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<124 Spirit Burial Ground Resurrection point, when the spirit is dead or nearly so. Experience of life is dead.
37
Points Outer Bladder Line ef* ^,tt
Aa-L ^n7
Definition Deep spirituaVmentalPoints. Characteristics Use alone or with Inner Bladder points or with Upper Kidney points. Five of these are namedfor their associationwith spirits related to Officials. Clinical Significance Can be usedon any CF. Some have associationswith particular Officials. Can be usedfor emotionalproblems. Points: BL 37 Soul Door - Po Hu. Po is the spirit of the Lung. At the level of Lung Correspondence- BL 13. For a patient who has shut offto cope with disasterthat is unbearable. A closed mind or sPirit. For a Metal CF who is cut offon a deeplevel. Where sadnessand grief affect the lungs. BL 38 Rich for the Vitals At the level of the Heart Protector Correspondence-BL 14. To build both Qi and Blood. Usually use moxa on this Point. For general fatigue and weariness For chronic and difficult diseases. To replenishFire at a deep level.
^(
BL 39 Spirit Hall - Shen Tang. Shen is the spirit of the Heart. At the level of the Heart Correspondence- BL l5For strains on the heart, shocks, broken heart. 5 Restoresthe spirit. Anxiety, insomnia.
-o \ 7
tw 39
f.letps 1o W
BL 40 Wail of Grief For a cry of anguish. For the patientwho is stuckin grief
PtrsoY''Y4*'- 1*4
For the patient who capnot deal yyith pain or loss' -{e;^+an 50 4rt€w4 ca++'f WrlL*ta-4 BL 4l Diaphragm Border First aid for hiccuPs. Breathing problems. / 5 q-ctuss 4BL 4zSpiritual Soul Gate - Hun Men. Hun is the spirit of the Liver. At the level of Liver Correspondence- BL 18. and depressio4mood swings,resentment,anger. For hopelessness For alcoholics,drug addicts. oflpr;rpose the patient find,a sens^e To -Uee help. '1o^ <-a'N*'fb a-n ' F-e,oPte 'd* BL 43 Yang Net At the level of Gall Bladder Correspondence- BL 19' BL 44 Thought Dwelling - Yi she. Yi is the spirit of the Spleen. At the level of SpleenCorrespondence-BL?O. nztt fu('_*< For obsession;helpsmental movement- e<'rvla For anorexia. BL 45 Stomach GranarY At the level ofthe StomachCorrespondence-BL2l. For anorexia. Helps thoughtsmove. Digestive disorders.
BL46Dia,phr^sm Z!"IX^rlrV ru ,H "tf BL 47 Ambition Room- zhi shi.zhi is the spirit of the Kidney. -BL 23At the levelof Kidney Correspondence For lack of ambitionor will; for revitalization.Also usedfor an over-drivenwillFor the patientwho is depletingherselfby doing too much' Greatfor a Water CF. andhopelessness' . lackof will, feelingof powerlessness Depression, ct>-z't Lznrk Fatnt *a Cn-a.ht7 rs alaat wk+-
40
4R
InfluentialPoints Gathering or Assembling Points
Definition The Chinesecharactermeans"to gather," or "to meet-" Characteristics Influential points have a special effect on eachof the eight principal constituentsthat make up a human being. Actording to the Nan Jing, these constituentsare the Yin Officials, Yang Officials, Qi, Blood, bone, malTow, sinews, and vessels Clinical Significance Used when a particular constituent needsaffention' May be addedwhere appropriateto a patient'streatmr
Points
anlloence -t-t'-'^'-t
LR 13 CV 12 cv 17 GB 34 BL 17 LrJ g BL I I GB 39
ZangYinorgans Fu/Yangorgans Qi Sinews Blood Pulsewessels/lvleridians Bones .-it,tt.,;n tgTrrta'/(lutD Marrow rBwr''rz1
YangMound SPring DiaphragmCorrespondence very GreatAbyss GreatShuttle HangingCup
M-
" ffi*oo| 41
TransportingPoints" Correspondto the AntiquePointsandFive-ElementPoints Definition i.e.,mostdistalto mostproximal. Affectthemeridianaccordingto their locationon the channel, Characteristics Are arrangedin orderfrom mostdistalto proximal,from thefingersto the elbowsandfrom thetoes to the knees,regardlessof the yin or yangnatureof the meridian. Clinical Significance May vary accordingto viewPoint.
Points /
Jing Well Points - ip,t I ftt'
t2
k't cc'D ot tnn-fu-[
4l
Correspondto Wood (yin meridian)andMetal (yangmeridian)points. Most distal:The toe or finger Point. The Qi is bubbling,small,and shallow. Clearsthe meridian. Usedin acutesituations. ny Ying Spring Points
,rat r'g-* Lllel<'t pts
- uvd l" ezz&" fu''f
Correspond to Fire (yin meridian) and Wate Second element point in from the toe or finp Qi is gushing a little. Clears Heat; for febrile diseases.
9
PointstarY(t a Wn4 ShuStream Oorr(9pr,2s-i /-a-*p
atrc{
r | m*4 ';.',
d' ;oanq
points.l'-"."."."'"lUWtW5:H Correspondto Earth (yin meridian)andWood (yangmeridian) CorrespondtoEarth(yinmeridian)andWood(yangmeridtan)pomts.| _* l"i Shou 'I'hrrd " ornnger. finger. pointin pomt m from trom the thetoe toeor Thirdelement element l"Jvra_-.prz*da-*fo Qi is startingto flourish,strongenoughto carryotherthingswith n l;;;;truLthfr oy of the body andpainfuljoints. For heavysensations f d-ur9 ClearsWind andDamp.
-ffi1yffi-ffi,tui'z[',r'{arutv( 2l
O,rt"id" tb" boundaries of strict Five Element ActPuncurre.
' . t , t l " l * - - l hvilll"t \i,,,tnllu'i U-
= d&n'4t /
42
ir */ iu,,7',1-,/7
gf,u'**/t'"Pt> (
*frr'zYts' trn"RiverPointshETftL
-fv*'h
Correspond to Metal (yin meridian)and Fire (yang meridian) points. fgtuth elementpoint iLfrom the toe or finger Qi is abundant. For upper respiratoryproblems. Dispelshot and cold sensations.
,AHeSeaPointsED.4*
[/-MEL
andEarth to Water(yinmeridian) Correspond Locatedgenerallyaroundthe@n4
s!!o*l
GoodforgEectingthe organsbecauseof their depth To treat direa;$ of tlre !'u^orgpns. ,-t , r
()n*a to
Aat>&o-<-. rtA4.e,,."
Lower Uniting Points Located around and slightly distal to the knees. To treat diseasesof the Fu organs.
the Triple Heater BL 53 addresses the Gallbladder GB 34 addresses Stomachandabdomen the 36 addresses ST the LargeIntestine ST 37 addresses the ST 39 addresses SmallIntestine
43
;
Windolys of the SkY sPr,rr Prs LutA'Pf!' Definition pointson certainmeridiansthat give the patienta clearerand/orgreaterperspectiveon themselves Characteristics Havea tremendouseffecton the spirit andthe mind. Windowshavethe capacityto let light in; they canbe too open,closedtoo tightly, or dirty. The following meridianshavewindows: sI, BL, PC, TE, LU, LI, ST, CV andGV In the course of treatment,a patient's Windows will usually open of their own accord. The in openingthe Window. practitionerneedlesWindowsonly whennatureneedsassistance More commonlyusedby practitionersof WorslgY-acgpyncture. drt > 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
( AnVof the signsfrom IDs above,plusan externalfactor suchas: Exposureto extremeweatheror climates;mustbe a graveinvasion. ? Externaltraumasuchasanaccidentor surgerywherethetorso is opened. ( Treatmentof Possession EXTERNAL DRAGONS
INTERNAL DRAGONS
GV 20 BL II BL 23 BL 6I
Masterpoint l/4" belowCV l5 ST 25 S T3 2 sT 4l
l. Insert all needlesright to left, top to bottom, straight in, to full fen depth of each point. Use a small degree of dispersionaction. 2. Be sure to get the energy of eachpoint. 3. Go back and disperseall needlesin the sameorder as they were inserted. 4. Wait and observe: Results are usually subtle, but may be dramatic. Look for changesin color, sound, odor, and emotion (CSOE), pulse, and/or breathing. Watch for emotional catharsis,return of memories,and/or clearing of the patient'seyes. 5. If there is a change,remove all needlesin the same order they were inserted. When treating a patient who is depleted,you may want to tonify as they are removed; if so, remove the needlesleft to right. 6. If there is no changein 15 minutes,go back and tonify eachneedle left to right , top to bottonl and remove the needlesas you go. 7. Observethe patient for changes. 8. After the possessionclears,follow the treatment by testing for AE in sametreatment or next treatment. 9. If ID treatment did not effect a change, and there is still no Shenin the eyes, do the EDs with the sameprocedure as above. Both can be done in one treatment if the patient is strong enough. They can also be done in two treatments.
52
lttz's rrt Chacos haldtn7 6i-,i #r//
u-rhtnTs 'tufe H.z; .
AggressiveEnergY Definition toxic or polluted energy AggressiveEnergfs (AE) is a block createdby independentlycirculating that moves along the Ke cYcle. to cope' is Sourcesof AE are internal or external stressorswith which the Official unable AE is a block recognized and treated only within the Worsley system' The test for AE is also the treatment. Diagnosis {f
than The only sure sign of AE is erythema around the needlesthat is darker and/or larger the test needle. Is passedalong the Ke cYcle Signs and symptoms show up along the Ke cycle'
SupportingSignsSpecificto AE
R6l ftACrS
Its presencemay be suspectedand tested, therefore treatedThe patient's history or complaint includesany of the following: History of serious emotional or physical illness. History of substanceabuseor toxic living or working situation. # Feeling of chaos but thepatient is still in control. Patient, usually one who has been in treatment for a while, will know "something is wrong" but can't say exactly what it is. Patient may report feeling "more emotional" than usual. The practitioner may'. Feel uncomfortablein the patient's presence. Seethe patient as irritable, aggressive,angry, emotional. Sensethe patient's condition from past experiencewith AE. Seethat treatment is not moving or holding. Read a sharp or unusual quality on the pulses. Supporting signs are indicators to check for AE. They do not indicate AE's definite presence. Only testing wilt determine it. For example,not everyonewho is feeling more emotional than usual hasAE.
28 See"Clinical Note: Tbe Mystery of AggressiveEoergy,"page133.
54
Clinical Significance Must be clearedto prevent its spreadto other Officials during treatment. May needto be clearedto clarify CSOE. Is usuallythe first treatmentdone on a patientunlessPossessionis suspected. Is drainedthrough the Yin Officials. Won't come out if the patient is possessed;do ID andlor ED treatment,then test AE. AE Treatment Preparation 1. Invite patient to empty bladder; this treatment could take a while. 2. Be surethe patient is comfortable. The treatment may be done with the patient lying face down or sitting up facing the treatment table. 3. Stay in connection with the patient during the entire process. This is frequently the first acupuncturetreatment for some patients.Know if they are about to faint! 4. Be sensitiveto your patient during treatment. Sometimesit is all right to talk, other times it is bestto be quiet.
Treatment BL 13 BL 14 BL 15 BL 18 BL20 BL 23
Lung Correspondence Pericardium Correspondence Heart Correspondence Liver Correspondence SpleenCorrespondence Kidney Correspondence
1. Insert needlesright to lefi, top to bottom into all AF,J:mSSPI BL 15, which is inserted after all other points have been Insert needlesvery shallowly, about one fen. If the ffid. needleis at the proper depttL it will hang down without touching the skin. If the needletouches the skin (in the sitting position),the needledepthis too shallow. If the needlesticks straight out, it is too deep. 2. Insert test needles,one per jiao, inside or outside the lnner Bladder line, but not in a point. The test needle is inserted in eachjiao immediately after all needlesare in place in that jiao. 8.g., insertBLl3. BLl4. and then the test needle.
))
4 ,
4
largerin areathanthe test needles 3. Whenthereis AE, an erythemaappearsthat is darkerand/or roundederythemafrom a andlastslongerthanthe test needle.Be sureto differentiatethe the grainof the tissue' histamine,.."ponr". A histamineresponseis bright red andfollows Seeillustrationbelow. 4. Leave in each needleuntil the erythemadisappears' are the same 5. If there is no redness,or if the rednessof the point needles remove, as the control needles,leave the needlesin a few minutes, and continue with treatment. no 6. If rednessappearson one side only, the needleon the side with or needle rednessmay not be on the point. Either add another repositionneedle. in 7. Test BL 15, Heart Correspondence,for AE after rednesshas cleared all other points. Add a new test needle' 8. Usually test all points unless you're sure where the AE is. In that case, test the two Officials acrossthe Ke cycle.
Testing AE on Heart
treatment' 9. If AE was present, you may want to retest for it at the beginning of the next Considerations Don't leave a patient with inserted needlessitting alone in the room. AE can r"".rrf it can be tested for again at any time if the practitioner suspectsit. After draining, the patient may feel better or may feel worse for a brief time' Recheck Akabanes after initial treatment for AE. AE may not drain completely if the patient is possessed.
Histemior
56
HusbandAilife Block Definition The Law of Husband^Vife: The left sidepulsesmust alwaysbe slightly strongerthan the pulses block. on the right side.When this is not so, thereis a husband/wife greaterboth in quantifi pulses are hand A husband/wife(FVW) imbalanceoccurswhen the right handPulses (volume) @ of the family. J.R. Worsley callsa husband/wifeblock the disaster/death If an FVW block is suspected,it shouldbe treated.It is a major block and a deepproblemthat may not be easyto move. It can also return in the courseof treatment. Diagnosis fF
Diagnosisis madesolelyby pulses;not by supportingsigns. The pulse quality on the right sideis hard and rigid, often describedas sharp,biting, tense, dominating,pecking,like a hammer,coming up to meetthe fingers of the practitioner. The left sideis relatively weak, empty, collapsing,thready. as a whole. Quality is the key to the diagnosis. The quality of the pulsesare considered
SupportingSignsSpecificto an H/W Block RgO FL+QS A senseof deepstrugglein the patient. The patienthasthe feeling of being split apart. Chronic illness,suchas multiple sclerosis,cancer,AIDS, or long term alcohol or substanceabuse. Relationshiptroubles,e.g., being bullied by someone. Treatmentsare not moving or holding. Examplesof pulsepicturesindicatingan FVW block (where pulsequality is strong on the right and weak on the left):
Note: Theseexamplesindicatean FVW only if the quality of energyis imbalanced.The relativity of the pulsesis important! The right hand pulsesas a whole havea relatively strongerquality than the left. The differencebetweenthe sidescan be subtle Pulsevolume, or quantity will also probablyshow the sameimbalance. 57
Treatment of an HAil Block the-right side to the left side' Start with Generaltreatment principle. Transfer energy from Water, then Metal and Wood' End the block betweenMetal and Water, then Earth and with the source points on the left side of Fire' spreadAE through the meridians' L check for AE so that the ensuingtransfersdo not points in water: 2. Transferfrom Metal to water. use the tonification BL 67 J' Kl 7J' Earth point in 3. Transfer acrossthe Ke cycle from Earth to Water. Use the Kidney: KI 3
J
point in 4. Transfer acrossthe Ke cycle from Metal to Wood. Use the Metal Liver: LR4 -|:' Controller 5. Toniff sourceson Heart and Small Intestine.This puts the Supreme on the throne: SI 4 J, HT 7 .[,
back
steps Check pulsesbetweeneachstepto determineif the block remains. Usually the above will break the block. If not, one or more of the following options may be used. Option One Dispersesourceson the right-sideOfficials and toniff sourceson the left-sideOfficials: Dispene
Toni$
LU I -19 LI 4 -E ST42-E SP3 -|9
Kl 3 -r, BL64 I LR3 J, GB4O J,
you mayinsertthe dispersion needlesandleavethemin for a while.Whilethe needlesare still in, tonifuthe left-sidepoints.
58
Option Two Tonify the AEPs of Liver and Kidney. BL 18 -E BL23-|: Option Three Dispersethe AEPs of Lung and Spleenand tonify the AEPs of Liver and Kidney. Toniff
Dispcrse BL 13 -E BL 20 -E
BL 18 J, BL 23 -|j,
Option Four Disperse all wife AEPs and tonify all husbandAEPs at the sametime: Tonif
Disperee BL 13 -I9 BL 14 J9 BLzO J9
BL 15 J BL 18 -t, BL23 X
Option Five Use four-needletechnique.'e Continue treating until the block is broken. Check the pulses after each step in treatment. Stop treatment once the block is broken. Considerations This is a dangerousimbalance,do as much as you can in one treatment. Have a strong intentiorq the issueis one of control and the strong side may not give up easily. The imbalanceis serious becauseit createsa lack of movement;the patient is stuck and everything seemsout of order.
2e
Worsley, J.R, Traditional Chinese Acuounc-hue.Volume I: Meridians and Points, Elemcnt Books, 1982,page299
59
Umbilical Pulse Definition An umbilicalpulsethat is oflcenter canbe a block to treatment. The umbilicafpulseis testedduringthe physicalexamandbeforetestingandcorrecting Akabanes;it canbe testedeverytrlatmentandshouldbe testedfrom time to time' is Eachpersonmeetsthe world from the Dan Tierqan areajust below the umbilicus' It bestto meetthe world "centered"from this area' Diagnosis l. Explainto the patientwhat you are aboutto do. 2. Considerthe patient'scomfort. Ask the patientto emptyhis/herbladder.You mayalso askthe patientto bring their kneesup astheykeeptheir feet flat on the treatment table. a>ds. 3. Placethe thumbandfirst threefingerstogetherforminga North/South/East/West press down gently 4. Ask the patientto take a deepbreathandexhale.As he/sheexhales, insidethe umbilicuswith the four fingers. 5. Note which finger(s)feel the pulse. If the umbilicalpulseis centered,it will pulse equallyon all four fingers. A strongerpulseon one or more fingersindicatesthe direction in which the pulse is of,F-center. 6. Annotate your findings by placing a circle on a
Off-center, to the top and right side of patient
Centered
Treatment: it to the centerl. Correctan umbilicalpulseby massaging 2. Usethe thumbsor the threemiddlefingersto gentlypushthe pulsebackto the center. Follow the breath. Do a few gentlestrokesandthenrecheck. 3. Correctingan oFcenter umbilicalpulsemaycolrect the Akabanes. the pulsetoo long. It maybe the resultof a structuralanomaly. 4. Do not massage
%l
T
the pulsebackto center Massage
60
Akabane Definition A techniquethat teststhe leff/rightbalanceof enerryof a singlemeridian.Akabanesdo not compareonemeridianto another. TestedduringTraditionalDiagnosis(TD), afterAE andanytime thereareone-sided symptoms. If manyof the Akabanesare ofi the patientmayhaveAE. Thistreatmentis not foundin Developed by Dr. Kobe Akabane(1895- 1983)in Japan.30 traditionalChineseacupuncture. Diagnosis The Akabanetest is the definitivemethodof diagnosis. SupportingSignsto indicate an Akabanetest -
LE-b
FLr+qS
PersonfeelsoFcenter. Onesidedsymptoms. injury, trauma,or surgery. Personhasexperienced A tick-tock pulse. Testing Note: Do not test Akabanes on thefeet of a diabeticwith neuropathy! l. Check the umbilical pulse first; correct if necessary. 2. Instruct the patient to tell you when the point begins to feel hot but not burning. This is not a test of endurance. 3. Beginning on the left side of the patient, move a lighted incense stick over the nail point of the meridian at a heiglrt of 1 to 2 fen. Bring the stick as close as possibleto the point, passing over it and going an equal distanceon either side of the point. Use the inside of the noil of the little toe to test Kidney. 4. If for any reason you cannot test the nail point, move up the meridian to the next point availableon both sides of the meridian. 5. Count each pass.Record the number of passesfor each meridian separately.The left side is always recorded first.
$
Ak b-.,
K, Method of Hinaishin- Idono-Nippon-sha, Yokosuka 1950. ln Japaaese.
61
f5('
Left SP LR ST
Fishl
Evaluation unbalanced' Readingsthat differ by at leastone-thirdareconsidered longerfor the The sidewith the mostn r-ber of passesis the deficientsidebecauseit took heatto connectwith the energyTreatment 1. Tonify the junction point on the deficientside'RecheckAkabanes' hasnot corrected,tonify the sourcepoint on the deficientside'Recheck 2. If theimbalance Akabanes. 3. If not corrected,ton$ bothjunction andsourcepoints' RecheckAkabanes' 4. If not corrected,addmoxaon the junction and/orsourcepoints. RecheckAkabanes' junction point 5. If not corrected,dispersethejunciion point on the excessside,toniff the on the deficientside.Recheck. 6. If not corrected,tonify the AEP on the deficientside.RecheckAkabanes' 7. Treatthe CF for a while.RecheckAkabanes. 8. If the abovemethodsdo not rectify the imbalance,a structuralblock may be impeding the energy.The patientmayrequiresomeothercare,suchaschiropractic, osteopathy,or bodYwork. Example: The Akabaneon Lung reads10/6 attemptsto correctthe imbalance: Treatmentin successive LU7LJ, 1. Tonify the junction point on the left. L U9Ll' 2. Tonify the sourcepoint on the left. andLUgLl, LUTLI 3. Tonifyjunction andsourcepointson the left. LUZLAandJorLUgL.A 4. Moxa on junction and/orsourceon the left. 5. Dispersejunction on the right; tonify thejunction on the LU 7R ,f and LU 7L -l: BL 13LI left. 6. Tonify the AEP of the Lung on the left. Treatment of Multiple Imbalances You mustdecidewhichmeridianto treat first. The optionsare: If an imbalanceis on the CF, correctthe CF meridian(s)first' Treatthe Mother of the CF. Treat the onethat is mostoff. Treat a meridianthat hasa one-sidedimbalancethat showsup in the patient. Go aroundthe Shengcycle,startingwith CF or first unbalancedmeridian afterthe CF. Treat the first meridianandcontinueto treat until it balances. will causethe rest of Recheckthe other Akabanes.Often corecting oneor rwo imbalances the meridiansto comebackinto balance.
62
Quality on the Pulses Definition A pulse quality is a distinctly different sensationthat standsout on one, some, or all of the pulses. Such qualities either feel outside of the normal range of pulse sensationfor that patient, or show up on only one, or a few pulses,as markedly different from the others. A "qualiqy'' in this senseis undesirable. The range of sensationis varied. Pulse qualities can feel wealg wiry, bounding, irregular, slippery,tight, and so forth. Diagnosis A sensationthat standsout on the pulse(s). Treatment Treat the CF. This will often clear qualities. If the quality does not clear with a CF treatment, treat the meridian that carries the quality' You may also treat the meridian most likely to be responsiblefor the quality, provided that the quallty pervadesseveralor all of the pulses. IJse source points. You may also use points that historically clear a particular quality. For example,LR 3 may be used to addressa wiry pulse; SP 6 and SP 9 may be used for a slippery pulse.
fr
e/ AF, Vunz'havtVr>
d?:n.hft: L tc-ut'f-tVt
- ix(? tuW^"
/
W!-er;ura<- p*
63
{a*
CV/GV Block Definition meridians' The Conceptionvessel(CV) andGovernorVessel(GV) aretwo of the eightextraordinary They are like the seasthat feedthe rivers of the meridians' If t[b seashaveenoughwater,the riversshouldalsohaveenoughwater' If the seasare blockei, watercannotflow into the riversandthe riversmaybecomevery low. If CV andGV areblocked,energyflows into thesetwo meridiansbut doesnot flow out. GV' A CV/GV block is treatedon the Wei Qi level,i.e.,by usingthe Entry andExit points on CV and Diagnosis All the pulsesarevery low, -2 or -3. Supporting SignsSpecificto a CV/GV Block The patientmay appearto havea lot of energybut haslow pulses. Work on the CF mayproducemomentarychangesthat do not hold. Treatment l. 2. 3. a.
Drapeyour patientappropriately. or gloveswhenworking in the genitalarea.Washhandsafter needlingeachpoint. Use-fing"r "btt Take the pulsesafter eachpoint to determinewherethe block is. Tonify the following pointsin order: CV I _U, cv 24 J, GVlJ. GV 28 J.
5. NeedleCV 1, l0 fen.Alwaysusea lt/zinchneedlefor CV l. Considerusingan insertiontube. Do it quickly. 6. NeedleCV 24.I to 3 fen. 7. NeedleGV l, only 3 ferqwith the patienton his/trerside;GV I is a tenderspo[. 8. NeedleGV 28, only I fen.Use aVzrnchneedleon GV 28. Pull the patient'slip up with your little fingers;somepractitionersaskthe patientto hold the lip. Considerations This is treatingthe Entry/Exit pointsof CV andGV. Considerhow you will explainthe treatmentto the patient. The morematter-of-factyou are,the more acceptingthe patientis.
64
Entry/Exit Block Definition An Entry/Exit (ElE) block is identified on the pulse. It may exist when a meridian of lower numberis strongerthan the next meridianin order, accordingto the sequenceof the Chineseclock. For example,a IVIII block is when the pulse of the Small Intestine (tr) meridian is stronger than the pulse of the Bladder meridian (III) . An E/E block occurs between meridiansof different elements(see page 3l). It does not usually occur between paired meridians. A pulse'differencebetween paired meridiansis called a split. If you suspect anEtE block, make a note to watch for it next time the patient is treated.
Diagnosis EIE blocksare not usuallydiscernibleat the beginningof treatment.Theymay showup on the pulseover time asonereviewsa patient'spulserecordsOR they may showup suddenlyas a pulsepicturethat seems"unusual"for that patient. Thepatientmay exhibitsymptomsaroundthe blockedmeridians. Treatment (evennumbered)meridian.This meridianwill be the Tonify the exit point of the lower-numbered3r relativelystrongerpulse. Thentonify the entrypoint of the next meridian.This meridian will showa relativelyweakerpulse.
Thispulsepicturesuggestsa SIIBL (Iru) Treatment:
block.
SI 19 l' BLI J
Sometimesa pulse picture is incorrectly interpreted as an E/E block: This is NOT a IVIII block:
3l
An exception to this rule is the trearment of a SP/HT QOVI) block in which the higher numbered meridian is tonified first
65
SPirit Block Definition is no pulseor particular Spirit blocksshowup in a patient'semotionsor emotionallife. There ..look, to the patientthatwill demonstrate a spiritblock..However,you candetectsucha block you sensethat his spiritis by listeningcloselyto what the patienthasto sayabouthis/herlife. Do him? Does the thriving? iVf,ut is feedinghis spirit? Does he havea senseof alivenessabout patienrindicatethereis somethingmissingin life? is not Many patientsaretreatedon the spirit level. It is only considereda block if treatment progressing. Diagnosis A sensethat the patient'sspirit is suffering. Treatmentis not moving/holding. Treatment Consider: UpperKidney points OuterBladderline Points Spiritpoints on the CF ConceptionVesselpoints GovernorVesselpoints
66
Tonification and Sedation Definition Tonification and sedationare needle techniquesthat move energy. An acupuncturepoint may be tonified or dispersed(sedated). Each method improves the pulses. Tonifying builds the pulses and may make them ciear.r. birp"rsing makesthe energy more availableand may also make the pulsesclearer.
lethargrc listless lack energl
hSiper higlrblood presslre can't rela:r
etc. pulse -2
etc. pulse*2
Treatment with uppers/amphetamines vuillmove the enerry toward the middle gror:nd but will detract from the lrfe force
r'ITA.L
FC'RCE
\']TAL
FE FICE
Treatnentwith downers urill movethe enerry towardthe middlegrouod but will detract from the lrfeforce
Tonification treatmentindicated to rnove the enerry toward middle ground
Sedation treatrnentindicated to rnove the enerry toward middle ground
AND enhance thelrfeforce
AND thelifeforce enhance
VITAL
69
FE rlc:E
NeedleTechnique Definition Methodof acupunctureneedleinsertion,manipulationandremoval' Characteristics needle Needlingtechniqueincludesthe orderof insertiorqangleof insertion,depthof insertion" movement,and closingaction. energy' A needletechniqueis selecteJtotonify or disperse(sedate)asa meansof movingthe Eachmethodimprovesthe Pulses. Tonifyingbuildsthe pulsesandmaymakethem clearer' Dispersingmakesthe energymoreavailableand maymakethe pulseclearer'
Tonification Needle Technique
FC5gF*'
\
Preparation AtwaysuseCleanNeedle Technique. Alwaysinsertthe first tonificationneedleon the left sideof the body,then the right. Somepractitionersaskthe patientto take a breath;someinsertthe needleon the intake,someon the exhalation.Therearevariousideasaboutbreathing. The procedureis completedfirst on the left andthen on the right. Treatment l. Insertthe needlern the direction of theflow of energt,at an appropriateangle- The exact angledependson the areaof the body beingtreated' 2. Go downto the fen depttr" 3. Make a l80o turn cloclcwise.You mayfeel a grabbingsensationon the needle. 4. Removethe needle. 5. Sealthe hole by gently touchingwith clean gauzeor a cottonball in the directionof the flow of energy.
70
L
Dispersion/SedationNeedle Technique
PC3
/
PCs
PC7
Preparation Atways use Clean Needle Technique. Always insert the sedation needlefirst on the right side of the body, then on the left. Both sidesare treated at the sametime. Treatment 1. Insert the needle against the direction of theflow of energt, at an appropriate angk. 2. Go down to the fen depttl 3. Make a 180"turn counter-clochaise. You may feel a slight grab, less than tonifying. 4. Lewe the needle in for 15 minutes or more until the pulseshave changed. 5. Remove the needle.It should come out easilv. 6. Do not seal the hole. Partner exercise: Practice with partners using a pen or a pencil as the needle. Decidewho is A and who is B. Go through the mechanicsof treating the following points.
Tonify the following:
Dispersethe following:
AB
AB
PC7 TH4
SI4 HT7
FI't 5 SI I
71
PC6 TH3
Moxibustion Definition burning a dried herb called The application of heat to points or certain locations of the body by ..moxa.,, The Latin name fol. -o*u is Artemisia Vulgaris Latifolia. The common name is Mugwort32. Treatment Planning Moxibustion is usedto: .
feeling Warm the meridian and expel cold. Moxa is indicated for a patient who reports jiao, etc have specific areasof coldnesssuch as the joints, lower cold. The patient may -feel bone deep-down, a of cold to the touch. Somepeople speak The patieni may also coldness.
.
who is Tonify ei and Blood. Moxa is usedto increasea patient'sQi or Blood. Someone the run down and presentswith deficiencywill benefit from moxa. Think of moxa as "chicken souP" of acuPuncfure.
.
will Smooth the flow of Qi and Blood. Becausecold contracts and slows movement, moxa increasethe flow of Qi and Blood by its warming action'
the The number of moxa used is determinedby the degreeof cold or deficiency in the patient and patient'stolerance for it. Refer to the point location text33 for the number of moxa recommendedfor a particular point. Treatment Methods Loose moxa is applied to the surface of the skin . directly on the skin . indirectly on a needle, on a cushion of salt, on a slice of ginger. A moxa sticlCais held/waved just above the surface of the skin'
32Fo,.or"informationaboutmoxibustioqs""@ForeipI",arrguagePress"l987'page339. 33 Worsley,J.R, Traditional ChineseAcupunctre. Volume I: Meridiars and Points.ElemeotBooks' 1982. a
See"Mor'a StickUsage,"page135.
72
Contraindications High blood pressure: Moxa shouldnot be used on someonewho has high blood pressure.Generally 120/80is a normal, safeblood pressure. If it is greaterthan this or if the differential is 50 points or more, do not use moxa. If the patient'sblood pressureis controlledby medication,do not use moxa. Heat signs,which include any of the following: . A patientwho reportsbeing hot or looks hot: red face, perspiring. . Red tongue body, yellow coating, and/or rapid pulse. During febrile diseases. Lower back or abdomen of a pregnantwoman. Over large blood vessels,varicoseveins,or veinsnearthe surface. When there is stabbing or sharp pain. Over areasof inflammation, skin ulcerations,psoriasisor eczema. With excessivebleeding. On any point that is forbidden to moxa. Refer to the lists in the Worsley text.35 Caution: If burning moxa on a patient'sface, be very careful. Facial skin is sensitive and can easily blister. A slice of ginger may be used under the moxa on the face. Be extremely cautious in using moxa with diabetic patients.
35 Worsley,J.R, TraditionalChineseAcuouncbre,VolumeI: MeridiansandPoints.ElemetrtBooks,l982,page298-299-
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Transfers Definition the pathwaysof Transfersarea methodof movingenergyfrom onemeridianto anotherby using of relatively the ShengandKe cycles. The enlergyis movedalongthesecyclesfrom a meridian strongerQi to onethat is relativelyweaker' Rulesfor Transferring .1 itl.,$ru '
l. Alwavsneedlethe deficiencyfirst' carrier z in"drst needledeterminesihe characterof the treatment;the rest of the needlesare needlesthat potentiatethe treatment' 3. Use tonification,grandmother,andjunction points' 4. The first needlein is the first needleout' 5. Needlethe left sidefirst; this is a tonificationprocess' 6. Make smallchangesratherthanbig ones,smallchangesmaycolrect the largeimbalances' Adjust + pulsesto - pulses.Leave the +2 to -2 pulsesalone. T.Energyiransfersyangto yangandyrn to yin on the Shengcycle;on the Ke cycleit canonlybe transferredYln to Yln. th" Fire wall. The Fire wall is betweenthe HT and SI sideof Fire andthe 8. Enerry cannot "ios PC andTE sideofFire. it's alreadygreedy. 9. Avoid a carrierthat is excessive; usethe PC instead. carrier, HT as a 10. Do not usethe Considerations l. It is all right to momentarilydisturba well-workingmeridian. Z. The Law of LeastAction saysdo as muchasyou canwith aslittle interventionas possible. FewerPointsarebetter. with the Shengcycleratherthanthe Ke cycleif possible. 3. End 4. Considerthe impliiationsof a particularpoint for a patientandhow the treatmentfits with past andfuture pt*r. For instance,if a patienttendsto sit on anger,it might be good to use PC 9. 5. Considerbody logistics. Certaincombinationsof pointsareawkwardwhen needles areleft in. Note: Whencallingthe energyfrom Fire to Earth or Metal, it will naturallycomefrom the sideof fue that hasenergYto give.
74
Technique Put your finger on the deficient meridian and choose a point. This is the point that you will needlefirst. 2. Ask "Where am I?" and write down that meridian. 3. Ask "Where is the energy coming from?" and write down the number of the elementpoint for the deficient meridian. l.
Example
TreatmentPlan: Move energyfrom Wood to Water Point Choice: l. The first needlegoesinto the deficiency,Kidney. that the characterof the treatmentwill 2. This determines be Water. or junctionpoints. 3. Usetonification,grandmother, Thoughts: "I am in the Kidney." "I canuseKI 7 (tonification),or KI 3 (grandmother)-" "KI7 will end on the ShengcYcle." "KI 3 will requirefewerneedles."
Scenario UsingKI7 KI7 callsthe enerryfrom Metal. Moving to Metal, I can use either LU 9 (tonification) or LU 10 (grandmother). Thoughts: "LU 9 directsenergyfrom Earth." "LU l0 directsthe enerryfrom Fire." "I will useLU 9." "[Jsing LU 9 callsthe energJfrom Earth. In Eartt\ I canuseSP2(tonificationlFire)or SP I (grandmotherMood)." "I will chooseSP I becauseI want to transfer Wood to Water." Treatmcnt:
75
K t 7 -|: LU9 I SPl I
Scenario Using KI3
eitherSP2 (tonificationlFire)or SP I KI 3 calls the energy from Earth' In Earttr' I canuse I want to pull the energyfrom Wood rather (grandmotherMood). I chooseSP1 because than Fire. Thoughts: 'SP 2 callsenergYfrom Fire" "SP I callsthe energyfrom Wood" 'I will useSP l" Treatment: Kl3 .|:' SPl JComments: and involves Earth and By usingKI 7 andLU 9 and SP I the treatment ends on the Shengcycle Metal in the transfer. involved. ChooseKI 7 if By using KI 3 and SP 1 fewer needlesare used and Metal is not following the Law of involving the Metal is desired.Choose KI 3 to use fewer needles, Least Action. Needling Technique: Example: Using KI 3 and SP l, the procedure for needling is: l. 2.
inserted so Insert needlesinto KI 3 on the left and then the right. The needlesare that they are ready to be tonified, both needlesare left in placeon left Insert needlesinto SP I in a neutral manner,perpendicularto the skiq first and then on the right. Leave needlesin place'
Earth to ll'ater' A pathway has been set up to bring the energtfrom the Wood through the 3. 4.
Repeat Go back to tonify KI 3 on the left. Remove the needleand sealthe hole. the process on KI 3 on the rightthe point is Remove needlesfrom SP I left and SP 1 right. There is no needle action and not sealed.
is complete' By tonifying KI 3, the energl has moved over the pathway created' The transfer is complete' If the Check the pulses, if the Kidney and Bladder pulsesare everLthe procedure junction point, to ensure the energy has not gone through to Bladder, then tonify BL 58, the Kid*y meridian sharesits energy with the Bladder meridian.
76
Treatment Plan Where is the deficiency? Mother point _ Your choicesare: Grandmother point Using the mother point, what other points must be used? Using the grandmother point, what other points must be used?
77
What is Five-ElementAcupuncture? by John Hicks, Ph.D., Dr. Ac.(J.K.), M.T.Ac.S. John Hicks, formerly Dean and a clinical supervisor at the College of Traditional Chinese Acupuncture at Leamington Spa in England, prepared this article to explain Leamingtonfive-element acupuncture to practitioners trained in TCM (Traditional Chinese Medicine). Both TCM andfive-element acupuncturists hqve welcomed the article's thoughful comparison of the two styles of acupuncture, andwe publish it tofurther mutual understanding cnnongpractitioners in the two traditions. We thank our English colleagues-the author and the editors of the Traditional Acupuncture Society Journal and the Journal of ChineseMedicine-for permitting us to bring this article to American readers. John Hicks has an acapuncture and herbal practice in Reading, England, and currently runs cm eight-month course for graduates in the diagnostic skills offiveelementacupuncture.In 1990,he will initiate (with Angela Hicks) a two-year clinical course based on five-element cqusativefactor diagnosis that also includes TCM diagnosis.
are necessary The first necessarystepis that LA be given a written account so that TCM practitioners know clearly the theory and assumptions underlying it. At the moment, there is only a partial account ofthe system transcript of a seminar presentedby Professor Worsley to a group of non-acupuncturists. The communication of the system has otherwise been verbal and given by some twenty-five to thirry teachersat the Leamington College [and by faculty of the Traditional Acupuncture Institute in Columbia, Marylandl. The secondstepis the sharing of practice time between practitioners from different backgrounds so that each can appreciate in clinical terms what the other does.The second step dependson the first, and hencethis article
The purpose of this article is to give a critical account ofthe "systern" of acupuncture that has come to be known as five-element acupuncture.It is the style of acupuncturethat has been taught at the College of Traditional Chinese Acupuncture in Leamington Spa in England since the early seventies[and at the Traditional AcupunctureInstitute in the United States since 1980]. Its father and developer has been J. R. Worsley. Although the system uses the five-element model, what makes it different is not simply the five-element theory found in any ofthe basic Chinesetexts. Hence it may be called "LeaminSon Acupuncfure" or LA for short. The following is not a detailed account, but more an overview of the significant differences between LA and the system called TCM (Traditional Chinese Medicine).
is onestepalongtheway. I would like to get one issueout of the are ManyTCM practitioners way immediately. awareof someofthe absencesfromLA. They are surprisedthat in LA theory there is no differentiationby substances,eightconditions,
In the West we are forming an acupuncture that is appropriateto our culture. LA hasa contributionto make,but two steps 83
Secondly, the concePts of TCM are explicit; €.g., "Ylr xu" is specifiedby malar dry mouthandthroat,night flush,restlessness, sweats,etc. Thirdly, the conceptsthat are the least andthereforeeasier abstractaresensory-based e.g.,you can"see"a malarflush, to ascertain; observerestlessness,and ask about a dry mouthandthroat. The following is a generalization; nevertheless,we can say that the concepts usedin LA are less systematic(in the above sense),less explicit, and less sensory-based than thoseused in TCM. TCM's underlying world is more physical and external;LA's morementaland internal.
jing luo and the four levels, sanjiao or six channels.In effect,this meansthat LA does not recognizethe channel-organdistinction and has no traditionalway of describingan acute, exterior condition. LA developedin Englandand dealt mainly with patientswith chroniclong-termcomplaintswho wentto the Westerndoctor whenthey caughta cold.It is clearly not realistic to look to LA for a contributionin theseareas. Returning to the develoPment of an acupuncture for the West, we can say that most acupuncturists have kept several standardsin mindfor a Westernacupuncture. Using a couple of these standards,we can higtrlighta very importantdifferencebetween TCM andLA. Thesestandardsare:
What is the significance of this difference?
l. Effectiveness of treatments with Westernpatients. 2. Testability and compatibitity with Westernscientificideas. 3. Adherence to the basic Chinese tradition. 4. Teachability or explicitnessof the material. 5. fndependenceof personalauthority.
A body of knowledge that is systematic, explicit, and sensory-basedis more easily taught.So it is easierto communicateTCM; andit is also easierto checkthat the student has understoodthe concepts.On the other hand,much of the languageof LA is poetic rather than literal, suggestive rather than articulate, and not unlike the tradition of Chinesephilosophy.Many of the diagnostic categoriesof LA refer, in part, to innerstates For and are difficult to make sensory-based' much is inert" quality and example,"lackingin harderto pinpoint without confusionthan is "malarflushandrestlessbehavior."Theextent to which LA usessuchconceptswill be clear aswe proceed.To the degreeto whichit does, it can be difficult to teach, learn"and check that it hasbeenlearned.LA alsoimpliesthat its teachers must be effective clinicians, whereasthe nature of TCM makes it less essentialthat teachershave extensiveclinical experience. But why use such conceptsat all when relatively explicit ones are available?The answeris that they do a differentjob. LA
The latter two highlight an important differencebetweenTCM andLAwhich needs to be dealtwith first. Expressionand StructureofModern TCM and LA When referring to TCM I will be referring to what is currentlytaughtin Chinaandrecorded in Essentials of ChineseAcupuncture. TCM hasthreeimportantcharacteristics. Firstly,TCM issystematicin the sensethat refer e.g.,syndromes its conceptsinterconnect; to substancesand organs; the function of organsis defined,at leastin part, in termsof substances. 84
idea that a disease's transformation into further diseasescan be controlled. TClvI, on the other hand, pays relatively little attention to the five-element theory when dealing with clinical diagnosisand treatment. Certainly, the associationsare not used consistentlyand the notion of preventionis paid little credence. LA goes further. In the teaching of LA there is considerabledescription ofthe nature of each element and how it functions within man.Thesedescriptionsinclude, but are wider than, the roles of the organs. Earth, for example, is not just the function of the stomachand spleenorgans. As earth supports and nourishesus, so also does the earth within us. Our abiliry, therefore, to nourish ourselves and others will be qualitatively determinedby the state of our own earth. In the teaching of Ld these metaphors are explored over and over agaiq often through examples from individual patients. For example, when a patient's metal is the fundamental weakness, what is the patient likely to say about himself? What is he likely to complain or boast about? How is he likely to think of treatment, behave towards the practitioner, or give feedback on changes? With the elements,particularly, there is the difference between explicitness and poetry mentioned above. It is not the purpose of this article to give an account of eachelement,but, rather, to state that in LA the nature of the elements,however metaphorically described, are used seriouslyin the clinical context. The above quote fromEssentials refened to the interaction of the elementsand the use of color on the face. The main models of interaction used by LA are the shen and ko cycles.Color, sound, emotion, and odor are the main associationsused clinically, but more willbe said of theselater.
clearly believes that the effectivenessgained through using such concepts offsets the diffi culty of learning and communicatingthem. This point will comeup againin the section on the function of the organs. Therefore, we begin with an important difference between LA and TCM in the way they are expressed.The other differencesarise from what LA leavesout and what it includes. This is the main subject of the article. We begin with LA's understanding of an element. The Elements In Essentials of ChineseAcupuncture thereis an account ofthe five elements.They are said to be the basic materials of the world. The five-elementassociationsare describedandthe ways in which one element interacts with another are discussed. Various clinical examples are given and the possibility of preventive treatment is suggested: . . . the condition of a patient suffering from heart trouble and whose complexion is abnormallydark may be explained as water (kidney) acting on fire (heart). If the above correlation of a disease is studied thoroughly the findings may be taken as a guide in treating the diseaseand preventing it from reaching another part of the body. Its possibletransformationinto other diseasesmay be controlled, so that the course of treatment can be shortened and the diseasecured in an earlystage.(p.21)
LA takesvery seriously thenatureof the elements, the waysin whichtheyaresaidto
What shouldbe obviousis ttrat LA usesonly parts of five+lement theory clinically and disregards the rest; hence my preference
interact, the use of associationssuch as color to discover the root of the disease.and the
85
organwith differentpartsof the body-e'g'' thJ fiver with nails, eyes, and tendons-is included.
(stated above) for calling this style of "LA" ratherthan "fi ve-element'" acupuncture There are many aspectsof traditional fiveelementtheory that are not taught in LA. On the clinical effectivenessof these,LA does not comment.
Behavioralor PhYsicalsYmPtoms? An important differenceis LA's attemptto describe the patholory of an official in behavioralterms.TCM goesfrom a function suchas liver storing the blood, to too much blood in circulatiorLto a symptomlike hearry of liver Qi, or anyof periods.For depression ihe other liver syndromes,there is a set of moreor lessphysicalsymptomswhich arethe manifestationof the liver's imbalance' What does lll do? LA begins with a generalstatementof the official's function, iuch as "receiving Qi energy from the heavens"or "transportandtransformation'"lt then proceedsto what occurs when these officials are sick. This accountmay include physical symptoms;but, in general, these symptomsare not so relevant.Referenceis madl mainly to typical forms of behavior (implying intention), andthe mannerin which the behavioris carriedout. "Manner" covers the context and the intensityof the behavior canbe evaluated' suchthat its appropriateness An organ in balancewill lead to appropriate behavior;an organout of balancewill leadto inappropriate behavior. By analogy, constipationor diarrheacould be saidto be "inappropriate." Many of the typically inappropriateforms ofbehaviorwill be drawn from patientexamPles. At this point the poetic versusexplicit natureofLA shouldbe kept in mind-LA does not find it easyto keep categoriesseparate' So,in the accountof an official or an element with anelement,you orthe emotionassociated maywell find aspectsofthe otherscreepingin' For example,a personcan do more than the usual amount of "looking after or nurturing others," or, indeed, the opposite, such as
Thenextimportantstep is I'A's treatmentof organs. Organs/Officials/Channels With respect to organs, LA makes some important omissions and some important additions. In theWestwe havetried variouswaysto ensurethat the Chineseconceptofan organ doesnot get confusedwith the Westernone' LA refersto the organasan ofEcial,usingthe analogyof a governmentofficial in chargeof a province.Functionratherthan substanceis implied. Thereis someconfusioq however.In LA the term"official" tendsto iry!@thegnggpl No distinctionis madebetweena of a channel. and an organ problem;and channel-problem the effect,when referring to the "lung," for example,is that a practitionermaybereferring to the channelor the organ.Thiswill comeup again when I refer to the tyPes of differentiationmadein LA diagnosis. In LA's descriptionof thefunction of an fficial or organ, there are someimportant diflerencesfrom TCM. Onedif[erenceis the omissions.LA refers to energ, but doesnot makereferenceto the sorts of Qi or even to different dffint ffinoreferencetoyin" i"rg, bt""a, jing, sherqjin ye, etc.This means that the officials' functionsare not described with referenceto substance;e.g., the liver is not saidto causethe easyflowing of Qi, or to storetheblood. On the other hand, the associationsof the
86
of equal rank. The five Zang organs are not singledout as any more significant in patterns of disharmonythan any ofthe other sevenSo, in specifying the main cause of the patient's imbalance--the causativefactor- the element would be specified first and then, if appropriate, the official within the element wouldbe indicatedThis ofEcial could aseasily be the small or large intestine as the heart or
caring for others very little or doing it begrudgingly. In either case, both sets of behavior can be judged as inappropriate.To go further, the same person may show an inability to nurhrre herself in all areasfronU literally, ensuringthat sheis fed well to getting her reasonableration of emotional strokes. These would be seen as a function (or malfunction) of the earth element and the stomachand spleenorgans.What practitioners often find difficult is the standard of appropriateness. Constipationcan easilybe seento be a malfunction,but how do we judge behavior? To give another example: A person may try to be the best in what she does in such a way that, in the end, this behavior seems inappropriateand detrimentalto health.At the same time, she may be unable to take in, appreciate,or feel the complimentsor respect that others give her. Her response may be observed as inappropriate; she D&Y, for example, deny compliments or push them away. These behaviors could be seenas two parts of a pattern or vicious circle and be attributed to the metal element and lung and colon officials. LA's assumption(not madeexplicit) isthat the quality of energt affects all aspects of oneself. A chronically deficient spleenwill not just affect our appetite and digestive systenq but our dreamsand hopes,our work and play, our friendships and relationships. It affects what we choose to read and the quality of information we are able to get. To understand this concept clearly, however, we need to touch on one other very important concept of Ld the CAUSATIVE FACTOR. Its connectionwith the abovelies in its long-term nature, especially when comparedwith the syndromesof TCM. After considering the causative factor, there is one other relevant factor in LA's treatmentofthe organs.InLAall fficials are
the lung. We can now consider the causative factor. The Causative Factor The first and most important stage of LA diagnosisis to find the causativefactor (CF)' The CF is definedasbeingone ofthe elements (sometimes as one of the officials or organs which make up an element).The concept can be made more sophisticatedby extendingit to the element within the element; for the purposes of this article, however, we will concentrateonly on the element. Within a person's energyfield, LA believes that one element is the main ccuse of the deteriorqtion in the other elements. Rather than the twelve individual organs standingup against the insults of the world and each suffering to some degree and, to that degree, requiring help, the gmphasisis on an eartYand qajsr insult to one elementan4 the daFagq to uiu ttraieiement b"i"g pu.t"d o" to th. the energetic exchangewithin the person. So, when an organ is malfunctioning, the crucial questionis whether it malfunctionsbecauseof an insult from the outside or because of the weaknessof another organ. LA's belief is that to effect an imProvement in the '$hole" person, the original weakness-the CF-must be treated. Before further clarification ofthe CF, two points are worth noting. The first is that TCM would recognaethat one synfuome can be a
87
(meaning what the patient is complaining and signs" about) La fCrra's "sSrmptomswhichquitetightly definea specificsyndrome' In any case,a Patient'sCF inot,PE determinidby her symplgrn[S6Fow do we ffiosoisrelativelY simpleto explairgbut difficult to carryout'
major factor leading to the presence of onott ti.In sucha case,the formermayneed to be treated to deal with the latter' The second point is that in some contexts confusionmty be created by the importance of LA'Wts on the CF- Becauseof the absence th.Lhu*"I organdistinctionandthe absence differentiationof exterior conditions, of any -implies, by omission, that channel LA problernsandacuteconditionsshouldbe dealt with by treatingthe CF-
lF
Daermining the CF The six mostimportantfactorsin determining the the voice, emo-tion,odor, pulse.s,and the the officialsandtheir elements' -M*t fulw:-nyof othet factors can arise, Q'E', the in the patient's sequenceof symptoms/events casehistory; thesewould be used more for corroboration.The first four-color, sound, emotion, and odor-are of the utmost importance.None ofthese areusedexactlyas thiy are in TCM so a word about each is necessary. 'By COLOR is meant the five-element colorsasthey showon the sideofthe facejust lateralto the eyes,underthe eye,in the laugh lines,andaroundthemouth.TheODORis the five-elementodor emanatingfrom the body' The SOUND and EMOTION are the fiveelement sound in the voice and the fiveelement emotion that are the most inappropriatein a rich sampleof the patient's beliavior.As the contextofthe diagnosisdoes not normallygive us this sampleof behavior, e practitionet interacts comes fundamentalin which the Patient.rrill
The (Jseof the CF ConcePt
changesin the patient'shealt[ the CF remains the same.Whetherthe CF is constitutionalor
emphasisin LA has not been on finding out when or how the CF occurred, but on discoveringits nature. We will saymore in a momentasto how to find the CF, but a word abouthow not to do it may clarify some of the points made previously.In TCM a group of signs(pulse, tongue,andsymptoms)will oftenbedefinitive of a specificsyndrome.In I'A it is stressedthat s will not lead theprycllti CF. Indeed it has sometimes been -said-maybe as a rhetorical device-that anything (any CF) can cause anything (any symptoms).This view may haveoriginatedas a reactionto thepracticeoftreatingsymptoms accordingto points known to be good for those symptoms but without any other diagnosis
@
This interaction to elicit better quality informationor responseis not presentin TCM or in Chinesemedicaltheory,but it is essential to LA. I will return to it in the sectionon diagnosis. It is worth noting that "emotion-words"
88
te
be implicit in the teachingsand practice ofLA. LAbelieves that consistentand appropriate ofthe CF will pro-duqetban€gE not treatment --.just inTapecific condition such as frozen shoulder or duodenalulcer, b.rt 9J ul-9gt sprr!.Thesechangesarenot easyto specifyand not always easyto reahze.They are, however, in my own experience,comrnonenoughand of considerable importance to patients. The changeswould involve the following: l. Changes in the whole person in the sensethat the patient describesthe whole of herself as improved. For example, "I feel better," or "I just feel satisfiednow taking the dog for a wallg" or "I feel like I want to live again," as opposedto "My shoulderis better," or "My stomachdoesn't hurt any more. 2. Changes in grouPs of sYmPtoms or functions which would not necessarilybe seen as related.For example,apatientdiagnosedas a metal CF who came for a frozen shoulder experiencedthe following changes.mild and periodic depression disappeared; excessive appetite reduced and weight normalized; allergy to dust disappeared;getting up in the night two to three times to urinate disappeared; dandruff reduced; shoulder improved. 3. Changes in overall capacity, not just to cope, but to live a satisfying[ife. These are changesthat in some other contexts would be labeled "growth" or personal development. For example,a person might report that a job or relationship which was mostly a struggle becomeseasierto handleand generallymore satisfying. Relating these kinds of changes to the effects of acupunctureis not so odd once you assumethat deficient spleenQi or lung Qi will affect our minds and spirits as well as our bodies-it is just that we do not seemto have a written tradition that clearlyrecognizesthese connections. Patients may not come expecting such
sometimes refer to arr occurrence, as m "George was angry yesterday,"and sometimes to apredisposition to suffer certain emotions, as in "George is an angry person." eare is also interestedhere in the pIg$SPIDg-It that in ttre occulrence of an *o.tffiting emotion, especiallywhen it may be judged as inappropriate> 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
2. How does the relationship between practitionerandpatientaffecttheCF? We ate well aware that the energy between practitioner and client is unique to their interaction.Somepatientsbenefitmore with one practitionerthan with another-we call this "chemistry." When a patient, for one reason or another, transfers to another practitioner, that practitioner may find a we mayview that differentCF. As westerners, differencejudgmentally,decidingthat the one practitionerwasright andthe otherwrong.We want to raisethe questiorqis the energyof the practitioneras it interactswith the client one of the factors in determiningthe CF? For
5. Is the CF tnrefor personsfor their lifetime or mcryit be true onlywithin a givenperiodof time? We are aware of patientswhose CF seemsto have changed over time--ever; perhaps,through the process of treatment 106
realized." However, because the concept is calledcausativefactor, peopletend to discuss one of the elements-the CF-as if it were difFerent from the rest; they may say, for example,that an individual is a wood person, which may be as dangerousas saying that an individual is an arthritic person. In a discussionabout CF, severalmembers of the faculty of the Traditional Acupuncture Institute compared clinical experiences.We realued that in approximately 35 percent of our patients there was a very clear CF, and as long astreatmentfocusedaroundthat element, the patient did extraordinarily well. We found that in another30 percent of our patients,two elements were strongly unbalanced and regardlessof which of these elementswas called the CF, treatment on both elementsand on their relationshipwas essentialto helping the patient do well. In 10 percent of our patients, we had the sense that something beyond the techniques of acupuncture was necessary to open the Process of healing-perhaps the transforming experience noted by Kaptchuk. While the other25 percent of the patients did progress in treatment, our concept of CF was not a clear fit. It may well be that as our skills continue to develop, the CF will become evident in this group. But at the present,we feel that another lens might be more useful for viewing these patients-we feel the need for an errriched concept, one incorporating more dynamic qualitiesthan are conveyed by the seemingly static notion of causation. The question remains: As we continue to improve our skills, how can this generation of acupuncturists evolve and develop the enonnous opening Worsley has made for oriental medicine?
itself. 6. Is CF dependent on the practitioner's image of what patients would be like f they werewhole and complete in themselves?One can imagine a situation in which one practitioner would see the patient needing support in one element, while another practitioner might not seea relationshipto that element at all, but insist on treating from another perspective. It may be that these differences come from two different perspectivesabout what is possiblefor the patient rather than from two absoluterealities that are in conflict with each other. Is this difference related to the length and depth of the practitioner's clinical experience,or is another factor involved? The Possibility of an Enriched Concept A topic that generatesas much discussion and conversationand confusion asthe topic of CF can be a source of great learning-the focal point for numerous insights that can enrichall ofus. We raisethese questionsasthe beginningof a discussion.We do not propose to provide any answers, but simply propose that some of the questions that we find perplexing may be the beginning point for fruitful development. The concept of CF hasboth greatly helped and conf.rsed practitioners for years. It is difficult to write about the CF, for as with many major contributions to human understanding,the work of Worsley runs the danger of being lessenedwhen it is expressed in words. Those who know Worsley understandthat in his clinical work he is seeing all five elements in dynamic interaction. Worsley seesthe importance of one elementas a tool for touching and involving all the elementsin the recreatingof a humanbeing so 'unique being' is that "every possibilityof his
This article is pinted with permissionfrom the Editor of Meidians. The onginal article was published in The Journal of TraditionalAaryuncture.Sping/Summer,I 987.
t07
In Response...
CausativeFactor Theforum on causative factor by facalty members of the Traditional Acupuncture Institute (Spring/Summer 1987 issue of the Journal) elicitedan on6y of responses.Each of our respondents focuses a dffirent lens on the concept of causativefactor (CF). By considering the following comments, readers can expand and refine their own view and use of the CF concept. [For personsunfamiliar with the CF concept, the Journal proviiles this explanation, excerptedfrom the last issue:"The causativefactor is an element(or an official) that becomeschronicallyimbalancedin a pervasiveway, lending a characteristictheme to a person's life. Further stressesor traumas affect this elementmore than the others, so that it continuesto be the first to cavein under stress.However we may define CF, we can say it may be related to an insult to the body-mind-spirit, as a physical, chemical or 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) growth. These aspectsof the person may result in behavior patterns that show themselvesas distortions or blocks in the energeticbalance."]
that the concept It is not my understanding practitioner to constantly of CF requiresthe questionthe diagnosisor that questioningthe diagnosisnecessarilyleadsto confusion.At timesI find that questioningthe diagnosisis a positiveandclearingprocesswhich makesme dig deeperandput moreenergyinto thework. My experienceshowsme that the searchfor the CF does not lead to confusion and uncertainty,but ratherthat my confusionand uncertaintyget in the way ofmy arrirringat the CF. I find the statementquestionablethat "insertingan acupunctureneedlein the midst of confusion cannot have a healingeffect." Looking back on my first monthsin practice, I find therewereseveraltreatmentsI did inthe
Confusion about a CF signalsthe need to improve diagnostic skills. I feel a need to respond to several points put forth in the article, "Causative Factor: A Forunq" by Traditional Acupuncture Institute faculty members. The authorsbelievethat the concept ofthe CF can be a positive factor in the treatment room because". . . it can bring a clarity to the practitioner and a focus to the acupuncture treatments."They also believethe converse: "There is the situation, however, where the search for the CF leads to confusion and uncertainty. If practitioners are constantly questioningthe diagnosis,there is a loss of clarity that defeatsthe purposeof the CF."
109
CF.
truly know?I don't think so. Each healingart has its diagnostictools' The cardiologist has the stethoscope,the radiologist,the x-ray machine.The diagnostic tools that leadthe acupuncturistto the CF are If I wish to grow asa practitioner, the senses. I haveto develoPthesesenses' Over the yearswhat I seemyselfdoingin the work is very slowly tuning my sensory which is my diagnosticinstrument, mechanisnr" so that gradually I am able to perceivethe diagnosticcriteria of color, sound,odor and emotionwith more precision-At this point I can't perceivethese accuratelybecausemy instrument is crude and unrefined' So confusion-instead of threateningchaosbecomesa familiar companionthat givesme importantinformationaboutwhereI needto' work on myself or get help from other practitionersat key momentsin my learning process. Theauthorsaskwhethera personcanhave morethanone CF.In reviewingtheircasesthe faculty at the Traditional Acupuncture Institute found, as I have found, that in additionto the patientswho havebeentreated on only one CF, there is a group of patients who have been treated on two or more elements,and anothergroup of patientswho seemto benefit from a modality other than acupuncture. Instead of seeing this as empiricaldata which leadsme to reevaluate asa the conceptof CF, I seethis phenomenon reflector of the limited precision of my diagnostictools at this time. We eachhaveour own way of regarding this work, and mineis that the conceptof CF astaughtis an excellentmodelin thetreatment room and has brought great benefit to my
MIRAIIDA MARLAI{D, B' Ac' (IK) Portland,Maine Look at underlYingissues.
.... transformation What are the issues underlYing the discussionof the CF concept?They may includethe relationshipthat the Traditional AcupunctureInstitute and somepractitioners havi with the parent(J. R. Worsley),issuesof andcontrol,andresentmentthat independence is aroused when only the "maste/' can reconcileandact asfinal arbiter. (tlow easyit seemsto forsakethe roots for the flowers') These issues certainly seem relevant and deservingof consideration. Concerningthe "areas of inquiry" about factor mentionedin the article: causative 1. Causation, central focus, design factor....Let'slook at what'sinside,primarily recognizingthat what we eachseeis part of ourself.This conceptof causativefactor was never intended as a static or singular to takeit assuchis to misinterpret description: it. It seemsto me that the elementor official that is moststaticin the individualis what the CF is mostlyabout;the CF itself is not static' word,butwe Causemaynot beaveryChinese You might China' in neitherlive nor practice like to characteize the phenomenonas ll0
person. If we treat someone where we see them to be in the future, ignoring where they are now, then we only treat our image' If one practitioner treatsdifferently than you do, who is right? Look at your patients, and they will tell you; look at yourself and understandthe
synchronousrather than causal,whole rather than separate-and in doing so you may be substituting one side of the patient for the other. The West finds it difficult to shake handswith the East; Newton couldn't shake hands with Einstein; and we are in a problem to hold the hands of all of them. Cause and synchronicity both exist. Can we hold them both? 2. Practitioner, patient and causative factor. The patient is as he is. If the practitioner can touch all of the patient's elementsand officials and find the placewhere the patient is most significantly affected,at the level the patient responds best, then the practitioner can be with the patient and facilitate his or her movement to a healthier place. When the patient doesn't move, we as practitioners must question the situation, ourselves,and again the patient. Do we have the facility and versatility to approach our patients differently, to really reachthem where they are, not where we are? What you want to call this place- CF, DF, X, Y or Z-seems less important. 3. Is there a secondary causative factor? Of course, and a tertiary one also. In fact, the mannerin which all twelve officials interact on each level is significant. 4. Dnamic relationship among elements and causative factor. The CF is a dynamic concept. Knowing more about our patients, observing the manner in which the elements and officials interact, is certainly helpful. We also need to know more about ourselves-especially when our patients are not getting better. 5. Causativefactor for W? CF is only a tool to better contact our patients.Whetherwe contact them on the same CF or someplace else seems less important than contacting them. There is no formula; eventhe CF cannot be pigeonholed. 6. Causativefactor and seeing the whole
difference. GARY KLAPMAN, MD., C.A. Aptos, California CF "an idea unnatural to ancient Chinese thinking. . ." Causativefactor is one ofthe concepts I most dislike in acupuncture theory' Yet I think it is amazing how well such a flawed concept works in practice. I use it, though not always, since sometimes it seems to work better than anything else. I would feel more comfortable with it, however, if the way we thought about what we do made more sense. Such a disjunctivediscrepancybetweentheory and practice cannotbe ahealthy stateof affairs for us as practitioners. Causativefactor is an idea unnatural to ancient Chinesethinking as well as to contemporary alternative or holistic thinking. I will go on to consider how the concept originated and what exactly is wrong with it. I am under the imPression that Jack Worsley invented the idea of causativefactor and it bothers me that he does not take credit for it. One of the forum commentators attributes the concept to him as "one of his major contributions." He has always claimed to his classesthat it was part of a long oral tradition-a view I do not understand.Why wasn't it ever written down? China has after all, an enorrnously long written tradition. Indeed the Chineseinvented the printing press! There is nothing so secretiveor preciousabout it that should keep it out of the classics.There is no mention of it in any of the acupuncture
nl
Thefirst commentatorinthe CFforum comparesthe CF conceptto Jung's idea of syniuonicity. The way that Jung intends the term synchronicitY, however, ls ln contradistinctionto the meaningof causality' Jung's booh Synchronicity,is subtitled'4n Aciusal ConnectingPrinciple' The notion of
literature.Very strange.I am left with the conclusionthat causativefactor is JR's baby, even if illegitimate and disowned' (Can a conceptbe a bastard?)In 1977,whenI wasan acupuncturestudentliving in Oford, one of the first Americangroupsto havetrainedat
curious to discuss matters such as the factorwith peoplefurtheralongthan causative myself.Most peoplein that group had never heardof the conceptof CF, andwere hearing it thenfor the first time despitebeingalready trainedandin practice.That would makethe idea aboutten yearsold. Whereverit comes from, or howeverold, asthe centralthemeof diagnosisit needsto be seriously acupuncture scrutinized.It shouldbe fortified by its merits Beforenow andcriticizedfor its weaknesses. it has stood on an anti-intellectualpedestal, like'anidol pretendingto be a lost icon from history, untouchable and beyond heretical doubt.As for its merits, I have alreadysaid that it doeswork. But then I am remindedof a play by Dennis Potter (England's outstandingplaywright), called Treacle and Brimstone, where the Devil slips into an and householdon falsepretenses unsuspecting givesthe impressionthat he loves and feels movedto care for a helplessyoung girl. She has lost control over her bodily movements and speechafter a tragic car accident-In privatehe cruellyteasesthis patheticcreature and repeatedlyrapesher until ultimately the full honor of her situationshocksher backto her senses.She screamsout, and in a mindbogglingtwist her speechis restoredand her body unwinds from its former spasmsand contortions. She is thus ironically and inadvertentlycured by her tormenter-cumsaviour.All normal valuesgo up in smoke. the playwasbannedfor tenyears Significantly, andonly recentlyreappeared.
acupuncture,and is a way of understanding them without resortingto causativefactors'
factoris thereforetheworst namethis concept could be calledand revealsa deepconfusion andmisunderstanding. Furthermore,searchingfor causative diagnosisis inevitablya factorsin acupuncture reductionistexercise.Here, agarn,we have takenthe worst of westernscienceon board' We move from a philosophyof interaction, interdependence and interrelation of elements-elementsthatholdwholeworldsof in flux-to onestaticelement:the associations causativefactor. This createsimbalance.It givesa higherstatusto oneelementagainstthe others and stops dead the movement of intertwiningenergies.This conceptforcesthe practitioner's thinking to stop the flow of movement and change, the ingredientsof transformation, and categoize and objectify the patientto whom it is applied.This doesnot mean that transformationcannot happenin practice,becauseit does.But it suggeststhat our thinkinggetsout of stepwith it. It happens despiteus-amazingly. Considerhow we use causativefactor for diagnosis.What mental operationsare involved?We weigh up the featuresthat we regardasmost inappropriate (whateverthat means)in our patientsat that
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concept. I believe this is at the heart of the error. This needfor an enrichedconceptpoints to some sort of poverty in acupuncturetheory or in ourselves. Chinese acupuncture, as I understand the spirit of the Nei Jing, is not about constructing clever concepts that then tell us what to do. Rather the richnesslies in the contact we make, the quality of our involvement with patients.The emphasisis not on the what (what is the CF?) but on how (how we meet, how we treat, how that makes us feel). The enrichmentand skill we seeklies within our attunement and sensitivity to each other, even if we like to think in elemental terms. It is poverty to think of only one element when we are infinitely rich in possibilities. Just think of the other person-then how we do what we do follows . . . naturally.
point in time, and deducefrom our knowledge of the officials who is the most likely culprit. Then that's it. The CF does not change,only exceptionally. If it doesn't worb we have probably guessedwrong, being imperfect and unmasterful.Guess again. In western medicine the situation is quite similar. The patient comes in feeling badly. Maybe it's a recognizable condition (readimbalance),maybenot. The doctor says. "It's a virus," or "It's an infectiorq"or ifno clearphysicalcause,then "It's stress."Of course, allopathic medicine has more sophisticatedmoments-as we do-but at the crudest level the mental operationsinvolved in such diagnosesare the same.How different is that from "It's wood" or "It's an earthCF" or even a complex relationship like "water drowning fire"? Does anyone really believe this adequatelydescribesthe essenceof a person's suffering? Presumably,the point of treatmentis for these "factors" to change, for patients to move on, for new issues to emerge. I think healing meansnot having a causativefactor. And shouldn't we as practitioners be fluid and perceptiveenough to view the freshnessand difference in our patients from one sessionto the next? The great strength and beauty of Chinesediagnosisis its opennessto what is happening in the present without recourse necessarily to other people's past (as in western medicine) or the crude syndromesof the other school of acupuncture (which is no better). Philosophicallyandpracticallywe need only begin with what we find before us as it unfolds. If the past is signfficant, it will be presentto us. How we treat dependson how someonefeels and is (with us). The person's ordinary experienceshould be our focus and point of depiuture for treatment. But it has no diagnostic categoriesnor causativefactors. The Journal's forum on causative factor concludes that we need an enriched
JAN RESNICK London, England -oAmong the oral responsesto the article on causativefactor, we receivedthe following commentthat deservesparticular attention."It shouldbe underscoredthat ProfessorWorsley does indeed work with all five elementsin a dynamic interaction. His way of working with CF is sometimesmisunderstood-people may think that he treats only the CF element. In fact, according to Dr. Worsley, there may be short or long periods of time when a person needs treatment on another element. One knows that this other elementneedstreatment becauseit is visible in the present moment through color, sound,odor, emotionandother such signs."@ditors)
This article is printedwith permission from the Editor of Meridians. The original arficle was published in The J ourn a I o fTr adi ti on al A ca puncture. Spri ng, I 988 -
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Why Do PeopleGet Sick? The ChineseView EdnaBrandt,Lic.Ac. Equilibrium betweenthe bodyandthe outsideworldandalsowithinthe bodyitself. Thereis a normalstateof equilibrium organism,not fixedat any onepointbut in a relativebalancethat adjustsitself' The bodyis homoeostatic is notcausal;thereis no cause. Chinesephysiology Ways to break balance to intemalor extemalchanges adaptable 1. Bodynotsufficiently too strongor powerfulfor bodyto adapt 2. Externalor intemalinfluences Qi:the body'sabilityto fightoffthingsandkeepthe balancein the body. lt is onefocusfor Anti-pathogenic preventivetreatment. Any diseasereflectsthe body'sresponseto a pathogenic especially treatment, whichcan be extemal,likecold,or intemal,likeanger. influence.
Anger Joy Pensiveness/worry Sadness/melancholy Grief Fear Fright
Other(Miscellaneous) Causes
External Causes
lnternal Causes
Wind Cold Damp
Dry Summerheat Fire
itY/CF Constitution/hered uries/oPerations Trauma/inj Parasites/poisons/ePidemics Wrongtreatment Lifestyle uP OverworUfatigue/using reserves Underwork Exercise Sex Diet
Patient Education the causesof disease.Takinghealthout of the We can reallyservepeopleby helpingthemto understand patients meansteachingthemto avoidthe causes putting professionals of the the it in hands and handsof to their illness'We can is contributing or anger their worry them that we can teach For instance, of disease. remindthemnotto lay on thecoolgrassaftersweatingin a tennisgame. Lifestylecan makethe differencebetweengettingwell and not gettingwell'
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Times We Can ChangeOur HealthMore Readily Any transitiontime has potentialfor increasedchangein health 1. 2. 3. 4.
Puberty(lotsof changesgoingon) Startinga big relationship(maniage,for instance) (by restingat'leasta month,in china they "dothe month") Pregna-ncy Menopause
lnternalOrigins of Disease Emotion
Anser
Directionof Qi and Blood
too XfrIill;'tl?,ffiglllr"nt'"nt
Damages Even if not the CF
Liver Heart
Joy
UPward,scatters,slowsQi
(worry) Pensiveness
Round and round, stagnation, spleen stuckness knottedness,
Sadness(melancholy)
pressurein chest Downward,
Heart'Lung
Grief
morethan sadness Downward, go not letting
Lung
Slowlydown,morementallevel
Kidney
suddendown,morebodyexperience panicattacks,Qi deranged,chaotic
Heart(sudden) Kidney
Fear Fright(shock) Su Wen Chapter39 says:
ln the caseof anger,breathsrise. In the caseof joy, breathsare loosened. In the caseofsadness,breathsare destroyed. In the caseof fear, breathsare descending. ln the caseof suddenshock,breathsare in disorder. In the caseof obsessivethought,breathsare knotted. Maciociasaysthat all emotionsdamagethe heartas well as theirownzang,becauseit is the heartthat For instance,the Heart knowsthatdamageis happening(becauseheartholdsour consciousness). it. know knowsthatangeris damagingliver,thoughliverdoesn't Theseintemalpathogensinjurethe organs. tnjurymay comewhenthe pathogencomesabruptly for a longtime. (tragedy).Injurymai comewhenan emotionis excessor deficientor inappropriate gmotiohscan ne especiallydamagingwhenthey are not expressedor acknowledgedYou mightnot do acupunclurerightaftersomeonehas had a severefrightor shock;bodywork or moxa may babetterto calmthe bodyand Qi, to get the Qi backto flowingwhereit shouldbe. Pattemsof illnesshaveshifteddramaticallyoverthe last 60 years,from extemalto intemalcauses. ln formertimes,most peoplegot sickfrom pestilence.Most peoplewerestrongintemally,so strong werethe norm. like purgatives, medicines, ll6
As the causesof diseasebecomemoreintemal(heartattack,stroke),we are losingthe battleagainst for treatingextemalcauses.Eastemmedicineis usefulfor disease.Westemmedicineis magnificent treatingintemalcauses,becauseit treatsenergyratherthanform. formedwithinthe body). diseases(diseases area majorcauseof endogenous Theseinternalpathogens to theirdisease. We mustteachpeoplethattheirangeror worryis contributing
External(Exogenous)Originsof Disease of the environment Thesearethe emotionsof theworld.Thesecan be an actualinvasion(theinfluence manifesting and symptoms be signs can OR they the orifices) touchesthe bodysurfaceandenters is not necessary. actual invasion an In other words, in the body. intemally Our mothers were right (oldwivestalesreflectcausesof disease) Don'tsit on dampground(damp) Don'tgo aroundwithwet hair(damp) Don'teatstandingup causes) Don'targuewhenyoueat (emotional Don'tgo into the waterrightafteryou eat withyourperiod Don'tgo s,wimming you get feet wet with yourperiod(footmeridiansconnectwith uterus) Don't Don'twalk on coldfloorwith barefeet (footmeridiansconnectwith uterus/forinfertility,keepfeet warm) Neversit in a draft(wind) Alwaysair your clothesaftertheyhave beenironed(damp) Don'tgo out in the sunwithouta hat (summerheat)"MaddogsandEnglishmen..." Aftergettingsweaty,put on dry clothes(damp) Feeda cold,staryea fever Restaftereating Don'tsit on stonesteps(cold) ExternalPathogens six evils,six weatherpattems,six Externalpathogensare alsocalledthe six pemiciousinfluences, climaticchanges.Theyarea majorwaythatdiseaseentersthe body.All actin the bodyas theyact in nature. Externalpathogensdifferfrom internalpathogensbecauseonset is very sudden (intemalimbalances arenotsudden)and usuallyhavecombinationof feverand chills (usuallyoneor the otherbut not both with intemalfactor)andtend to havefear reaction (fearof gettingcold,or sensitiveto wind). Wind (goingin andoutof air conditioning) fans,changein environment Weather,air conditioning, Yang of disease) Drivesthingsintothe boy (spearhead Affectsskin and Lungsfirst Makesthingsshakeands,.lay(tremors,convulsions) Arisesquicklyand movesfast (symptomschangerapidly) Combineseasilywith heatand cold
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Gold Yin yangQi Consumes ano warming,contractsand makesobstruclions lmpairsmoving -pain in yourhand) (imagineholdinga snowball Makessevere Damp Yin lmpairsyang,obstructsQi circulation Heavy,iirty, sicfi, lingering(heavyhead,no appetite,dirtydischarges,bandaroundhead,headfull of cotton,Poorconcentration)
Dry Yang lnjuresbloodand yin Summerheat Yang Extemal,shortterm heatstroke) Consumesbodyfluids(heatprostration, Fire Yang Intemalonly,extremeform of heat lnjuresbloodand yin, depletesQi, injuresshen Can be in one partof body,i.e.joints Damp heat Comboof dampand heat Dirty,foul smelling,thick discharge(bladderinfection,Montezuma'srevenge) whenthe illnesshassuddenonset,whereasa longer EXemal causesare likelyto be the explanation existenceof the conditionmay indicateintemalpattems.Extemalpathogenstendto enterfromthe Qi and protectiveQi is exterior,usuallythe mouth,nose,skin,backof neckor back. lf our constitutional strong,we can fight them off. or extremeor suddenor if Extemalpathogenscan affectthe bodyif a climaticchangeis unseasonable on whichinfluenceand depends disease of the form the body'sresistanceis low or out of balance.The to certaincauses. vulnerable person given be especially person. may A also the disharmonywithinthe pathogens: extemal to certain us more susceptible make For instance,theseweaknesses 1. 2. 3. 4. 5.
Yangxu, especiallyKidney(cold) Spleenxu (damp) Intemalheat (fire) Woodimbalance(wind) Old injuryor overusedpartallowingpathogento invade
118
factorcan transformintoothers;for instance Any exogenous ' coldcanenterand go to lungsandtum to heat . heatcanenter,bum up fluids,tum to dryness . extremeheatcan makewind
Other (Miscellaneous)Originsof Disease causesof disease.Thesecan be an important theseimportant We musthelpour patientsunderstand the differencebetweengettingwell and not patient, can make since lifestyle for the sourceof homewoik gettingwell. 1. Constitution/heredity/CF Age andhealthof parents(amount,healthof parent'sjing) Shocksin pregnancy imbalances lnherited '
2. Trauma/injury/oPerations Burns Bites Radiation/chemothera PY 3. Parasites,poisons,epidemics diseases Contagious ozone Pollution, 4. Wrong treatment Morelikelywith herbsthanwithacupuncture Possiblewith acuPuncture 5. Lifestyle(the big one) (using up reserves) A. OvenrrrorUfatigue Work whilefatigued Heavywork, liftingandstrainingcausestagnation (carPaltunnel) Repetition Longhours Dissatisfaction Sittingin one Placetoo long B. Undenryork No self worth No challenge C. Exercise to age Needbalanceappropriate Healthdependson adequatemovement(haveto stir the soup) Insufficient(Qi and blooddon'tcirculate,resistancedecreased,breedsdamp,bonesand tendonsget soft) Qi) consumesvital energy,weakensantipathogenic Too much (exhaustion, Usingone areaof bodytoo much Exercisingtoo muchwhenyoung ldealis to supportthe insideandthe outside(walkingandtai chi)
119
D. Sex
E. Diet
Too much(spendKl essenceandyuanQi and Kl OD Givingbirthconsumesjing and blood Sex whentoo Young Too littlesex
distention Overeating(SP/STcan'tprocess,so foodstagnates(belching,sour regurgitation' and Painin abdomen) weakensSP and ST; deficient nourishment (fastfood/eaiingdisorder/insufficient Malnutrition makeit; lessantipathogenic to nourishment enough ei anddeficientbloodbecausenot factor will nourished lmbatanceddiet or limitedvariety(repetitivediet):organor functionnot being suffer Co|dfoods,raw foods, frozenfoods(injuresSP yang,ST cant cook right) Hot foods(lamb,beef,a|cohol)injureyin, contributeto dampheat phlegm irieO,alcohol,s$/eets,juices,oil, ice cream) OampformingtooOsiOairy, "nb in excesswi1 dimage ifr" org"n it pertainsto; smatlamountof foodwill tonifyit Any flavor Huniedeating(SP can'tfunction) Eatingwrongconditions(angry,lateat night) Unsanitaryfood (foodPoisoning) article,LateSummer,1994 See Qurnfessence
How to communicatethese to patients 1. Authority Ask in TD: "lf I askedyou to makesome changes,wouldyou be willingto do them?" Then,"TherearesomechangesI wantyouto make..-." 2. Experiment "Wbuktyou be willingto do an experiment?Let'stest somethingout." "Let'stry threeweeksof no greasyfoodsand seewhat happens'" Gettheii cooperation-. 3. Get rid of conflict betweenyou and patientand put the responsibility where it should be "X" is the change(getmore rest,stopeatingdairy) tells me that X wouldhelpyou. What X woulddo of you,from my Oiagnosis, A. "My unOerstani]ng is...." B. Of course,I don'twant you to MAKETHATCHANGENOW. Onlywhen you are readyto ENJOY THESEBENEFITS.Takeallthe timeyoureallyneedto MAKEA GOODDECISIONFOR YOURSELF. c . GhangesubjectimmediatelY. D . Nexttime: "Lasttime we weretatkingabout'..."and repeatabove'
This article is printed with the permissionof the author,Edna Brandt.
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Five ElementTreatmentPrinciples The following list of treatment principles and point choicesis a guide only. It is not meant to be an exhaustivelist. It is offered solely to stimulatethinking about how to proceed with treating a patient
TreatmentPossibilities
TreatmentPrinciple Clear Internal (IDs) or External Demons @Ds)
IDs: MasterPt belowCV 15,ST25,ST32,ST4l MasterPt below CVl5, ST37,Master IDs il depression: and ST37,ST4l 5T36 Pointbetween BL6l BL23, BLtl, EDs:GV20.
Clear AggressiveEnergy (AE)
BLI3. BLI4, BLI5,8L18,BL2O,BL23
Correct Husband/Wife (IVW) Imbalance
BL67,Kr'l,KI3, LR4,HT7, SI4 (HTl)
CenterUmbilical Pulse
Massagetoward centerof umbilicus
Correct AkabaneImbalance
Unilateraljunction point, sourcepoint or AEP, moxa
AddressPulseQuality
Sourcepoint commandPoint
Supportfirnction of CausativeFactor @lement or Official)
Sowcepoin! commandpoint, junction point' xi cleft point, body point, spirit of the point AEP, window of the slcy
Supportan element in horary time of day or in season
Horary point
Clear blocUincreasecommunicationbetweenpaircd meridiant Junctionpoint Supportmovementalong Shen/I(eClcles (tralsfer energy from areasof relative excessto relative deficiency)
Commandpoint: Tonificationpoint, sedationpoint, appropriateelementpoint junction point
Clear stubbornblock along ShenClcle of energy
Four needlelschnique
junction point Clearblock/supportmovementof Qi on wei or meridianlevels Entry/exit points, CV poing GV poing Supporton the level of body, mind, spirit
Qsmmandpoint, spirit of the point outer AEP, upper Kidney point, CV point, GV poin! window of the slry
Supportfirnction of the Eight Extraordinary \dsfifiens
Master-couplepoins of the Eight Extraordinary \4sridiens
Supportmovement/functionof specific substances
Seasand oceans,ssssrnsling(influentiaUgathering) point
Harmonize movemenVfunctionof severalmsrifians or organs Reunion poina (including meetingpoints, entry/exit points, andjunction points) at the sametime Treat elementsother thnn CF element
tend pulseqrraliliss, Sourcepoint, conect akabanes, tra-nsfer,junction point, entry/exit points, CV point and GV point, spirit of the point
Apply first aid
First aid point
Stimulate horuroneproduction
Points of endocrineglands
Volumel: M abovecanbefoundin TraditionalChineseAcupuncture, N.B , a completelistingof pointsmentioned J.R Worsley.
!4!$ ElernsntBooks,1982'by
Reconsiderpossibility of:
Reconsideringthe CF:
I
Before changing a CF, considerthe list of possibilities on the right.
E-n3rgeticBlocks: I Vtaior ID-s/EDs I
AE
ww Off-center umbilicus Akabaneimbalance Pulsequalities TreatmentOptions: Moxa Level of treatment Four needletechnique Transfers Re-establishrapPort Reconsiderpatient/practitionerexpectations Structurd Blocks: Trauma/injury Operations Scars Spinaland/orjoint anomelies Environmental Blocks: Extreme climate (heat col{ dtmpness, dqmess,win4 zumner heat) Parasites,poisons,ePidemics HeaW metals Occupationalhazards Pollutants Lifestyle Blocks: Over/undenvork Exercise Sex Relationships Diet Medications RecreationaldrugValcohol Cafieine (Ihis list is not meantto be exhaastive,but rather to stimulatethought-) @ Tom Balles, 1998
This chart is printed with the permission of the author, Tom Balles. l)1
andPoints The Paradoxof Paradigms StephenHoward, Lic. Ac., NESA Faculty
For any complaint the acupuncturist could face in the presentationof a patienf how many paradigmsindicate the besr point prescription for the disorder? A patient complains of asthma and interviews three acupuncturists. Onepractitioner usesthe paradigms of TCM to diagnoseand choose poins mirroring the diagnosis. Another practitioner trained in the traditionformulatedby J.R Worsley frames the diagnosis, and chooses points accordingto the perceptionof the patieng and an understandingof the points which reveals a logic quite different from the story told in the language of TCM. A third practitionerfollowing theexperience of a renownedJapanesepractitioner perceives the picture of the imbalance associated with the asthma from a third point of view, which requires the use of points drawn from extensive clinical experience with similar cases in Japan. Each practitioner believes that he or she has made the best choices. The same paradox of paradigmsand points occwswithin each tradition. Within TClvI, one can diagnoseaccording to patterns associatedwith: the Six Stages,the Channels, the 8 Principles, etc. Within the Worsley tradition, difierent practitioners may perceive an imbalance in terms of: energy blockagesthat require use of Entry and Exit points, the Husbandand Wife Law, Possession by Demons,
etc. Japan has produced manY renownedpractitioners,like lvlanak'4 Ito, Yanagiya, etc. whose theories provide practitioners with many paradigms from which to choose. And this does not exhaust the possibilities.Practitionersin Korea, Vietnarn, France, Russi4 and the United States. to name a few, continue to expand our understanding of the potential beyondthe points when they serve as gateways to a vast mystery. This diversity is not new. A multitude of ac'upuncture traditions span the history and expiurse of China many dating before acupuncture was even practicedoutsideof China. With various traditions choosingfrom amongthe samesetof acupuncturepoints,forvery different reasons,what are the implications in termsof ourknowledgeof the points, andwhat is the logic which givesour un6srctanding somecoherence? A practitioner's reasons for choosinga point not only reflect the tradition in which he or she is trained, but the goal of treatment. The immedixfs eim may require acute, symptomatic treatment in orderto relieveseveresuffering. The long term aim rnay require the treatment of chronic disorders, cultivating a balance on the constitutional level. The treatment ofacute or chronic disorderscan also be aimed at growt\ development and firlfillrnent on a spiritual level. Every practitioner,in all traditions, has the potential to treat at every
t23
level, depending on how the practitionerandthe patientchooseto frame the healingwork they embark on together. Aside ftom the generalgoal of treatment, and the rationale underlying the treatment strategies of eachtradition, what is the nature of the knowledgewe use regarding eachpoint? Treatrnentrarely relies on the use of a point by itself. The more points use4 the more difficult it is to isolate which point triggers specificresponses.A combinationof points will reflect a treatment strategy, and the evaluation of a responsewill reflect the treatment goals. This createsabias, a selective perceptionofchanges that occur in the patient, and the practitioner may only see the kinds of things for which he or sheis looking. However helpfirl modern researchtechniques may be, the clinician inmersed in the flux of practice still faces the faced sameproblemour predecessors tryrng to identif the actions and effects of an individual Point. Historically points have been describedin many ways: . specific indications in terns of symptomsor in relation to areasof the body; . general channel and organ dynamicsin relation to symPtom pattems associated with Jng Well, Ying/Spring, Shu/Streaul JinglRiver, He/Sea, XilClefi, Yuar/Source, Lou/Connecting, Shu/Back Associated.Mu/Alarm points;
. general functional tenns like thoseusedin the herbal tradition (tonifies yin, drains damPness, etc.); . analogiesto the namesof a Point; to namebut a few of the waYsin which pointshavebeendescribed. For any one Point, SPleenl, for example, specific indications vary depending on the source. SYmPtoms that involve bleeding are the most conrmon. ActtPuncture a ComprehensiveText, addsinfantile convulsions.ChineseActtpuncture and Moxibustion adds dream disturbed sleep; Felix Mann adds severevomiting; and Dr. So adds epilepsy,etc. The general channel and organ dynamics also varY dePending on the source. as described in the classics.NanJing Chapter68 states that a JinglWell point like SpleenI is indicated for frrllness below the heart. Ling Soz ChaPter 44 states the JingAVell points shouldbe used during the winter to treat the 5 Yin organs. In termsofthe energeticdYnanics relatingto 5 phasstleory, SPleenI as a JingAVell Wood poing would effect the Wood/LiverAVind in general. According to YanagiYa, SpleenI shouldbeused(with Liver l, Lung 8, and Spleen 5) to treat excessin the Spleen. When using general functional terms like those used in Chinese herbal therapy,SpleenI is said to: Regulate and Toni$ the SPleerl Contain the Bloo4 Calm the SPirit, and Clear the Brain. Finally, when Spleen I is called by name,that name may be Yin Bai (translatedas Hidden White), Gui Lei (GhostPile),or Gui Yan (Ghost Eye). Most points have been given more tlran one name over the years. Interpretationofthe nameswill vary and suggesta possible relation to
white/Lung, and the useof SPleenI as a Ghost Point treating mental disorders. The recognitionof new Patternsrn groupsofpoints continuesto expand our understanding of the Points' pointsgenerallywill Lou/Connecting have indications for mental or emotional complaints, that were not mentionedin the classics' JingiVell points generallyhaveindicationsfor fwer, exceptfor SPleenl. How reliable are these"command points" for indications associated with eachgrouP like Well, SPring, Streanu River and Se4 or for indications associated with the 5 Elements as pathogenicfactors? A generalsurveyof the Command The practitionereither liveswith a thom in his or her side, or rigidlY believesthat there is only one true with no paradoxes. paradigm, points comparingtheoreticalindications with clinical indications in Chinese Acapuncture and Moxibustion andActtpuncturea Comprehensive Text revealsthat they agree rouglrly 6OYo of the time How appropriate are point descriptions using general functions like those used in Chinese herbal theraPY? if the points have Perhapsonly 25%;o general functions related to the majority of specific indications associated with the point in clinical practice. Spleen I would serve zrs a positive examPle. [1 Qsateinstlte Blood asseenin specificindications, like: abnonnal uterine bleeding, bleeding in the digestive tract, continuous nosebleedand blood in urine or stool. The paradox of Paradigms and points threatens to bewilder and overwhelm the modern snrdent searching for a logic that provides coherence and understanding. Western cultures have come to
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presume that where there's contradiction,somethingis not right' We strive to integrate and balance our lives, to understand the contradictions that confound us, to resolve the Paradoxof which we are a part. The practitioner'schoiceof a point often imPliesa choicemadein the face of blatant contradictions' The practitioner either lives with a thorn in his or her side, or rigtdlY believes ttnt there is only one tlue paradigtrl"with no Paradoxes. The legacl of Aristotle has somethingto do with this dilemma. With regard to contradictions and logic, Aristotleput it this way: If you havetwopropositionslike"everyA is B" and "some A is not B," then one must be true and the other must be false. Without thinking of Aristotle' the acceptanceof his assertion is responsiblefor the thorn in the side of the practitioner aware of the choiceshe or shemakeseverydaY. It is said that every JingAVell Point treats a fullness below the heart - not true. It is said the 5 Element associationswith pathogenicfactors alwaysapply - also not true. General frrnctions like Toni$ Yin or Drain Dampness may onlY aPPIYto one indicationout ofa dozenindications associatedwith a point. The nameof the point occasionallybearsquite an obscure relationshiP to the indications of the poing like "Hidden White" for SpleenI. Accepting Aristotle's assertion suggeststhat ifall ofyour experience doesn'tfityour logic,your logic must be faulty. But our exPerience is riddled with contradictions, the heritageof the omnipresentparadox. The paradigms we relY on as practitionerscomewith a long history of successfirl clinical application which sustainstheir life in practice, even thougb Paradigtrl A and paradigp B apparentlY contradict eachother.
The life of logic in China developeddifferent applicationsand provided different insights than thoseengenderedby Aristotle. The Chinese were concerned with practicaland moral problems,and a mystical interpretation of life. For example, the Dao contains and includes contnrdictions, and paradoxically createsa dynamic balance in the process. In order to encompassthe range of experience, the logic of the Dao includes the irrational. Daoiss were generally contentto co-existwith other points of view like thoseof the Confusions and Moists. The limitations of our explanations need not limit the
application of procedures with reliable outcomes,whether the logic applies in all casesor not. A logic that applies only some of the time requires the recognition of those cases in which it aPPlies, and its limitations, and thosecasesin which it does not. It makes life more complex when it is not Presumedto be black and white, right and wrong. The challengeis to be true to our expenence. The right logic at the right time can serve the practical PurPoseof hooking slippery memoryat the end of a line of experiences. A Pattern leapsout from the murky waters of experience, like a rainbow trout breaking water, and you need to
t25
remember the flY that caught his eye, or in our case, OrePoints that triggered a healing for a Pattern glimpsedin the lives of our patients. Patternsemerge from the darkness, and a line of logic maY retneve thenu but the darkness remains undefinedwith bright momentsof creation.
Note: This article is printed with the permission of the author, StePhen Howard, Lic. Ac. It was originallY ci etv-eI printe d in the @ Massachusetts Newsletter. #6, MaY
r 995.
AS METAPHOR POSStrSSION by Vicki CohnPollmd
When I was trained in five-element acupuncture, I was taught how to treat a particular blockage of energycalled"possession"- ths metaphorto describe this block. As an acupuncturist for twelve years, I have explored this metaphor, finding that each new level of understanding reveals a new layer of mystery. Possession-asmetaphor is still a central theme in my work. Metaphors are like parablesor Zen koans;they are teaching stories. They lead us to an understandingthrough our "hearts," our inner experience,rather than our minds. The beauty of the five-elementtradition of acupuncture is that much of what we learn lies within the realm of metaphor. There is richness and poetry h our descriptions of people, disease, health, and nature.Each ofthe elementsofChinese medicine is a metaphor.A personwe treat as having a Fire causativefactor, for example, is not literally "on fire." Each of the laws is also a metaphor. In the Law ofMother-Child, we are given an imagewe can relate to, and we then can understand the workings of energy by returning to that image. The namesof the points, too, are metaphors.As we usethem, we learnmore deeplythe "spirit" of the points signaledby their metaphoric names. Metaphor is both the beauty of our systemand the fulcrum ofthe work. As a student, I hearthe words spokenby our teacher, J. R. Worsley. I write them down on paper; therq in my practice, I make the words come alive for me. I make the teachingsmy own, allow them to live inside of me. I discovermeaningfor myself, from my own
experience.As I grow and change,what I am able to see about each of the elements,about each patient, and about the world, expands-As above, so below. In this article I wish to sharea bit of my journey with one of the metaphors of the five-element system-possession.In 1978, when I first heard the word "possession" in my beginning acupunctureclasses,my imagination was off and running into pictures of Hollywood and the Catholic Church. We were being taught how to diagnosethe energeticblock calledpossession.It is a difficult block to determine, partly because one needsto move beyond some of the images evoked by the word itself. The two primary ways to diagnosepossessionare, first, to look into the person's eyes, ascertaining whether or not "anyoneis home"; and second,to determinefrom talking to the person whether he or she is fully there-or whether "someone else" is in charge. I was intimidated by the enormity ofwhat I was being prepared to diagnose.I had no faith that I could even look directly into a person's eyes, much less detect an absence.The whole notion seemedbizarre to me. In additiorg when I was taught the points that are used to treat this blockage, I quickly saw that they are difficult to find. The points, known collectively as the Seven Dragons, must all be located precisely for the treatment to work. If even one needle is misplaced,the treatment won't go through. Added to all this, I couldn't quite dispel the notion that perhapsstrangeguttural voices would
wasa reasonshehad survivedthis accident,that person'smouttqalong comeout of a possessed therewaswork shewas meantto do, andit was with a little fire flaring from the nostrils end timefor herto get on with doingit. Shewas(and demons' horns poking up through the hair' Theonlyproblemwasthatin is) quiteremarkable. Basically, I began my journey certain that if the difficulty of integratingher experience,she that person anyonecameto seeme possessed, attributedher entirerebirth experiencesolelyto would just haveto staYPossessedheld as It took a few yearsfor me to get comfortable the powers of her surgeon,whom she almost supernatural in his ability to put her with this process.During the clinicalpart of my destroyedbody back together. She fantasized earlytraining,orily onepersoncameto the clinic about leaving her husbandof thirty years and " and I with the condition called "possession moving to the city to be near this doctor. She didn't participatein any of her treatments.In imaginedhewasthe only personwho understood later training, however, a man who was her. Sheturned him into her deity, externalized wasseenby ourwholeclass.Thisman possessed the locusof her recovery,andin so doing,lost a had one of the most dramaticresponsesto the part ofherself. insertionof the SevenDragonneedlesthat I've WhenI learnedfrom J. R. Worsleythat Marilyn everseen.His eyeswidened,thennarrowedback I could not have been more was possessed, and forth severaltimes. His body shook. He shocked.I burstout crying.How couldthis truly seemedto be in battle with whatever was anazng woman be possessed?I was deeply keepinghim from beingwholeandhealthy' disturbedthat I couldfeel suchcloserapportwith While this treatmentwasextraordinaryfor hinq her and didn't have a clue that she was absent the dramaof his clearinggot in the way of my from herselfin someessentialway. understandingthis metaphor.For quite a time During the ensuingweeks,asI steppeddeeper after that, wheneverI did this dragontreatment, into the meaningof my experience,deeperinto I worried that nothinghad happenedbecauseI did not seesucha visceralreaction.Nevertheless, the metaphor,I sawthat in truth -I had Imown.I knewthateverytimeshespokeaboutthissurgeon I was beginningto learnaboutthe metaphor. in largerthan life ways, I cringedinside.I knew My first major leapforward in learningabout that when I offeredher the possibilityof taking possession waswhenI took a patientto Boston responsibility for her own life, for her own with J. R. Worsley.I in 1982for a consultation miracle,rather than giving it all to hirn, I bumped In my had absolutelyno ideasheu/aspossessed. into a mile-high wall. When I expressedmy consciousmind, the reasonI took her was that she was physicallyone of the most vulnerable dismaytoProfessorWorsleyfor not knowingshe he pointedout to me that, in fact, peoplein my practice.SheandI had developed waspossessed, my deep I hadtold him aboutit whenI expressed a strong connectiorqand I wantedher to have of the fantasy her allowing was concernthat she the best treatments possible. The woman, surgeonto take over her lifeMarilyn, had been in a head on automobile I was beginningto learn what this metaphor collisionthat hadmutilatedher body, insideand looks like. As I grew in my ability to discern out. "kneu/' a personwas possessiorlI sometimesjust It wasatrue miraclethat shewasalive,andshe possessed whenwe met for the first time.WhenI was deeplyaware of that. Through a mystical am certainthat quickly, I think it showsin the experience,she cameto understandthat there 128
person's eyes and on the person's face. Sometimes I know without words. I sensethe wall of darknessand feel a ripple of fear. With many of the people I diagnoseas possessed,I feel uncomfortable; I know something is not right. looks What is more difficult is when possession not possessed does is normal. A person who appear demonic.He or she may be respected, competent, excited about life, and growing in many ways. But there will be at least one area of this person'slife wherethereis no growth. There is an impenetrabledarkness.The situation can,in some ways, resemble that of an addict: the person may spendmany hours each day living a perfectly normal and productive life, but when the addiction takes over, there is no wayto reach this him or her. In the personwho is possessed, prevents stuck place-this darkness-ultimately spiritual growth. InMarilyn's case,her adoration ofher surgeon closely resemblednormal behavior.Most of us have occasionswhen we idolize peoplewho have helped us. This is part ofthe transferenceprocess which helps us grow and be more like that person. But for Marilyn, this situation was not about growth; shecouldn't move on from it. She had lost her senseof her own divinity. She had lost touch with her Self. Most peoplewho come to seean acupuncturist present themselvesas fairly healthy. It can be difficult to know the depth of a person's pain when she isn't telling us outright. The practitioner's work is to be thorough enoughin the seeing, the hearing, the touching, and the asking ofthe personthat such a major block does not get hidden in the healthy aspects or compensatingbehaviors the person brings to treatment. I learnedabout hidden blocks with a womar\ Rebecca. I had heard about Rebeccabefore she came to see me for acupuncture. She was an outspoken leader of the lesbian community. She
was well known in the state as one of the outstanding therapists doing work with incest survivors. She herself was a survivor and was a pioneer in offering survivor groups, doing public speaking and education work throughout the region. When she began working with me, I assumed that, for the most part, she had completed her healing from her horrendous childhood. Rebeccaand I had great rapport. I respectedthe work shedid and was eagerto hear her reports of the ways she was helping people' In my enthusiasnqI blinded myself to the fact that she was getting sicker and sicker within herself' She continually was getting into relationships that didn't work. Her body was deteriorating.Shewas sadandlonely, sick and tired. Finally I understood that in some major way, despite the years and years of work she had done, Rebecca still was stuckin her incestexperience-possessed,in fact. I did the SevenDragons treatment. Her whole body shook and shook. Immediately after the treatment, a tremor that had always been present in Rebecca's voice disappeared,and it has not returned. She didn't know the nature of the treatment, but she spoke eloquently of her treatment experience.She told me it cameto her that her father owned herbody, that he was ln her body-notjust that he had sexually assaultedher, but that he had ownedher body, lock, stoclg and
129
barrel. When I sawRebecca agal.;lshereportedthat on the evening ofthe treatment she had gone to bed at7.30, exhausted.During the night she had the samedream seventimes. "Each dreamwas about fighting with a benevolent demon. Each demon was a shadowy thing. Each was a different color-all darlg but all diferent. It was scary,yet not scary.We were fightittg with paddedmaterial, like taffy. The fighting was about resistance, pulling-not fighting to the death." Since therg Rebecca reported, "I can confront the reality of my father's abuse. It's not me any
more. The treatmentmadethat separationfor me.Onecan't confrontthe abuseif the parentis still inside.I couldn't deal with my father-he wasme.He was in mYbodY." in herlife Rebeccahasmadenumerouschanges and now is in a satisfying and committed relationship.We both believethat her flexibility to be different from her previouspersonais a signof healthandhealingfor her. My journey of discoveryaboutthis possession metaphorhasbeenanexciting,up anddown,and continuingprocess.It hasmanyfacets.Learning in people'seyesis an ongoing to seepossession processfor practitioners.J.R. Worsleydescribes it this way: "Whenyou look in the eyes,thereis no one home." I have searchedfor ways to difficult asthat is describemy own experiences, to do, andthesearethe words that cometo me: looks back at me with a,wall of Possession I could a look of dismissal. hardness, coldness, at me comes that look neversmileback at the from thoseeyes.I want to shudder,to shakeoff In contrast,lookinginto theeyes theexperience. I seespark, of someonewho is not possessed, warmth.I rememberhearingRamDass aliveness, "If I look deeplyinto your eyes,I time, one say seeGod looking back at me." With possession, I don't seeGod. To havedirect eyecontactwith someoneis an intenseexperienceof intimacy.In order to be proficientat this skill andto betterevaluatewhen someoneis possessed,I now practicelooking into people'seyeson a regularbasis. My most recent learning about possession remindedme that the peoplewe work with are alwaystelling us what is going on with them. Often it takes time to hearthem. That was the casefor me with Anna. She cameto me with serious physical problems. She had seen numerousWesterndoctorsandhadgonethrough seven surgeriesin the recent past, since her husbandhad come close to having an affair. Their relationshipwas stuck in a hellishregion
where they treated each other miserablyand neitherwas ableto leave.In her childhoodwith two completelydysfunctionalalcoholicparents, When she sheendurednightmarishexperiences. her locked mother wet her bed,for example,her with rats.Throughthe years,she in the basement had done--and continued to do--various psychologicaltherapies.She was h deeppain, searchingfor a way out. The day I did the traditional diagnosis,I felt instant rapport with her. Her struggle to be a healthywomanwasquitemovingfor me.I began treatmentwith a great deal of enthusiasm.It wasn't long, though, before I began to feel discouraged.Sometimessheseemedbetterafter treatments;moreoftenshefelt no changeor even felt worse.I couldn't figure out what was doing wrong. I tried absolutelyeverything--exceptthe SevenDragontreatment,ofcourse!I didn't know whatto do. An opportunityarosefor me to take Annato a shewouldbe examinedby amaster seminarwhere acupuncturist.I thought it might be helpful if I could see her from a completely different perspective.This teacherwas extraordinarywith her, showing himself as a deep and powerful healer.He examinedher thoroughlyfor a total of about six hours.I learneda greatdealabouther from his wisdom. He taught everyonein the seminarhow he would proceedwith treatments for her. I usedthe suggestionshe gaveme that had meaningwithin my five-elementcontext. At first I was excited. She seemedto be experiencingsomerelief. But soon things were right backwherethey hadbeen.Up to this time, shehadbeenutterly faithfulin her commitmentto thistreatmentprocess.Now shebeganto question whether acupuncturecould help her. I was I decidedit wastime to dismayedanddepressed. suggestttrat she stop treatment.It felt unfair to keepher coming. Themorninga^fterI madethat decision,I awoke and sat bolt upright.I lcnewshewas possessed.
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The minute I had the thought, I was absolutely certain. I couldn't wait to do the treatment. And, of course, that was the answer- What has happenedto Anna sincethen is nothing short of miraculous. The first thing she said when she camefor her follow-up treatmentwas "I feel like the old me." IIer symptomsaregreatly alleviated, some almost gone. She is sleepingwell for the first time in years. The relationship with her husbandhas altered dramatically. She ironically reported at one point, "He isn't the sameperson he was three weeks ago." They have sincegone away for a two-week vacation, something they hadn't done for years. These examples of possessionwere powerfi'rl teachers for me, helping me understand and appreciate this metaphor from our healing tradition. Our work is about transformation" helping people live their lives more fully. The SevenDragons treatment is a unique tool in this worh allowing breakthroughs that otherwise would seemimpossible.
As I write this article, describing my journey to understandthe metaphorof possession,I seethat I still have questions.I am excited by that. I feel that I am in the presence of a very powerful metaphor (one of many in the five-element tradition) and will continue to work with it and grow in my understanding for the rest of my days.That's why I love this work. Vicki Pollard practices acupuncture in a small town in Maine. The founding president of the Maine Association of Acupuncture and Oriental Medicine, she is on thefaculty of the Traditional graduate education Acupuncture Institute's '\V'orsley Institute of Classical program nd the Acupuncture.
13l
This article is printed with permission from the Editor of Meridians. The original article was published in fu Joumal of Traditional Acapuncture. Autumn, I99 I '
CLINICALNOTE TIIE MYSTERY OF AGGRESSIVEENERGY JenniferDownsFlickinger,R.Ac.,M.Ac' (LJK)
be sare the AE hasdrained. Treatment without eliminating the AE can result in aggravation.
I am fascinated by the phenomenon of Aggressive Enerry-when it appearsand who showsit. This is a brief reviewof someexperiencesand insightsfrom my practice. A 36-year-oldwomaa psychologistwith a successful practiceand a fairly balancedlife comesfor a Traditional Diagnosis. Sheis mainly interestedin "balancing," feels fairly healthy in general,and has a goodfriend who bas benefittedfrom treatment. Physical function is generally good; a few minor achesand pains. She is in a good relationshipand relatively happyin her life. I am tempted not to testfor AggressiveEnerry. Shehad a hard time as a child, with tremendouslyunstablefamily dynamics. She suwived, and after a geatdeal of self inquiry hasbecome quite a strong person. Nonetheless,I check for AE as I routinely do with new patients, and find three officials with a very clear erJthema, indicating the presenceof aggressryeenerry. It is amazing to seehow peoplevary in how they cope with and relate to how they feel inside. This woman learnedearly on that it wasn't worth complaining. It was more traumatic to see the reaction of the family to her unhappinessand fears than to put the stressofit out of sight. Shedid this quite literally and as an adult carried a geatdeal of tensionburied deeply. After that treatment and subsequenttreatments she felt much better. She hadn't known that the inner tension she had learned to live with could be dispelled. This exampleillustrates how elusiveaggressiveenergi canbe. Severalother examplescometo mind particularly of thosepatiens already in treatment who experiencea severeshockor loss. A 37-year-old man with a zuccessfirlbusinessand migrainesasa maincomplainthas improvedsignificantly
in treatment. He is a Fire CausativeFactor (Wood within), runs his businesslike a general-verypowerfirlly' When his father died quite suddenly,he was shockedand thendevastated.This wasquite apparentwhen I sawhim for his next treatment. I tappedfor aggressiveenergyand found it on D( (Lung) and V (Ileart Protector)- It cleared in about halfan hour. Becausethe Heart Protector had been hit by AE, I tested I (Heart) for AE in the next treatment. (fhe Heart should not be tested at the same time as the other officials.) He had a small but distinct erythemaon tle AEPs of the Heart that lasted lessthan ten minutes. The aggressiveenergyhad barely begunto affectthe Heart. Thesetreatmentswere someof tlte most significant in his experience. He felt a distinct relief of the intensity of emotionalPain. A patient was robbed at gunpoint- She came for Eeatment a week later still lsoking quite shaken. I checkedfV (Kidney) for AE. Before I had takenmy hand awayfrom puning the needlesuL she had developedan erythema the size of a quarter, which rapidly grew to silver dollar size. This took two hours to drain. Sometimes a person is severely shaken by such obviously traumatic events. However, I have found it important to watch for a person'sreaction1s sssmingly minor events. A secretarywho is very conscientiouswas upsetabout a work situation. Although it didn't appearto me to be a big issue,clearlyit wasfor her. Sheis an Earth Causative Factor. Treatmentwas going quite well. A few weeks after the work incident, it seemedthat shefelt aggravated after treatment rather than bener. I testedfor AE. She had it on VItr (Liver) and )flI (Spleen-Pancreas).Since then she has done beautifirlty and has changedhow she
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related to certain peopleand sinrationsat work. AE may also appearfrom excessiveuse of drugs or alcohol. Whencomplicatedby the presenceof internal or external Devils, the AE may not drain at first. After the Devils treatmenLit is necessaryto retestfor AE' There have been times when I missedAE; when I discover it later, I review events around the time the personstartedto feel worse. Inevitably, somethingwill emergethat could havebrought it on. Locating the AE points is obviously crucial to testing accurately. It is worth moving the needlesseveraltimes I h av e fo u n d tobe surepointlocationiscorrect. aggressiveenergy to be a major obstacleto healing. It forcesus to refine our skills ofdiagnosis and alsoofpoint
location. I still find it very myst€rious' The detectionand draining of AE can make a world of difference in tlte courseof treatment. Jennifer DownsFlickinger is practicing acttpuncturein Baltimore. Sheis a PastVicePresidentof theMaryland AcupunctureSocietY. Thisarticle is printedwith permissionof the author' Theoriginal article waspublished in the Marvland ActtpunctureSocietvJournal' Spring, I 990'
EDITOR'S COMMENT ON AGGRESSIVEENERGY While N4s.Flickinger provides excellent insight into the clinical procedure and efrectivenessof the aggressive energytreatment,in my mind clinical resultsalwaysraise theoretical questions. Why is this treatment effective? How doesit work? The following thought may provide a focus for further reflection. Shallow needle insertion of long duration l. characterizestreatmentfor pain causedby local excessdue to stagntion to sedatebody firnctions. we may infer that a subjectivelyoverwhelming trauma migbt createmild to serious microcirculatory inhibition and stagnation in particular. The nahfe of the trauma may determinethe organ and particular body zone affected; i.e., death of a spouseto theHeart orlung orbs. The result of circulatory inhibition would be a constant low level discomfort and dysfirnaion. The AE treatments' relaxing and draining characteristics may release this microcirculatory inhibition. 2. The shallow insertion in the area of the principle spinal nervesto major organsmay give a mild stimulation to the functioning of the organ and its correspondingzone or meridian complex. A strong stimulation in the presenceof pre-existing trauna might exacerbatethe sensitivity. 3. The shallow insertion suggestsan activation of the Iilei chi (defensiveenergy) tlat moves just above and below the skin. 4. The sftzpoints lie in ttre zone of the parasympathetic nerve ganglia and may stimulate a parasympathetic response.This would clearly explain why the ueatmentis effective in counterbalancing the extreme sympathetic activity inducedby trauma. 5. StimulationoftheBladdermeridian"which is ayarg
134
meridian, may stimulate yang generally, enabling the patient's active energies to overcome patterns of local stagnationor inhibition. 6-. The presenceof erythemaon the acupunctue point when a nearby nonpoint shows none suggests that
certain conditions, accounting for the increased microcirculatory exchangewhen stimulated. ?. I have found that points other tban sftz points may develop erythemaswhen stimulated. These also may benefit with treatment. However, there is a clear theoretical and practical relationship between the five organshu points basedon Five-Element diagnostics. We haveclinically corroboratedthe(o cycle dynamic in the movementof toxic enerry and find that the AE treatment corrects this perverse movement of energy. Ms' Flickinger points out that the characterofthe traumadoes reflect in tlre presenceof AE on coresponding points' Thesepatternsofconnection canbe verified in the pulses' 8. I describe AE as treatment for environmentally induced neurosis. In my country practice I find that very few peoplehaveAE, wen patientswith a history of severe trauna. t beliwe that AE may developamongpeoplewho live more in their mental ratler than physical environments: people who have high strung nervous systemsand thosewho are bracedwith constantlow level stress(especialtyftom over-crowding) with consequent behavioral guarding' ri/irtiam r4tadsworth
Moxa StickUsage SherrySmith,Lic. Ac. feeling' Moxa sticks are used for treating local areaswhere there is coldnessor an aching energy in much too Aching generallyindicates a deficiency iuh"."ur a stabbingpain would indicate or too much heat' the area. Moxa would be contraindicatedlocally in a situation of too much energy Therefore, if someonehas a low back ACIIE, the stick may be used over that area into her A moxa stick may be used for l5-30 minutes. A person may feel the warmth moving reaches pelvis, down the legs, and into the feet. Discontinue using the moxa stick when the warmth ihe feet, when the aching is relieved, or if the personbecomeshot. the If a woman has dull cramps during her period the moxa stick may be used between be should and skin the umbilicus and the pubic bone. The stick stroutObe held about an inch above done for 15-20 continually movedin circles or in a spiral motion. In the caseof cramps, it can be begins to flow, it minutes or until the cramps are relieved. If the crampsare relieved and the blood shouldnot be done again. for a In the caseof a dull ache in the muscles,use the moxa stick for 15'20 minutes a day is chou lower if the week or until aching is relieved. The moxa stick can also be used for infertility owlation' It can cold. It can be used for 15-20 minutes the day before, the day of and the day after if the woman then be used the following month if the woman has not gotten pregnant. Discontinue becomespregnant. the For heating a large are4 the moxa stick should be held approximately one inch above the area' areabeing treatedhoving the stick continually to allow the heat to penetrateand cover is expected This Note that the areabeing ireated will become ied during the course of treatment. the person becausethe blood and circulation are respondingto the heat. If , at any time, however, being treated becomesuncomfortable, discontinuethe treatment immediately. have someone Though you may give a moxa stick to a patient -herselffor home use, caution her to concentration lose may become too relared, else do the treatment. A person using moxa on and burn herself. Observethe contraindications listed for moxibustion.
135
ForbiddenPoints t2
ilI il18 I
2 5
ilt 16 ilt 56 tv 11
o
30 50 51 54 62
V1 (Women
6h month 6h month
tv1 tv2 tv4 lv7
5h month
1srmonth 4h month 2d month
x13
6h month 66 month 6h month 6b month
6h month 7h month
xl 17 cv8 cv 17
th month 1srmonth th month
GV7 GV 1O GV 11 GV 17 GV 24
5h month 8h month 6h month
?
8 10 11
4s month 4d'month 46 month
3d month 4n month
vilt 12
1s month 1trmonth th month
XI XI XI XI XI XI
GV6 GV7 GV 15 GV 16 GV 17 GV 18 GV 25 GV 28
1t' month 1tt month l"t month 1"1month
3'd month 3'o month 3'd month
Women 4n month 3d month
vt 8 vt 19 vt 20 vlt 3 vil 18
15 22 33 42
8h month 8n month 3tdmonth 8h month
vlt 2 x4 xil1 xil2
7n month
lv1 tv2 lv7 xl 36
Sdtmonth 86 month 8d'month 8s month
X2 x10 xll 6
O Regina Norton, 19EE
137
Meridian Namesand Abbreviations Meridian Lung Large Intestine Stomach Spleen Heart Small Intestine Bladder Kidney Pericardium (tleart Protector) Triple Heater (Triple Energizer) Gall Bladder Liver ConceptionVessel Governor Vessel
Abbreviation LU, LU LI, CO ST, St SP,SP FIT, Ht, He SI BL, UB K[, Ki PC,TIP,CS,CX TE, TB, TTL SJ GB LR, LV, Liv CV, RenMo, RenMai GV, Du Mo, Du Mai
PulsePositions:
BladderMeridianNumbering:5E/TCM 5E BL 1-35 BL 36-49 BL 50-54
TCM Same B L 4 T -5 4 BL 36-40
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Number IX X )il )(II I II ilI IV V VI VII VIII )ilI )ilv
Index 21,30 50,52, 54-56,58,61, l2l, 133 21,35 50-52,54-56,58,61, 121,722,133,134 .. ...62 21,36 42 21,35,127 21,35 35 47, 49,91,122 5 4 , 5 0 , 5 1 , - 5 6 , 5 8 , 6 112l 61
AccumulationPoints AE
AEPs AggressiveEnergy Akabane Alarm Points Antique Points
AssociatedEffect Points Back ShuPoints Back Transporting Points
Blocks AggressiveEnergy Akabane AkabaneImbalance AkabaneImbalance
62,l2l 50,122
50,64 5 0- 53,l 2l 50,51 50,65
CV/GV . . EDs Energetic Entry/Exit
r22 50-53 50 57- 59,l 2l ,122 5l-53,121 50-53 50,122 50 50, r2l,122 63 50,66 50,122 50
External Dragons Heavy Metals
ife Husband/W IDs Internal Dragons
Lifeswle Patient Dependenceon Illness Pulse Quality
Qualityon the Pulses Spirit Structural Types UmbilicalPulse CausativeFactor Causesof Disease
CF Cheng Cycle
ChineseClock CleanNeedleTechnique
50,60,12r,722 44,62- 64,66,87,103,109,121 1l, 13,14,17,28,35,37,39, 1 6 , 1 7 , 5 1 9, 1 , 1 0 0 ,1 1 5
I l, I 3, 14,17,28,35,37, 39, 44,62-64,66,87, 103,109 8 10,31 70,7r
r43
21,22,t2l
CommandPoints
2l 2l 2l 2l 2l 21,32,33,64
Element Points Horary Points
JunctionPoints SedationPoints Tonification Points Conception Vessel
7
ControlCycle CreativeCycle CrossingPoints CSOE CVPoints CV/GV Block
21,45 52,55
t21 64 60 5r, 54,57,60,61,64-66,92
Dan Tien
Diagnosis DirectingVessel Disease,Causes Dispersion Dragons,External Dragons,Internal Du Mai
JJ
1 7 ,5 l 7l 51,52 52 34 34 51- 53 2l-23 21,24 21,26 21,25 1 , 5 - 1 , 8 51, 0 0 1, 0 1 17 47 65 21,31,64,65,r 2l 1 7 ,l 1 5 5l 32 l2l 21,46,
Du Mo EDs . ElementPoints Horarv Points SedationPoints TonificationPoints Elements Emotions EnergeticBlocks Entry/ExitBlock EntrylExit Points ExternalCausesof Disease ExternalDragons ExtraordinaryMeridian First Aid Points Five ElementAcupuncture. Five ElementPoints
. .. 1,83,97
42
tzl
Five Element Treatment Principles
21,46,137
ForbiddenPoints Four NeedleTechnique Front CollectingPoints Front Mu Points Fu..
r22 36
21,36 35,36,41,43 t44
21,41
Gathering Points G e n e r a t i n g C y c l.e. . . Governing Vessel
5 34
21,32,34,64
GovernorVessel G V P o i n t s. . . .
tzl 21,43 2r-24,127
He SeaPoints
Horary Points Block Husband/TVife IDs InfluentialPoints Inner BladderLine . InsultingCycle
57-59 5 1-53
2r, l2l 39 9 t7, 115
Internal Causesof Disease Jing River Points Jing Well Points Junction Points
21,43 42 2 r , 2 2 , 2 76 , 2,74 9
Ke.. Ke Cvcle
I
t2
Law of Cure
13,57-59 11
Law ofHusband-Wife Law ofleast Action Law ofMidday-Midnight . . Law ofMother/Child Level of Treatment
10 6,25,26
Il, 1 2,14,122 21,43 27 139
Lower Uniting Points Luo ConnectingPoints . . . MeridianAbbreviations. . Meridians
JL)
ConceptionVessel
J)
33,34 32,34 39 t7, l t 5
Extraordinary. . GovernorVessel Inner BladderLine . Miscellaneous Causesof Disease
72,r22
Moxa
135 72 41
Moxa Stick Moxibustion Nan Jing Needle Technique Sedation Tonification
70,71 69,71 69,70
6l 21, 39,66,r2l
Neuropathy Outer BladderLine Over-actingCycle Point Classification
8
t9 t45
t23 2l
Point Use . . Points
21,30 21,36 42 21,35 21,35
Accumulation
Alarm Antique AssociatedEffect Back Shu Command ConceptionVessel
21 21,33,34 21,45 2L 21,23 21,31 21,46
Crossing CV/GV Element
Entry/Exit First Aid F i v e El e me n... t Forbidden F r o n t M u. . . . . .
42 21,46 21,36 ''l
A1 ' LL' ar
Gathering
" ' 21,32-34 " " 27' 43
GovernoiVessel He Sea
il
""LL''a
Horary
)4 )LL 1
Influential
A1 nr 21,43 21,42 21,27,62,74 43 27 21,39,66
InfluentialPoints JingRiver JingWell Junction Lower Uniting Luo Connecting .
OuterBladder Reunion Sedation ShuStream Source Spirit Tonification . . . Transporting UpperKidney Windowsofthe Sky . .
2r,45 21,26 21,42 21,28 21,37-40,66 21,25,74-76
2r,42,43 21,37,66 21,44 21,30 21,42 51,52,5 5,127- l 3l
X Cleft Ying Spring . . Possession Ren Mai Ren Mo
5) JJ
21,45,121
Reunion Points
t46
34
Seaof Yang Channels Seaof Yin Channels
JJ
69,71
Sedation SedationPoints SevenDevils SevenDragons
2l-23,26 5l 5l
5-7,23,25,26 21,42 27, 28, 29, 44,62, 63, l2l 66
ShengCycle ShuStreamPoints SourcePoints SpiritBlock SpiritPoints OuterBladderLine UpperKidney TCM Tonification . . . TonificationPoints tonificationProcess TraditionalDiagnosis(TD)
21,39,66 21,37,66 83,97
69,70,74 2l-23,25 74 61 122 74- 77, 79,80, 21,4 2,43,l 2l 21,43 21,43 21,42 21,43 21,42 21,42 21 6l 21,37 t6 9 69 3l
Transfers
TransportingPoints He Sea
JingRiver Jing Well Lower Uniting ShuStream Ying Spring Typesof Points UmbilicalPulse Upper KidneyPoints . . . Upright Qi ViolationCycle Vital Force Wei Qi Windowsof the SkyPoints
21,44, l2l
37,44,54,5'.1,73
Worsley, JR . .
7,9
21,30,r2l 21,42
Ying SpringPoints YuanQi...
28 28 35
Yuan Source Points
Zang .
t47
SharonM. Smith Sharon(Sherry)Smithholdsa Master of Acupuncturedegreeand a certificateof ChineseHerbologyfrom the TraditionalAcupunctureInstitutein Columbi4Maryland, andis recognizedas a Diplomateof Acupunctureby the NationalCommissionfor the Certificationof Acupunctureand OrientalMedicine. As a full facultymemberof the TraditionalAcupunctureInstitute,sheteachestheoryandhasbeena clinicalsupervisor. Ms. Smithhasextensivelypursuedfurther studieswith prominentpractitioners.She Spq England,andcompletedthe Clinical trainedwith J.R.WorsleyinRoyalLe'amington Integrationcoursewith JohnandAngelaHicks, and attendedworkshopsand seminars rorrJ.ing topics such as GynecologicalAcupuncturewith Govanni Maciocia, Pulse Diagnosiswith Lonnie Jarrettandthe ExtraordinaryMeridianswith JeremyRossMs. Smithis a memberofthe NationalAlliance,theNationalAssociationofTeachers of Acupunctureand OrientalMedicineandthe MarylandAcupunctureSociety(MAS); sheservesasthe treasurerof MAS. Shehasa privatepracticein Columbia,Maryland.
