An example of the order of the first treatments to give a patient

I think it is always good to emphasize to all five element acupuncturists, even to those who have been in practice a long time, that we should start by offering a new patient’s elements the gentlest treatment we can, one that doesn’t startle or overwhelm them.  I remember being told by one of my teachers that giving complex point combinations right at the start of a patient’s treatment is much like somebody standing on a platform and watching an express train thundering past without stopping.  This may briefly rattle the waiting passengers but not help them get to where they want.  Instead they must wait for a slow train which will stop for them, and allow them to get on and off.   I think this is a good analogy for the wastefulness of starting to address the elements in too complicated a way.

At the start of treatment, patients’ elements are in a vulnerable state and unsure of how to accept the adjustments to their balance which is what we hope treatment will provide.  We therefore need to offer them the simplest and purest treatment we can, and nothing is simpler and purer than command point treatment.  I am therefore giving below an example of the order of the first treatments I might give my patients. The points I have added to the command points, such as the CV (RM) or Outer Bladder points I have chosen here, are ones which can be used for any element, and are all aimed at helping strengthen the patient’s spirit.  A fuller discussion can be found in my Handbook of Five Element Practice (obtainable from the SOFEA website www.sofea.co.uk ).

All points are needled using the tonification method, with moxibustion added before needling except where contraindicated.  If Entry/Exit blocks are discovered at any point, these must be cleared before the final command points are needled.  If blocks are discovered at the end of treatment, even after the final command points, then the blocks should be cleared then and the command point treatment repeated, but this time without moxa. 

Command points have an in-built safety factor, and put the patient back in charge of their own energy. This is why they are always used to complete a treatment.

Treatment 1: 

1 Check for Possession – if there, Internal Dragons treatment
2 Aggressive Energy drain
3 Source points of the Guardian Element

Treatment 2:
1 Correct any Akabane imbalances if not already done as part of the physical diagnosis.
2 CV (RM) 8 (or CV (RM) 14 if BP differential too high for moxibustion)
3 Tonification points if possible, if not, then source points again

Treatment 3: 
1 Bl 38 (43)
2 Command points (source, tonification or transfer across the Ke cycle)

Treatment 4:
1 AEPs (Back Shu points)
2 Command points

Always remember the five element mantra:  the simpler the better.

 

 

 

 

 

 

 

 

A list of simple treatments

I am adding this list to my five element treatments blog in the hope that it will inspire five element practitioners to stay on the straight and narrow path of simplicity, and avoid the temptation to wander off into the jungle of complex point combinations.

I suggested these treatments for 6 patients whom another practitioner brought to me for consultation.  I like to think that they show the kind of simple treatments I use in my own practice.

Moxa cones were added to the points before needling unless where contra-indicated, and all points were tonified.

Patient 1:  Water
Treatment supervised by me:
           Husband/wife correction
           Ki 24
           Bl 64, Ki 3
Suggestions for future treatments:

1         CV 14, Bl 67, Ki 7

2         Bl 39 (44), Bl 60, Ki 2

3         AEPs (back shut points) of Water, source or transfer

Patient 2: Fire

Treatment supervised by me:
           CV/GV block
           Husband/wife correction
           TH 4, HP 7
Suggestions for future treatments:

1         CV 8 (3 moxas on salt, no needling), TH 3, HP 9

2         AEPs of Outer Fire, TH 10, HP 7

3         Bl 38 (43), HP 8, TH 6

Patient 3:  Earth

Treatment supervised by me:

Bl 38 (43), St 42, Sp 3

Suggestions for future treatments:

1         SP 8, St 36, Sp 3 (late summer seasonal treatment, if possible also in Earth horary time)

2         AEPs of Earth, St 41, Sp 2

3         St 25, Sp 15, source or tonification points

Patient 4: Fire

Treatment supervised by me:

Husband/wife correction

TH 4, HP 7

Suggestions for future treatments:

1         CV15, HP 8, TH 5

2         AEPs of Outer Fire, TH 3, HP

3         Bl 39 (44), TH 10, HP 7

Patient 5: Earth
Treatment supervised by me:

IDs

AE drain

St 42, Sp 3

Suggestions for future treatments:

1         Ki 24, St 36, Sp 3 (late summer season treatment, if possible also in Earth horary time)

2         CV 14, St 41, Sp 2

3         AEPs of Earth, source or tonification points

Patient 6: Metal

Treatment supervised by me:

LI 4, Lu 9 

Suggestions for future treatments:

1         Bl 38 (43), Co 11, Lu 9

2         AEPs of Metal, Lu 10

3         LI 18, Lu 3 (Windows), source or tonification points

Putting this blog on hold for the moment

I have decided that I have now written as much as I need to about my approach to treatment as it relates to specific point selections. In particular, I hope it is clear to any reader of this blog how important I think it is not to focus too much on individual point selections but to concentrate instead on understanding the elements and their officials. Anybody interested in my thinking here can read the following entries on my other blog:

16 Nov 2010: “Think elements, not points,” and “The cumulative effect of points”,   

29 July 2010: “Find the element and the points will look after themselves”

14 Jan 2011: “Further insights into point selection” 

Combined with a reading of my Handbook, these provide enough insights for people to get a flavour of the principles underlying my approach to point selection. 

I think it is therefore now time for me to leave readers to work out their own approaches, with, I hope, the words, “The simpler the better” engraved on their hearts. I am not closing this blog completely, because there may be occasions in the future when I wish to share a particularly interesting treatment with you, but I will no longer be doing this on a regular basis.

I would like thank a reader, calling himself, mysteriously “Hamilton loves acupuncture”, for prompting me to think about the future of this blog by asking me for more. The “more” will now mostly be built around my other blog, which is much wider-ranging than the rather narrow focus of this treatment blog, and therefore more stimulating for me to write and, presumably, for people to read.

A typical treatment day

I am giving below the treatments I did today on three of my patients.  I think they are a good representation of the kind of treatments I do.  And I hope everybody reading this will note how simple they are and, I think if you were to ask my patients, how effective.  Another one of my mantras is “the simpler the better and the fewer points the better”.  In this way we do not overwhelm the elements with confusing signals, but, like the magic bullets Western medicine is always desperately seeking for its drugs, we direct a concentrated amount of treatment straight at the guardian element.  That is why we should always consider command points to form the heart of all our treatments, not, as some practitioners tend to think of them, as a kind of add-on after apparently more complex points.

Two patients were Fire (Inner Fire) and one was Metal.

I find it interesting that it is often my Metal and Inner Fire patients who are most aware of the value of their treatments;  each of these are able to sort and evaluate properly in their differing ways.  They recognise the need for regular treatments and know when they need a treatment, but like to space their treatments differently.  Patients 1 and 3 like to come on average once every 2 months, whilst Patient 3 only gets in touch when she feels she needs to.

Patient 1          Fire (Inner Fire)          GV 12, SI 11, SI 3, Ht 9

Patient 2          Metal                           Lu 1, Co 1, Lu 8 (she felt it was already autumn, and I always give seasonal treatments which relate to how the patients are experiencing a season).

Patient 3          Fire (Inner Fire)          SI 9, SI 4                    

Patient 32 Metal Treatment 4

For this patient’s first three treatments, see Blog of 12 August 2011

Patient’s comments since I saw her last week:

“Now I feel detached and can see all the things that have happened to me in the right way.  I am assessing my life.”

Treatment given today:

1      Windows:  Co 18, Lu 3

2    Co 4, Lu 9

This was a simple, but, in its very simplicity, a very beautiful treatment.  The patient looked glowing as she left, and we decided between us that her next treatment could now be in two weeks, as she feels so good. 

Proposal for next treatment:   Bl 39 (44) or Lu 1

Two points about today’s treatment: 

a.  When to use Windows: I mentioned at the end of my last Blog on this patient that I was considering doing Windows very soon for her, because “she is already “seeing” a lot”.  It is interesting how often a patient mentions the word “seeing” when their element starts to be in control and is helping them put their life in perspective.  This is most likely to happen with Metal, which is the element above all that wants to see things in their true colour, to assess their true value.  And, significantly, this patient used both the word “see” and “assess” here.

The other element which needs to “see” things properly, and revels in doing this, is the inner aspect of Fire, the SI and Ht aspect.  The Small Intestine’s role is to assess what is appropriate for the Heart, and it is no coincidence that it is the only official to have two Windows, SI 16 and 17.  These two, the Metal element and Inner Fire, will appreciate having their Windows opened more than any of the other elements or officials.  So it is likely that we do these points quite frequently for them to help them in their task of sorting (SI) and assessing, then letting go (Lu and Co).  Here the Small and the Large Intestines have similar work to do, but at different stages of the process of taking in and eliminating.

There is no point deciding to do the Windows if you feel the patient is still very much “in the dark” about where they are going in their life.  Some light must be filtering into the dark spaces where we wander when our life is troubled before we are ready to be able to cope with the very bright light which Windows can cast upon us.  We may find that we do the Windows too soon, and nothing much happens, and then we need to wait a little, and do them again a little further on, when treatment has helped the patient move forward enough to value this extra light thrown on their life.  As practitioners, our own Windows need to be wide open to assess when to do or not to do the Windows for our patients!

b.  Spacing of treatments:  When I start spacing treatments more widely, I always tell patients that, if they feel treatment is not holding (and Metal, more than any other element, is very clear about this), they should phone for an earlier appointment.  You don’t want to give a patient the feeling that you may be banishing them from the practice room as you extend the times between treatments.  It is always a somewhat delicate question as to how to space treatments, and we can get it wrong sometimes, either by making them too frequent for too long (the most common error – perhaps consciously or unconsciously a practitioner’s eye on their own finances comes into play here!), or by spacing them too widely too quickly.  Some practitioners have told me that they may be relieved to do this, particularly in the case of what they might consider “difficult” patients, i.e., patients with whom they have failed to develop a good relationship.  It is always good to review our own particular way of spacing treatments, and look carefully at what our reasons for doing this are.  Each patient will demand a different schedule of treatments, some needing weekly treatments for a long time, others, as with this patient, feeling happy to go out and confront their life on their own, with less frequent support from their practitioner.

 

Patient 24: Update &Treatment 5

See Treatments 1 & 2 for this patient given in my blogs of 19 & 25 Feb

Even though this patient reported some very big improvements from the first two treatments, she said that the pain in her wrist and the trouble with her eyes had recurred after treatment 4, and decided that she wanted to discontinue treatment.  I felt that I had not been given enough time to help her, but understood why she made her decision.  I was therefore rather surprised when she phoned me again last week to say that she was delighted to report that her wrist was virtually pain-free, and that she would like another treatment to build on this improvement.  I was happy to offer this, as I was dissatisfied with treatment ending is this unsatisfactory way, as I always am if I feel that I have somehow not done my best.

I am listing below treatments 3 & 4, and finally today’s treatment:

 Treatment 3:   

1                    Co – St block  .

2                    AEPs of Wood

3                    Li 4 (transfer from Metal to Liver) I could have added GB 37, as I did in treatment 2, but after a few treatments the two sides of an element will feed each other.  In the first few treatments it is good to give each yin and yang official some attention so that neither feels deprived!

Treatment 4:  This was the treatment when the patient reported that the symptoms had recurred and she had decided to discontinue treatment.

1                    SI – Bl block again

2                    Li 14 (Gate of Hope)

3                    GB 41, Li 1 (spring seasonal treatment)

I was very glad that I had been able to fit in her seasonal treatment before she stopped treatment.

Treatment 5 (today):

1                    TH-GB block (TH 22, GB 1)

2                    GB 20

3                    Liv 4, Lu 9 (transfer from a strong Earth through Metal to Wood)  I chose this treatment because it involved inserting a carrier needle into Lu 9 at the wrist, and I felt this would encourage energy to flow over the wrist.

She looked very pink and glowing as she left, and was delighted with the treatment.  

This is one of those happy cases with a somewhat unexpected result.  I had

assumed up till now that treatment had not helped, and was delighted to find that it

had.  On looking back at her notes, I realised that the seasonal treatment had

obviously done the trick, but that Wood’s natural impatience to get out there and get

going had prevented her from persisting with treatment.  Her specialist had told her

that the pain was related to the pisiform bone, over and through which the SI

pathways passes, and this problem in the SI may well have had led to the need for

clearing a SI-Bl block several times.

She said that her eyes were still very runny, but perhaps the TH-GB block I needled

today will help them, too.  She will come back in the autumn for a follow-up

treatment, and she is happy to do that.

You could say that her Wood element could not “see the wood for the trees”.  For an element which is all to do with vision, it is surprising how often it cannot see what is right there in front of it.  

I felt very happy at the end of this treatment, for it is an outcome such as this which

makes my work worthwhile, and confirms for me the power and efficacy of very

simple treatments directed straight at an element.

Patient 32 Metal (Treatments 1 - 3)

Patient: Female, age 24

Element: Metal: I think her official is Lung, not Large Intestine. She has no problem letting go, but quite a few problems in taking in, literally in finding “inspiration”.

Number of treatments: Today is her third treatment. Treatment 1: AE drain and source points of Metal. Treatment 2: Entry/exit block Co-St, Bl 37, Co 11, Lu 9.

Main problem today: Feels quite uncertain about her future career. Is an artist, and feels unsure about what direction her studies will take her. Is from another European country, and does not know yet whether she wants to settle in England, although has a long-standing English partner.

Patient’s comments since I saw her last week:
“I have started to paint again in the last week. I was frightened to look at my work because I couldn’t see what I needed to do, but I found myself re-evaluating what I had done, which I couldn’t do before. A really lovely moment when I realised that I wasn’t so stuck.”

Treatment given today:

1 AEPs of Metal

2 Lu 10, Co 6  JR always said that Lu 10 is the most spiritual point in the body, and I tell my patients this and watch their reaction. Metal without exception reacts with a look of wonder and delight, indicating “So I am worth having this most spiritual point, am I?”. If I have not got the right element, and the patient is not Metal, there are different reactions. Fire looks fairly, but not overly, pleased (Outer Fire) or puzzled (Inner Fire, SI trying to sort out what that means), and Earth indifferent. I have used these reactions to help me change elements.  We have to use every little indication we can!.

At the end of treatment: She said that the rather uncomfortable and bloated abdomen she had come with now felt warm and relaxed.

Time of next treatment: Next week

Proposals for next treatments: Bl 39 (42) and Lu 8, or possibly Windows. Normally I would wait a little longer before doing Windows, but she is already “seeing” a lot, and will welcome the Window points.

See Blog of 22 August for Treatment 4.

Patient 31: Description of an emergency treatment

This blog discusses whether and when it is appropriate to give what can be called emergency treatment to somebody who you will only be able to treat once or twice.  A Japanese woman, now living in Thailand and a friend of a patient of mine, was in London for 5 days, and wanted very much to have some treatment.  There would be time to give her only two treatments.  I always have to think carefully about whether such little treatment does more harm than good, and each case will be different.  I would have to condense into the three or so hours I could give her what normally is spread over many weeks.  And then there is the added question-mark about the patient’s guardian element.  In the short space of time available to me how likely is it that I will be able to home in on the right element and understand her needs enough to be able to help her?

I decided that I would accept the challenge in this patient’s case for several reasons.  She is herself an acupuncturist and has been very interested in learning about five element acupuncture.  She therefore understood without my telling her that what I would be offering her would be different from the normal slow unfolding of treatment, and was prepared to accept that.  She was also desperately unhappy at the moment, having lost a beloved father recently, and just uprooted herself and her family to move to a new country.  I could hear on the telephone from the despair in her voice that at the very least she would benefit from those simple but profound treatments, the AE drain and possibly clearing a H/W imbalance.  Having decided to see her, I resolved to do the best I could in terms of finding her element. 

The two treatments I was able to give her are a very good example of how I approach emergency treatment of this kind.  I started the first treatment by carrying out a short diagnosis of about half-an-hour.  The more experienced I have become, the more quickly I find I can pinpoint the important aspects of a patient’s life. 

She is a woman of 35, married, with two children, and has just moved to Thailand from Japan where her husband has been relocated.  After this initial half-hour, I knew a great deal about her present life, the difficulties of having a much older husband, of living in a different culture, her relationship with her children, her feelings of inadequacy at not having her own career, her very close relationship with her father, her grief at his unexpected death and her hopes for the future.  I also had details of any medical conditions (none, except high BP, for which she was on medication).  I also did a brief physical diagnosis (Centre Pulse, Akabanes, BP, which was high, so no moxa). 

I basically now knew a lot about her and in particular about how she approached each of the different aspects of her life, which would help me in trying to decide upon an element with which to start her treatment.  The only sensory pointers I could get related to her emotion, which was a mixture of fear and joy, and her colour which seemed to have a bluish-black tinge.  I opted first for Water, although I kept the possibility of Fire at the back of my mind.

Treatment 1 (2 hours):

1                    AE:  none.  I was surprised to find there was none in view of her obvious desperation, but this only goes to confirm that the presence or absence of AE can never be predicted.  A person apparently surprisingly well can have lots of AE, whilst, as here, a desperate patient can have none.

2                    H/W:  As I had suspected from the start, the desperation had led to a H/W imbalance.  She looked much better after this cleared.

3                    CV 14:  I could also have chosen Ki 24 to resuscitate her spirit, but felt that treatment directed at the Heart (CV 14 is the Alarm Point of the Heart) was what she needed more.

4                    Bl 64, Ki 3:  Source points of Water.  There was no change in her colour, and by then something about Water did not satisfy me.  Instead, I was seeing increasing signs of joy/lack of joy lurking below the surface, particularly after the H/W cleared and her cheeks flushed.  I therefore decided to change to Fire.  This is not what I would do in normal treatment.  Chopping and changing elements in the same treatment only serves to confuse both the practitioner and the patients’ elements themselves.  It is always much better to stick to one element at a time in any one treatment, wait to see what its effect is (don’t expect major changes from one treatment on an element, in any case), and give yourself the chance to see exactly which element is responding over time.  There is never a hurry.  The elements will tell us what they need if we give them time.

5                    TH 4, HP 7: Source points of Outer Fire.  After this there was at last some observable change, that of her colour, which became pinker, and she looked more relaxed and much happier as she left. 

She phoned me two days later and told me she felt much better.  Her voice now definitely had an excited, laughing tone, reinforcing my feeling that she was Fire. She said, “I can’t wait to have my next treatment”.

When she came back a few days later for her second treatment, she told me that when she got home after her treatment, “I felt as if I had many tubes in me and they kind of moved around and drained.  I cried and cried for my father.  Now I feel good.”  She was pressing her hand to her heart as she described where these “tubes” were.  I think this is a very graphic description of a H/W imbalance clearing, and the effect on her heart of treatment on the Heart Protector.

Treatment 2 (1 hour):

1        Bl 38

2        TH 6, HP 8 (summer seasonal treatment)

She left looking very happy and cheerful, and I felt happy and cheerful, too. The always risky business of giving such short-term treatment had, in this case, proved successful.  Luckily this patient will be coming back to London in the next 6 months, and will be able to continue her treatment then.

Husband-wife imbalance

Please see my sister blog http://norafranglen.blogspot.com/ for a detailed answer to the comment sent to me about my blog of 23 June:  Patient 29 Treatment 4, asking how I had diagnosed a Husband/Wife imbalance before taking the pulses.

Patient 29: Treatment 6 & 7 (Wood)

Patient:  Male, age 25

Element:  Wood

Number of prior treatments: Five  (see blogs of 15.5.11, 19.5.11,  27.5.11 &  23. 6. 11 for previous treatments) ,

Treatment 6

Observation of patient at the start of treatment 6:   

“I felt positive after the last treatment.”  I felt his eyes looked better and less clouded over.

Treatment given:

I decided to do some points on the Gall Bladder around the eye and head, to reinforce the good energy passing through the eye:

1                    GB 2 

2                    GB 14     

3                    SI – Bl block (again):  I noticed that there was a build-up of fluid on the corner of the eye, and he told me that he had had rather runny eyes all week.  It is unusual to need to re-do entry/exit blocks on several occasions close together, but I think the fact that I have found this block again confirms that there is some trouble with his eyes.  It’s always good to clear a block, because I feel that I am letting good energy flow where it is most needed, to the blocked meridian (this time the Bladder).

4                    GB 34, Li 5

At the end of treatment:  My relationship with the patient is getting warmer and easier each time we meet.

Proposals for next treatment:  Re-check SI – Bl block, just in case I have not cleared it. 

Treatment 7 (one week later)

Observation of patient at the start of treatment 7:  
He walked into the practice room much less heavily, and seemed generally happier.  His eyes had not been so runny until the last 24 hours.

Treatment given:

1                    SI-Bl block again, SI 19 – Bl 1 

2                    GB 3 - strengthening around the eye again

3                    GV 12 Body Pillar:  I felt he could benefit from this point, which I see as straightening the back.  He sits rather slumped over.

4                    Bl 42 Spiritual Soul Gate – to strengthen his spirit.  The point is at the level of the AEP of the GB, and therefore I see this as having a direct relationship with the Wood element.

5                    GB 39, a centre of energy, according to my point book, Liv 3

At the end of treatment:  He closed his eyes after the treatment, and looked as if he could fall asleep.  He was pleased to be offered the chance of just lying quietly on the couch for a further 10 minutes.    

Proposals for next treatment:    GB 25 or Bl 39