Decision fatigue

Each element is subject to its own stresses.  Mine relate to the functions of the Small Intestine within the Fire element.  We know that its task is to protect the Heart, its close companion, by making sure that it only allows the pure through.  This involves the never-ending work of screening everything coming to it before it allows it to pass.  Physically, of course, this means its work in filtering out impurities in the blood, but at the deeper level, which acupuncture recognizes, it also filters all that relates to our thoughts and emotions.


The Small Intestine must constantly ask itself, “Is this the right way to do this?”, “Is this the right thing to do?”, “Is this how I should be feeling?”  This is demanding work, and just as surely as we can become too tired to walk another step, so my Small Intestine can grind almost to a halt after a day of such constant activity.  It is as though I succumb to decision fatigue, lacking the strength to work out what I need to advise my Heart to do.  If I am not careful, this is when I may start to do the most inappropriate things, say the most inappropriate things, send off an intemperate email by mistake, or make a sudden decision based on ill-founded reasons.  With the years, I have grown better at recognising the early signs of this tiredness, and have learnt that I need to put all my thoughts on hold until my Small Intestine has had time to recover.  I have also learnt never to press the Send button on a difficult email until I have slept on it and woken to a refreshed Small Intestine, now able to resume its tasks and thus more likely to make the right decisions.
 

Curiosity – a five element acupuncturist’s most important quality

I have always maintained that one of the qualities we must develop in ourselves as five element acupuncturists is being curious about other people (and about ourselves).  Without this, we will never be able to help our patients.  A lack of curiosity is evidence that we are not really looking at them with the depth of interest we need to have to see them as they are.

I was glad to have my belief in the importance of this quality confirmed by something I read in the newspaper today.  A reader wrote the following:  “There are many reasons why we should cherish Albert Einstein.  What a pity then that biographer Steven Gimbel (about whose book there was a review in the Guardian on 13 June) omitted one of the greatest: curiosity.  Einstein is quoted as referring to this important disposition on several occasions, asserting:  “I have no special talent.  I am only passionately curious.”  Perhaps it was curiosity that led this patent clerk to become such a great physicist, and perhaps it is curiosity that our schools should cherish, rather than testing and league tables.”  (Quoted from the Guardian readers’ letter page today, 19 June).

Oh, how I agree with that!  Perhaps I, too, have “no special talent”.  But I am certainly “passionately curious.”  And it is this curiosity which leads me to explore every more deeply the world of the elements within each of us.

Heartening email from a five element student in China

I love hearing how my Chinese students are progressing in their five element practice, so I was very happy to receive the following email from one of them:

Practising five element acupuncture these days, I got some feelings that I would like to share with you.

Now, more and more I feel that it needs love and patience, just like growing flower; we just need to water and add fertilizer, then wait for it to blossom.  We wait for five elements to blossom, wait for the blossom of every single life.

And for a period of time, I put too much emphasis on the diagnosis of the element, and neglected building connection and relationship with my patients, only until one of the patient gave me some feedback that I realize it.

So I calm myself down to listen, giving every patient as much time as can be, to let them express themselves. One of the patients has already received five element acupuncture treatments for half a year, but the effect is not quite pleasing. Till recently I open up myself, she said that she finds it difficult to express her sorrow and sufferings to other people, but she can pour forth to me. Afterwards, she sent me message telling me that she feels much better every time, on the second day after treatment.

How well this practitioner expresses what lies at the heart of five element practice.

 

The truth at the heart of five element acupuncture

One thing I am absolutely convinced of, and was from the very first day I was introduced to the elements through my own treatment, and that is that there are different aspects of our life force which make unique individuals of each one of us, and that these have been given by the ancient Chinese the symbolic names of what are called the five elements, Wood, Fire, Earth, Metal and Water.   These different aspects create our life, and by some esoteric miracle of comprehension by these same ancient Chinese they were understood to have perceptible presences in each of us, so that we can hear them with our ears, see them with our eyes, smell them with our noses and feel them through our emotional sensors, provided these ears, eyes, noses and emotional sensors have trained themselves to do this.

There is thus a truth underlying my practice of five element acupuncture which is confirmed each day I spend simply observing my fellow human beings and myself, as well as each day I practise.  After all these thirty or more years of my acquaintance with the elements, I remain as fascinated by them as I was on that very first day at acupuncture college, and am in ever-growing awe of those early practitioners who perceived this truth and passed it on down the centuries and across the oceans to me, happening to sit at a party here in London next to a five element acupuncturist.  As I now book the flight for my next visit to China in the autumn, I feel how extraordinary it is that the journey of my own life is playing itself out in terms of these same elements, and how fortunate I am to be part of the great route of transmission from those olden days hidden deep in the past to the present day.  I am privileged to allow this small needle of mine held in my hand as I practise to draw to itself some of these centuries of understanding, and pass them on through the tiniest of manipulations to those who come to me for help.

 

How quickly Metal makes decisions

Although Wood is the element which controls decision making, it is Metal which is by the best element at making quick decisions.  It wants to make them all by itself, with no interference from anybody else. 

It is therefore a good element to give advice, because its advice is done in short, sharp sentences, and like any metal object cuts straight through to the heart of the problem

An amusing confirmation of my diagnostic skills

As many of you know, I enjoy watching sport on TV, as much for the sport itself as for being another way of observing the elements revealing themselves under stress.  And ever since I was a young child, in quarantine for 6 weeks with scarlet fever, and forced to amuse myself with the only thing available all those years ago, which was the radio (of course then called the “wireless”), I have enjoyed listening to cricket commentaries and now watching cricket on TV.  So imagine my delight when yesterday I heard a commentator describe one of the cricketers, Joe Root, who I had already diagnosed as definitely being Fire, with the words “Root is the heartbeat of the side”.

How nice to know that the elements evoke universal echoes in all of us, not just in those who learn about them as part of their acupuncture training.

If you want to see Joe Root in action, those of you who are from the cricket-loving and cricket-playing countries of the old British Commonwealth, look him up on YouTube, and you will see Fire blazing away.

 

Beware of becoming too comfortable in our work

All therapist can fall into bad habits over the years, risking becoming careless in what we do.  One such pitfall is that we may become a little bit too comfortable in our work, not challenging ourselves as much as should do.  We may start to forget that each time we see our patient we see a slightly different person who is altered by the passage of time.  The patient before us is not the same person we saw at the last treatment.  We have to understand the need to see them with fresh eyes, requiring possibly a different approach from us.

It is indeed very difficult to retain a freshness of approach to our patients if they have been coming to us for a long time.   Often we are only too pleased to welcome patients we think are doing well, because we feel they are unlikely to challenge us by presenting us with new problems.  These are patients whose treatment we assume to know in advance.  Here we can be at risk of falling into rather too well-worn a rut if we are not careful, thinking that our patients will be as they were before.  Perhaps unconsciously we ignore the possibility that they may have changed in some way, since changes require us to make more effort.  It is much easier, we may think, to continue doing what we have done so apparently satisfactorily before.

And then we may not see, or choose not to see, something in our patient which should be pointing us in a new direction.  A long- term patient of mine, whose treatment I regarded as being simple to plan ahead for, turned up for one appointment not as I expected her to be.  If I had not been alert, I could easily have overlooked the slight change I perceived in her.  She herself volunteered nothing until I probed a little more and discovered that quite a disturbing event had happened to her, which totally changed the direction of the treatment I was intending to give.  Looking back on this afterwards I realized that I had been in danger of assuming in advance that I would find her as I had done before, and might perhaps have ignored the pointer alerting me to a need to re-evaluate the treatment I was intending to give her, which was now no longer appropriate.  We must never assume that we know our patient’s needs of today, since yesterday may have changed them

 

 

Getting to know our patients

If you are going to be of any help at all to another human being, as we as acupuncturists surely hope to be, then we have to make every effort to get to know who the person is who is coming to us for help.  And getting to know somebody is certainly not as easy as it may sound.  For each of us can present different faces to the world, having learnt during our life to adapt ourselves to the different people we encounter.  The practice room represents an unknown world, and at first patients will be unsure both about the treatment being offered and the person offering this treatment.  Practitioners, too, meeting an unfamiliar person, will have their own concerns to face in adapting to what is to them also a new situation. 

All this represents different kinds of challenges.  Patients are being asked to reveal something of themselves to a stranger about whose capacity for empathy and ability to put them at their ease they are initially unsure of. They will be asking themselves whether the practitioner is a safe person to whom to show any vulnerabilities, those which all of us may wish to hide from others, but which reveal the true nature of why we are seeking help.  The practitioner, too, will be trying to adapt to the many different ways patients present themselves in the unfamiliar situation they find themselves in.

There is a great skill in helping a patient overcome their natural reticence at opening themselves up to another person.  We have to learn ways of convincing our patients that we are a safe repository for self-exposure of this kind.  We need to know what kind of a relationship with their practitioner our patients feels comfortable with, since for each person this differs.  Some, with a trust in human nature, will assume that anybody in the guise of practitioner will be worthy of this trust.  Others, at the other end of the spectrum, will take much longer and request much greater evidence from their practitioner that the practice room is a safe place before lowering their defences.

The initial encounters between patient and practitioner are therefore delicate affairs, requiring great sensitivity on the practitioner’s part to all the little signs we give out indicating where others must tread warily when they approach us.  If practitioners do not pick up such signals, we are very likely to act too clumsily and effectively silence our patient.  Here, as with all things, a knowledge of the elements comes to the practitioner’s aid.  For each element demands a different approach from us.  And as we get better and better at analyzing the complex nature of each approach, this will give us increased insight into what may well be our patient’s element.

 

 

The legacy we leave behind

Every time I go to China I am reminded of how important the Chinese regard the transmission of knowledge from generation to generation.  For there on the wall in the centre where we teach I find a photo of JR Worsley, and hanging next it one of me, then of Mei and of Guy.  Our hosts regard us as the guardians of an inheritance of traditional acupuncture which is now no longer part of the traditional medicine practised in China, and all the more lamented for its absence.  And we, as inheritors of this tradition, are therefore warmly welcomed and deeply revered.

Here in the UK, and I suspect in the West in general, it is rare for such reverence to be accorded to those, like me, who have many years’ practical experience.  I am made aware of this each time I return from China, when I compare the number of practitioners wishing to learn personally from me, a very small group now, with the many who crowd into our twice-yearly seminars in China.  What is there about us in the West that we appear to be somewhat arrogant about how much we know and somewhat indifferent to how much we really still need to learn, whilst to the Chinese the acquisition of knowledge is a much sought after privilege?

I am also increasingly worried when I notice how few five element acupuncturists there are here in the West (and by implication also therefore in the future in China) who are prepared to go out and teach what they have learnt, something I find myself repeatedly pointing out.  And here I am talking only about those acupuncturists whose five element practice is not altered by the introduction of TCM concepts, as occurs unhappily nowadays all too often.   I am also concerned about how much of what I have learnt I will in turn pass on as my own personal transmission of this legacy.  Am I doing enough myself?

I always remember what a very wise old Austrian astrologer and musician, Dr Oskar Adler, wrote.  He said that we each have a duty to leave behind for others whatever we have ourselves learnt, however small and insignificant in our own eyes this might appear.  So I am always alert to the need to encourage any who are now practising five element acupuncture to have the courage to hand on whatever they have learnt to those coming after them.  There are, unfortunately, so few who want to do this, probably because they think they have to emulate JR Worsley who would diagnose people’s elements within a few minutes of meeting them.  Most of us know that it will take much, much longer to diagnose the elements.  This has never worried me.  As JR always reminded us, “I have been doing this for more than 40 years.  You will be able to do the same when you have practised as long as I have.”

In the meantime, I try to encourage experienced five element acupuncturists to take their courage in their hands and think about teaching others.  In my case, I only dared to start doing this because I was asked to run an evening class on acupuncture.  At first I was reluctant to accept this challenge, since I had only just qualified, but as JR told me later when I discussed my doubts with him,  “Remember, you know more than they do!”.  And another tutor of mine reinforced this by telling me, “When you teach, never pretend you know more than you do.  If you are honest and say that you don’t know the answer to a student’s question, tell them so and they will respect you for that.”  I myself never believe those who always seem to find an answer to everything, whilst I do believe those who tell me they don’t know what the answer is.  These I trust for their honesty.

So to any five element acupuncturist out there keen to pass on their knowledge to those with less experience than they have, I say, “Please do so, whatever your doubts.  After all, we badly need you.”  

 

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!