How should we interpret patients’ reactions to treatment?

In her comment on my New Thoughts on Aggressive Energy blog (28 May 2010), Janet mentioned a negative reaction to an AE drain, and asked the interesting question as to whether acupuncture could cause “a sudden downturn in a patient’s underlying condition”. As usual, other people’s thoughts set me thinking, and here are some new thoughts of mine.

Any kind of treatment, from conventional medicine to psychotherapy to acupuncture, tries to change something, and, if effective, will change something for the better. But the processes of change in themselves can be disturbing, and often are, as body and soul have to adapt to a new condition, to a state of greater balance, which they are unused to, or have actually never experienced before. A return to balance is not achieved in some seamless transition from imbalance to balance, but usually through fits and starts, some of them challenging. We and our bodies are creatures of habit, and have grown used to the familiarity of imbalance over the years (and the onset of an imbalance can often be measured in years, not days or months). We may therefore find the changes necessary for balance to be restored as surprisingly difficult to deal with. Ultimately, however, they should be rewarding if we stick with it.

I cannot comment on any particular treatment, but in general terms I have found that what somebody may describe as a negative reaction to treatment may in the long run turn out to be a difficult first step on the path towards health. As practitioners, we have to have the patience to accept that all lasting change takes time. As patients, we have to have the patience to give our practitioner the time to help us. Most patients we see have been in and out of doctor’s surgeries for years before they come to us. Why, then, do we think we must be able to help them in a matter of weeks, as some of us in our over-eagerness do? I have found that patients are not in a hurry if we are not. A slow, steady, tortoise-like approach is what we should be aiming at, rather than one which hustles us into thinking that it only requires a few needles to overturn years of imbalance. This represents a hare-like approach, and we know who ultimately won the race!

Does it matter if a five element practitioner is not sure of their own element?

We can only be absolutely sure of our element if treatment focused upon it leads to the kind of profound transformation this element will show when its needs are addressed. But practical difficulties have to be faced here. Many people do not have access to a five element acupuncturist for geographical reasons. What are they to do? You can’t ask somebody in many of the 40-odd countries that I gather are now reading this blog to make their way to a five element acupuncturist if there is no-one within reach of where they live who practises this kind of acupuncture.

Depending on how determined a person is to learn, they may decide to travel to gain these insights. Others will have to make do with trying to work out for themselves what their own element is, and what the elements of their patients are. It is worth remembering here that even the great master of five element acupuncture, JR Worsley, started with a blank sheet as to his own and others’ elements, and only gradually worked his way towards his deep understanding of the presence of the elements in all of us. I would therefore hope that those who have to carry out their five element studies on their own have the courage to explore the world of the elements by themselves, trying to glean as much information from wherever they can. This is one of the reasons which has spurred me on to write this blog. Even though I cannot come to each of these 40 countries to offer in person my insights into the elements, I can at least try to work out ways of helping with some distance learning, as I am doing now.

So to all those many out there who are showing, to me, a surprising amount of interest in reading my blog, I would say, “Go to it and explore the world of the elements in any way you can. And if you dare to, and are qualified to do this, lift up a needle and work out your own way of practising. Even something as simple as the Aggressive Energy drain can transform a person’s life!”

Also, even if you think you don’t really what your own element is, at least you have the right to make an inspired guess. And, if you are a qualified acupuncturist, you can still help others. As long as you follow safe needling procedures, you can’t hurt anybody. The worst you can do is to leave the patient exactly as they were before you treated them. And remember, also, that treatment directed at any of the elements, even the ones which are not the guardian element, helps all the elements, for, as the Three Musketeers said (or in this case we can say the Five), “one for all and all for one”.

Famous people I think are Wood

These are some of the famous people I think are of the Wood element:
Margaret Thatcher
George Bush
Boris Becker
Wayne Rooney
Queen Elizabeth
Princess Anne
John Prescott
Peter Snow
Ann Widdecombe (now on Strictly Come Dancing)

As a reminder:
Colour of Wood is green
Sound of Wood’s voice is shouting
Smell of Wood is rancid
Emotion of Wood is anger (which I also call forcefulness)

Tips to look out for:
Tight tendons, visible on video-clips particularly around the lips and neck;
Tightly gripped lips, leading to mouth turning downwards. I suggest you try this out yourselves, and you will find that your whole face becomes rigid. It’s very tiring to hold this pose for more than a few seconds, unless, of course, it is natural to you because you are yourself Wood;
Forceful speech (telling others rather than just talking) with each word enunciated clearly. The voice does not have to be loud, as implied by the word shouting, but have a push behind it, even if the person is talking quietly;
A feeling of movement, or of suppressed movement, of energy either being released or waiting to be released.

There can, of course, also be what we call a lack of anger, as evidence of an absence or suppression of some of Wood's positive, outgoing qualities. In that case, the speech may best be described as a kind of whisper, which may have the effect of making the listener angry because they cannot hear it properly. It is worth remembering that each element projects out on to others the emotion it is itself most at ease with. Wood may therefore be happy to create a level of anger or irritation in others which it has been forced to suppress in itself.

How to learn to recognise the elements in the simplest way possible

I am exploring new ways of helping those who have an interest in learning about the elements. This includes not only those who want to learn how to practise five element acupuncture but those who are just interested in learning more about human nature. My own deepest learning about the elements started soon after I qualified, when I was asked to teach some evening classes, and found myself talking to a whole range of people, from plumbers to retired people to young, unemployed mothers. Looking back, I realise that in explaining what the elements represented for me, and trying to find examples of them in famous people the whole class were familiar with, I learnt to see the elements, not simply as a component of acupuncture treatment, but as one way of approaching the complexities of human behaviour. I have always felt that anybody interested in understanding more about human nature in all its amazing variety can benefit from learning about the elements, whether they then wish to extend this knowledge into the field of acupuncture or not.

So how can I best help people wanting to learn about the elements? One way is obviously to let people observe me or other five element practitioners in our practice room, so that we can point out exactly why we think that person is Wood and the other is Metal. But that possibility is only available to acupuncturists or acupuncture students, and then only to very few amongst these, as they have to live near a five element practitioner, or be happy for us to come to their practices wherever these may be. I do this on a regular basis.  For the person wishing to step for the first time inside the circle of the elements, and needing initially to study on their own for whatever reason, the simplest and, for me, still one of the most rewarding, ways of doing this is to sit yourself down in front of your computer screen and use U-tube or similar little five-minute snippets of interviews with people in the news, as a readily available, cheap and highly effective source of study.

This can be considered the first step in what I think can be called a form of distance-learning course on the elements, something which is so badly needed now. There are not enough courses anywhere in the world which concentrate the core of students’ studies on the elements. There are unfortunately many courses which offer a kind of add-on five element component which I believe does more harm than good in consigning five element acupuncture to a subsidiary or even inferior role. In doing this, they do it a great disservice, allowing students to think they have a training in the elements which they do not have.

To counteract this, and to help those who really want to study the elements in the way they deserve to be studied, I am preparing lists of famous people who in my view represent examples of each of the five elements. Obviously, since I have never personally met or treated any of these people, I cannot say for sure that I am always correct in these diagnoses-at-a-distance, but then nobody can absolutely guarantee that they have got it right, until changes brought about by treatment confirm the diagnosis.

Inevitably, I will be starting with Wood, which from many points of view can be considered the starting-point of the elements, the bud of life (although Water, the seedbed of life, is perhaps the real starting-point). This Wood list will be in my next blog.

Another lovely quote, this time about teachers

I have just read this lovely quote from Goethe.  I give it in German first, for those amongst my readers who understand German:  "Er hat gelernt, er kann uns lehren."  "Only he who has learnt can teach us." 

We can indeed only learn from those who themselves have truly learned - a rare breed, I'm afraid.  There are many people who teach who have never done their learning at the deepest level.

Nora's new blog

I have decided to start a new addition to my blog which will include examples of five element treatments taken from my practice.

Please click on the link below:
http://www.five-element-treatments.blogspot.com/

Treatment of Patient 2

Patient 2: Female, age 24
Element: Fire (Inner Fire) (Small Intestine)

Number of years coming for treatment: 4
Number of prior treatments: 36
Original main complaint: Lack of direction in life, need to sort out a complex relationship.
Time of last treatment: 3 months ago
What has changed since last treatment: Much surer about where her work is going, looking forward to new challenges in her job rather than being apprehensive about them, happy to have completely cut off from previous boyfriend.

Treatment given:
1. SI 19/Bl 1 (entry/exit block found between SI and Bl – pulses of SI and Ht very strong, those of Bl and Ki very weak). This block is very common on Inner Fire, for obvious reasons. The sorting official can become overloaded, causing energy to dam up at SI 19, and weakening the vision we all need which is provided by the first point on the Bladder, Eyes Bright. Re-opening the passage-way between the two officials by needling these points has a remarkable effect on Inner Fire’s capacity to sort out the troubles of the world.
2. SI 4, Ht 5: Source point of SI, plus the lovely point, Ht 5, Penetrating Inside, which I see as taking good SI energy deep down inside to the Heart.

At the end of treatment: Colour changed after block was cleared, she said her head felt clearer.
Time of next treatment: She will phone me if she feels she needs another treatment before Christmas.
Proposal for next treatment: Windows of the sky on SI (SI 16, Heavenly Window or SI 17, Heavenly Appearance). I like to think of SI 17 as being a little bit stronger than SI 16, as I feel it must gather up some of the energy from SI 16 as the official moves up from the side of the neck to the jaw. I therefore start by doing SI 16, and then later on in treatment move to SI 17.

Five element treatment procedures

Because I feel that not enough is written about the clinical side of a five element practice, I am going to include more details of treatment procedures in this blog from now on so that people can see how I approach treatment.

For those interested in learning more, my Handbook of Five Element Practice is a good place to start.

How to approach long-term five element treatment

Many people appear to be puzzled by what they see as the problem of what treatments to give a long-term patient, that is, somebody who returns to us for treatment over many years.

I think this worry is quite unnecessary, because it comes from the mistaken feeling that we need constantly to ring the changes in the points we select. Such a feeling is based on uncertainty and a lack of understanding about what we are doing. We can, I hope, rightly, assume that with long-term patients we have by this time worked out their guardian element, and therefore which element we direct most of our treatment towards. Why, then, do some of us think that it is not enough merely to continue treating this element in the way we have in the past, and in the way that has, presumably, led to the good results which persuade a patient to keep on wanting to come to us year on year? Why not simply repeat the cycle of treatments in some form or other, not necessarily each time using the same points, which have in the past led to such a successful outcome that the patient thinks it good to return to us for more?

To help the many people who have asked me to solve what to them is a problem, and to me appears the simplest part of treatment, I have gone through the files of patients of mine who have been coming to me for treatment for some considerable time, in the cases I selected, from 6 to more than 15 years, looking for examples of treatments for all five elements. I have then listed the treatments I have given them over the past 3 years. People to whom I have given these lists have told me how surprised they are to see how simple my treatments are. If they were to see these patients, I think they would also think how effective these treatments have proved to be.

The elements which have received all these years of treatments, initially as frequently as once or more a week, now as infrequently as a few times a year, are now so attuned to receiving the support offered them by the needle that they need only the slightest nudge to help them back along the path to balance. If, as does of course happen, life deals a patient some heavy blow, then treatment may for a while become more frequent and more intense again, for example if a Husband/Wife imbalance or Aggressive Energy appear, but again the patient’s energy will take a surprisingly short time to re-balance itself compared with similar events happening to a patient in the early stages of treatment.

It is indeed always surprising and heartening for me to observe how somebody who returns to me after an absence of a few years may require just one or two treatments to get them back on track, even though the gap since the last treatment has been so long. It is a sign that the elements have long memories, respond very quickly to the familiar feeling of energy re-charging itself in treatment and yearn to regain balance as quickly as they can.

I hope these lists will help those who are unnecessarily worried about the whole question of long-term treatment, and confirm my firmly-held conviction that, in acupuncture, as well as in many things in life, “less is more”, a term I heard an Indian histrorian using on the radio this week. So simplicity, and thus the least number of needles for the least number of treatments, is what we must always aim at. It is quite clear to me that those who know what they are doing, in whatever field they are working, and here in the field of acupuncture, always do less than those who don’t, and always do it more effectively.

Anybody wishing to have my list of points for long-term treatment can now download the relevant PDF from the SOFEA website, www.sofea.co.uk, under Stop Press.

Examples of five element treatments from my practice: Treatment 1 of Patient 1

Because it is useful for those reading this blog to have a practical example of the kind of treatments a five element acupuncturist does, I give below one such treatment, to which I will add as I come across treatments which I think will be of interest. For obvious reasons, all personal details have been changed, but the actual points and the reasons for choosing them have not.

For anybody unfamiliar with five element protocol, my book The Handbook of Five Element Practice describes five element treatment procedures in detail.

Since five element acupuncture has always used the term Heart Protector for what others now call the Pericardium official, I am continuing to do so by abbreviating it to HP, rather than P. We also use Conception and Governor Vessels (CV and GV) for Ren Mai and Du Mai. I have coined the phrases Inner and Outer Fire to describe the two quite distinct sides of the Fire element, the Small Intestine and Heart (Inner Fire) and the Three Heater and Heart Protector (Outer Fire).

We also always apply small moxa cones to each point before we needle, except where contraindicated, and the number of moxa cones is that listed in J R Worsley's Point Reference Guide.

Treatment 30 Sept 2010

Patient: Female, aged 42 (to be called Patient 1)

Element: Fire (Outer Fire) (initial diagnosis only – to be confirmed or changed as treatment progresses)

Number of prior treatments: None. This was the first treatment by me after she was passed on to me by another practitioner, who had been treating her for 5 treatments.

Main complaint: Panic attacks, depression, painful shoulder and hips, bad sleep. A history of under-achievement, usually apparently self-induced: failing her final university degree by not working in last year, even though she sailed through the first two years, giving up on being a tennis player just as she was about to make the county team as a teenager. The really deep-lying problems lay, as they always do, in early childhood, because her mother had alcohol-problems and her father disappeared. She has never married and is in an on-off relationship with a married man.

Treatment given:
The physical examination was done during the initial Traditional Diagnosis (TD) the week before: BP (normal), Centre Pulse (in the centre), Akabane tests (any that were out were corrected).
1 Checked for Possession: Not found
2 Aggressive Energy (AE) drain: AE found on HP and H. Drain took 1 hour.
3 Checked for Husband-Wife (H/W) imbalance (which I had thought might be there, because of the great imbalance between left and right pulses and her desperation): Not found
4 Source points of Fire (Outer Fire): TH 4, HP 7 (tonification without moxibustion)

At the end of treatment:
She looked calmer, and less agitated after treatment. But only time and more treatment will tell if she is Fire, and, if so, which side of Fire, Inner (SI and H) or Outer, TH and HP).

Things to look out for next time:
1 Re-check for the possible presence of H/W imbalance, which can appear once the AE drain has helped the patient’s mask to drop.
2 Check for the appearance of any Entry/Exit blocks (to be checked at each treatment, as they can appear at any point, a good sign that good energy is trying to push its way through the meridian system, and causing a slight overload at some point).

Suggestions for next treatment:
1 CV 8 (no needling, but 3 moxa cones on salt) – a balancing,
reinforcing point for the spirit on CV.
2 Source or tonification points (i.e., from Wood (mother) - Fire (child),
TH 3, HP 9 with 3 moxa cones, or transfer from another element to Fire, depending on pulse picture found.