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 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.

Treatment of the three major blocks

I have just given three different treatments over the past few days, each involving one of what, in five element acupuncture, we call the three major blocks.  I am listing them in order of their importance.

Treatment 1:   Internal and External Dragons (IDs and EDs)

This was for a very disturbed patient who talked in such a confused manner at our first meeting that I could not follow the thread of anything she said.  I first started with IDS, but moved to EDs when the IDs didn’t clear the block.  This block is what we call Possession, too loaded a word, I think, and I wish I could think of a better one which removes from it something of its stigma.  It is merely one stage removed from obsession, and is a form of dissociation where the spirit finds shelter from some trauma or intolerable situation by blocking itself off.

This can only be definitely diagnosed by the practitioner looking closely into one of the patient’s eyes (you need to hold the eyelids open and tell the patient to look at one of your eyes), and finding that we cannot establish any direct contact with the patient’s spirit.  This will be shown by a pupil which remains fixed and does not flinch or move in any way, as eyes normally do when there is such close eye-to-eye contact.

This treatment is always followed by an AE drain, even though this may have already been done, even very recently.  AE can be concealed, and often is, by possession.

Treatment 2:  Husband/wife imbalance

All the pulses of the right side are stronger in quality than those on the left, most obviously revealed by depletion in the Ht/SI pulse, indicating a dangerous weakening of the energy of the Supreme Controller, the Heart.

Treatment 3:  Aggressive Energy

This was in a patient who returned for treatment after 2 years and after having gone through a very difficult year.  I found AE on the AEPs of Lu, HP and Ht, and it remained on the needle in the Ht AEP (Bl 15) on the left for much longer than on the other needles (1½ hours), indicating a dangerous attack upon the Heart.

All three treatments were rounded off by command points, of course.

I am always awed by what amazingly simple means (a few needles placed in a few points) such powerful effects can be achieved.  At the end of these treatments, all three patients seemed as though reborn, not too powerful a description for the lifting of the weight bearing down upon their spirits.

(Details of the procedures and points to be used for all these three blocks are given in my Handbook of Five Element Practice)

The usefulness of the Akabane test

The test is named after a Japanese acupuncturist who discovered that correcting an imbalance in energy between the left and right sides of the body before you start to treat a patient helps the officials return to balance more easily.  Basically, you compare the strength of energy along each meridian on the two sides of the body, and if you find any discrepancy between the two, you correct it by transferring energy from the side of the meridian which is relatively stronger to feed its weaker side.  I have described the technique for doing this in my Handbook of Five Element Practice (pages 62-63). 

If there is an unequal distribution of energy of this kind, it is as if the official concerned is limping to one side rather than walking straight.  Akabane devised a remarkably simple method of correcting this imbalance.  Doing this helps ensure that any balancing of energy through subsequent treatment is not weakened by a pre-existing tendency for a meridian to favour one side or another.

Left-right imbalances of the kind Akabane discovered can be the cause of one-sided symptoms, such as neuralgia on one side of the face, or joint pains on one side of the leg. Sometimes patients say that they feel lopsided when they walk, as if one side is weaker than the other, another sign of this imbalance.  Symptoms such as these may persist, despite good treatment, if the officials concerned are struggling internally to send balanced energy down both sides of the body.  It is therefore always a good idea to carry out the Akabane test and correct any imbalances found as a matter of course as part of our initial physical diagnosis. 

Often several meridians can be found to be unbalanced, but I have found that correcting the one that is most out of balance can in many cases restore balance to any other imbalances that you find.