The Five Element Acupuncture Handbook

The

Five Element Acupuncture Handbook SecondEdition

SharonM. Smith,L.Ac., Dipl.Ac.(NCCAOM) Illustrations by BarbaraDonelan

Acknowledgments ideas' I As with most major projects,thisbook is the productof manypeople'senergyand Grissmer'Haig thank my many teacheis.nobert Duggan,Dianne Connelly,Jack Daniel,..Jane and Cyrie Ignatius,Zoe Brenner,Erica Lazaro,JuliaMeasures,PeterMarinakis,Leslie Shapero for the first Barnes.EdnaBrandtgavemehernotesandgraciouslysupportedmeasI taughttheory tlme. this handbook The studentswho taught me over the yearswere a major influenceo|Jh: way and what could be was put together. They made many valuablesuggestionsabout what they liked fortunate to be with improved t-o make the material more helpful to ttrem as learners. I am so students. Barbara Rise Two studentswere especiallyinvaluableto the production of this handbook. and clarity to the Donelan made the information come alive. Her editing skills gave consistency to her for her grateful words. Her graphics added anotherdimensionto the material. I am deeply Element Acupuncture' dedication and skills and for the many interesting conversationsabout Five She is truly a marvel. asked great I also want to thank AlexandraKnox who stepped in for the final editing; she the material' The questions,researchedsources and made suggestionsfor further clarification of look- I appreciateher subtle changesshe made in fonts and layout gave the handbook a fresh new generousgifts of her time and talents. as the Worsley I deeply appreciate that J. R. Worsley brought the information together Tradition of Five Eiement Acupuncture. Thank you Professor Worsley' seemingly My husband John deservesa million kisses and hugs for his support as I spent endlesshours at the computer - hours I could have spent with him.

Introduction the clearerit is to methat therearemanywaysto reachthe ThemoreI studyacupuncture, sametherapeuticend. The method reflectedin this handbookis derived primarily from J.R. There alsoknownasleamingtonAcupuncture. Acupuncture, ofFiveElement Worsley'sformulation are other types of Five ElementAcupuncture,notably Meridian Therapy as developedby the Japanese. EnergeticBlocks,and PointClassificatiorq Concepts, Thehandbookconsistsoffour sections: in a brief, fashion.Ideasarepresented in snapshot TreatmentTechniques.Eachsectionis presented discussion. presentation and classroom un-elaboratedstyle and are then expandedupon during Studentsareinvitedto addtheir own notesto thesepages. Thishandbookexplainsa sliceofWorsleyFiveElementAcupuncture.Thetheorypresented is in realityjust oneof the waysthat Five ElementAcupuncturehasbeentaughtat the Traditional AcupunctureInstitutein Columbia,Maryland.Overtheyears,practitionershavecreatedvariations on Worsley'soriginalmaterial. Despitesuchvariations,the primary body of informationin this tradition hasheld constant. It is my intentionin this handbookto presentthe centraltheoretical frameworkfor basicenergeticconceptsandtreatment,ratherthanthe details. Someof theinformationincludedis not from Worsley'sFiveElementtraditioq for example, the Over-ControllingandViolation Cycles,andthe TransportingPoints.Suchconceptsarewidely usedby bothFive Elementandpractitionersof othertraditionsandstyles. Theyarehigtrlyvaluable in understandingenergetics,and give Five Element practitionersa broader vocabulary for conversation.Any materialthat is outsidethe boundariesof Worsley'sFive ElementAcupuncture will be notedas such. theory is to providea coherent The majorbenefitof this handbookon acupuncture patients. Theoryhelpsus organizeour patholory,andfor treating energetics, basisfor understanding ofpatients,developtreatmentplans,andgenerallyprovidesa frameby whichto structure observation our practic. of urupnncture.Theoryis simplythe body of knowledgeand principlesderivedfrom astuteobservationandextensiveclinicalexperience. Llltimately,this handbookis intendedto serveas a referenceand guidefor students.The who taughtme informationin this handbookis the combinedknowledgeof my manyteachers-those whenI wasa studentandthosewho continueto teachme. It is my hopethat this acquiredwisdom will enrichthe practiceof all my students. SherrySmith Columbia,Maryland July, 1998

Table of Contents lll

lntroduction

Acknowledsments Five ElementAcupuncture. a J

Concepts ShengCycle

5 6 7 8 9 l0 11 t2 13 l4 14 l6

Law of Mother/Child Ke Cycle

ChengCycle Wu Cycle Law of Midday/Ivlidnight Law ofleast Action Law of Cure . . .

Law ofHusband/Wife CausativeFactor Level of Treatment . . .

Causesof Disease Point Classification Types ofPoints Command Points

SourcePoints Xi Cleft Points EntrvlExit Points ConceptionVesselandGovernorVessel AssociatedEffect Points(AEPs) Front Mu Points UpperKidneyPoints OuterBladderLine Points Influential Points TransportingPoints Windowsofthe Slcy. . . . . . ReunionPoints ForbiddenPoints First Aid Points

t9 2l 22 28 30 3l

32 35 36 37 39 4l 42 45 46

47 49

Energetic Blocks

Blocks vll

EnergeticBlocks con't: InternalDragonsandExternal Dragons AggressiveEnergY Block Husband/Wife UmbilicalPulse

5l 54 57 60 6l 63

Akabane Quality on the Pulses

CV/GV Block Entry/Exit SpiritBlock

65

67

TreatmentTechniques Tonificationand Sedation

70 72 74

Needle Technique

Moxibustion.. . . Transfers Readings What is Five-ElementAcupuncture? FromLeamingtonAcupunctureto TCM andBack Again Factor:A Forum Causative CausativeFactor Why Do PeopleGet Sick? The ChineseView F i v e E l e me n tT re a tme n tPr inciples.... TheParadoxofParadigmsandPoints asMetaPhor Possession ClinicalNote: The Mystery of AggressiveEnergy MoxaStickUsage... ForbiddenPoints MeridianNamesandAbbreviations

""'81 " " 83 ' ' ' 97 " " 103 " 109 ' ' ' ' ' 115 ' "" l 2l " " " 123 ' ' 127 ' ' 133 "'135 ' ' 137 ' ' ' 139

r4l

Index

vllr

l

Five ElementAcupuncture FiveElementAcupunctureris basedon nature. The Chineseobservedthe cyclesof nature in the rhythmsof dayandnight,andin the movementof all asthey arereflectedin the seasons, living thingsthroughbirth, growth, declineanddeath.Humanbeings,aspart of nature,are governedby the samelaws. a The five elementsarewood, fire, eartlqmetal,andwater. Eachelementrepresents with each seasonin nature'scycleanda phaseof a person'senergy.Themeridiansassociated job in orderfor the elementarelikenedio * Official of a kingdom. EachOfficialmustdo its of the person'senergymust kingdomto prosper.Likewisein eachpersonthe variousaspects functionwell for the personto enjoygoodhealth. WhenoneOfficialbecomesunableto do its job, otherOfficialsmust stepin to fulfill thosefunctions.Five ElementAcupunctureseeksto strengthenand supportthe person'senergyso that all Officialsin the kingdomfunctionwell. of the five elementsis important. Eachelementaffectsandis The inter-relationships affectedby all the others. In a person,the dynamicsamongthe elementsare observedin orderto understandhow bestto treat a patientwith acupuncture. Emphasisis placedon the with a setof correspondences. Eachelementis associated by areobserved ofcolor, sound,odor,andemotion.Thesecorrespondences correspondences person. in the seeing asking,feelingandsmellingin orderto discernthe stateof the elements The personcanthenbe treatedaccordingly. The roots of the traditionofFive ElementAcupuncturego backto ancientChina.Using theseroots alongwith informationfrom othersources,Dr. J. R. Worsleyof LeamingtonSpa, asit is taughttoday-2Later the informationinto a systemof acupuncture England,synthesized generationsof practitionerscontinueto addto the body of knowledgethroughtheir own in the treatmentroom. experiences

I

See "What is Five Elerneot Acupuncture?" page 83, aad "From Lramington Acupuncture to TCM and Back Agairl" page97'

2

For detailed information, see Eckmaru Peter, In lhe Footsteps of lhe Yellow Empetor. Cypress Book Company, 1996-

ShengCycle Generatingcycle or Creative cycle

Definition Everything that exists, from a single cell to planet Earth, goes through its own cycle of birth, maturity, decline, and death. This is a cycle of creation; there is no beginning and no end. At any given moment everything is in a stageof the Shengor creation cycle. The cycle can be observed in u -orn.nq in a lifetime, and in all periods of time in between. With the five elements,each elementis generatedby the precedingelement.Water generatesWood, Wood generatesFire, and so forth. Characteristics Energy moves in a clockwise direction on the cycleThe Qi3 moving in the Sheng cycle is alwaysin motion. The flow of movement in this cycle is from Yin Official to Yin Official and Yang Official to Yang Official. The Qi in this cycle is sharedby pairedmeridians. Wood : growth Wood createsFire Fire = maximal growth Fire createsEarth Earth : balance Earth createsMetal Metal : decline Metal createsWater Water : maximal decline Water createsWood

Clinical Significance Explainshow the Qi flows, essentialto both diagnosisand treatment planning. Provides a pattern with which to direct the flow of Qi in the patient.

'

Qi is often lranslated from the Chinese as "enerry."

Law of Mother/Child

Definition

I

The law of Mother/Child is a relationship that perpetuatesthe Sheng cycle. That is, the mother generatesthe child. Each of the five elements,Water, Wood, Fire, Earth, and Metal, is generatedby the elementthat precedesit. Thus, each elementis the Mother of the succeedingelement. The succeeding elementis the Child element.

Characteristics Symptomsmay show up in the Mother and/or the Child. Pathologt occurs when one or both Mother and/or Child are out of balance. An excessiveMother will causejust as much trouble as a deficient Mother. A strong Child may be well even though the Mother is out of balance. A Child that is sick for a very long time will eventuallydepletethe Mother. A healthyMother and Child reinforce each other.

Clinical Significance In diagnosis,to discern the health of the Mother and Child. If an imbalanceoccurs in an element,the Mother and the Child4 of that element may also be unbalanced. Treating the Mother may help the Child. Treating the Child may help the Mother.

o

Not" th"l "Motte/' and "Child" are relative teros. For exa.nrple: (1) The relatiorship of two elements: Fire is the Mother of Earth aod Earth is the Child of Fire. (2) The relationship of tbree elernents: Fire is the Mother of Earth and Metal is the Child of Earth

Ke Cycle Controlcvcle

Definition The Kes cycle prevents the Shengcycle from getting out of control. The Grandmother controls the Child's growth. Characteristics The Ke cycle exists simultaneouslywith the Shengcycle. Patholog occurs when the Child's growth is over-controlled (Cheng qtcle, page 8/ or uncontrolled (Wu cycle, page 9). Either one is as harmful as no growth at all. Energy moves only from Yin Official to Yin Official on the Ke cycle. Ke cycle pathways do not generatetheir own energy.

Metaphorically:

Earth guidesWater Water coolsFire Fire warmsMetal Metal prunesWood Wood holdsEarth

Clinical Significance To discernthe influence of the Grandmother on the Child. The paths of the Ke cycle can be used to transfer energy from one Yin Official to another Yin Official.

5

AJ"o "K'o" in the Wade Giles rraosfiteration-

Law of MiddaYlVlidnight Definition two-hour time period Each meridian'senergyflow is highestand functioning optimally during a These eachday. Conversely,its energyflow is lowest during the oppositetime of day. two hour time periodsare illustratedon the ChineseClock.s During the high phase,the Official is most accessible' During the low phase,the Official is least accessible' Characteristics Providesa guide to observedaily cycles'standard' time. The time periods are expressedin sun or Clinical Significance In diagnosis,this is the time when a patientmay feel best or worst. This law may be used as a guide to set daily rhythms in one'slife. The Horary pointe is used during the high phaseto accessthe official. In praaice, the first paired meridian may be treated at the end of its high phase, and the second paired meridian at the beginning of its high phase.

| 2 3 a t 6f

a lrorrlar

Pm

2 t /1 5 5 I t Sr0lll2

am

Treat the Btadder/Ill lvleridian just before5PM sun time and sun time. the Kidney/TVMeridian just after 5P1s.f

8

The time periods are shown by the Chinese clock in the ceoter of the Worsley Five Elenrent chart

9

Horuy means..hourly."

See page 24 for discwion

of time and sonal

t0

usge of Horary points.

Law of LeastAction Definition Do aslittle aspossibleto initiatethe desiredeffect. andwork within naturallaws. Qive simple,clear,direct messages Characteristics to awakenthe profoundnaturalselfEffectivetreatmentprovidesall the stimulationnecessary healingpowers of the body/mind/spiritand supportsself-healing;doesnot do the healing' Practitionerencourages Clinical Significance A simpletreatmentmakesclearthe specificeffect of a treatment. In practice,take into account: CausativeFactor (CF)to Level of treatment:body/mind/spirit Time of day Time ofyear

l0

So p"g" 14 for a discussion of Causative Factor.

ll

Law of Cure Definition processes. The Law of Curetr describesthe order and precedenceof the natural healing According to the principle of Law of Cure, healing occurs: . in reverse chronological order, from most recent to oldest 'from aboveto below . from within to without . from most important organ to least important organ Characteristics To identify the Law of Cure after acupuncturetreatments: Law of Cure usually occurs within 24 to 48 hours after treatment. It usually lasts no longer than 72 hours.12If it's longer, it is not the Law of Cure. Note: Skin reactions may persist longer. The patieni has experiencedthe problem before. If the problem is something new, it's not Law of Cure. The Law of Cure can show up as an emotional catharsis.Ask how the patient is doing in herself. If the patient reports feeling better inside, and the reaction does not threaten the patient's weil-bling, let it run its course. When in doubt, give the patient appropriate directives toward other treatment modalities. Healing can begin on any level: body, mind, or spirit. The patient may experiencefurther recurrencesof the Law of Cure until all possible healing has taken place. Clinical Significance The Law of Cure in action indicates effective treatmentAllows the practitioner to distinguish effective treatment from a new illness or an adversereaction to treatment.

II American edilion of Co*tuotio" Hering ( 1800 - I S80), a German physicia4 first mentioned tbe phe,romenon in his introduction to the first ..Chronic Diseases" vAere le zuggjea thaf ne oUservea certain thingF happening as cure developed The most i'oteresting was a cutaneous eruptioo at are simple observations' rbe end of a long cure of ctuolric?isease. Tbe most certain patt€f,n he saw was tbe "reverse rder." All tle other patterns 12 Homeopalbs do Dot use lhis time Farne; law of Cure can go on for weeks or months.

L2

Law of HusbandAilife Definition Pulsesof the Officialson the left side belongto the Husband. Pulsesof the Officials on the right sidebelongto the Wife. proper balanceoccurs when the pulseson the left side are slightly stronger in quality and quantity than the pulses on the right side. Characteristics

On the left side: Sorter(SI) SupremeController(HT) DecisionMaker (GB) Planner(LR)

Left Side

will (Kr)

SI GB BL

On the right side: Receiver (LI-J") Eliminator (LI) Processor(ST) Transporter(SP) Heart Protector @C)

HT LR KI

Right Side

LU SP PC

LI ST TE

Pathologt existswhenthe right sidepulsesare strongerthanthe left sidepulses. Pulsequantityandqualitymay be out of balance. Clinical Significance whenthe right sideis strongern quolity and quantity thantheleft The pulsesareunbalanced side. imbalanceindicatesa seriouscondition;it showsthat the patienthasgivenup A Husband/TVife controlof the directionof his/herlife; thereis a lack of movement. Whenpresent,a Husband/Wifeimbalancemayblock the cleardiscernmentof CFt3. Requireshigh-prioritytreatmentattention.

13

For a discussionofCF, seepage 14.

t3

CausativeFactor the concept in a The idea of CausativeFactor (CF)tn is a dynamic concept. Most practitioners use as the diagnosed highly personal way. One practitioner may treat only the elementthat has been for observing a patient's CF. Another might apply - itr. id"u of CF loosely, using it as a basis clear about energy in the moment. ivh"n having a conversationabout CF, both people have to be eachone's working definition. Definition CF is a term used in Worsley Five Element Acupuncture. It has beenunderstood as: . . .

The root problem or imbalance.One elementis the root causeof imbalance; A person's constitution, where an individual is designatedto be of one elementaltyPe; The central focus for treatment. This would be the elementthat has the greatest positive imPact on the Patient'

Characteristics May arise when a patient's energy cannot fully recover from the impact of congenital, constitutional, or emotional factors. It can also develop from physical trauma or illness. Where the most slgns- color, emotion, sound and /or odor - correspond to a given element. That element is determinedto be the CF. @xample: yellow color, singng voice and fragrant odor would classify a patient as an Earth CF). Reflects the interplay of energetic dynamics and phenomenain a person. A place of personalstruggle as well as a place of outward accomplishment. Clinical Significance

CF is the elementthroughwhich the patientreceivesthe most supportand makesthe most improvements. Treatingthe CF will affectall the other Officials. Treatingthe CF changesall the pulsesexceptsometimesthe CF itself. Experiencedpractitionersreport that one majorpoint of treatment(that is, one element)is clearin only aboutone-thirdof their patients.In anotherthird, two elementshave of impact. In the rest of their patients,the phenomena equalor indistinguishable two even pin one or to to the individualandhis or her symptomsaretoo complex elements.

lasee

"Carrsative Fac{or: AForunr," page 103, and "In Response'..Calsative Factor," page 109

l4

Causesof Disease Definition influences' Diseaset5reflectsthe bodyimind/spirit'sresponseto pathogenic world and to its own inner outside the to The body/mind/spirit has an equilibrium in ielation world: without equilibrium,diseaseoccurs' pathogensand keep the balancein Anti-pathogenic Qi, or Upright Qi, is the body's ability to fight of the pathogen and the antithe body. The practitioner needsto considerihe relative strength pathogenicQi (Diagram 1).

Diagram I pathogenic influence Diseasecan occur when the balancebetweenthe anti-pathogenicQi and the external changes or breaks down. Either the body is not sufficiently strong to adapt to internal

(Diagram2):

Diagram 2 3) or the external or internal influencesare too powerful for the body to adapt @iagram

Diagram 3 or a combination of both a weak anti-pathogenicQi and strong pathogen occurs'

t5

S"" "Why Do People Get Sick? A ChineseView," page I 15

16

Annut *|,esc--

Internal Causesof Disease:The Emotions Joy Anger Sadness Grief Worry, pensiveness Fear Fright 4 za+e- N-(

External Causesof Disease:Climate n Eat;lL

Wind Cold Fire - Heat Dryness SummerHeat Damp The abovecanbe combined;for example:wind-cold,damp-heat,etc.

MiscellaneousCausesof Disease Constitutio4 heredity Traum4 injury, surgery poisons,ePidemics Parasites, Wrong treatment Lifestyle Overwork, fatigue Underwork Sex Diet

Clinical Significance Knowing the causeof diseasewill influencethe choiceof treatment. Knowing the causeof diseaseallowsfor effectivepatienteducationto a particularcauseof disease' A patient'sCF maymakehim/hermore susoeptible Causeof diseaseis not the CF.

T7

Typesof Points Commandpoints: . Elementpoints: Horary Points TonificationPoints SedationPoints . Junctionpoints Sourcepoints Xi Cleft or AccumulationPoints EntrylExit points ConceptionVessel GovernorVessel AssociatedEffectPoints(AEPs) or Back Shupoints Front Mu or Alarm Points UpperKidneyor Spirit Points OuterBladderLine Points Influential or GatheringPoints Transportingpoints: ' JinBWell Points ' Ying SPringPoints . ShuStreampoints ' JingRiver points . He Seapoints . Lower Uniting points Windowsofthe Sky Reunionor CrossingPoints Forbiddenpoints First Aid pointsr5

16 The above list is not all-inclusive.

2l

ElementPoints Definition elements' Command points on the meridiansthat representeach of the five Characteristics Include horary, tonificatiorq and sedationpoints' the Shengcycle Their order on the meridiansand the body is distal to proximal and follows

on thei"*T:::tans.

tu'fln il -r f a-IvxFs Wood-+Fire-+ Earth-+ Metal Water. (So'trce

-+ Water -+ Wood -+ Fire + Earth. On the Yang meridians: Metal Clinical Significance

The nature or energy of each elementbecomesaccessibleat thesepoints' Ke cycles' Used to transfer .nogy from one elementto another following the Sheng and

23

.

(3oorcet4x'ts &tlq''' C'ob {

Horary Points Definition to its elementwhenusedaccordingto the Law of Thepointon eachmeridianthat correspond MiddayAvlidnightor in the seasonof the element. Example:the Wood point on the Gall BladdermeridiaqGB 4l from l lPM to lAM andlor duringthe spring.Seethe point tablebelow. Characteristics duringits horarytime. Powerfi.rlbecausethe energyof a meridianis moreaccessible Are not assafeas sourcepoints. Theytreatthe Officialswithout transferringenergyfrom or to anothermeridian. Clinical Significance time. Usedto treat the meridianat its most accessible seasorLcarriesan enhancedeffect. Whenusedin its corresponding treatments. Canbe usedalonefor seasonal Are generallytoffied but canbe sedated. Points Metal. Earth: Fire: Water: Fire. Wood:

LU8 LI 1 S T3 6 SP3 Fil8 SI5 BL 66 KI 10 PC8 TE6 GB 4I LRI

MeridianGutter MerchantYang Leg ThreeMiles SupremeWhite LesserPalace Yang Valley PenetratingValley Yin Valley Palaceof Weariness BranchDitch Foot AboveTears GreatEsteem

24

3AM-5AN4 5AM-7ANd 7AM-9ANd 9 Alvl - ll AM IIAM-IPM IPM-3PM 3PM-5PM 5PM-7PM 7PM.9PM 9PM-IlPM llPM-1AI{ lANd-3AM

TonificationPoints Definition The elementpoint of theprecedingelementon the Shengcycle,i.e.,the Mother point in the Child. For example,the Wood point on a Fire Official' Characteristics Canbe usedasa tonificationpoint only whentheMother hasrelatively moreenergythanthe child. Moves enerry by pulling or calling the energyfrom the Mother to the ChildTransfersylnto yin andyangto yang on the Shengcycle:

Clinical Significance Use of a tonification point requires understandingof the Law of Mother/Child. Fostersthe natural movement of the Shengcycle. Points

LU9 LI I1 ST4 I SP2 HT9 SI3 BL 67 KT7 PC9 TE3 GB 43 LR8

Very GreatAbyss CrookedPond ReleasedStream GreatCapital Little RushingIn Back Ravine Extremity of Yin ReturningCurrent RushingInto the Mddle Middle Islet Valiant Stream CrookedSpring

25

SedationPoints Definition The elementpoint of thefollowing elementon the Shengcycle, i.e., the Child point in the Mother. For example,a Fire point on a Wood Official. Characteristics Can be used as a sedation point only when the Mother hasrelatively more energy than the Child. Moves energy by dispersing or pushingthe energyfrom the Mother to the Child. Is not as direct a statementto the energy as the tonification point. Is more likely to be used when the quality or quantity of the Mother's energy is excessive. Clinical Significance Use of a sedation point requires understandingof the Law of Mother/Child. Fosters the natural movement of the Shengcycle.

Points LU5 LI2 ST 45 SP5 IlT7 SI 8 BL 65 KII PC7 TE 10 GB 38 LR2

OutsideMarsh SecondInterval Hard Bargain MerchantMound Spirit Gate SmallSea BoneBinder BubblingSpring GreatMound HeavenlyWell Yang Support Walk Between

26

Junction Points Luo or ConnectingPoints Definition points that connectandmove energybetweenthe yin andyangmeridianswithin an element. Part of a networkof connectingchannels. Characteristics Typicallythejunction point on the relativelymore deficientmeridianis tonified. meridianmaybe dispersed. thejunction point of the relativelymoreexcessive If necessary, Clinical Significance Usedto balancethe energybetweenpairedmeridians. Usedto treatAkabaneimbalances. Canbe usedat the end of a transferwhenthe pairedmeridiansare not in balancewith one another. x Car be usedwith the sourcepoint to reinforceits action. Points ' LIJ 7 LI6 ST 40 ' SP4 ' IfT 5 ' SI 7 BL 58 ' KI4 PC 6 ' TE 5 GB 37 . LR 5

'

Narrow Defile SidePassage AbundantSplendor Prince'sGrandson PenetratingInside Upright Branch Fly and Scatter GreatBell Inner FrontierGate Outer Frontier Gate Bright andClear InsectDitch

27

SourcePoints Yuan SourcePoints

Definition Points that contain the Source Qi, called Yuan Qi or Original Qi which comes from the KidneysSourceQi can be accessedfrom thesepoints.

Characteristics Are safe, simple, gentle, and powerfi.rl. Do not transfer energy. Are self-regulating. Can be tonified or dispersed. Can be used for their spirit.

Clinical Significance A treatment using sourcepoints is often the first CF treatment on a patient. Source points have far-reachingand longJasting effects. Often used to clear qualities on the pulses. Used to steady or ground a body point or spirit point, or to supplementa treatment.

Location On the Yin Meridians, thesepoints correspond to the Earth points. On the Yang Meridians, these points corespond to the points immediately proximal to the Wood points. For example, on the Bladder meridiaq BL 65 is the Wood point; the point immediately proximal to it is BL 64, which is the source point. On the Large Intestine meridiarq the Wood point is LI 3; the point immediately proximal to it, LI 4, is the source point.

28

Xi Cleft Points AccumulationPoints Definition The Chinesecharactermeansa cleft or fissure. Characteristics PlaceswhereQi andBloodrTconvergeand accumulate. Clinical Significance Oftenusedwhen an acutesituationarises. May alsobe usefulfor severeor persistentailments. for diagnosticpurposes. Canbepalpatedfor tenderness

Points LIJ 6 Ll7 ST 34 SP 8 IIf 6 SI 6 BL 63 KI 5 PC 4 TE7 GB 36 LR 6

GreatestHole Warm Current BeamMound Earth Motivator Yin Mound Nourishingthe Old GoldenGate Water Spring Gateof Qi Reserve Assemblyof Ancestors OuterMound Mddle Capital

17Iochioo",xur.

30

Entry/ExitPoints Definition Entry points are where the energy enters the meridian. Exit points are where the energy leavesthe meridian. Characteristics Connectthe meridiansin the sequenceof the Chineseclockr8- different from the Shengcycle flow. Entry and exit points are not always the first and last points on a meridian. Usually tonified. Clinical Significance Used to break blocks from one meridian to Example: SI to BL KI to PC TE to GB May be usedto clear a meridian.

the next, specifically from one element to the next. LR to LU

LI to ST SPto HT

Points Entry

LU I LI4 ST I SP I HT I SI I BL 1 KI 1 PC I d PCz? TE I GB I LR I CV I GV I

18

Middle Palace Joiningofthe Valleys ReceiveTears RetiredWhite Utmost Source Little Marsh EyesBright BubblingSpring HeavenlyPond HeavenlySpring Rushingthe FrontierGate Orbit Bone GreatEsteem Meetingof Yin Long Strength

Exit LU 7 LI20 ST 42 SP2l HT 9 SI 19 BL 67 Kl22 PC 8

Narrow Defile WelcomeFragrance RushingYang GreatEnveloping Little RushingIn ListeningPalace Extremity of Yin Walkingon the Verandah PalaceofWeariness

TE22 GB 4l LR 14 CV 24 GV 28

HarmonyBone Foot Above Tears GateofHope ReceivingFluid Mouth Crossing

S"" pug" l0 for discussionofChinese clock

3l

ConceptionVesseland Governor Vessel Definition Along with the otherextraordinarymeridians,the Conception(CV) andGovernorVessels(GV)'n act asreservoirsfor the mainchannels,which arelike rivers.CV andGV derivetheir energyfrom the Kidneys. Along with the PenetratingVessel,CV andGVare Anterior Heavenor pre-birthreservoirsof Qi. cyclesof womenand They circulateWei Qi or DefensiveQi andregulatethe seven-year the eight-yearcyclesof men.

Characteristics Often usedfor their spirit andtheir locationin anatomicalareasor in proximityto corresponding organs. Two of the eight extraordinarymeridians. Unlike other extraordinarymeridians,they eachhavetheir own points. May be usedfor their pointsalonewithout regardto their useasan extraordinarymeridian. To accessthe functionsof CV andGV asextraordinarymeridians,masterandcouplepointsmust be used.

Clinical Significance Reinforce treatment on the twelve meridians. Used for their spiritual connotation. May be used to 1:reata particular jiao or area of the body. Treat at a deep constitutional level.

re

Io chino".

R en Mai andDu Mai .

32

ConceptionVessel RenMo, RenMai, DirectingVessel,or Seaof Yin Channels

Definition This meridianrunsup the anteriormidlineof the body. Nourishesyin energy,includingthe reproductivesystem. Regulatesthe uterusandblood in women' Moves Qi in the lower burnerandthe uterus. Influencesall burners. Characteristics Has to do with receptivity. Is relativelymoreyin thanthe GovernorVessel. Associatedwith Earth asopposedto Heaven. Clinical Significance May be usedasa spirit treatment. Areasof influence:abdomerqthorax,lungs,throat, andface. Treatson a deepconstitutionallevel.

33

Governor Vessel Du Mo, Du Mai, GoverningVessel,or Seaof YangChannels

Definition This merridianrunsup the posteriormidlineof the body, over the headandendsat the upper gum line. TonifiesKidney yang and strengthensthe back. ExpelsWind. Nourishesthe spineandthe brain. the mentalandphysicallevelsof energyif they arelow or depleted. Strengthens Characteristics Is relativelymoreyangthan ConceptionVessel. with activity anddirection. Is associated with Heaven. Is associated Holdsthingsup. Clinical Significance Hasto do with standingupright. May be usedas a spirit treatment. Areasof influence:baclg spine,backof neckandhead. In women,is usuallycombinedwith CV. Treatson a deepconstitutionallevel.

34

AssociatedEffect Points(AEPs) Back ShuPoints,or Back TransportingPoints

Definition directlywith an Official. Pointson the backusedto communicate directly. Wherethe Qi of the Zang (solid organs)andthe Fu (hollow organs)canbe accessed The Chinesecharacterfor Shumeans"to transport." an-rttne(

characteristics

Bl,{der

lrht

Strongandpowerfulpoints. Generallyusedwith a sourcepoint. Relativelyyang in nature,but usedto treatyrn aswell. Influencethe expansive,activefunctionsof an Official. Clinical Significance Use only after determininga patient'sCF. Usewhentreatmentis not holdingor moving. Use in acuteor chronicsituations,but mostlychronic. May be palpatedfor tenderness. ShuandMu pointsmaybe combinedin treatment. Points BL 13 BL 14 BL 15 BL 16 BL 17 BL 18 BL 19 BL 20 BLzl BL 22 BL23 BL 24 BL 25 BL26 BL 27 BL 28 BL 29 BL 30

Lung Correspondence PericardiumCorresPondence HeartCorrespondence GovernorVesselCorrespondence DiaphragmCorrespondence Liver Correspondence GallbladderCorresPondence SpleenCorrespondence StomachCorrespondence ThreeHeaterCorrespondence Kidney Correspondence Seaof Qi Correspondence Large IntestineCorrespondence Orig" PassCorrespondence SmallIntestineCorrespondence BladderCorrespondence Mddle of the BackboneCorrespondence WhiteRingCorrespondence 35

Front Mu Points Front CollectingPointsor AlarmPointswhenuseddiagnostically Definition Where the structiveto energy of the Official is expressed. Points on the abdomenthat complementthe Back Shu points. The Chinesecharacter means"to collect." Characteristics Are found close to the corresponding organ. Are relatively yrn in nature. Fu organsare responsiveto Mu points. Clinical Significance Useful diagnostically. Used to treat an organ and local area around the organ. Mu and Shu points may be combined in treatment.

Point

Corresponding Oflicial or Jiao

Name

-/rt9

LUI ST 25

cv 12 LR 13 CV 14

cv4 cv3 GB 25 CV I5 CV5

cv7 cv t7 GB 24 LR 14

t-uz Lunglrtu i,UncZ 6u'o"u Large Intestine lttl Middle Jiao, Stomach Mtt 4 nca Spleen/vrrJ r t+a '"'iI-

Middle Palace HeavenlyPivot Middle Duct ChapterGate GreatDeficiency First Gate UtmostMiddle CapitalGate Dove Tail StoneGate Yin Crossing Betweenthe Breast SunandMoon Gate of Hope

Heart MU SmallIntestine SE tt'tO 3 ac/ lqct 'z(Bladder ftru KdneYrqu t*n'l'7ncz Pericardium/hU Triple Heater/4U ,-L4g1' nl tn'€ Lower Jiao Mu i fi'r Upper Jiao mu 4ft7's Gallbladder f4u 7 r's Liver MU tcr6a,J'

20 E-bodi.d or relatively morephysicalthan non-physical.Stustive is alsorelalively more yin in qudtty This Grnr was rntoducedby Manfred Porker! prominentscholarof Chinesemedicinein The Esscntialsof ChineseDiaenostics.ChineseMedicinePublicationsL14 1983.

36

Upper Kidney Points Definition Spirit points in the Worsleytradition. Characteristics One or two may be used in a treatment. May be used in sequentialtreatments. Can be used with any CF. May be combined with Outer Bladder Line points. Clinical Significance Influencesa patient at the spirit level. Influencesthe upper jiao. Points: KI20

Through the Vattey and KI21 Dark Gate (Used together) For someonewho is fearful, trapped in fear. For someonewho may be lonely, suicidal;when everything seemsnegative. Someonefacing death. To guide a person out of the darknessof the valley.

KI21

Dark Gate When everything seemsnegative.

KI22

Walking on the Verandah Convalescentpoint after a long illness. For a senseofsafety and protection.

KI23

Spirit Seal (Shen) A sealis a patient'sidentity. Used if a patient is not connectedwith his/her own spirit. To reawaken the spirit. Often used after, or wittg K124.

l p'e+sy'e-ac* Q rtttg lL.LLLrr4 C,lbtuLVtr2ttClinical Significance Are usedcautiously,only whenthe patientis ready;the patientwill indicatewhenthat is. Are consideredlater ratherthanearlierin treatmentbecause. The patientmustbe stable; The patientmustbe ableto integratethe experience; A pJtientwho is not stableor strongenoughcouldbe overwhelmedby the experience. Usuallytriat the Window on a patient'sCF, althougha Windowmaybechosenin a non-CFelement whenthe non-CFelementhaspreviouslybeentreated. Windowscanbe openedby eithera strongor gentletonification. Windowscanbe dispersedifthey are stuckopen,for instance,drug abusecancausethis condition. A commandor sourcepoint shouldbe needledafter needlinga Window.

toluZ-A

Points

'fera-n

SI 16 SI 17 BL l0 PC lcr or 2? TE 16 LU 3 LI l8 ST 9 CV 22 GV 16

HeavenlyWindow HeavenlyAppearance HeavenlyPillar HeavenlyPond or HeavenlySpring HeavenlyWindow HeavenlyPalace SupportandRushOut PeopleWelcome HeavenRushingOut Wind Palace

44

+az-al-

4z s/aJ/<

, .,e"*6-""/'dre-4tu;T

Reunion Points CrossingandMeetingPoints Definition Points where severalmeridiansjoin or are confluent, often through deep pathways. Characteristics Energiesof more than one meridian can be influencedby treating a Reunion point. A completelist of thesepoints may be found in the Worsley point location book.22 Clinical Significance To influencethe energy of two or more meridiansat the sametime. Touchesthe energyofseveral meridians;the stateofthe energyin eachmeridianmust be considered.

Important Reunion points Yin

CV 3 UtmostMddle CV 4 First Gate SP6 ThreeYin Crossing LR 13 ChapterGate PC 5 The Intermediary

3 leg Yin Officials 3 leg Yin Officials 3 leg Yin Officials 5 Yin Officials 3 armYin Officials

KI, LR SP KI, LR' SP KI, LR' SP IIT, LR' KI, LU, SP I{T, PC, LU

Yang

BL I

EyesBright

CV 12 Middle Dua GV 14 GreatHammer GV 20 OneHundredMeetings GB 39 HangingCup TE 8 ThreeYang Junction

22

All six Yang officials plusYin QiaoMo and Yang QiaoMo SI, BL, GB, LI, ST 5 Yang Officials All Yang Officials All Yang OfficialsplusLR BL, GB, ST 3 leg Yang Officials SI, TE, LI 3 armYang OfEcials

Worsl"y, J R, Traditionat Chinese Acupuncturc, Volume I: Meridians and Points. Element Books, 1982, page 308.

45

Forbidden Points Definition Forbiddenpointstsarepointsthat may not be needledand/ortreatedwith moxa' Somereasonspoints are forbidden Physicalconditions Pregnancy High bloodPressure Swellings:growths,tumors,injuries,moles Skin conditions Anatomicalor structuralconsiderations Breasttissue Nipples Umbilicus Arteries Nerves Power of the points

cv 17 GV7 GV IO GV II Specificconditionsin the patient High bloodpressure. High bloodpressureandbad temper:Forbiddento tonify LR 2. High blood pressureandfatigue.Forbiddento tonify ST 9. Proximityto an arteryor a nerve,e.g.,nearthe carotidartery. Delicatetissue,e.9.,on the face. Heat in a patientwith pathogenicHeat. Energeticeffect,e.g.,increases Referto the Worselypoint locationbook for pointsthat areforbiddento needleand.iormoxa.

First Aid Points until the patientcanbe treatedmore thoroughly. Generally,usethesepointsin emergencies Refer to any numberofbooks, includingthe Worsleypoint locationtext, on point usage-

a

See "Forbidden Points," page 137 .

Internal Dragonsand ExternalDragons Releasingthe SevenDragons on the SevenDevils Definition The patient with Internal or External Dragonszuhas a seriouslack of control of his or her own body/mind/spirit. A possessedpatient cannot be reachedbeyond a superficiallevel. Internal Dragons (IDs)are related to the internal causesof disease. External Dragons (EDt are related to the external causesof disease. 'the or devilstreatment.' Often referredto as IDs and EDs. Also calledPossession, Diagnosis *-

The practitioner will sensethat talking to the patient is like talking to a mask or shell and/or that he or sheis failingto: (1) reachthe patient, (2) communicatewell with the patient;and/or (3) get honestresponses.2T Unable to seeinto the patient's eyes;there is no Shenin the eyes. Patient does not make or keep eye contact. However, lack of eye contact does not always indicate possession. Supporting signs (listed below) may raise the question of possession,leading the practitioner to observethe patient's eyes. Supporting signs donot prove possession. Possessionis a phenomenonof the present. The patient'shistory is not a basisfor diagnosisof possessionbut may prompt the practitioner to considerit. Supporting Signs of Possession Patient is out of control or in chaos. Information from the patient indicatesthat someone/thinghas taken control of him or her. Patient makesconsistentremarks about being possessed,out of control, in the grip of something. Patient does not respondto regular treatment. Patient has history of drugs and/or alcohol abuse. History of attemptedsuicideor destructive behaviors. Clear demarcationof time when the patient changed. Evidence of extreme emotional disturbance. Chaotic pulses. Practitioner is uncomfortablein the presenceof the patient.

26

See "Possessionas Metapbor," page 127.

27 Wo."l"y, J R, Traditional Acupunctrre, Volume II, Tradilional Diagtosis. The College of Tradilional Acupunclre, 1990, page 170

SuppoftingSignsSpecificto ExternalDragons

t' 3 r ne- z - t!f! f2- - t' r s€1'i 1naf**/ A we are talking about many different ways of manifesting-from internal sensations,to external physiological changes, to externalbehavior. Returning to the color, sound, emotion, odor, and the behavioral manifestation of the officials, it is important to note that although these are observed separately,it is the overall patternthey createthat indicatesone CF rather than another. Thus, in diagnosing the CF, the emphasis not is on the patient's symptoms,but rather on the patient'scolor, sound,emotion,odor, and behavior. The symptoms are not necessarily correlatedwith the CF; however, color, rguqd, emotion- odor. and behavior dre conelated with the cF. We can now inquire into the meaning of the CF. What, therL doesLA do with the patient's symptoms? Slmptoms are taken seriously, but not attributed to any elementor official. They are seenas part of the whole; and only whenthewhole is considered,via the CF, can we know how to treat this person and-in passing-his sEptoms.

The Meaning of the CF Two questionsarise about the meaningof the CF. The fnst concerns its importdnce in treatment. The second concerns its relationship to the syndromesof TCM. Why and how is the CF important in treatment? The following is not really an explicit part of LA teaching, but I believeit to 89

f

With this in mind, we canmakea comparison with TCM which will often trace one syndromeas havingoriginatedfrom.another, from deficientkidneyyin' e.g.,liversyndromes Iflhere was saidto be an original syndrome, thenwe mightbetalkingaboutthe samethings asthe CF. The abovespeculationis not essentialto LA theory. It is basedon my own clinical experience.We can now considerone other basic policy of LA theory becauseof its relevanceto the CF.

overall changes.They may simplywant relief from a shoulderpain. It was clear to me in Chinathatpatientsmainlyexpectedrelieffrom physicalsymptoms.It was alwaysodd to me io r"" someofthe Chinesepatientsreturnafter one or two treatmentslooking obviously better, but sayingthat they were the same' Those patients invariably began to report improvementin their symptomsover the next few visits.It was as if the patientand doctor had agreed to pay attention only to the physicalcomplaint.It is anoption' but not the only one. The second question concerns the relationship between the CF and the syndromesof TCM. Is it the sameto saythat a patientis an earthCF andthat he is a spleen Qi xu or spleenyangxu, or, indeed,anyofthe spleensyndromes?The answerin one sense to be'T'{o."There.itonlyoneCF, but appears there can be---or have been-more than one syndrome.Liver Wind mayhaveoriginatedvia Liver Fire Blazing, deficient liver yin, and deficientkidneyyrn.Or it mayhaveoriginated of liver Qi. from depression hand, there maYbe some other the On overlap.What I am sayingnow is speculativeLA looJs at the deteriorationof a patient's Fatttr mainly as a worseningoftheenery-gt

Levels: BodY/lVIind/SPirit

l"LA

on p3{-glgldiagnosis is to assess

*iI"i@e'6fffir

to the notion of body/mind/spirit. In Chinesemedicinethere are various termsthat enablea practitionerto specifythe and,whilebody/mind/spirit depthof a disease; these notions, it is overlaps way in some clearlynot the same.The concepthas been this patientis taughtmainlyby demonstration: spirit level,that one mentallevel, and so on. Hencewe haveno explicitdifferentiation. The following, however,will give some clarification: If the symptomsandgeneralwelfareof a patientva^rymore accordingto food intake, temperature,or body use,thenthe body level is indicated. If symptomsand welfare of a patientvary mainly accordingto mentalfactors, suchas stress,then the mind level is indicated.Also indicativeof mind level would be inabilityto thinkthingsout, makenormalcauseandeffect connections,and set and maintain ordinary goals. On the other hand, if the Patient's problems center around inabilities-"I ss1'1s"-lvhich are curiouslyunsupportedby any lack of physicalor mentalresourcesand whiclu therefore,seemto come more from a

the-CF and its resqlting failure to noud en q4{ !o c- : -

Fpatient becomesanearthCF at some cyc-les. ffige' This means,in effect,that the previous level of functioningwill not be resumed-in the sameway that stayingup late for several weeks in a row can often be wiped out by resuminggoodsleeppatterns,takingaholiday, or whatever. This does not mean that any deteriorationof the other elementshasto be due to this cause-for example,taking too many drugs will adverselyaffect the liver ofthe CF.But it doesmeanthat independently the most importantpatternof deteriorationis a spreadfrom the originalweakness,the CF. 90

information is used in a practical way to understandhow a patient becameill and what the patient can do to help herself get better' LA also teachesthe internal and external causesof disease,but makeslittle referenceto the miscellaneousfactors. Most attention is

lack of motivation or will, then the spirit level is indicated. The use ofthe distinction gives us a further indication as to its meaning. Determining the level affects three areas: l. patient management, 2. the intention when needling, and 3. the selectionof points.

not havethe

relatestypical causesto specificsyndromes. This may reflectthe differencebetweena CF and a syndrome.In practice, however,LA practitionersare often aware of, and pay attentionto, the factors that they know are currently contributing to their patients' ill health. thereis With respectto causesof disease, one other important difference.I-g-lgrye notion of phleg& *g!pige-I*-U44(--:td !EE-*!tg"ps-i,9-c-94-dery-:ggq99-Qtdisease. These may be the result of some other energetic deficiency und ry.-!auejq-!" treated directly. alongside treating thq underlying deficiencv.In LA there.is no theorA[d framework for dealing with the resultingmixedxu/shicondition.

In one of J. R. Worsley's interviews, he illustrated the effect of determining the level on point selection:

q"*"t?rd pggls

wherethe lre.ngintl meant

Bythis is is contmanded. .energ'y not just ih" glgg ,!th. !g!Y but of the mind arylggirit as well o n e ca n reach @ the deepestlevel from the command points.The trouble is that it may take amountoftime. Forthis a considerable reasonwe usethe other pointson the body which canenableus to reachthe damagemore effectivelyand perhaps more quickly. (Traditional Acupuncture Society Newsletter, October1984)

Wecan now go to the notion of blocksin I/1. Thesearedifferentfronu but havesimilarities to, the secondarycausesof diseaseof TCM. Blocks LA describesvarious conditions that are to thesuccessof treatmenrbased impediments but aroundthe CF. They vary in significance, be must they is that have in cornmon what they dealt with directly. Otherwise, further will havelittle treatment,howeverappropriate, or no effect, or may evenhave a worsening effect. In this respect,these conditionsare marginallyanalogousto the secondarycauses mentionedabove.

Wecan return now to lll's understandingof the causesof disease. Causesof Disease TCM refers to internal, external, and miscellaneous disease factors. For each syndromethere are indicationsof how these can factors and alreadyexistingdisharmonies This maintain a disharmony. causeand help 91

and are usuallydealt with by tonificationof both the exit andthe entryPoint' Wecan now look at theprocess of diagnosis in I/1. LA's Processof Diagnosis Theaimsof LA diagnosisareto determinethe patient's CF, the te"el of the patient's *trether moxa is aPProPriate, ffiUffi;, whether the patient requirestonific4lgg sedation,andwhetherthere are anyblocksin referredto aboveiiFe Thedffirences in theorybetweenLA and by variousdffirences TCM areaccompanied Althoughall schools proce.ss. inthe diagnostic start with looking, listening, asking, and touching, there are important variationsin emphasis. There are three important differences concerning the differential diagnosis of a disease, tongue diagnosis, and pulse diagnosis. LA doesnot usea differentialdiagnosisof a disease.If a patient comesin with facial paralysisor dysmenorrhe4theLA practitioner does not have at her disposal the typical differentiation according to stagnation of blood,stagnationofQi, accumulationof cold, etc. The reason for this should be obvious from what has gone before. An LA practitionergoesfirst &,r the CF; the patient's symptomsor the diseasedo not play a primary role in the diagnosis. Tongue diagnosisis simplynot used;and the questionoften arisesas to why not? One likely reasonis that many of the diagnostic categoriesassociatedwith condition of the tongue are not part of the languageof LA. That a purpletongueindicatesblood stasisis not useful when "blood stasis" is not a meaningfulterm within LA. Pulse diagnosis,on the other hand,is

AGGRESSIVEENERGY,qardlgbe"!d or "malicious"form.of an orgarLis a "bad" -. *-renergv tnat mu$ 5e withdrawn from the personvia a very specifictreatmentprocess which is labeled "tapping for aggressive energy."When aggressiveenergyis present, not only is other treatmentunlikely to be but sometreatmentswill actually successful, encourageaggressiveenergy to appear in other organs, thus worseningthe patient's condition. TIIE HUSB AI{D-WIFE IMBALA}{CE is a conditionin which one"side"of thepatient's englrygets split from the otherandthe normal balanctand interaEoi no io-ngerexists.By "side" is meant,on onehand,the heart,small intestine, liver, gall bladder, bladder, and kidney organs, ild, on the other, the remainingorgans. Neither the manifestation nor diagnosisof the block is easyto describe briefly, but its effect is a severeblock to treatment.Readingof the pulsesis successful usually essentialto diagn6sFFtfimfiAiari on. TIIE *INTERI{AL OR EXTERNAL DEVILS" is a label appliedto a condition whictr, alternatively, is referred to as The specificsof the natureof the oossession. ifib-alance.how it manifestsand how it is correctedare not relevanthere,exceptto say, agaiq that it is seriousenoughto createin many casesvery severeand often bafling symptoms. Normal treatment will be unsuccessful. EKT-ENTRY blocksoccur betweenthe end of one channel and the beginning of another,e.g.,betweenLiver 14 andLung l, ^-e2-

92

color, sound,emotio4 andodor. Someof the are the of better obvious

used in LA and appears to be given a more important place than in TCM. Pulses have tlnee specific uses. One use is to read the energetic condi$g ofthe individual organs;a second is to determine whether the patient requires tonirtcqfion or sedotion: a third is to atthe evaluateth" elfuctiu"nest o.fat "om time of treatment or at the patient's subsequentvisits.

smoothness, important when the quality ofthe various pulse positionscomesclosertogether.As with many other aspectsoflAt the conceptof qualityhas not beenmadeexplicit and is therefore difficult to specify.

The Pulses

The Diagnosis

The taking of the pulsesis different from that in TCM. LA studentsare taught to record the "strength" of the pulse at the different pulse positions and at a superficial and deep level. The position/organ correspondenceis that of Wang Shu-he, except that the chi position on the right wrist hasthe sanjiao inthe superficial position,the pericardiumin the deepposition, and, on the left wrists, both aspectsof kidney in the deepposition. (See "An Introduction to Pulse Diagnosis" n The Journal of Chinese Medicine, No. 14.) No use is made of the basic,traditional twenty-eight pulse qualities. The omission of thepulse qualities ls not explained. Again, as with the tongue, the significanceof many of the pulse qualities is expressedin concepts not used in LA. The use of pulsesto evaluatetreatmentis worth some comment. Although LA does not use the twenty-eight pulse qualities, practitioners find it hard to pay attention only to strength, and, therefore, inevitably record quality. They often usea continuumfrom good to bad quality, applyrng either to one pulse position or to the overall quality of the pulse. LA practitioners take pulses after or during a treatment; and if there is an improvement in "quality''in the above sense,this will be taken as an indication that the treatment will be effective. This ability to evaluatepulse quality becomesrefined with practice and is naturally combined with observation of chanees in

We can now turn to some of the overall differencesin the processof the diagnosis. Diagnosisin LA variesfrom TCM in several ways. One is the relative unimportanceof askingspecificinformationtypequestionsand

with the patient in order to create interaction --...-_;_.-z----;;-

meaningfulor "true" patient responses.A fur ther oneist@to developthe diagnosis.I will look at these althoughbriefly. differencesseparately, Observationand Questions. In TCM part of anyspecificpatternof disharmonywill not be observable in the context of a diagnosis.Hence the importance of asking about such things as whether there is an aversiontocold,whenthe periodpainoccurs, whetherthe thirst is for hot or cold drinks. In L4 it is irypg4ant to lrave a. clear for recordof the patient'ssymptoms..partly but more for coF-@sis, o that changes the algesqlng As discussed above,symptomsare ttg4t!0e41!, not important in the diagnosisof the CF. Therefore,the cruciallyimportantfactorsare onesthat can be observedat the time of the diagnosis- color, sound, emotion, odor, and pulses-and theserequireacate sensory discrimination and obsertation of non-verbal is a relativedifference behavior.Thisemphasis

93

)t

which will not harm the patient,is a way of sorting out the diagnosis.Pulse and-patient ,"rpoir" to the treatment are used in the assessment. Another exampleariseswhen the CF is first treated.Assumingthereare no blocks,it is expectedthat all pulsepositions-except, perhaps,the CF-will improvein quality and quorttty.If they do not, thenquestionsarise suchas "Is this elementreally the CF?" "Is therea block that hasnot been recognized?" This illustratesthe useof feedbackat the time of treatmentand the diagnosisas an ongoing process. Similarly,it is a principlein LA to grve minimal treatment."How muchis minimal?" can often only be revealedby the treatment of how a itself. So, again,carefulassessment patientrespondsis itself informationthat will be usedin determiningfuturetreatment. A relatedpoint is the importancein LA of continuing the diagnosis throughout treatment.In J. R. Worsley'swords:

betweenLA andmodernTCMAnotherdifferenceis theLApractitioner's interactionwith the patient in sucha way that a "truer response" and therefore truer informationis obtained.This is a largesubject in itselfanddifEcultto explainbriefly;but it is, fundamentalto the processof nevertheless, in LA. diagnosis Quality of Patient Response.Assume that a patientis describinghermajorcomplaint or any other aspectof her life. The way the practitioner is responding (especiallynonverbally)willfeed backto the patientand be extremelyimportant in determiningwhether the patient expressesherself guardedlyand from the surface or openly and from her depths.In LA" the aim ofthe practitioneris to respondwith sufficientemotionalflexibility so that closerapport is obtainedandthe patient revealsherselfinan openandunguardedway. This impliesthe ability to create a variety of emotionalcontextsin responseto the patient andis clearlya skill that takestime to develop. It does,however,promotea differentquality of responseand informationfrom the patient. In thecontextoffinding the patient'smost inappropriateemotiorqthis processhasbeen labelled"emotiontesting." The practitioner's canbe consideredas questionsand responses the patient's responsesas answers. This processis an importantpart of LA diagnosis. Treatment and Further DiagnosisAnother assumptionin LA is that treatment itself canfurtherthe diagnosis.Although it is important for the practitioner to commit herselftoa diagnosisbeforetreatment,it is an ideal attributed only to the mature and experiencedpractitioner that a complete diagnosistakesplacefirst and that treatment merelycarriesout the diagnosis.For example, the practitioner may know that there is a seriousblock to treatment,but be unableto labelit either"aggressiveenergy''or "devils." The treatmentto removeaggressiveenergJ,

During these subsequenttreatments this is what we should alwaYs be doing, to keeP questioning and communicatingwith the Officials ..-. All thesequestionsshouldarisesothat eachtreatmentis not just a movingon but a questionand answerwith the OfEcials. (Traditional Acupuncture SocietyNewsletter,October1984) These are the major differencesbetween modernTCM andLA diagnosis' We can now look briefly at treatment and treatmentPlanning. TreatmentPlanning and Treatment The answer to the question""How is LA treatmentdifferent?"followsfrom the theory 94

appropriately, the person will change on all levels,hencethecla1lmoflAtobetre

discussed above. Some of LA's marn differences.with TCM are as follows: l. The main means of restoring health is by treating the CF.It may be hyperactive,in which caseit needssedation;it is, however, more likely to be underactive,in which caseit needstonification.To be able to work on the CF, any blocks of the sort we describedabove will need to be cleared. In addition, it may also be necessaryto pay some affention to another element which has been "insulted," such as the child of the CF through years of neglect, or the wood through excessivedrugtaking. But the main thrust of treatment is normally on the CF. 2. Points are selectedon a theoretical rather than empirical basis. For example, prescriptions based on clinical experience, such as Ren 12 and Stomach36 for stomach disorders,are not taught. Thus points are mainly chosen from the source points, the five-element,the back shu, or the connecting points on the appropriate channels.Transfers, more or lessas describedin the books ofMary Austin and Wu Wei-P'ing, are also taught. A final important principle is the selection of points to treat the right level of the CF. This principle of selection was referred to in the sectionon levels. 3. The underlying principle and aim is to balance the CF. The expectationis that the patient will improve generally, feeling better in herse[ and her symptoms will also clear. This process,however, is not always thought to be a completely smooth one. J. R. Worsley often describesLA in terms of five laws, one of which is the LAW OF CIIRE. Part of the Law of Cure is that the diseasewill disappearin the reverse order in which it came.A lung imbalance,which at one time manifestedin acneand later in a problem of the lung itse[ will, when being cured, manifest once again in acne. In any case, when the CF is treated

I will end with two questions that often occur to practitioners: 1. In our intentions.do we treat the whole person or the person's symptoms?Trying to answerthat questionforces us to attach some value to both possibilities. 2. What is the most effective waY of treating the persorL and what is the most effectiveway oftreating a person's symptoms? Are they different, can they be reconciled, and-in individual cases- is the answer necessarilydifferent? answers are clear and LA's uncompromising:treat the person, not the symptoms; and, to treat the person, treat the CF. Summaty . LA's expressionis poetic and metaphorical rather than explicit and literal. As such, it has problems with communication and standardization,but it focuses easily on the individual and the individual's inner experience. . LA does not teach a conceptual framework to deal specifically with channel or acute exterior problems. . LA assumesthat the energy of an official affect all aspects of a person and will describesthe pathology of an official more in terms of behavior than in terms of physical symptoms. . LA assumesthat one element is a major weakness and that most of the patient's problems stemfrom this weakness.This is the CF, the major focus of treatment. ' Diagnosis of the CF concentrateson color, sound,emotiorqodor, pulses,andthebehavior of the officials. The practitioner's ability to interact with the patient, thus producing a

95

Traditional ChineseAcupunchre and ElementBooks' t982.

truer response,is crucial. . Consistentand appropriatetreatmentofthe CF at the right level is thought to bring changesin the whole Person.

Traditi onal A anpuncture Society Newsletter'Published by the Traditional Acupuncture Society, l1 Grange parh Stratord-AvorL Warwickshire CV37 6)Cl England.

References: Essentialsof ChineseAatpuncture' Compiledby the Beijing College of Traditional ChineseMedicine, et. al. Beijing: ForeignLangrragesPress,1980.

This article is pinted with permissionfrom the Editor of Meridians. The oiginal article was published in !fu. iounal of Traditional Aanwncnre' Summer, 1989'

TheJournal ofChineseMedicine.22 CromwellRoad, Hove, SussexBN3 3EB, England. Talking About Acapuncture in New York- J- R. Worsley. Royal Leaminglon Spa:Collegeof

96

From LeamingtonAcupunctureto TCM andBack Again trainedin An acupuncturist both five-elementand TCM acupuncture comparesthe two approaches. by AngelaHiclcs,M.Ac.,M.T.Ac.S. A Brief HistoIT of Acupuncture in England

I have practiced and taught in the style of acupuncture associatedwith the Leamington College for over ten years, and I get great satisfactionfrom doing so. I decidedlast year, however, much to the surprise of many, to take the TCM course held in London. (For anyone who has not heard of this course, TCM standsfor Traditional ChineseMedicine and is based on acupuncture as taught and practiced in post-revolutionary China.) I joined the course for a number of reasons: l. I had heardmanyjudgments about it and realizedthat I still did not know of what I it consisted. 2. I had come to realize that although I chooseto treat with a Leamington bias, I can increasemy knowledge and skills and maybe becomea better practitioneras a result. 3. If the good health of patients is my priority, I cannot ignore an area of acupuncture that might help them-just for the sakeofbeing associatedwith one "camp." Many people have asked me what I got out of the course.I have written this article to try to present an unbiasedview ofall that I gainedfrom the TCM course and how I added to the five-elementbasis.I also wish to stress the knowledge that Leamington-style acupunctureoffers that is not included in the TCM course and that I value highly

At the moment,in the main, two distinct styles of acupuncture are practiced in England. TCM becameeasily availablein England only when Ted Kaptchuk taught a courseln.1979. For anyone who wished to train in acupuncturebefore then, there was a choice of three main colleges.None of these taught TCM. Professor Worsley, having set up the College of Traditional ChineseAcupuncture, had already evolved the unique style of acupuncture taught at Leamington. He was able to adapt what he learned during his travels in Europe and the Far East to a Western civilization. In Professor Worsley's approach, much more emphasiswas put on "mind" and "spirit," as distinct from the Chinese emphasis on the physical. (David Eisenberg, in his book Encounters with Qi, points out that in China the admission of mental problems is regarded as social stigma. Even symptoms such as anxietY and restlessnessare called "neurasthenia." The Chinesetend not to talk about their problems to anyoneoutside the family, not even to their physicians.) When TCM arrived in the United Kingdom in 1979, it seemed very different from what had been practiced before and was wrongly classified a as "symptomatic" by

97

have chronic complaints and Western medicine can treat the acute conditions

some of those practicing Leamington acupuncture. Two "camps" began to emerge-those practicingfrom a Leamingtonbasisandthose fro* u TCM basis;at the time it seemedto be aneither/orsituation.This divisionis not very Chinese!The nature of Chinesemedicine, historically,has beento grow, change,and adaptto whateverusefulcomesits way. climateis now changing. Theacupuncture that everything recognizing Practitionersare ultimately comes from one source (albeit, adaptedto the culture)andthat differentways differentpartsofthat source-Each emphasize waycanbeusefulandwe canlearnfrom each. Whatmust be a priorityfor us all is that our practice works and that the patient gets better.

on the other hand, is

"acupuncture of the people;" it has, of necessity,developedto treat patientsso that they can be well and functioningas quickly and cheaplyas possible-It therefore-jlealls conditionsandinjuriesvgly-etrectivell acute -l; t""g.trel lost when a patienthasan acutecondition;this is particularlyimportant asI live in a roadwhereeveryoneknowsI do acupuncture and is likely to call in with illnessesand injuries! I have heard many Leamingtonpractitionerssaythat theydo not want to treat acute conditionsand so they haveno reasonto learnhow to do so. I find thatmy practiceis not that blackandwhite-I do needto be ableto treat acuteconditions. Patientswith chronicconditionsmaygetacute symptoms during the course of their treatment,in whichcasetreatingthe CF in the usualway maybe inaPProPriate.

The Usefulnessof TCM The following are aspectsof the TCM coursethat I found useful: the treatmentof acuteillnessand injuries,tongue diagnosis, pulse diagnosisusing pulse qualities,more detailsof the function of the organs,and a differentway ofcategorizingthe imbalanceof an organinto yin, yilg blood, Qi, etc. Also valuablewere guidelinesto the usesof the points,rest, and diet, and how the Chinese look at other causes of disease besides emotionalcauses. Overall,the TCM coursegave structure and guidelinesthat did not conflict with my ofthe causativefactor (CF); it understanding alsohelpedme to treat acuteconditionsand injurieswith confidence.

TongueDiagnosis Tonguediagnosis,aswell as pulsediagnosis, is a primary tool of Chinesemedicine.The size,shape,color,moisture,andcoatingofthe tongue are dl diagnostically useful. For example,a red tongue will indicate that a personhas a tendencyto be hot, and a pale tongueoften indicatescold. This information can be helpful in decidingwhetheror not to use moxa. A thick coating on the tongue indicatesa conditionmore in excess,and a thinner coating indicatesa deficiency.For example,if a patient has a red tongue with little coating, he or she may be deficientin energy, and-at the same time-Hot (yin deficiencyin Chinesemedicine);so moxa is not normallyindicated.I havealsofound the tongue condition useful as an added confirmationof the CF.

Treatmentof Acate lllness and Iniury Thetreatmentofacuteillnessandinjury is one of the most useful aspectsof TCM. Acute illnesses have never been catered to at Leamingtonbecausethe majority of patients 98

The Pulses

Yin/Yang, Qi, andBlood

Leamington acupuncturists are taught to feel the amount of energy in the pulses; this is calledFull and Empty in TCM. Other qualities about the pulsesare simpleto read,yet useful, and are taught by TCM. For example, fast pulsesshow that there is heatin the body; slow

The termsyln, yang, Qi, blood, jing, and body fluids are familiar to anyone using TCM; they describethe different substancesand statesof energy in the different organs. The two easiest conceptsto describeare yln and yang, as they are suchfamiliar terms to us all. A patient may be generally deficient in energy; within this, however, either the yin or the yang may be more deficient.If the patient'syin is the most deficient, then he or she will experience"yang type" symptoms,asthe yang is comparativelyin excess@iagram l); these symptoms may be or hyperactivity. heat, restlessness,

twenty-eight pulse qualities, but they are clearly discussedin Ted Kaptchuk'sbook, The Web That Has No Weaver,and in otherbooks on TCM. Finding the qualities and knowing what they mean is not diffcult; often it brings further clarification of the patient's condition and helps in deciding the treatment that is needed;a.8., z pulse that is called a "wirY'.' pulse (stretched like a wire) wifl-indicate blockage, often in the liver, when the energyis stuck. One practice not always taught in TCM-but emphasizedat Leamington-is to feel the pulse changesafter treatment as well as before. Feeling the pulse at this time is one of the best feedbacks of a good quality treatment.

YIN

YANG

Diagram I I4 on the other hand,the yangis the most deficient,thenthe patientwill experience"yin or type" symptomssuchascoldness,slowness, less movement.Because the yin is in comparative excess, this is called yang deficiency@iagram2).

The Functions of the Organs The functions ofthe organs,astaught in TCM are a useful addition to existing knowledge about the organs/officials.For example,one of the functions of the liver is to allow the Qi energy to be free-4gl4ttg-f-the liver energy nby supPressed

Excess Deficiency

YANG DEFICIENT

;"g"rAmrtrationj, it@ stagnateand the pulsesto go into excess.This out bY the liver and is the reasonwhy there is more often an excessshowing on the liver pulse than on any other organ/official.

YIN

Diagram 2 99

YANG

If the patient is, for example,a "water CF," heor shewill be qualitativelydifferentif yrn deficientor yang deficient; predominantly knowing this can be helpful in changingthe oftreatmentto suitthe patient'This emphasis is alsotrue in relationto the Qi and blood in differentorgans,and also the jing and body fluidsin certaincases. Points TCMs informationon the points can enlarge theknowledgeofpointsgainedatLeamington. Much TCM informationon pointsis empirical; somanypeoplehavebeentreated i.e.,because with the point and with the sameresult, the Chineseknow its efFectwithout doubt.

The Usefulness of Leamington Acupuncture(aspectsnot mentionedin TCIvf) Thefollowing arenot mentionedin TCM: a view of treatingthe p4l@-as a wholg, basedon findingthe CF ofthe disease;the ;an co in elements ofthe understanding additional fire the relationto our culture,especially andmetalelements;and the spiritsof the points, e.g., the Windows, kidney chest points, etc. The style of acupuncture laughtat Leamingtonprovidesan overall picture of the whole patient and how to treatbeyondPhYsicalsymPtoms. TheFire Element

Causesof Disease

In TCM the fire element(or often, the heart in TCM-the heart protector is rarelymentionedand often is merged,in practice, with the heart) is not as commonlydiagnosedasanimbalanceasI havefound it to be :rmongmy patients,a numberof whom I have treated as fire CFs. This is really a cultural difference betweenChina and the West. In China there is less rejectiorq loneliness,and lovelessnessthan in many Western countries.Alan Papier writes about this difference in his article, "Social end Cultural Features Affeaing Chinese Medicine".

The internalcausesof diseaseareemphasized at Leamington.TCtvI, on the other hand, describesmany other causes-Although I think thatthe Chinesetaketoo little sometimes notice of the internal causesand how they manifestfrom the early yearsof life, perhaps we might questionwhether we take enough noticeofthoseothercausesthat T-CMvalues. For exampl", 9hin"* P*Ple are wary of eatinggg!q_@_and I

@

alsosavthattoo much beihe c anda fevercan:r in manydifferentorgans.We often overlook thesedetailsof rest,diet, worlg exercise,etc', and how an rrnlglglgq d the1g_asgectsof lifeswlemavm@16;edThere are other ways in which I have found TCM useful,but those aspectsI have mentionedareonesthat canbedescribedfairly simply. I realizethat by gving only a few I haveskimmedthe surfaceof TCM examples but it is hard to give it full justice in sucha short article.

The Chinese familY is famous throughoutthe world. It is closely knit and nurturing.The guidance, providedin directionsand'lessons' the family context are most importantto the structureof the personalityand future foundation for adult life .... In China, the continuedstability of family life is 100

earlier,but also may be due to lack of experienceof this condition in a large numberof people.tr CFshaveno placein TCM.

apparentin many things which are less conspicuousthan in the West: less individual neuroses,a lower incidence of stress, greater satisfaction and acceptanceof one'slife, etc. Neurosis and stress do exist, but to a lesser degree than in the West. (Journal of Traditionol Chinese Medicine, May le88)

TheMetal Element The otherelementoftenmissedin TCM is the metalelement.As describedin TCIvI, with the most of the illnessesassociated symptoms. the cough among have a lung Leamington-styleacupuncturedescribes the lung and metal elementin a different on the lack ofrichness way, concentrating and quality experiencedwhen the metal andon the senseof elementis imbalanced emptinessthat comesfrom grief.

Another example is from Mother Theresa who noticed an important differencebetween the Indian culture and that of England. When she came to England in 1970 she said, "In England everyone looks prosperous, but no one looks happy." Shehad observedthat there is more love and joy amongthe poor in India than in the English population. The Chinese do not have the same problems as we do in the West, and have not, therefore,neededto describe"an impoverished spirit" nor the results of lack of love that are so prevalenthere. They do, however, describe "anxiety, restlessness,insomnia" etc." that come from heat deficiency (heart yin deficiencyin TCM)-but not fire CF patients. I describe these patients as looking "lack of red" and showing "lack ofjoy," fluctuating to "excessofjoy." Thesepeople are often very volatile emotionally and may feel vulnerablein relationships with other people. They may have diffculty loving themselves,and this may manifest as a lack of self-confidenceand selfesteem. It is hard to describea "typical" fire CF, as color, sound,emotion,andodor form the basis of the diagnosis at Leaminglon; however, the fire CF sometimescorrespondsto a condition in TCM that is called "heart Qi deficiency." The syrnptomsof heart Qi deficiency are pale faoe, breatilessnesson exertioq spontaneous sweating,palpitations,and tiredness.This lack of detaileddescription may be partly due to the emphasis on the physical that I described

Mind and Spirit The stateof a patient'smind and spirit are importantto a practitionerwho hasbeen trained at Leamington. Although the Chinesedo mentionthe spirit anddescribe one of the functions of the heart as "housingthe shen" (shenis translatedas spirit), and also say that suppressed the liver, nothing emotionswill unbalance is said about how the spirit is affected when the other organs are imbalanced. Much informationon the "spirits" of the differentorgansin written in old Chinese texts,but this is not a part of TCM. Father ClaudeLarre mentionsthe differentspirits of the organs in Survey of Traditiornl ChineseMedicine, abook he co-authored with JeanSchatzandElisabethRochatde la Vall6e. helpsus acupuncture Leamington-sryle people be affected can how to understand at any level of their being when they are sich and how a symptom maY be a of a sickspiritor mindrather manifestation thana sickbody.Treatment,therefore,is l0l

acupunctureccm be better than one' ln spiteof the differences,two practitioners - each treating in a different style of - will oftenarriveat the same acupuncture color, sound, diagnosis.One emphasizes other attends the and odor, emotion,and to signsand symptoms.Onemay saythe patientis a Wood CF and the other say that the patient has liver Qi stagnation. Often thesediagnosesresultin the useof similar points. Therein lies the unity of Chinesemedicine.

mostly directedat curing the patient at the level of the sickness. Treatingthe Personas a Wholeand the CF I need hardly mention the concept of treating the person as a whole rather than treating the symptom,as this is constantly at Leamington. In TCM groups emphasized of signsand symptomsare seenas cornmon patterns. These patterns are called "syndromes."A practitioner of TCM may diagnosea patient as having many diferent syndromesfrom different organs,all at the sametime. For example,the spleen,kidney, and liver mayall be diagnosedasbeingout of balance and all receive treatment- In the Leamingtonstyleoftreatment,we look for the one areaof energythat initially went out of balance and caused all the symptoms to manifest.Thepatient'scolor, sound,emotion, and odor will help us to find this causative factor. Whenthis CF is found and treated,it can affectthe patient at all levels of being. Very few needlesareusedfor treatment,and the patientis allowedto heal himselfso that the symptomsdisappear.Thisis a very elegant and naturalway of treating and neverforces the energy.

References David Eisenberg. Encounters with Qi: Exploing ChineseMedicrze.New York, London:Norton' 1985' Ted Kaptchuk. The lteb that Has No Weaver'New York: Congdonand Weed, 1983. ClaudeLarre, JeanSchatz,and ElisabethRochatde la Y allee. SurtteyofTraditiotnl ChineseMedicrne.Trans Sarah Stang, Columbi4 Maryland: Traditional Acupunctwe Institute, I 986. AIan Papier: "social and Cultural FeaturesAlfecting Chinese Medicine." Jourttal of Traditional Chinese Medicine.Beijing. lvlaYI 988.

Angela Hicks, M.Ac.M.T.Ac.S', has practiced acupuncturefor thirteen years.Previouslya lecnuer and clinical supen'isor at the College of Traditional Acrpuncturein Leaminglon Spa,shecurrentlyconducts study groups in Traditional Chinese Medicine for acupunchriststrained in the five-elementtradition. She has an acupuncturepractice in Reading,England.

Points JustasTCM providesextrainformationon the points,so doesLeamingtonacupuncture. Especiallynoted shouldbe points suchasthe Windowsof the Sky and kidney chestpoints and pointsthat do specialthings,suchas the pointsfor the internaland externaldragons.

This article is pinted with permissionfrom the Editor The onginal article was published in of Meidians. The Joumal of Tmditional Actpuncture' Summer, I 989.

I hopethat the gulfbetweenTCM andthe taughtin Leamingtonmay styleofacupuncture as a result of this narrower little made a be article. Thereis a sayingthat "two headsare better than one," and perhapstwo styles of

r02

CausativeFactor: A Forum by Faculty Membersof the Traditional AcupunctureInstitute Causativefactor (CF), a central conceptinfive-elementacapuncfiire,often is misunderstoodby acupuncturistswho are not trained in thefive-element tradition, and it is the subject of much discassionamongfive-elementpractitioners. The Journal publishes this forum to bring greater understanding of the CF to the acapuncturecommunity,to encouragefruitful discussion,and to further the evolutionof the concept. Theforum begtnswith a brief explanationof the CF conceptand continueswith commentssttbmittedbyfaculty membersof the Traditional AcupunctureInstitute, including Haig lgnatius, Robert Duggan, Dianne Connellyand Gary Dolowich. In the next issueof the Journalwe will sharelettersand commentsstimulatedby thisforum---an interaction that wi ll benefit our mutual understanding. to compare it to a phenomenon audiologists call "recruitment." If a person is exposedto excessivelyloud sounds in one ear, that ear may become deafened to sounds at certain pitches.If the person is then tested for these pitchesat soft levels,the soundis heard only in the good ear. But as the intensity is increased, the soundwill be heard louder in the deafened ear than in the normal ear. This is recruitment- a distortion or hypersensitivity in the abnormal ear. If one finds impaired function or impaired energy in an element, behavior may be observed that is at times peculiar, as when a person is too easily hurt, or angered, or fearful; one may also observe behavior that demonstratesboth a particular excellenceor strength and the opposite of that strength (i.e. a person who is so tenderly sympathetic one moment and very callous a moment later).

lil/hat is CF? The causative factor is an element (or official) that becomes chronically imbalanced in a pervasive way, lending a characteristic theme to a person's life. Further stressesor traumas affect this element more than the others, so that it continues to be the first to cave in under stress.However we may define CF, we can say it may be relatedto an insult to the body-mind-spirit, as a physical,chemicalor emotional trauma. CF also may be related to a pattern of development that is hereditary, congenital or acquired in the process of physical, mental or emotional (spiritual) $owth. These aspects of the person may result in behavior patterns that show themselvesas distortions or blocks in the energeticbalance. A way to understandthe effect of a CF is

103

Commentsto Stimulate Discussion Comment 1. J. R- WorsleY's unique contribution. CF as an invaluable organizingprinciPle. TraditionalChineseacupuncture,whichis basedon the conceptsof Chinesemedicine, hasbeenpracticedfor thousandsofyears and We maybe is now expandingacrosstheglobe. of development in the witnessinga moment this ancientsystemof humanunderstanding suchashasnot occurredin severalmillennia. Someof the most creativeand important contributions to contemporary western havecomefrom J. R. Worsleyof acupuncture LeamingtonSpa.ProfessorWorsley'sgenius hasenabledhim to drawtogetherthe concepts of body, mind and spirit asunderstoodin the eastand west, and to draw the attentionof modern practitionersto the very subtle energeticsignsthat providedeepercluesto the balanceandharmonyof the life force. is One of factor.His life's work theconceptof causative is dedicatedto teachingpractitioners,guiding them in the developmentof the diagnostic skills of interpreting color, sound, odor, emotionandpulses-skills throughwhichthey which elementis the CF of energy understand imbalancewithin an individualwho hascome Like many creative concepts for assistance. (andI amsureDr. Worsleywould wishto pay homage to the concept in Korea of constitutionalacupuncture),his contribution has created excitement, passion and controversy.The conceptis unknownin many traditions of acupuncture. Whenever acupuncturiststrained in the five element tradition meet, they search for further aboutthe meaning,the validity, understanding of this conceptof causative andtheusefulness factor.

As five-elementpractitioners,we have found the CF to be a Powerful tool for uncoveringthebasicimbalancein our patients' Whenwe becomeclearin our understanding of a person's imbalanceby meansof this model, it seemsthat we have accessto a of to the very essence wisdomthat penetrates anindividual,addresshgthebasicissuesin the person's life. The CF can provide a deep understandingof patients' weaknessesand confrontthe uniquestrengths.Wb@ents taskspresentedbv their CF, they arebrought t6-th-"growing edge" that furthers inLe-r development. ;i practicalvalue in the treatment room is that it can bring a clarity to the practitionerand a focus to the acupuncture treatments. Although Worsley's teaching seems to stress finding the CF based exclusivelyon color,sound,odorandemotion, practitionershave reported that by asking they "Who is this personat his/heressence?" find a and symptoms can drop beneaththe This searchfor the CF deeperunderstanding. shakesthe practitionerout of complacency: Canoneassumethatthe obviousangercome-s',ubt/ po from a wood CF?Or is it reallv dueto a lack of meaninglqetal CF)? In this way we can treat, asthe Chinesesay,the root ratherthan the branches.In the CF we have a tool that brings order to all aspectsof our work with the patient-at least,when it works well. Thereis alsothesituation,however,where the searchfor the CF leadsto confusionand uncertainty. If practitioners are constantly questioningthe diagnosis,there is a loss of clariry that defeatsthe purpose of the CF. needlein themidstof Insertineanacupuncture '

'

r

tt

,r--

@heionceptofCFis the word "cause" which seemsto imply a westernscientificapproachof causality-The Chinese operate by another principle: 104

Comment II. Possibility of a secondary CF. CF concept may be held too tightlY.

"Whatever happens in a given moment inevitably the quality peculiarto that possesses moment." Under this view, originating events are not seenas separatein time, but are part of the total expressionin the moment. Thus the anger at one's parent, which created an imbalanceduring childhood, can be observed in the green color present todaY. Jung coined the term "s5mchronicity" to describe this meaningful conculrence of events. According to Jung, the essential question asked by the Chinese mind, when confronted by a set of circumstances,is not "What is the cause?"but rather "What does it meanthat thesethings are together?" It seems re, that in the practice of tradit we are co ,{q synchronicity, and it is the CF that attributes the meaningto the situation. When confronted by a patient who has suffered a loss, who is stuck in grief and develops shoulder pain, we can avoid both the trap of allopathic medicine, which negatesthe problem if no causeisfound on x-ray, andthe excessesofthe holistic camp, which blamesthe person for creating his own illness.Instead, we can chart a middle course; by holding the problem in terms of the CF we have an organizing principle that finds the essentialmeaning of the situation and allows us to addressit in this moment. The power of the CF as a healing tool is n just this ,, h to Often the is its illness m@of isolating effect-the person is alone in his or her pain without connection to the world. By understandingthe problem in terms ofthe CF, we are grving meaning to a situation in terms of universal archetypes of the elements and officials. Through acting in this way our work hasa healingeffect. As Jung has stated,"Ifthe archetypalsituation underlying the illness can be expressed in the right way the patient is cured."

Although the CF is the elementmost likely to weaken under stress, it is possible that stresseswill affect another ofEcial or element enough that it becomes a second CF. The patient will benefit by treatment of any imbalance,and in the process,the elements needing the most treatment will show themselves. If this observationis true, it is easyto see how a CF may changeor seemto change,and how the severity of one imbalance (CF) may shift relative to the severity of a secondary imbalance (CF). It may account for the differencesin the diagnosesmade by different practitioners -particularly when a patient is referred after a period of treatment to another practitioner. If the concept of CF is held too tightly, it may impair treatment, as, for example,when a practitioner is affected by the fearful doubt that he or she is treating the "right" CF. The concept of CF is a useful way to orgaruze diagnosticinformation and is a useful Strategy in treatment, but only if it is seen as just that-and not held too tightlY. Comment Itr. We may be at a moment of transformation in the concept of CF. During a lecture at the Tri-State Institute of Traditional Chinese Acupuncture, Ted Kaptchuk discussed the importance of a "transforming vision" for people in extreme pain. According to our understanding of his comments,he found that such patients had to move through a healing process that transported them beyond the pain of the presentto a vision of a new possibility-to a transforming moment when theY see alternativesfor their lives. Perhapswe are at such a moment of transformation in the

105

conceptof causativefactor- It may be that transformation will call forth further development of the concept of CF-development that moves it from the dangerof becomingstaticinto a moredynamic concept through which we understandthe immediateinteractionof all the elements. Comment IV. Six Areas of InquirY. I. Is there "causafion" in ac'upuncturethat parallels causation in western science? Westernscientificmethodseeksto determine absolute, specific causation- Perhaps functionsin a way that makesthe acupuncture use of the word causation inappropriatePerhapswe would moreaccuratelyspeakof a designfactor or a centralfocusor simplyof a mutual arising. These terms suggest a particularrelationshipof elementsandofficials characteristicof the patient at a particular timq-a result of all the interactionsin the patient'slife to that moment.Suchterms are not burdened with the implication of singularityor causality.Perhapsthe attemptto designatesingularcausationmayhinderrather than further our efforts to diagnoseand treat the individualswho cometo us for assistance.

element.May not both of thembe right? 3. Is therea secondnryas well as a primary who havebeenin practice CF?Acupuncturists for sometime areawarethat therearepatients who have a very clear CF. However, practitionersoftencommentthatinmanycases there seemsto be both a primary CF and a the challenge CF. lntheseinstances secondary is to balancewhat appearsto be two CFs in treatmentand to acceptthe fact that what is constitutionally weak-by definition the primary CF-may, at any glven moment,be lessimportantthan what hasbeenweakened through recent toxicity or emotional stress-the secondaryCF. 4. Is lcnowingthe uniquedynamic among the elementsin a patient equally important as I