the kind of mothering, nurturing and feeding of body and soul which we each received as a child and which stamped itself upon how our Earth element deals with the food we are given.  With eating problems of all kinds, whether those associated with over-eating or under-eating, we need to look at the kind of nurturing our patients received in childhood.  If we look deeply enough, it will be there that we may find some explanation for what may later on have disturbed our patients’ approach to food.  In my own case, I feel it was no coincidence that, war child that I was, there were long periods when we were left in our grandmother’s care to free our mother to return to London for weeks at a time to help our father with his London work.

It is revealing, too, to see the changes in body-shape which under- and over-eating cause.  An anorexic person can appear to be shrinking gradually back down to their shape as a young child, as weight drops off, muscle loses its tone and menstruation ceases.  An obese person moves in the opposite direction, as bulk is added.  It is as though they are forming themselves into a shape which accommodates not only themselves but somebody else inside their skin.  They appear to be enclosing themselves within something which could be said to offer the warm comfort of a home into whose arms they can sink.  And this great envelope of flesh seems to be able to offer them an endless supply of food for a hunger that cannot be satisfied unless the deep underlying needs can be acknowledged and understood.

We may think that such imbalances in the Earth element point to this element being the guardian element in each of these cases, but that is not so.  Any of the five elements, including Earth, may suffer from eating problems.  The anorexic patient I saw this week was of the Wood element, and my element is Fire.  In each case, though, it is our Earth element which takes on the burden (emotionally and physically) of whatever imbalance lies at the root of the problems.   

Finally, since the actual level of food intake is the effect, not the cause, of a patient’s imbalance, it is unhelpful to focus all our and our patients’ attention upon the amount of food consumed, as many therapies dealing with eating problems do.  Instead we need to help patients work out ways of dealing with the underlying problems, and this is done by strengthening the guardian element’s ability to restore balance. My craving for chocolate, I always think, is more to do with my mother’s absences from home and my fear that something might happen to her under the London bombings than to the rather sad paper chocolates in the kiosk window.

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.