The Five Element Acupuncture Handbook PDF

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
grateful to her for her
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
ThemoreI studyacupuncture, the clearerit is to methat therearemanywaysto reachthe
sametherapeuticend. The method reflectedin this handbookis derived primarily from J.R.
Worsley'sformulation Acupuncture,
ofFiveElement alsoknownasleamingtonAcupuncture. There
are other types of Five ElementAcupuncture,notably Meridian Therapy as developedby the
Japanese.
Thehandbookconsistsoffour sections: Concepts, EnergeticBlocks,and

PointClassificatiorq
TreatmentTechniques.Eachsectionis presented fashion.Ideasarepresented
in snapshot in a brief,
un-elaboratedstyle and are then expandedupon during classroom presentation and discussion.
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.
The majorbenefitof this handbookon acupuncture theory is to providea coherent

basisfor understanding patholory,andfor treating
energetics, Theoryhelpsus organizeour
patients.
observationofpatients,developtreatmentplans,andgenerallyprovidesa frameby whichto structure
our practic. of urupnncture.Theoryis simplythe body of knowledgeand principlesderivedfrom
astuteobservationandextensiveclinicalexperience.
Llltimately,this handbookis intendedto serveas a referenceand guidefor students.The

informationin this handbookis the combinedknowledgeof my manyteachers-those who taughtme
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
Law of Mother/Child 6
Ke Cycle 7
ChengCycle 8
Wu Cycle 9
Law of Midday/Ivlidnight l0
Law ofleast Action
11
Law of Cure . . .
t2
Law ofHusband/Wife 13
CausativeFactor
l4
Level of Treatment . . .
14
l6
Causesof Disease
t9
Point Classification
2l
Types ofPoints
22
Command Points
28
SourcePoints
30
Xi Cleft Points
3l
EntrvlExit Points
ConceptionVesselandGovernorVessel
32
AssociatedEffect Points(AEPs)
35
Front Mu Points
36
37
UpperKidneyPoints
39
OuterBladderLine Points
4l
Influential Points
42
TransportingPoints
Windowsofthe Slcy. . . . . .
45
ReunionPoints
46
ForbiddenPoints
First Aid Points
47
Energetic Blocks
Blocks 49
vll
EnergeticBlocks con't: 5l
InternalDragonsandExternal Dragons 54
AggressiveEnergY 57
Husband/Wife Block
60
UmbilicalPulse 6l
Akabane
63
Quality on the Pulses
CV/GV Block
65
Entry/Exit
SpiritBlock
67
TreatmentTechniques
Tonificationand Sedation
70
Needle Technique
72
Moxibustion.. . .
74
Transfers
Readings ""'81
What is Five-ElementAcupuncture? " " 83
FromLeamingtonAcupunctureto TCM andBack Again ' ' ' 97
" " 103 l
Causative Factor:A Forum
CausativeFactor " 109
Why Do PeopleGet Sick? The ChineseView ' ' ' ' ' 115
F i v e E l e me n tT re a tme n tPr inciples.... ' "" l 2l
TheParadoxofParadigmsandPoints " " " 123
Possession asMetaPhor ' ' 127
ClinicalNote: The Mystery of AggressiveEnergy ' ' 133
MoxaStickUsage... "'135
ForbiddenPoints ' ' 137
MeridianNamesandAbbreviations ' ' ' 139
Index r4l
vllr
Five ElementAcupuncture
FiveElementAcupunctureris basedon nature. The Chineseobservedthe cyclesof nature
asthey arereflectedin the seasons, in the rhythmsof dayandnight,andin the movementof all
living thingsthroughbirth, growth, declineanddeath.Humanbeings,aspart of nature,are
governedby the samelaws.
The five elementsarewood, fire, eartlqmetal,andwater. Eachelementrepresents a

seasonin nature'scycleanda phaseof a person'senergy.Themeridiansassociated with each
elementarelikenedio * Official of a kingdom. EachOfficialmustdo its job in orderfor the
kingdomto prosper.Likewisein eachpersonthe variousaspects of the person'senergymust
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.
The inter-relationships of the five elementsis important. Eachelementaffectsandis

affectedby all the others. In a person,the dynamicsamongthe elementsare observedin orderto
understandhow bestto treat a patientwith acupuncture.
Eachelementis associated with a setof correspondences. Emphasisis placedon the

correspondences ofcolor, sound,odor,andemotion.Thesecorrespondences areobserved by
seeing asking,feelingandsmellingin orderto discernthe stateof the elementsin the person.
The personcanthenbe treatedaccordingly.
The roots of the traditionofFive ElementAcupuncturego backto ancientChina.Using

theseroots alongwith informationfrom othersources,Dr. J. R. Worsleyof LeamingtonSpa,
England,synthesized asit is taughttoday-2Later
the informationinto a systemof acupuncture
generationsof practitionerscontinueto addto the body of knowledgethroughtheir own
experiencesin the treatmentroom.
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 cycle-

The 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 createsFire Wood : growth
Fire createsEarth Fire = maximal growth
Earth createsMetal Earth : balance
Metal createsWater Metal : decline
Water createsWood Water : maximal decline
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.
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
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
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 2 t /1 5 5 I t Sr0lll2
Pm am
Treat the Btadder/Ill lvleridian just before5PM sun time and

the Kidney/TVMeridian just after 5P1s.f sun time.
8
The time periods are shown by the Chinese clock in the ceoter of the Worsley Five Elenrent chart
9 See page 24 for discwion of time and sonal usge of Horary points.
Horuy means..hourly."
t0
Law of LeastAction
Definition
Do aslittle aspossibleto initiatethe desiredeffect.

Qive simple,clear,direct messages andwork within naturallaws.
Characteristics
to awakenthe profoundnaturalself-
Effectivetreatmentprovidesall the stimulationnecessary
healingpowers of the body/mind/spirit-
Practitionerencouragesand supportsself-healing;doesnot do the healing'
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.
The Law of Cure in action indicates effective treatment-

Allows 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)
Left Side Right Side
Planner(LR)
will (Kr) HT LU LI
SI
GB LR SP ST
On the right side: TE
BL KI PC
Receiver (LI-J")
Eliminator (LI)
Processor(ST)
Transporter(SP)
Heart Protector @C)
Pathologt existswhenthe right sidepulsesare strongerthanthe left sidepulses.

Pulsequantityandqualitymay be out of balance.
The pulsesareunbalanced whenthe right sideis strongern quolity and quantity thantheleft
side.
A Husband/TVifeimbalanceindicatesa seriouscondition;it showsthat the patienthasgivenup
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
diagnosed as the
highly personal way. One practitioner may treat only the elementthat has been
for observing a patient's
- itr. id"u of CF loosely, using it as a basis
CF. Another might apply
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.
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
equalor indistinguishable impact. In the rest of their patients,the phenomena of
the individualandhis or her symptomsaretoo complex to pin to one or eventwo
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
to the outside world and to its own inner
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 anti-
the body. The practitioner needsto considerihe relative strength
pathogenicQi (Diagram 1).
Diagram I
pathogenic influence
Diseasecan occur when the balancebetweenthe anti-pathogenicQi and the
or external changes
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
External Causesof Disease:Climate n Eat;lL 4 za+e- N-(
Wind
Cold
Fire - Heat
Dryness
SummerHeat
Damp
The abovecanbe combined;for example:wind-cold,damp-heat,etc.
MiscellaneousCausesof Disease
Constitutio4 heredity
Traum4 injury, surgery
Parasites,poisons,ePidemics
Wrong treatment
Lifestyle
Overwork, fatigue
Underwork
Sex
Diet
Knowing the causeof diseasewill influencethe choiceof treatment.

Knowing the causeof diseaseallowsfor effectivepatienteducation-
A patient'sCF maymakehim/hermore susoeptible to a particularcauseof disease'
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.
-r f a-IvxFs
Wood-+Fire-+ Earth-+ Metal Water. (So'trce
tu'fln il
.
-+ Water -+ Wood -+ Fire + Earth. (3oorcet4x'ts &tlq''' C'ob {
On the Yang meridians: Metal
The nature or energy of each elementbecomesaccessibleat thesepoints'

Ke cycles'
Used to transfer .nogy from one elementto another following the Sheng and
23
Horary Points
Definition
Thepointon eachmeridianthat correspond to its elementwhenusedaccordingto the Law of

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
Powerfi.rlbecausethe energyof a meridianis moreaccessible duringits horarytime.

Are not assafeas sourcepoints.
Theytreatthe Officialswithout transferringenergyfrom or to anothermeridian.
Usedto treat the meridianat its most accessibletime.

Whenusedin its corresponding seasorLcarriesan enhancedeffect.
Canbe usedalonefor seasonal treatments.
Are generallytoffied but canbe sedated.
Points
Metal. LU8 MeridianGutter 3AM-5AN4

LI 1 MerchantYang 5AM-7ANd
Earth: S T3 6 Leg ThreeMiles 7AM-9ANd
SP3 SupremeWhite 9 Alvl - ll AM
Fire: Fil8 LesserPalace IIAM-IPM
SI5 Yang Valley IPM-3PM
Water: BL 66 PenetratingValley 3PM-5PM
KI 10 Yin Valley 5PM-7PM
Fire. PC8 Palaceof Weariness 7PM.9PM
TE6 BranchDitch 9PM-IlPM
Wood: GB 4I Foot AboveTears llPM-1AI{
LRI GreatEsteem lANd-3AM
24
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 Child-
Transfersylnto yin andyangto yang on the Shengcycle:
Use of a tonification point requires understandingof the Law of Mother/Child.

Fostersthe natural movement of the Shengcycle.
Points
LU9 Very GreatAbyss

LI I1 CrookedPond
ST4 I ReleasedStream
SP2 GreatCapital
HT9 Little RushingIn
SI3 Back Ravine
BL 67 Extremity of Yin
KT7 ReturningCurrent
PC9 RushingInto the Mddle
TE3 Middle Islet
GB 43 Valiant Stream
LR8 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.
Use of a sedation point requires understandingof the Law of Mother/Child.

Fosters the natural movement of the Shengcycle.
Points
LU5 OutsideMarsh
LI2 SecondInterval
ST 45 Hard Bargain
SP5 MerchantMound
IlT7 Spirit Gate
SI 8 SmallSea
BL 65 BoneBinder
KII BubblingSpring
PC7 GreatMound
TE 10 HeavenlyWell
GB 38 Yang Support
LR2 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.

thejunction point of the relativelymoreexcessive
If necessary, meridianmaybe dispersed.
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 Narrow Defile

' LI6 SidePassage
ST 40 AbundantSplendor
' SP4 Prince'sGrandson
' IfT 5 PenetratingInside
' SI 7 Upright Branch
BL 58 Fly and Scatter
' KI4 GreatBell
PC 6 Inner FrontierGate
' TE 5 Outer Frontier Gate
GB 37 Bright andClear
. LR 5 InsectDitch
27
SourcePoints
Yuan SourcePoints
Definition
Points that contain the Source Qi, called Yuan Qi or Original Qi which comes from the Kidneys-
SourceQi 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.
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.
Oftenusedwhen an acutesituationarises.
May alsobe usefulfor severeor persistentailments.
Canbepalpatedfor tenderness for diagnosticpurposes.
Points
LIJ 6 GreatestHole
Ll7 Warm Current
ST 34 BeamMound
SP 8 Earth Motivator
IIf 6 Yin Mound
SI 6 Nourishingthe Old
BL 63 GoldenGate
KI 5 Water Spring
PC 4 Gateof Qi Reserve
TE7 Assemblyof Ancestors
GB 36 OuterMound
LR 6 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.
Used to break blocks from one meridian to the next, specifically from one element to the next.
Example: SI to BL LR to LU
KI to PC LI to ST
TE to GB SPto HT
May be usedto clear a meridian.
Points
Entry Exit
LU I Middle Palace LU 7 Narrow Defile

LI4 Joiningofthe Valleys LI20 WelcomeFragrance
ST I ReceiveTears ST 42 RushingYang
SP I RetiredWhite SP2l GreatEnveloping
HT I Utmost Source HT 9 Little RushingIn
SI I Little Marsh SI 19 ListeningPalace
BL 1 EyesBright BL 67 Extremity of Yin
KI 1 BubblingSpring Kl22 Walkingon the Verandah
PC I d HeavenlyPond PC 8 PalaceofWeariness
PCz? HeavenlySpring
TE I Rushingthe FrontierGate TE22 HarmonyBone
GB I Orbit Bone GB 4l Foot Above Tears
LR I GreatEsteem LR 14 GateofHope
CV I Meetingof Yin CV 24 ReceivingFluid
GV I Long Strength GV 28 Mouth Crossing
18
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.
They circulateWei Qi or DefensiveQi andregulatethe seven-year cyclesof womenand
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.
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.
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.
Strengthensthe mentalandphysicallevelsof energyif they arelow or depleted.
Characteristics
Is relativelymoreyangthan ConceptionVessel.
Is associated with activity anddirection.
Is associated with Heaven.
Holdsthingsup.
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
Pointson the backusedto communicate directlywith an Official.

directly.
Wherethe Qi of the Zang (solid organs)andthe Fu (hollow organs)canbe accessed
The Chinesecharacterfor Shumeans"to transport."
an-rttne( Bl,{der lrht
characteristics
Strongandpowerfulpoints.
Generallyusedwith a sourcepoint.
Relativelyyang in nature,but usedto treatyrn aswell.
Influencethe expansive,activefunctionsof an Official.
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 Lung Correspondence
BL 14 PericardiumCorresPondence
BL 15 HeartCorrespondence
BL 16 GovernorVesselCorrespondence
BL 17 DiaphragmCorrespondence
BL 18 Liver Correspondence
BL 19 GallbladderCorresPondence
BL 20 SpleenCorrespondence
BLzl StomachCorrespondence
BL 22 ThreeHeaterCorrespondence
BL23 Kidney Correspondence
BL 24 Seaof Qi Correspondence
BL 25 Large IntestineCorrespondence
BL26 Orig" PassCorrespondence
BL 27 SmallIntestineCorrespondence
BL 28 BladderCorrespondence
BL 29 Mddle of the BackboneCorrespondence
BL 30 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.
Useful diagnostically.
Used to treat an organ and local area around the organ.
Mu and Shu points may be combined in treatment.
Point Name Corresponding Oflicial or Jiao

-/rt9 t-uz
LUI Middle Palace Lunglrtu i,UncZ 6u'o"u
ST 25 HeavenlyPivot Large Intestine lttl
cv 12 Middle Duct Middle Jiao, Stomach Mtt 4 nca
LR 13 ChapterGate Spleen/vrrJ r t+a '"'iI-
CV 14 GreatDeficiency Heart MU
cv4 First Gate SmallIntestine SE tt'tO 3 ac/
cv3 UtmostMiddle Bladder ftru lqct 'z(-
GB 25 CapitalGate KdneYrqu t*n'l-
'7ncz
CV I5 Dove Tail Pericardium/hU
CV5 StoneGate Triple Heater/4U ,-L4g1' nl
tn'€
cv7 Yin Crossing Lower Jiao Mu i fi'r
cv t7 Betweenthe Breast Upper Jiao mu 4ft7's
GB 24 SunandMoon Gallbladder f4u 7 r's
LR 14 Gate of Hope 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.
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
Outer Bladder Line Points
^,tt ef*
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.
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. -o
At the level of the Heart Correspondence- BL l5- \
For strains on the heart, shocks, broken heart. 5 7
Restoresthe spirit.
Anxiety, insomnia.
tw
39
f.letps 1o W PtrsoY''Y4*'- 1*4
BL 40 Wail of Grief
For a cry of anguish.
For the patientwho is stuckin grief
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.
4R
/ 5 q-ctuss 4-
BL 4zSpiritual Soul Gate - Hun Men. Hun is the spirit of the Liver.
At the level of Liver Correspondence- BL 18.
For hopelessness and depressio4mood swings,resentment,anger.
For alcoholics,drug addicts.
To
-Ueehelp.
'1o^ oflpr;rpose
the patient find,a sens^e
F-e,oPte 'd* <-a'N*'fb a-n '
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.
At the levelof Kidney Correspondence -BL 23-
For lack of ambitionor will; for revitalization.Also usedfor an over-drivenwill-
For the patientwho is depletingherselfby doing too much'
Greatfor a Water CF.
Depression, lackof will, feelingof powerlessness andhopelessness' .
Cn-a.ht7 Lznrk - *a ct>-z't
Fatnt
wk+- rs alaat
40
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
Used when a particular constituent needsaffention'

May be addedwhere appropriateto a patient'streatmr
Points anlloence
-t-t'-'^'-t
LR 13 ZangYinorgans
CV 12 Fu/Yangorgans
cv 17 Qi
GB 34 Sinews YangMound SPring
BL 17 Blood DiaphragmCorrespondence
LrJ g Pulsewessels/lvleridians very GreatAbyss
BL I I Bones .-it,tt.,;n GreatShuttle
tgTrrta'/(lutD HangingCup
GB 39 Marrow rBwr''rz1
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.
May vary accordingto viewPoint.
Points
t2 k't cc'D ot tnn-fu-[
<o-tesPn&
/ Jing Well Points - ip,t I ftt'
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.
- uvd l" ezz&" fu''f
ny Ying Spring Points ,rat r'g-* Lllel<'t pts
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 ShuStreamPointstarY(t a Wn4
Oorr(9pr,2s-i /-a-*p
r
d' ;oanq
atrc{ | m*4
';.',
Correspondto Earth (yin meridian)andWood (yangmeridian)'-"."."."'"lUWtW5:H
CorrespondtoEarth(yinmeridian)andWood(yangmeridtan)pomts.| points.l- _* l"i Shou
'I'hrrd pointin
m from thetoe ornnger.
toeor finger. "
Thirdelement
element pomt trom the l"Jvra_-.prz*da-*fo
Qi is startingto flourish,strongenoughto carryotherthingswith n l;;;;truLthfr oy
For heavysensations of the body andpainfuljoints.
f d-ur9
ClearsWind andDamp.
-ffi1yffi-ffi,tui'z[',r'{arutv( ir */
iu,,7',1-,/7
2l
O,rt"id" tb" boundaries of strict Five Element ActPuncurre.
\i,,,tnllu'i
' . t , t l " l * - - l hvilll"t
= d&n'4t
U- / 42
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.
()n*a to<aajii))ffi2 ,-t , r -
Aat>&o-<-. ;
rtA4.e,,."<-
fiL50"
Lower Uniting Points
Located around and slightly distal to the knees.

To treat diseasesof the Fu organs.
the Triple Heater

BL 53 addresses
GB 34 addressesthe Gallbladder
ST 36 the
addresses Stomachandabdomen
ST 37 addressesthe LargeIntestine
ST 39 addresses SmallIntestine
the
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
practitionerneedlesWindowsonly whennatureneedsassistance in openingthe Window.
More commonlyusedby practitionersof WorslgY-acgpyncture.drt
> p'e+sy'e-ac*
Q rtttg lL.LLLrr4 C,lbtuLVtr2tt-
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 +az-al-
Points
'fera-n 4z s/aJ/<
SI 16
SI 17
HeavenlyWindow
HeavenlyAppearance , .,e"*6-""/'dre-4tu;T
BL l0 HeavenlyPillar
PC lcr or 2? HeavenlyPond or HeavenlySpring
TE 16 HeavenlyWindow
LU 3 HeavenlyPalace
LI l8 SupportandRushOut
ST 9 PeopleWelcome
CV 22 HeavenRushingOut
GV 16 Wind Palace
44
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
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 3 leg Yin Officials KI, LR SP

CV 4 First Gate 3 leg Yin Officials KI, LR' SP
SP6 ThreeYin Crossing 3 leg Yin Officials KI, LR' SP
LR 13 ChapterGate 5 Yin Officials IIT, LR' KI, LU, SP
PC 5 The Intermediary 3 armYin Officials I{T, PC, LU
Yang
BL I EyesBright All six Yang officials plusYin QiaoMo and

Yang QiaoMo
CV 12 Middle Dua 5 Yang Officials SI, BL, GB, LI, ST
GV 14 GreatHammer All Yang Officials
GV 20 OneHundredMeetings All Yang OfficialsplusLR
GB 39 HangingCup 3 leg Yang Officials BL, GB, ST
TE 8 ThreeYang Junction 3 armYang OfEcials SI, TE, LI
22
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.
Energeticeffect,e.g.,increasesHeat in a patientwith pathogenicHeat.
Referto the Worselypoint locationbook for pointsthat areforbiddento needleand.iormoxa.
First Aid Points

Generally,usethesepointsin emergencies until the patientcanbe treatedmore thoroughly.
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
Often referredto as IDs and EDs. Also calledPossession, or devilstreatment.'
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
t' 3 r ne- z -
f2- - t' r s€1'i 1n- - t!f! af**/
SuppoftingSignsSpecificto ExternalDragons A<ctd'a'qf tL farra
( AnVof the signsfrom IDs above,plusan externalfactor suchas:

? Exposureto extremeweatheror climates;mustbe a graveinvasion.
( Externaltraumasuchasanaccidentor surgerywherethetorso is opened.
Treatmentof Possession
INTERNAL DRAGONS EXTERNAL DRAGONS
Masterpoint l/4" belowCV l5 GV 20

ST 25 BL II
S T3 2 BL 23
sT 4l BL 6I
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
6i-,i #r// haldtn7
u-rhtnTs 'tufe H.z; .
AggressiveEnergY
Definition
toxic or polluted energy

AggressiveEnergfs (AE) is a block createdby independentlycirculating
that moves along the Ke cYcle.
is to cope'
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
than
{f 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 treated-

The 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
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 Lung Correspondence
BL 14 Pericardium Correspondence
BL 15 Heart Correspondence
BL 18 Liver Correspondence
BL20 SpleenCorrespondence
BL 23 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
ffid. Insert needlesvery shallowly, about one fen. If the
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.
4
,
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
))
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
rednessmay not be on the point. Either add another needle or
repositionneedle.
in
7. Test BL 15, Heart Correspondence,for AE after rednesshas cleared
all other points. Add a new test needle'
Testing AE on Heart
8. Usually test all points unless you're sure where the AE is. In that case,
test the two Officials acrossthe Ke cycle.
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
on the right side.When this is not so, thereis a husband/wife block.
A husband/wife(FVW) imbalanceoccurswhen the right hand pulsesare greaterboth in quantifi
(volume) @ handPulses
J.R. Worsley callsa husband/wifeblock the disaster/death of the family.
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 back
5. Toniff sourceson Heart and Small Intestine.This puts the Supreme
on the throne:
SI 4 J,
HT 7 .[,
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 Kl 3 -r,
LI 4 -E BL64 I
ST42-E LR3 J,
SP3 -|9 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.
Dispcrse Toniff
BL 13 -E BL 18 J,
BL 20 -E BL 23 -|j,
Option Four
Disperse all wife AEPs and tonify all husbandAEPs at the sametime:
Disperee Tonif
BL 13 -I9 BL 15 J
BL 14 J9 BL 18 -t,
BLzO J9 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.
3. Placethe thumbandfirst threefingerstogetherforminga North/South/East/West a>ds.
4. Ask the patientto take a deepbreathandexhale.As he/sheexhales, gently pressdown
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
Centered Off-center, to the top and right side of patient
Treatment:
l. Correctan umbilicalpulseby massaging it to the center-

2. Usethe thumbsor the threemiddlefingersto gentlypushthe pulsebackto the center.
Follow the breath. Do a few gentlestrokesandthenrecheck.
3. Correctingan oFcenter umbilicalpulsemaycolrect the Akabanes.
4. Do not massage the pulsetoo long. It maybe the resultof a structuralanomaly.
%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.
Developed by Dr. Kobe Akabane(1895- 1983)in Japan.30 Thistreatmentis not foundin
traditionalChineseacupuncture.
Diagnosis
The Akabanetest is the definitivemethodof diagnosis.
SupportingSignsto indicate an Akabanetest - LE-b FLr+qS
PersonfeelsoFcenter.
Onesidedsymptoms.
Personhasexperienced injury, trauma,or surgery.
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 f5('
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. Left Fishl
4. If for any reason you cannot test the nail point, move up the SP
meridian to the next point availableon both sides of the LR
meridian. ST
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
Evaluation
Readingsthat differ by at leastone-thirdareconsideredunbalanced'

longerfor the
The sidewith the mostn r-ber of passesis the deficientsidebecauseit took
heatto connectwith the energy-
Treatment
1. Tonify the junction point on the deficientside'RecheckAkabanes'

2. If theimbalance hasnot corrected,tonify the sourcepoint on the deficientside'Recheck
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
Treatmentin successive attemptsto correctthe imbalance:

LU7LJ,
1. Tonify the junction point on the left.
L U9Ll'
2. Tonify the sourcepoint on the left.
LUTLI andLUgLl,
3. Tonifyjunction andsourcepointson the left.
4. Moxa on junction and/orsourceon the left. LUZLAandJorLUgL.A
5. Dispersejunction on the right; tonify thejunction on the LU 7R ,f and LU 7L -l:
left. BL 13LI
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.

Recheckthe other Akabanes.Often corecting oneor rwo imbalances will causethe rest of
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.
d?:n.hft: e/ AF, Vunz'havtVr>

fr<ut-C€-
Ti: Cltu* r'. L tc-ut'f-tVt /
{a*
- ix(? tuW^"
W!-er;ura<- p*
63
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. Drapeyour patientappropriately.
2. Use-fing"r or gloveswhenworking in the genitalarea.Washhandsafter needlingeachpoint.
3. "btt
Take the pulsesafter eachpoint to determinewherethe block is.
a. 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) block.
Treatment: 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 hSiper
listless higlrblood presslre
lack energl can't rela:r
etc. etc.
pulse -2 pulse*2
Treatment with
uppers/amphetamines Treatnentwith downers
vuillmove the enerry urill movethe enerry
toward the middle gror:nd towardthe middlegrouod
but will detract but will detract
from the lrfe force r'ITA.L FC'RCE \']TAL FE FICE from the lrfeforce
Tonification Sedation
treatmentindicated treatrnentindicated
to rnove the enerry to rnove the enerry
toward middle ground toward middle ground
AND AND
thelrfeforce
enhance VITAL FE rlc:E thelifeforce
enhance
69
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
/ PCs
PC3
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 SI4 FI't 5 PC6

TH4 HT7 SI I TH3
71
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
have specific areasof coldnesssuch as the joints, lower jiao, etc
cold. The patient may-feel
The patieni may also cold to the touch. Somepeople speak of a deep-down, bone
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-
73
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 l. Alwavsneedlethe deficiencyfirst'
carrier
z in"drst needledeterminesihe characterof the treatment;the rest of the needlesare
itl.,$ru
'
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.
8. Enerry cannot th" Fire wall. The Fire wall is betweenthe HT and SI sideof Fire andthe
"ios
PC andTE sideofFire.
9. Avoid a carrierthat is excessive; it's alreadygreedy.
10. Do not usethe HT as a carrier, usethe PC instead.
Considerations
l. It is all right to momentarilydisturba well-workingmeridian.

Z. The Law of LeastAction saysdo as muchasyou canwith aslittle interventionas possible.
FewerPointsarebetter.
3. End with the Shengcycleratherthanthe Ke cycleif possible.
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
l. 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.
Example
TreatmentPlan: Move energyfrom Wood to Water
Point Choice:
l. The first needlegoesinto the deficiency,Kidney.
2. This determines that the characterof the treatmentwill
be Water.
3. Usetonification,grandmother, or junctionpoints.
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: K t 7 -|:
LU9 I
SPl I
75
Scenario Using KI3
KI 3 calls the energy from Earth' In Earttr' I canuse

eitherSP2 (tonificationlFire)or SP I
(grandmotherMood). I chooseSP1 because I want to pull the energyfrom Wood rather
than Fire.
Thoughts:
'SP 2 callsenergYfrom Fire"
"SP I callsthe energyfrom Wood"
'I will useSP l"
Treatment:
Kl3 .|:'
SPl J-
Comments:
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:
inserted so
l. Insert needlesinto KI 3 on the left and then the right. The needlesare
that they are ready to be tonified, both needlesare left in place-
on left
2. 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
Repeat
3. Go back to tonify KI 3 on the left. Remove the needleand sealthe hole.
the process on KI 3 on the right-
the point is
4. 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?

Your choicesare: Mother point _
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 offive-
elementacupuncture.In 1990,he will initiate (with Angela Hicks) a two-year clinical
course based on five-element cqusativefactor diagnosis that also includes TCM
diagnosis.
The purpose of this article is to give a critical are necessary

account ofthe "systern" of acupuncture that The first necessarystepis that LA be given
has come to be known as five-element a written account so that TCM practitioners
acupuncture.It is the style of acupuncturethat know clearly the theory and assumptions
has been taught at the College of Traditional underlying it. At the moment, there is only a
Chinese Acupuncture in Leamington Spa in partial account ofthe system transcript of a
England since the early seventies[and at the seminar presentedby Professor Worsley to a
Traditional AcupunctureInstitute in the United group of non-acupuncturists. The
States since 1980]. Its father and developer communication of the system has otherwise
has been J. R. Worsley. Although the system been verbal and given by some twenty-five to
uses the five-element model, what makes it thirry teachersat the Leamington College [and
different is not simply the five-element theory by faculty of the Traditional Acupuncture
found in any ofthe basic Chinesetexts. Hence Institute in Columbia, Marylandl.
it may be called "LeaminSon Acupuncfure" or The secondstepis the sharing of practice
LA for short. The following is not a detailed time between practitioners from different
account, but more an overview of the backgrounds so that each can appreciate in
significant differences between LA and the clinical terms what the other does.The second
system called TCM (Traditional Chinese step dependson the first, and hencethis article
Medicine). is onestepalongtheway.
I would like to get one issueout of the
way immediately. ManyTCM practitioners are
In the West we are forming an awareof someofthe absencesfromLA. They
that is appropriateto our culture.
acupuncture are surprisedthat in LA theory there is no
LA hasa contributionto make,but two steps differentiationby substances,eightconditions,
83
jing luo and the four levels, sanjiao or six Secondly, the concePts of TCM are
channels.In effect,this meansthat LA does explicit; €.g., "Ylr xu" is specifiedby malar
not recognizethe channel-organdistinction flush,restlessness, dry mouthandthroat,night
and has no traditionalway of describingan sweats,etc.
acute, exterior condition. LA developedin Thirdly, the conceptsthat are the least
Englandand dealt mainly with patientswith abstractaresensory-based andthereforeeasier
chroniclong-termcomplaintswho wentto the to ascertain;e.g.,you can"see"a malarflush,
Westerndoctor whenthey caughta cold.It is observerestlessness,and ask about a dry
clearly not realistic to look to LA for a mouthandthroat.
contributionin theseareas. The following is a generalization;
Returning to the develoPment of an nevertheless,we can say that the concepts
acupuncture for the West, we can say that usedin LA are less systematic(in the above
most acupuncturists have kept several sense),less explicit, and less sensory-based
standardsin mindfor a Westernacupuncture. than thoseused in TCM. TCM's underlying
Using a couple of these standards,we can world is more physical and external;LA's
higtrlighta very importantdifferencebetween morementaland internal.
TCM andLA. Thesestandardsare:
What is the significance of this difference?
l. Effectiveness of treatments with
Westernpatients. A body of knowledge that is systematic,
2. Testability and compatibitity with explicit, and sensory-basedis more easily
Westernscientificideas. taught.So it is easierto communicateTCM;
3. Adherence to the basic Chinese andit is also easierto checkthat the student
tradition. has understoodthe concepts.On the other
4. Teachability or explicitnessof the hand,much of the languageof LA is poetic
material. rather than literal, suggestive rather than
5. fndependenceof personalauthority. articulate, and not unlike the tradition of
Chinesephilosophy.Many of the diagnostic
The latter two highlight an important categoriesof LA refer, in part, to innerstates
differencebetweenTCM andLAwhich needs and are difficult to make sensory-based' For
to be dealtwith first. example,"lackingin qualityand inert" is much
harderto pinpoint without confusionthan is
Expressionand StructureofModern TCM "malarflushandrestlessbehavior."Theextent
and LA to which LA usessuchconceptswill be clear
aswe proceed.To the degreeto whichit does,
When referring to TCM I will be referring to it can be difficult to teach, learn"and check
what is currentlytaughtin Chinaandrecorded that it hasbeenlearned.LA alsoimpliesthat
in Essentials of ChineseAcupuncture. TCM its teachers must be effective clinicians,
hasthreeimportantcharacteristics. whereasthe nature of TCM makes it less
Firstly,TCM issystematicin the sensethat essentialthat teachershave extensiveclinical
its conceptsinterconnect;e.g.,syndromes refer experience.
to substancesand organs; the function of But why use such conceptsat all when
organsis defined,at leastin part, in termsof relatively explicit ones are available?The
substances. answeris that they do a differentjob. LA
84
clearly believes that the effectivenessgained idea that a disease's transformation into
through using such concepts offsets the further diseasescan be controlled. TClvI, on
diffi culty of learning and communicatingthem. the other hand, pays relatively little attention
This point will comeup againin the section on to the five-element theory when dealing with
the function of the organs. clinical diagnosisand treatment. Certainly, the
Therefore, we begin with an important associationsare not used consistentlyand the
difference between LA and TCM in the way notion of preventionis paid little credence.
they are expressed.The other differencesarise LA goes further. In the teaching of LA
from what LA leavesout and what it includes. there is considerabledescription ofthe nature
This is the main subject of the article. of each element and how it functions within
man.Thesedescriptionsinclude, but are wider
We begin with LA's understanding of an than, the roles of the organs. Earth, for
element. example, is not just the function of the
stomachand spleenorgans. As earth supports
The Elements and nourishesus, so also does the earth within
us. Our abiliry, therefore, to nourish ourselves
In Essentials of ChineseAcupuncture thereis and others will be qualitatively determinedby
an account ofthe five elements.They are said the state of our own earth. In the teaching of
to be the basic materials of the world. The Ld these metaphors are explored over and
five-elementassociationsare describedandthe over agaiq often through examples from
ways in which one element interacts with individual patients. For example, when a
another are discussed. Various clinical patient's metal is the fundamental weakness,
examples are given and the possibility of what is the patient likely to say about himself?
preventive treatment is suggested: What is he likely to complain or boast about?
How is he likely to think of treatment, behave
. . . the condition of a patient suffering towards the practitioner, or give feedback on
from heart trouble and whose changes?
complexion is abnormallydark may be With the elements,particularly, there is the
explained as water (kidney) acting on difference between explicitness and poetry
fire (heart). If the above correlation of mentioned above. It is not the purpose of this
a disease is studied thoroughly the article to give an account of eachelement,but,
findings may be taken as a guide in rather, to state that in LA the nature of the
treating the diseaseand preventing it elements,however metaphorically described,
from reaching another part of the are used seriouslyin the clinical context.
body. Its possibletransformationinto The above quote fromEssentials refened
other diseasesmay be controlled, so to the interaction of the elementsand the use
that the course of treatment can be of color on the face. The main models of
shortened and the diseasecured in an interaction used by LA are the shen and ko
earlystage.(p.21) cycles.Color, sound, emotion, and odor are
the main associationsused clinically, but more
LA takesvery seriously
thenatureof the willbe said of theselater.
the waysin whichtheyaresaidto
elements,
interact, the use of associationssuch as color What shouldbe obviousis ttrat LA usesonly
parts of five+lement theory clinically and
to discover the root of the disease.and the
disregards the rest; hence my preference
85
(stated above) for calling this style of organwith differentpartsof the body-e'g''
acupuncture "LA" ratherthan "fi ve-element'" thJ fiver with nails, eyes, and tendons-is
There are many aspectsof traditional five- included.
elementtheory that are not taught in LA. On
the clinical effectivenessof these,LA does
Behavioralor PhYsicalsYmPtoms?
not comment.
An important differenceis LA's attemptto

describe the patholory of an official in
Thenextimportantstep is I'A's treatmentof behavioralterms.TCM goesfrom a function
organs. suchas liver storing the blood, to too much
blood in circulatiorLto a symptomlike hearry
Organs/Officials/Channels periods.For depression of liver Qi, or anyof
ihe other liver syndromes,there is a set of
With respect to organs, LA makes some moreor lessphysicalsymptomswhich arethe
important omissions and some important manifestationof the liver's imbalance'
additions. What does lll do? LA begins with a
In theWestwe havetried variouswaysto generalstatementof the official's function,
ensurethat the Chineseconceptofan organ iuch as "receiving Qi energy from the
doesnot get confusedwith the Westernone' heavens"or "transportandtransformation'"lt
LA refersto the organasan ofEcial,usingthe then proceedsto what occurs when these
analogyof a governmentofficial in chargeof officials are sick. This accountmay include
a province.Functionratherthan substanceis physical symptoms;but, in general, these
implied. symptomsare not so relevant.Referenceis
Thereis someconfusioq however.In LA madl mainly to typical forms of behavior
the term"official" tendsto iry!@thegnggpl (implying intention), andthe mannerin which
of a channel. No distinctionis madebetweena
the behavioris carriedout. "Manner" covers
channel-problem and an organ problem;and
the context and the intensityof the behavior
the effect,when referring to the "lung," for suchthat its appropriateness canbe evaluated'
example,is that a practitionermaybereferring An organ in balancewill lead to appropriate
to the channelor the organ.Thiswill comeup behavior;an organout of balancewill leadto
again when I refer to the tyPes of inappropriate behavior. By analogy,
differentiationmadein LA diagnosis. constipationor diarrheacould be saidto be
In LA's descriptionof thefunction of an "inappropriate." Many of the typically
fficial or organ, there are someimportant inappropriateforms ofbehaviorwill be drawn
diflerencesfrom TCM. from patientexamPles.
Onedif[erenceis the omissions.LA refers At this point the poetic versusexplicit
to energ, but doesnot makereferenceto the natureofLA shouldbe kept in mind-LA does
dffint sorts of Qi or even to different
not find it easyto keep categoriesseparate'
ffinoreferencetoyin" So,in the accountof an official or an element
i"rg, bt""a, jing, sherqjin ye, etc.This means orthe emotionassociated with anelement,you
that the officials' functionsare not described maywell find aspectsofthe otherscreepingin'
with referenceto substance;e.g., the liver is For example,a personcan do more than the
not saidto causethe easyflowing of Qi, or to usual amount of "looking after or nurturing
storetheblood. others," or, indeed, the opposite, such as
On the other hand, the associationsof the
86
caring for others very little or doing it of equal rank. The five Zang organs are not
begrudgingly. In either case, both sets of singledout as any more significant in patterns
behavior can be judged as inappropriate.To of disharmonythan any ofthe other sevenSo,
go further, the same person may show an in specifying the main cause of the patient's
inability to nurhrre herself in all areasfronU imbalance--the causativefactor- the element
literally, ensuringthat sheis fed well to getting would be specified first and then, if
her reasonableration of emotional strokes. appropriate, the official within the element
These would be seen as a function (or wouldbe indicatedThis ofEcial could aseasily
malfunction) of the earth element and the be the small or large intestine as the heart or
stomachand spleenorgans.What practitioners the lung.
often find difficult is the standard of
appropriateness. Constipationcan easilybe We can now consider the causative factor.
seento be a malfunction,but how do we judge
behavior? The Causative Factor
To give another example: A person may
try to be the best in what she does in such a The first and most important stage of LA
way that, in the end, this behavior seems diagnosisis to find the causativefactor (CF)'
inappropriateand detrimentalto health.At the The CF is definedasbeingone ofthe elements
same time, she may be unable to take in, (sometimes as one of the officials or organs
appreciate,or feel the complimentsor respect which make up an element).The concept can
that others give her. Her response may be be made more sophisticatedby extendingit to
observed as inappropriate; she D&Y, for the element within the element; for the
example, deny compliments or push them purposes of this article, however, we will
away. These behaviors could be seenas two concentrateonly on the element.
parts of a pattern or vicious circle and be Within a person's energyfield, LA believes
attributed to the metal element and lung and that one element is the main ccuse of the
colon officials. deteriorqtion in the other elements. Rather
LA's assumption(not madeexplicit) isthat than the twelve individual organs standingup
the quality of energt affects all aspects of against the insults of the world and each
oneself. A chronically deficient spleenwill not suffering to some degree and, to that degree,
just affect our appetite and digestive systenq requiring help, the gmphasisis on an eartYand
but our dreamsand hopes,our work and play, qajsr insult to one elementan4 the daFagq to
ttraieiement b"i"g pu.t"d o" to th. uiu
our friendships and relationships. It affects
what we choose to read and the quality of the energetic exchangewithin the person. So,
information we are able to get. when an organ is malfunctioning, the crucial
To understand this concept clearly, questionis whether it malfunctionsbecauseof
however, we need to touch on one other very an insult from the outside or because of the
important concept of Ld the CAUSATIVE weaknessof another organ. LA's belief is
FACTOR. Its connectionwith the abovelies in that to effect an imProvement in the
'$hole" person, the original weakness-the
its long-term nature, especially when
comparedwith the syndromesof TCM. CF-must be treated.
After considering the causative factor, Before further clarification ofthe CF, two
there is one other relevant factor in LA's points are worth noting. The first is that TCM
treatmentofthe organs.InLAall fficials are would recognaethat one synfuome can be a
87
(meaning what the patient is complaining
major factor leading to the presence of and signs"
onott ti.In sucha case,the formermayneed about) La fCrra's "sSrmptoms-
to be treated to deal with the latter' The whichquitetightly definea specificsyndrome'
In any case,a Patient'sCF inot,PE lF
second point is that in some contexts
confusionmty be created by the importance determinidby her symplgrn[S6Fow do we
LA'Wts on the CF- Becauseof the absence of ffiosoisrelativelY
th.Lhu*"I organdistinctionandthe absence simpleto explairgbut difficult to carryout'
of any differentiationof exterior conditions,
-implies,
LA by omission, that channel
problernsandacuteconditionsshouldbe dealt Daermining the CF
with by treatingthe CF-
The six mostimportantfactorsin determining
The (Jseof the CF ConcePt the
the voice, emo-tion,odor, pulse.s,and the
-M*t
fulw:-nyof the officialsandtheir elements'
othet factors can arise, Q'E', the
sequenceof symptoms/events in the patient's
casehistory; thesewould be used more for
changesin the patient'shealt[ the CF remains corroboration.The first four-color, sound,
the same.Whetherthe CF is constitutionalor 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
emphasisin LA has not been on finding out colorsasthey showon the sideofthe facejust
when or how the CF occurred, but on lateralto the eyes,underthe eye,in the laugh
discoveringits nature. lines,andaroundthemouth.TheODORis the
We will saymore in a momentasto how five-elementodor emanatingfrom the body'
to find the CF, but a word abouthow not to The SOUND and EMOTION are the five-
do it may clarify some of the points made element sound in the voice and the five-
previously.In TCM a group of signs(pulse, element emotion that are the most
tongue,andsymptoms)will oftenbedefinitive inappropriatein a rich sampleof the patient's
of a specificsyndrome.In I'A it is stressedthat beliavior.As the contextofthe diagnosisdoes
s will not lead theprycllti not normallygive us this sampleof behavior,
CF. Indeed it has sometimes been e practitionet interacts
-said-maybe comes fundamentalin
as a rhetorical device-that te
anything (any CF) can cause anything (any which the Patient.rrill
symptoms).This view may haveoriginatedas @
a reactionto thepracticeoftreatingsymptoms This interaction to elicit better quality
accordingto points known to be good for informationor responseis not presentin TCM
those symptoms but without any other or in Chinesemedicaltheory,but it is essential
diagnosis<learly not the practiceofTCM. It to LA. I will return to it in the sectionon
may also have arisen from the failure to diagnosis.
distinguish clearly between "sSrmptoms" It is worth noting that "emotion-words"
88
sometimes refer to arr occurrence, as m be implicit in the teachingsand practice ofLA.
"George was angry yesterday,"and sometimes LAbelieves that consistentand appropriate
to apredisposition to suffer certain emotions, treatment
--.- ofthe CF will pro-duqetban€gE not
as in "George is an angry person." eare just inTapecific condition such as frozen
interestedhere in the pIg$SPIDg-It is also shoulder or duodenalulcer, b.rt 9J ul-9gt
*o.tffiting that in ttre occulrence of an sprr!.Thesechangesarenot easyto specifyand
emotion, especiallywhen it may be judged as not always easyto reahze.They are, however,
inappropriate> we are talking about many in my own experience,comrnonenoughand of
different ways of manifesting-from internal considerable importance to patients. The
sensations,to external physiological changes, changeswould involve the following:
to externalbehavior. l. Changes in the whole person in the
Returning to the color, sound, emotion, sensethat the patient describesthe whole of
odor, and the behavioral manifestation of the herself as improved. For example, "I feel
officials, it is important to note that although better," or "I just feel satisfiednow taking the
these are observed separately,it is the overall dog for a wallg" or "I feel like I want to live
patternthey createthat indicatesone CF rather again," as opposedto "My shoulderis better,"
than another. or "My stomachdoesn't hurt any more.
Thus, in diagnosing the CF, the emphasis 2. Changes in grouPs of sYmPtoms or
is not on the patient's symptoms,but rather on functions which would not necessarilybe seen
the patient'scolor, sound,emotion,odor, and as related.For example,apatientdiagnosedas
behavior. The symptoms are not necessarily a metal CF who came for a frozen shoulder
correlatedwith the CF; however, color, rguqd, experiencedthe following changes.mild and
emotion- odor. and behavior dre conelated periodic depression disappeared; excessive
with the cF. appetite reduced and weight normalized;
allergy to dust disappeared;getting up in the
We can now inquire into the meaning of the night two to three times to urinate
CF. disappeared; dandruff reduced; shoulder
improved.
What, therL doesLA do with the patient's 3. Changes in overall capacity, not just
symptoms? Slmptoms are taken seriously, to cope, but to live a satisfying[ife. These are
but not attributed to any elementor official. changesthat in some other contexts would be
They are seenas part of the whole; and only labeled "growth" or personal development.
whenthewhole is considered,via the CF, can
For example,a person might report that a job
we know how to treat this person and-in
passing-his sEptoms. or relationship which was mostly a struggle
becomeseasierto handleand generallymore
The Meaning of the CF satisfying.
Relating these kinds of changes to the
Two questionsarise about the meaningof the effects of acupunctureis not so odd once you
CF. The fnst concerns its importdnce in assumethat deficient spleenQi or lung Qi will
treatment. The second concerns its affect our minds and spirits as well as our
relationship to the syndromesof TCM. bodies-it is just that we do not seemto have
Why and how is the CF important in a written tradition that clearlyrecognizesthese
treatment? The following is not really an connections.
explicit part of LA teaching, but I believeit to Patients may not come expecting such
89
overall changes.They may simplywant relief With this in mind, we canmakea comparison
from a shoulderpain. It was clear to me in with TCM which will often trace one
Chinathatpatientsmainlyexpectedrelieffrom syndromeas havingoriginatedfrom.another,
e.g.,liversyndromes from deficientkidneyyin'
physicalsymptoms.It was alwaysodd to me
io r"" someofthe Chinesepatientsreturnafter Iflhere was saidto be an original syndrome,
one or two treatmentslooking obviously thenwe mightbetalkingaboutthe samethings
better, but sayingthat they were the same' asthe CF.
Those patients invariably began to report The abovespeculationis not essentialto
improvementin their symptomsover the next LA theory. It is basedon my own clinical
few visits.It was as if the patientand doctor experience.We can now considerone other
had agreed to pay attention only to the basic policy of LA theory becauseof its
physicalcomplaint.It is anoption' but not the relevanceto the CF.
only one.
The second question concerns the Levels: BodY/lVIind/SPirit
relationship between the CF and the
l"LA on
p3{-glgldiagnosis is to assess
syndromesof TCM. Is it the sameto saythat
a patientis an earthCF andthat he is a spleen *iI"i@e'6fffir
Qi xu or spleenyangxu, or, indeed,anyofthe to the notion of body/mind/spirit.
spleensyndromes?The answerin one sense In Chinesemedicinethere are various
appears to be'T'{o."There.itonlyoneCF, but termsthat enablea practitionerto specifythe
there can be---or have been-more than one depthof a disease; and,whilebody/mind/spirit
syndrome.Liver Wind mayhaveoriginatedvia in some way overlaps these notions, it is
Liver Fire Blazing, deficient liver yin, and clearlynot the same.The concepthas been
deficientkidneyyrn.Or it mayhaveoriginated taughtmainlyby demonstration: this patientis
from depression of liver Qi. spirit level,that one mentallevel, and so on.
On the other hand, there maYbe some Hencewe haveno explicitdifferentiation.
overlap.What I am sayingnow is speculative- The following, however,will give some
f LA looJs at the deteriorationof a patient's clarification:
Fatttr mainly as a worseningoftheenery-gt If the symptomsandgeneralwelfareof a
the-CF and its resqlting failure to noud patientva^rymore accordingto food intake,
c- : - en q4{ !o temperature,or body use,thenthe body level
Fpatient becomesanearthCF at some
cyc-les. is indicated.
ffige' This means,in effect,that the previous If symptomsand welfare of a patientvary
level of functioningwill not be resumed-in mainly accordingto mentalfactors, suchas
the sameway that stayingup late for several stress,then the mind level is indicated.Also
weeks in a row can often be wiped out by indicativeof mind level would be inabilityto
resuminggoodsleeppatterns,takingaholiday, thinkthingsout, makenormalcauseandeffect
or whatever. This does not mean that any connections,and set and maintain ordinary
deteriorationof the other elementshasto be goals.
due to this cause-for example,taking too On the other hand, if the Patient's
many drugs will adverselyaffect the liver problems center around inabilities-"I
independently ofthe CF.But it doesmeanthat ss1'1s"-lvhich are curiouslyunsupportedby
the most importantpatternof deteriorationis any lack of physicalor mentalresourcesand
a spreadfrom the originalweakness,the CF. whiclu therefore,seemto come more from a
90
lack of motivation or will, then the spirit level information is used in a practical way to
is indicated. understandhow a patient becameill and what
The use ofthe distinction gives us a further the patient can do to help herself get better'
indication as to its meaning. Determining the LA also teachesthe internal and external
level affects three areas: causesof disease,but makeslittle referenceto
the miscellaneousfactors. Most attention is
l. patient management,
2. the intention when needling, and
3. the selectionof points. not havethe
In one of J. R. Worsley's interviews, he relatestypical causesto specificsyndromes.

illustrated the effect of determining the level This may reflectthe differencebetweena CF
on point selection: and a syndrome.In practice, however,LA
practitionersare often aware of, and pay
q"*"t?rd pggls wherethe attentionto, the factors that they know are
lre.ngintl meant currently contributing to their patients' ill
is contmanded.
.energ'y Bythis is
not just ih" glgg ,!th. !g!Y but of health.
the mind arylggirit as well With respectto causesof disease, thereis
@ o n e ca n reach one other important difference.I-g-lgrye
the deepestlevel from the command notion of phleg& *g!pige-I*-U44(--:td
points.The trouble is that it may take !EE-*!tg"ps-i,9-c-94-dery-:ggq99-Qtdisease.
a considerable amountoftime. Forthis These may be the result of some other
reasonwe usethe other pointson the energetic deficiency und ry.-!auejq-!"
body which canenableus to reachthe treated directly. alongside treating thq
damagemore effectivelyand perhaps underlying deficiencv.In LA there.is no
more quickly. (Traditional theorA[d framework for dealing with the
Acupuncture Society Newsletter, resultingmixedxu/shicondition.
October1984)
Wecan now go to the notion of blocksin I/1.
Thesearedifferentfronu but havesimilarities
to, the secondarycausesof diseaseof TCM.
Blocks
Wecan return now to lll's understandingof LA describesvarious conditions that are

the causesof disease. impediments to thesuccessof treatmenrbased
aroundthe CF. They vary in significance, but
Causesof Disease what they have in cornmonis that theymust be
dealt with directly. Otherwise, further
TCM refers to internal, external, and treatment,howeverappropriate, will havelittle
miscellaneous disease factors. For each or no effect, or may evenhave a worsening
syndromethere are indicationsof how these effect. In this respect,these conditionsare
factors and alreadyexistingdisharmoniescan marginallyanalogousto the secondarycauses
causeand help maintain a This
disharmony. mentionedabove.
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
AGGRESSIVEENERGY,qardlgbe"!d Theaimsof LA diagnosisareto determinethe

or "malicious"form.of patient's CF, the te"el of the patient's
an orgarLis a "bad"
*-r- -.
energv tnat mu$ 5e withdrawn from the ffiUffi;, *trether moxa is aPProPriate,
personvia a very specifictreatmentprocess whether the patient requirestonific4lgg
which is labeled "tapping for aggressive sedation,andwhetherthere are anyblocksin
energy."When aggressiveenergyis present, iiFe referredto above-
not only is other treatmentunlikely to be Thedffirences in theorybetweenLA and
but sometreatmentswill actually TCM areaccompanied by variousdffirences
successful,
inthe diagnostic Althoughall schools
proce.ss.
encourageaggressiveenergy to appear in
other organs, thus worseningthe patient's start with looking, listening, asking, and
condition. touching, there are important variationsin
TIIE HUSB AI{D-WIFE IMBALA}{CE is emphasis.
a conditionin which one"side"of thepatient's There are three important differences
englrygets split from the otherandthe normal concerning the differential diagnosis of a
balanctand interaEoi no io-ngerexists.By disease, tongue diagnosis, and pulse
"side" is meant,on onehand,the heart,small diagnosis.
intestine, liver, gall bladder, bladder, and LA doesnot usea differentialdiagnosisof
kidney organs, ild, on the other, the a disease.If a patient comesin with facial
remainingorgans. Neither the manifestation paralysisor dysmenorrhe4theLA practitioner
nor diagnosisof the block is easyto describe does not have at her disposal the typical
briefly, but its effect is a severeblock to differentiation according to stagnation of
successful treatment.Readingof the pulsesis blood,stagnationofQi, accumulationof cold,
usually essentialto diagn6sFFtfimfiAiari on. etc. The reason for this should be obvious
TIIE *INTERI{AL OR EXTERNAL from what has gone before. An LA
DEVILS" is a label appliedto a condition practitionergoesfirst &,r the CF; the patient's
whictr, alternatively, is referred to as symptomsor the diseasedo not play a primary
oossession.
^-e2-
The specificsof the natureof the role in the diagnosis.
ifib-alance.how it manifestsand how it is Tongue diagnosisis simplynot used;and
correctedare not relevanthere,exceptto say, the questionoften arisesas to why not? One
agaiq that it is seriousenoughto createin likely reasonis that many of the diagnostic
many casesvery severeand often bafling categoriesassociatedwith condition of the
symptoms. Normal treatment will be tongue are not part of the languageof LA.
unsuccessful. That a purpletongueindicatesblood stasisis
EKT-ENTRY blocksoccur betweenthe not useful when "blood stasis" is not a
end of one channel and the beginning of meaningfulterm within LA.
another,e.g.,betweenLiver 14 andLung l, Pulse diagnosis,on the other hand,is
92
used in LA and appears to be given a more color, sound,emotio4 andodor. Someof the
important place than in TCM. Pulses have obvious of better are the )t
tlnee specific uses. One use is to read the smoothness,
energetic condi$g ofthe individual organs;a
second is to determine whether the patient important when the quality ofthe various pulse
requires tonirtcqfion or sedotion: a third is to positionscomesclosertogether.As with many
evaluateth" elfuctiu"nest o.fat atthe other aspectsoflAt the conceptof qualityhas
"om not beenmadeexplicit and is therefore difficult
time of treatment or at the patient's
subsequentvisits. to specify.
The Pulses The Diagnosis
The taking of the pulsesis different from that We can now turn to some of the overall
in TCM. LA studentsare taught to record the differencesin the processof the diagnosis.
"strength" of the pulse at the different pulse Diagnosisin LA variesfrom TCM in several
positions and at a superficial and deep level. ways. One is the relative unimportanceof
The position/organ correspondenceis that of askingspecificinformationtypequestionsand
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 interaction
--...-_;_.-z----;;-
with the patient in order to create
in the deepposition. (See "An Introduction to meaningfulor "true" patient responses.A
Pulse Diagnosis" n The Journal of Chinese fur ther oneist@to
Medicine, No. 14.) No use is made of the developthe diagnosis.I will look at these
basic,traditional twenty-eight pulse qualities. differencesseparately, althoughbriefly.
The omission of thepulse qualities ls not Observationand Questions. In TCM
explained. Again, as with the tongue, the part of anyspecificpatternof disharmonywill
significanceof many of the pulse qualities is not be observable in the context of a
expressedin concepts not used in LA. diagnosis.Hence the importance of asking
The use of pulsesto evaluatetreatmentis about such things as whether there is an
worth some comment. Although LA does not aversiontocold,whenthe periodpainoccurs,
use the twenty-eight pulse qualities, whetherthe thirst is for hot or cold drinks.
practitioners find it hard to pay attention only In L4 it is irypg4ant to lrave a. clear
to strength, and, therefore, inevitably record recordof the patient'ssymptoms..partly for
quality. They often usea continuumfrom good coF-@sis, but more for
to bad quality, applyrng either to one pulse algesqlng the changes that o
position or to the overall quality of the pulse. As discussed
ttg4t!0e41!, above,symptomsare
LA practitioners take pulses after or during a not important in the diagnosisof the CF.
treatment; and if there is an improvement in Therefore,the cruciallyimportantfactorsare
"quality''in the above sense,this will be taken onesthat can be observedat the time of the
as an indication that the treatment will be diagnosis- color, sound, emotion, odor,
effective. This ability to evaluatepulse quality and pulses-and theserequireacate sensory
becomesrefined with practice and is naturally discrimination and obsertation of non-verbal
combined with observation of chanees in behavior.Thisemphasis is a relativedifference
93
betweenLA andmodernTCM- which will not harm the patient,is a way of
Anotherdifferenceis theLApractitioner's sorting out the diagnosis.Pulse and-patient
interactionwith the patient in sucha way that ,"rpoir" to the treatment are used in the
a "truer response" and therefore truer assessment.
informationis obtained.This is a largesubject Another exampleariseswhen the CF is
in itselfanddifEcultto explainbriefly;but it is, first treated.Assumingthereare no blocks,it
nevertheless, fundamentalto the processof is expectedthat all pulsepositions-except,
diagnosis in LA. perhaps,the CF-will improvein quality and
quorttty.If they do not, thenquestionsarise
Quality of Patient Response.Assume
that a patientis describinghermajorcomplaint suchas "Is this elementreally the CF?" "Is
or any other aspectof her life. The way the therea block that hasnot been recognized?"
practitioner is responding (especiallynon- This illustratesthe useof feedbackat the time
verbally)willfeed backto the patientand be of treatmentand the diagnosisas an ongoing
extremelyimportant in determiningwhether process.
the patient expressesherself guardedlyand Similarly,it is a principlein LA to grve
from the surface or openly and from her minimal treatment."How muchis minimal?"
depths.In LA" the aim ofthe practitioneris to can often only be revealedby the treatment
itself. So, again,carefulassessment of how a
respondwith sufficientemotionalflexibility so
that closerapport is obtainedandthe patient patientrespondsis itself informationthat will
revealsherselfinan openandunguardedway. be usedin determiningfuturetreatment.
This impliesthe ability to create a variety of A relatedpoint is the importancein LA of
emotionalcontextsin responseto the patient continuing the diagnosis throughout
andis clearlya skill that takestime to develop. treatment.In J. R. Worsley'swords:
It does,however,promotea differentquality
of responseand informationfrom the patient. During these subsequenttreatments
In thecontextoffinding the patient'smost this is what we should alwaYs be
inappropriateemotiorqthis processhasbeen doing, to keeP questioning and
labelled"emotiontesting." The practitioner's communicatingwith the Officials ..-.
responses canbe consideredas questionsand All thesequestionsshouldarisesothat
the patient's responsesas answers. This eachtreatmentis not just a movingon
processis an importantpart of LA diagnosis. but a questionand answerwith the
Treatment and Further Diagnosis- OfEcials. (Traditional Acupuncture
Another assumptionin LA is that treatment SocietyNewsletter,October1984)
itself canfurtherthe diagnosis.Although it is
important for the practitioner to commit These are the major differencesbetween
herselftoa diagnosisbeforetreatment,it is an modernTCM andLA diagnosis'
ideal attributed only to the mature and
experiencedpractitioner that a complete We can now look briefly at treatment and
diagnosistakesplacefirst and that treatment treatmentPlanning.
merelycarriesout the diagnosis.For example,
the practitioner may know that there is a TreatmentPlanning and Treatment
seriousblock to treatment,but be unableto
labelit either"aggressiveenergy''or "devils." The answer to the question""How is LA
The treatmentto removeaggressiveenergJ, treatmentdifferent?"followsfrom the theory
94
discussed above. Some of LA's marn appropriately, the person will change on all
differences.with TCM are as follows: levels,hencethecla1lmoflAtobetre
l. The main means of restoring health is
by treating the CF.It may be hyperactive,in I will end with two questions that often
which caseit needssedation;it is, however, occur to practitioners:
more likely to be underactive,in which caseit 1. In our intentions.do we treat the whole
needstonification.To be able to work on the person or the person's symptoms?Trying to
CF, any blocks of the sort we describedabove answerthat questionforces us to attach some
will need to be cleared. In addition, it may value to both possibilities.
also be necessaryto pay some affention to 2. What is the most effective waY of
another element which has been "insulted," treating the persorL and what is the most
such as the child of the CF through years of effectiveway oftreating a person's symptoms?
neglect, or the wood through excessivedrug- Are they different, can they be reconciled,
taking. But the main thrust of treatment is and-in individual cases- is the answer
normally on the CF. necessarilydifferent?
2. Points are selectedon a theoretical LA's answers are clear and
rather than empirical basis. For example, uncompromising:treat the person, not the
prescriptions based on clinical experience, symptoms; and, to treat the person, treat the
such as Ren 12 and Stomach36 for stomach CF.
disorders,are not taught. Thus points are
mainly chosen from the source points, the Summaty
five-element,the back shu, or the connecting
points on the appropriate channels.Transfers, . LA's expressionis poetic and metaphorical
more or lessas describedin the books ofMary rather than explicit and literal. As such, it has
Austin and Wu Wei-P'ing, are also taught. A problems with communication and
final important principle is the selection of standardization,but it focuses easily on the
points to treat the right level of the CF. This individual and the individual's inner
principle of selection was referred to in the experience.
sectionon levels. . LA does not teach a conceptual framework
3. The underlying principle and aim is to deal specifically with channel or acute
to balance the CF. The expectationis that exterior problems.
. LA assumesthat the energy of an official
the patient will improve generally, feeling
better in herse[ and her symptoms will also will affect all aspects of a person and
clear. This process,however, is not always describesthe pathology of an official more in
thought to be a completely smooth one. terms of behavior than in terms of physical
J. R. Worsley often describesLA in terms symptoms.
. LA assumesthat one element is a major
of five laws, one of which is the LAW OF
CIIRE. Part of the Law of Cure is that the weakness and that most of the patient's
diseasewill disappearin the reverse order in problems stemfrom this weakness.This is the
which it came.A lung imbalance,which at one CF, the major focus of treatment.
' Diagnosis of the CF concentrateson color,
time manifestedin acneand later in a problem
of the lung itse[ will, when being cured, sound,emotiorqodor, pulses,andthebehavior
manifest once again in acne. of the officials. The practitioner's ability to
In any case, when the CF is treated interact with the patient, thus producing a
95
Traditional ChineseAcupunchre and ElementBooks'
truer response,is crucial.
t982.
. Consistentand appropriatetreatmentofthe
CF at the right level is thought to bring Traditi onal A anpuncture Society Newsletter'Published
changesin the whole Person. by the Traditional Acupuncture Society, l1 Grange
parh Stratord-AvorL Warwickshire CV37 6)Cl
References: England.
Essentialsof ChineseAatpuncture' Compiledby the

Beijing College of Traditional ChineseMedicine, et. This article is pinted with permissionfrom the Editor of
al. Beijing: ForeignLangrragesPress,1980. 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.
I have practiced and taught in the style of A Brief HistoIT of Acupuncture in England
acupuncture associatedwith the Leamington
College for over ten years, and I get great At the moment,in the main, two distinct styles
satisfactionfrom doing so. I decidedlast year, of acupuncture are practiced in England.
however, much to the surprise of many, to TCM becameeasily availablein England only
take the TCM course held in London. (For when Ted Kaptchuk taught a courseln.1979.
anyone who has not heard of this course, For anyone who wished to train in
TCM standsfor Traditional ChineseMedicine acupuncturebefore then, there was a choice
and is based on acupuncture as taught and of three main colleges.None of these taught
practiced in post-revolutionary China.) TCM. Professor Worsley, having set up the
I joined the course for a number of College of Traditional ChineseAcupuncture,
reasons: had already evolved the unique style of
l. I had heardmanyjudgments about it and acupuncture taught at Leamington. He was
realizedthat I still did not know of what I it able to adapt what he learned during his
consisted. travels in Europe and the Far East to a
2. I had come to realize that although I Western civilization. In Professor Worsley's
chooseto treat with a Leamington bias, I can approach, much more emphasiswas put on
increasemy knowledge and skills and maybe "mind" and "spirit," as distinct from the
becomea better practitioneras a result. Chinese emphasis on the physical. (David
3. If the good health of patients is my Eisenberg, in his book Encounters with Qi,
priority, I cannot ignore an area of points out that in China the admission of
acupuncture that might help them-just for mental problems is regarded as social stigma.
the sakeofbeing associatedwith one "camp." Even symptoms such as anxietY and
Many people have asked me what I got restlessnessare called "neurasthenia." The
out of the course.I have written this article to Chinesetend not to talk about their problems
try to present an unbiasedview ofall that I to anyoneoutside the family, not even to their
gainedfrom the TCM course and how I added physicians.)
to the five-elementbasis.I also wish to stress When TCM arrived in the United
the knowledge that Leamington-style Kingdom in 1979, it seemed very different
acupunctureoffers that is not included in the from what had been practiced before and was
TCM course and that I value highly wrongly classified a as "symptomatic" by
97
some of those practicing Leamington have chronic complaints and Western
acupuncture. medicine can treat the acute conditions
on the other hand, is
Two "camps" began to emerge-those
practicingfrom a Leamingtonbasisandthose "acupuncture of the people;" it has, of
fro* u TCM basis;at the time it seemedto be necessity,developedto treat patientsso that
aneither/orsituation.This divisionis not very they can be well and functioningas quickly
Chinese!The nature of Chinesemedicine, and cheaplyas possible-It therefore-jlealls
historically,has beento grow, change,and acute
-l; conditionsandinjuriesvgly-etrectivell
adaptto whateverusefulcomesits way. t""g.trel lost when a patienthasan
Theacupuncture climateis now changing. acutecondition;this is particularlyimportant
Practitionersare recognizing that everything asI live in a roadwhereeveryoneknowsI do
ultimately comes from one source (albeit, acupuncture and is likely to call in with
adaptedto the culture)andthat differentways illnessesand injuries! I have heard many
emphasize differentpartsofthat source-Each Leamingtonpractitionerssaythat theydo not
waycanbeusefulandwe canlearnfrom each. want to treat acute conditionsand so they
Whatmust be a priorityfor us all is that our haveno reasonto learnhow to do so. I find
practice works and that the patient gets thatmy practiceis not that blackandwhite-I
better. do needto be ableto treat acuteconditions.
Patientswith chronicconditionsmaygetacute
The Usefulnessof TCM symptoms during the course of their
treatment,in whichcasetreatingthe CF in the
The following are aspectsof the TCM usualway maybe inaPProPriate.
coursethat I found useful: the treatmentof
acuteillnessand injuries,tongue diagnosis, TongueDiagnosis
pulse diagnosisusing pulse qualities,more
detailsof the function of the organs,and a Tonguediagnosis,aswell as pulsediagnosis,
differentway ofcategorizingthe imbalanceof is a primary tool of Chinesemedicine.The
an organinto yin, yilg blood, Qi, etc. Also size,shape,color,moisture,andcoatingofthe
valuablewere guidelinesto the usesof the tongue are dl diagnostically useful. For
points,rest, and diet, and how the Chinese example,a red tongue will indicate that a
look at other causes of disease besides personhas a tendencyto be hot, and a pale
emotionalcauses. tongueoften indicatescold. This information
Overall,the TCM coursegave structure can be helpful in decidingwhetheror not to
and guidelinesthat did not conflict with my use moxa. A thick coating on the tongue
understanding ofthe causativefactor (CF); it indicatesa conditionmore in excess,and a
alsohelpedme to treat acuteconditionsand thinner coating indicatesa deficiency.For
injurieswith confidence. example,if a patient has a red tongue with
little coating, he or she may be deficientin
Treatmentof Acate lllness and Iniury energy, and-at the same time-Hot (yin
deficiencyin Chinesemedicine);so moxa is
Thetreatmentofacuteillnessandinjury is one not normallyindicated.I havealsofound the
of the most useful aspectsof TCM. Acute tongue condition useful as an added
illnesses have never been catered to at confirmationof the CF.
Leamingtonbecausethe majority of patients
98
The Pulses Yin/Yang, Qi, andBlood
Leamington acupuncturists are taught to feel The termsyln, yang, Qi, blood, jing, and body
the amount of energy in the pulses; this is fluids are familiar to anyone using TCM; they
calledFull and Empty in TCM. Other qualities describethe different substancesand statesof
about the pulsesare simpleto read,yet useful, energy in the different organs. The two easiest
and are taught by TCM. For example, fast conceptsto describeare yln and yang, as they
pulsesshow that there is heatin the body; slow 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
twenty-eight pulse qualities, but they are type" symptoms,asthe yang is comparativelyin
clearly discussedin Ted Kaptchuk'sbook, The excess@iagram l); these symptoms may be
Web That Has No Weaver,and in otherbooks heat, restlessness, or hyperactivity.
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. YANG YIN
One practice not always taught in
TCM-but emphasizedat Leamington-is to Diagram I
feel the pulse changesafter treatment as well
as before. Feeling the pulse at this time is one I4 on the other hand,the yangis the most
of the best feedbacks of a good quality deficient,thenthe patientwill experience"yin
treatment. type" symptomssuchascoldness,slowness, or
less movement.Because the yin is in
The Functions of the Organs comparative excess, this is called yang
deficiency@iagram2).
The functions ofthe organs,astaught in TCM
are a useful addition to existing knowledge Excess
about the organs/officials.For example,one of Deficiency
the functions of the liver is to allow the Qi YANG DEFICIENT
energy to be free-4gl4ttg-f-the liver energy
nby supPressed
;"g"rAmrtrationj, it@
stagnateand the pulsesto go into excess.This
out bY the
liver and is the reasonwhy there is more often YIN YANG
an excessshowing on the liver pulse than on
any other organ/official. Diagram 2
99
If the patient is, for example,a "water The Usefulness of Leamington
CF," heor shewill be qualitativelydifferentif Acupuncture(aspectsnot mentionedin
predominantly yrn deficientor yang deficient; TCIvf)
knowing this can be helpful in changingthe
emphasis oftreatmentto suitthe patient'This Thefollowing arenot mentionedin TCM:
is alsotrue in relationto the Qi and blood in a view of treatingthe p4l@-as a wholg,
differentorgans,and also the jing and body basedon findingthe CF ofthe disease;the
fluidsin certaincases. co ;an
additionalunderstanding ofthe elements in
relationto our culture,especiallythe fire
Points
andmetalelements;and the spiritsof the
TCMs informationon the points can enlarge points, e.g., the Windows, kidney chest
theknowledgeofpointsgainedatLeamington. points, etc. The style of acupuncture
Much TCM informationon pointsis empirical; laughtat Leamingtonprovidesan overall
i.e.,becausesomanypeoplehavebeentreated picture of the whole patient and how to
with the point and with the sameresult, the treatbeyondPhYsicalsymPtoms.
Chineseknow its efFectwithout doubt.
TheFire Element
Causesof Disease
In TCM the fire element(or often, the
The internalcausesof diseaseareemphasized heart in TCM-the heart protector is
at Leamington.TCtvI, on the other hand, rarelymentionedand often is merged,in
describesmany other causes-Although I practice, with the heart) is not as
sometimes think thatthe Chinesetaketoo little commonlydiagnosedasanimbalanceasI
notice of the internal causesand how they havefound it to be :rmongmy patients,a
manifestfrom the early yearsof life, perhaps numberof whom I have treated as fire
we might questionwhether we take enough CFs. This is really a cultural difference
noticeofthoseothercausesthat T-CMvalues. betweenChina and the West. In China
For exampl", 9hin"* P*Ple are wary of there is less rejectiorq loneliness,and
eatinggg!q_@_and I lovelessnessthan in many Western
countries.Alan Papier writes about this
@ difference in his article, "Social end
alsosavthattoo much
anda fevercan:r beihe c Cultural Features Affeaing Chinese
in manydifferentorgans.We often overlook Medicine".
thesedetailsof rest,diet, worlg exercise,etc',
and how an rrnlglglgq d the1g_asgectsof The Chinese familY is famous
lifeswlemavm@16;ed- throughoutthe world. It is closely
-
There are other ways in which I have knit and nurturing.The guidance,
found TCM useful,but those aspectsI have directionsand'lessons' providedin
mentionedareonesthat canbedescribedfairly the family context are most
simply. I realizethat by gving only a few importantto the structureof the
examples I haveskimmedthe surfaceof TCM personalityand future foundation
but it is hard to give it full justice in sucha for adult life .... In China, the
short article. continuedstability of family life is
100
apparentin many things which are less earlier,but also may be due to lack of
conspicuousthan in the West: less experienceof this condition in a large
individual neuroses,a lower incidence numberof people.tr CFshaveno placein
of stress, greater satisfaction and TCM.
acceptanceof one'slife, etc. Neurosis
and stress do exist, but to a lesser TheMetal Element
degree than in the West. (Journal of
Traditionol Chinese Medicine, May The otherelementoftenmissedin TCM is
le88) the metalelement.As describedin TCIvI,
most of the illnessesassociated with the
Another example is from Mother Theresa lung have a cough among the symptoms.
who noticed an important differencebetween Leamington-styleacupuncturedescribes
the Indian culture and that of England. When the lung and metal elementin a different
she came to England in 1970 she said, "In way, concentratingon the lack ofrichness
England everyone looks prosperous, but no and quality experiencedwhen the metal
one looks happy." Shehad observedthat there elementis imbalanced andon the senseof
is more love and joy amongthe poor in India emptinessthat comesfrom grief.
than in the English population.
The Chinese do not have the same Mind and Spirit
problems as we do in the West, and have not,
therefore,neededto describe"an impoverished The stateof a patient'smind and spirit are
spirit" nor the results of lack of love that are importantto a practitionerwho hasbeen
so prevalenthere. They do, however, describe trained at Leamington. Although the
"anxiety, restlessness,insomnia" etc." that Chinesedo mentionthe spirit anddescribe
come from heat deficiency (heart yin one of the functions of the heart as
deficiencyin TCM)-but not fire CF patients. "housingthe shen" (shenis translatedas
I describe these patients as looking "lack of spirit), and also say that suppressed
red" and showing "lack ofjoy," fluctuating to emotionswill unbalance the liver, nothing
"excessofjoy." Thesepeople are often very is said about how the spirit is affected
volatile emotionally and may feel vulnerablein when the other organs are imbalanced.
relationships with other people. They may Much informationon the "spirits" of the
have diffculty loving themselves,and this may differentorgansin written in old Chinese
manifest as a lack of self-confidenceand self- texts,but this is not a part of TCM. Father
esteem. ClaudeLarre mentionsthe differentspirits
It is hard to describea "typical" fire CF, as of the organs in Survey of Traditiornl
color, sound,emotion,andodor form the basis ChineseMedicine, abook he co-authored
of the diagnosis at Leaminglon; however, the with JeanSchatzandElisabethRochatde
fire CF sometimescorrespondsto a condition la Vall6e.
in TCM that is called "heart Qi deficiency." Leamington-sryle acupuncture helpsus
The syrnptomsof heart Qi deficiency are pale to understand how people canbe affected
faoe, breatilessnesson exertioq spontaneous at any level of their being when they are
sweating,palpitations,and tiredness.This lack sich and how a symptom maY be a
of detaileddescription may be partly due to the manifestation of a sickspiritor mindrather
emphasis on the physical that I described thana sickbody.Treatment,therefore,is
l0l
mostly directedat curing the patient at the acupunctureccm be better than one' ln
level of the sickness. spiteof the differences,two practitioners
- each treating in a different style of
acupuncture - will oftenarriveat the same
Treatingthe Personas a Wholeand the CF
diagnosis.One emphasizes color, sound,
I need hardly mention the concept of emotion,and odor, and the other attends
treating the person as a whole rather than to signsand symptoms.Onemay saythe
treating the symptom,as this is constantly patientis a Wood CF and the other say
emphasized at Leamington. In TCM groups that the patient has liver Qi stagnation.
of signsand symptomsare seenas cornmon Often thesediagnosesresultin the useof
patterns. These patterns are called similar points. Therein lies the unity of
"syndromes."A practitioner of TCM may Chinesemedicine.
diagnosea patient as having many diferent
syndromesfrom different organs,all at the References
sametime. For example,the spleen,kidney,
David Eisenberg. Encounters with Qi: Exploing
and liver mayall be diagnosedasbeingout of ChineseMedicrze.New York, London:Norton' 1985'
balance and all receive treatment- In the
Leamingtonstyleoftreatment,we look for the Ted Kaptchuk. The lteb that Has No Weaver'New
one areaof energythat initially went out of York: Congdonand Weed, 1983.
balance and caused all the symptoms to ClaudeLarre, JeanSchatz,and ElisabethRochatde la

manifest.Thepatient'scolor, sound,emotion, Y allee. SurtteyofTraditiotnl ChineseMedicrne.Trans
and odor will help us to find this causative Sarah Stang, Columbi4 Maryland: Traditional
Acupunctwe Institute, I 986.
factor. Whenthis CF is found and treated,it
can affectthe patient at all levels of being. AIan Papier: "social and Cultural FeaturesAlfecting
Very few needlesareusedfor treatment,and Chinese Medicine." Jourttal of Traditional Chinese
Medicine.Beijing. lvlaYI 988.
the patientis allowedto heal himselfso that
the symptomsdisappear.Thisis a very elegant
and naturalway of treating and neverforces Angela Hicks, M.Ac.M.T.Ac.S', has practiced
the energy. acupuncturefor thirteen years.Previouslya lecnuer and
clinical supen'isor at the College of Traditional
Acrpuncturein Leaminglon Spa,shecurrentlyconducts
Points study groups in Traditional Chinese Medicine for
acupunchriststrained in the five-elementtradition. She
has an acupuncturepractice in Reading,England.
JustasTCM providesextrainformationon
the points,so doesLeamingtonacupuncture.
Especiallynoted shouldbe points suchasthe This article is pinted with permissionfrom the Editor
The onginal article was published in
Windowsof the Sky and kidney chestpoints of Meidians.
The Joumal of Tmditional Actpuncture' Summer,
and pointsthat do specialthings,suchas the I 989.
pointsfor the internaland externaldragons.
I hopethat the gulfbetweenTCM andthe

styleofacupuncture taughtin Leamingtonmay
be made a little narrower as a result of this
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.
lil/hat is CF? to compare it to a phenomenon audiologists

call "recruitment." If a person is exposedto
The causative factor is an element (or excessivelyloud sounds in one ear, that ear
official) that becomes chronically imbalanced may become deafened to sounds at certain
in a pervasive way, lending a characteristic pitches.If the person is then tested for these
theme to a person's life. Further stressesor pitchesat soft levels,the soundis heard only in
traumas affect this element more than the the good ear. But as the intensity is increased,
others, so that it continues to be the first to the soundwill be heard louder in the deafened
cave in under stress.However we may define ear than in the normal ear. This is
CF, we can say it may be relatedto an insult to recruitment- a distortion or hypersensitivity
the body-mind-spirit, as a physical,chemicalor in the abnormal ear.
emotional trauma. CF also may be related to a If one finds impaired function or impaired
pattern of development that is hereditary, energy in an element, behavior may be
congenital or acquired in the process of observed that is at times peculiar, as when a
physical, mental or emotional (spiritual) person is too easily hurt, or angered, or
$owth. These aspects of the person may fearful; one may also observe behavior that
result in behavior patterns that show demonstratesboth a particular excellenceor
themselvesas distortions or blocks in the strength and the opposite of that strength (i.e.
energeticbalance. a person who is so tenderly sympathetic one
A way to understandthe effect of a CF is moment and very callous a moment later).
103
Commentsto Stimulate Discussion As five-elementpractitioners,we have
found the CF to be a Powerful tool for
Comment 1. J. R- WorsleY's unique uncoveringthebasicimbalancein our patients'
contribution. CF as an invaluable Whenwe becomeclearin our understanding
organizingprinciPle. of a person's imbalanceby meansof this
model, it seemsthat we have accessto a
wisdomthat penetrates to the very essence of
TraditionalChineseacupuncture,whichis
basedon the conceptsof Chinesemedicine, anindividual,addresshgthebasicissuesin the
hasbeenpracticedfor thousandsofyears and person's life. The CF can provide a deep
is now expandingacrosstheglobe. We maybe understandingof patients' weaknessesand
witnessinga moment in the development of uniquestrengths.Wb@ents confrontthe
this ancientsystemof humanunderstanding taskspresentedbv their CF, they arebrought
' '
t6-th-"growing edge" that furthers inLe-r

r tt
suchashasnot occurredin severalmillennia.

Someof the most creativeand important development.
;i practicalvalue in the treatment
contributions to contemporary western
acupuncture havecomefrom J. R. Worsleyof room is that it can bring a clarity to the
LeamingtonSpa.ProfessorWorsley'sgenius practitionerand a focus to the acupuncture
hasenabledhim to drawtogetherthe concepts treatments. Although Worsley's teaching
of body, mind and spirit asunderstoodin the seems to stress finding the CF based
eastand west, and to draw the attentionof exclusivelyon color,sound,odorandemotion,
modern practitionersto the very subtle practitionershave reported that by asking
energeticsignsthat providedeepercluesto the "Who is this personat his/heressence?" they
balanceandharmonyof the life force. can drop beneaththe symptoms and find a
One of is deeperunderstanding. This searchfor the CF
theconceptof causative factor.His life's work shakesthe practitionerout of complacency:
is dedicatedto teachingpractitioners,guiding Canoneassumethatthe obviousangercome-s',ubt/ po
them in the developmentof the diagnostic from a wood CF?Or is it reallv dueto a lack
skills of interpreting color, sound, odor, of meaninglqetal CF)? In this way we can
emotionandpulses-skills throughwhichthey treat, asthe Chinesesay,the root ratherthan
understand which elementis the CF of energy the branches.In the CF we have a tool that
imbalancewithin an individualwho hascome brings order to all aspectsof our work with
for assistance. Like many creative concepts the patient-at least,when it works well.
(andI amsureDr. Worsleywould wishto pay Thereis alsothesituation,however,where
homage to the concept in Korea of the searchfor the CF leadsto confusionand
constitutionalacupuncture),his contribution uncertainty. If practitioners are constantly
has created excitement, passion and questioningthe diagnosis,there is a loss of
controversy.The conceptis unknownin many clariry that defeatsthe purpose of the CF.
traditions of acupuncture. Whenever Insertineanacupuncture needlein themidstof
acupuncturiststrained in the five element ,r--
tradition meet, they search for further @heionceptofCFis
understanding aboutthe meaning,the validity, the word "cause" which seemsto imply a
andtheusefulness of this conceptof causative westernscientificapproachof causality-The
factor. Chinese operate by another principle:
104
"Whatever happens in a given moment Comment II. Possibility of a secondary CF.
possesses inevitably the quality peculiarto that CF concept may be held too tightlY.
moment." Under this view, originating events
are not seenas separatein time, but are part of Although the CF is the elementmost likely
the total expressionin the moment. Thus the to weaken under stress, it is possible that
anger at one's parent, which created an stresseswill affect another ofEcial or element
imbalanceduring childhood, can be observed enough that it becomes a second CF. The
in the green color present todaY. patient will benefit by treatment of any
Jung coined the term "s5mchronicity" to imbalance,and in the process,the elements
describe this meaningful conculrence of needing the most treatment will show
events. According to Jung, the essential themselves.
question asked by the Chinese mind, when If this observationis true, it is easyto see
confronted by a set of circumstances,is not how a CF may changeor seemto change,and
"What is the cause?"but rather "What does it how the severity of one imbalance (CF) may
meanthat thesethings are together?" It seems shift relative to the severity of a secondary
that in the practice of tradit re, imbalance (CF). It may account for the
we are co differencesin the diagnosesmade by different
,{q synchronicity, and it is the CF that attributes practitioners -particularly when a patient is
the meaningto the situation. When confronted referred after a period of treatment to another
by a patient who has suffered a loss, who is practitioner.
stuck in grief and develops shoulder pain, we If the concept of CF is held too tightly, it
can avoid both the trap of allopathic medicine, may impair treatment, as, for example,when a
which negatesthe problem if no causeisfound practitioner is affected by the fearful doubt
on x-ray, andthe excessesofthe holistic camp, that he or she is treating the "right" CF. The
which blamesthe person for creating his own concept of CF is a useful way to orgaruze
illness.Instead, we can chart a middle course; diagnosticinformation and is a useful Strategy
by holding the problem in terms of the CF we in treatment, but only if it is seen as just
have an organizing principle that finds the that-and not held too tightlY.
essentialmeaning of the situation and allows
us to addressit in this moment. Comment Itr. We may be at a moment of
The power of the CF as a healing tool is transformation in the concept of CF.
just this n
,,
h to Often the During a lecture at the Tri-State Institute
m@of illness is its of Traditional Chinese Acupuncture, Ted
isolating effect-the person is alone in his or Kaptchuk discussed the importance of a
her pain without connection to the world. By "transforming vision" for people in extreme
understandingthe problem in terms ofthe CF, pain. According to our understanding of his
we are grving meaning to a situation in terms comments,he found that such patients had to
of universal archetypes of the elements and move through a healing process that
officials. Through acting in this way our work transported them beyond the pain of the
hasa healingeffect. As Jung has stated,"Ifthe presentto a vision of a new possibility-to a
archetypalsituation underlying the illness can transforming moment when theY see
be expressed in the right way the patient is alternativesfor their lives. Perhapswe are at
cured." 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. element.May not both of thembe right?
Comment IV. Six Areas of InquirY. 3. Is therea secondnryas well as a primary

CF?Acupuncturists who havebeenin practice
I. Is there "causafion" in ac'upuncturethat for sometime areawarethat therearepatients
parallels causation in western science? who have a very clear CF. However,
Westernscientificmethodseeksto determine practitionersoftencommentthatinmanycases
absolute, specific causation- Perhaps there seemsto be both a primary CF and a
acupuncture functionsin a way that makesthe secondary the challenge
CF. lntheseinstances
use of the word causation inappropriate- is to balancewhat appearsto be two CFs in
Perhapswe would moreaccuratelyspeakof a treatmentand to acceptthe fact that what is
designfactor or a centralfocusor simplyof a constitutionally weak-by definition the
mutual arising. These terms suggest a primary CF-may, at any glven moment,be
particularrelationshipof elementsandofficials lessimportantthan what hasbeenweakened
characteristicof the patient at a particular through recent toxicity or emotional
timq-a result of all the interactionsin the stress-the secondaryCF.
patient'slife to that moment.Suchterms are
not burdened with the implication of 4. Is lcnowingthe uniquedynamic among the
singularityor causality.Perhapsthe attemptto elementsin a patient equally important as
designatesingularcausationmayhinderrather I<nowingthe CF? CF by its naturecreatesa
than further our efforts to diagnoseand treat staticnotion:"This is theoperativeelementfor
the individualswho cometo us for assistance. the individual." We want to discussthe
possibilitythat in additionto the conceptof CF
2. How does the relationship between theremay be a conceptgquallypowerful:the
practitionerandpatientaffecttheCF? We ate dvnamic amonq the elements.Is it more
well aware that the energy between i@eristheCF,oris
practitioner and client is unique to their it equally powerful to know that the key
interaction.Somepatientsbenefitmore with dynamicin a given patientis the relationship
one practitionerthan with another-we call betweenearth and water?It may be just as
this "chemistry." When a patient, for one important for the practitionerto understand
reason or another, transfers to another this dynamicbetweentwo or moreelementsas
practitioner, that practitioner may find a to know the individual'sCF.
differentCF. As westerners, we mayview that
differencejudgmentally,decidingthat the one 5. Is the CF tnrefor personsfor their lifetime
practitionerwasright andthe otherwrong.We or mcryit be true onlywithin a givenperiodof
want to raisethe questiorqis the energyof the time? We are aware of patientswhose CF
practitioneras it interactswith the client one seemsto have changed over time--ever;
of the factors in determiningthe CF? For perhaps,through the process of treatment
106
itself. realized." However, because the concept is
calledcausativefactor, peopletend to discuss
6. Is CF dependent on the practitioner's one of the elements-the CF-as if it were
image of what patients would be like f they difFerent from the rest; they may say, for
werewhole and complete in themselves?One example,that an individual is a wood person,
can imagine a situation in which one which may be as dangerousas saying that an
practitioner would see the patient needing individual is an arthritic person.
support in one element, while another In a discussionabout CF, severalmembers
practitioner might not seea relationshipto that of the faculty of the Traditional Acupuncture
element at all, but insist on treating from Institute compared clinical experiences.We
another perspective. It may be that these realued that in approximately 35 percent of
differences come from two different our patients there was a very clear CF, and as
perspectivesabout what is possiblefor the long astreatmentfocusedaroundthat element,
patient rather than from two absoluterealities the patient did extraordinarily well. We found
that are in conflict with each other. Is this that in another30 percent of our patients,two
difference related to the length and depth of elements were strongly unbalanced and
the practitioner's clinical experience,or is regardlessof which of these elementswas
another factor involved? called the CF, treatment on both elementsand
on their relationshipwas essentialto helping
The Possibility of an Enriched Concept the patient do well. In 10 percent of our
patients, we had the sense that something
A topic that generatesas much discussion beyond the techniques of acupuncture was
and conversationand confusion asthe topic of necessary to open the Process of
CF can be a source of great learning-the healing-perhaps the transforming experience
focal point for numerous insights that can noted by Kaptchuk. While the other25 percent
enrichall ofus. We raisethese questionsasthe of the patients did progress in treatment, our
beginningof a discussion.We do not propose concept of CF was not a clear fit. It may well
to provide any answers, but simply propose be that as our skills continue to develop, the
that some of the questions that we find CF will become evident in this group. But at
perplexing may be the beginning point for the present,we feel that another lens might be
fruitful development. more useful for viewing these patients-we
The concept of CF hasboth greatly helped feel the need for an errriched concept, one
and conf.rsed practitioners for years. It is incorporating more dynamic qualitiesthan are
difficult to write about the CF, for as with conveyed by the seemingly static notion of
many major contributions to human causation.
understanding,the work of Worsley runs the The question remains: As we continue to
danger of being lessenedwhen it is expressed improve our skills, how can this generation of
in words. Those who know Worsley acupuncturists evolve and develop the
understandthat in his clinical work he is seeing enonnous opening Worsley has made for
all five elements in dynamic interaction. oriental medicine?
Worsley seesthe importance of one elementas
a tool for touching and involving all the
This article is pinted with permissionfrom the Editor
elementsin the recreatingof a humanbeing so of Meidians. The onginal article was published in The
'unique
that "every possibilityof his being' is 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."]
Confusion about a CF signalsthe need to It is not my understandingthat the concept

improve diagnostic skills. of CF requiresthe practitioner to constantly
questionthe diagnosisor that questioningthe
I feel a need to respond to several points diagnosisnecessarilyleadsto confusion.At
put forth in the article, "Causative Factor: A timesI find that questioningthe diagnosisis a
Forunq" by Traditional Acupuncture Institute positiveandclearingprocesswhich makesme
faculty members. dig deeperandput moreenergyinto thework.
The authorsbelievethat the concept ofthe My experienceshowsme that the searchfor
CF can be a positive factor in the treatment the CF does not lead to confusion and
room because". . . it can bring a clarity to the uncertainty,but ratherthat my confusionand
practitioner and a focus to the acupuncture uncertaintyget in the way ofmy arrirringat the
treatments."They also believethe converse: CF.
"There is the situation, however, where the I find the statementquestionablethat
search for the CF leads to confusion and "insertingan acupunctureneedlein the midst
uncertainty. If practitioners are constantly of confusion cannot have a healingeffect."
questioningthe diagnosis,there is a loss of Looking back on my first monthsin practice,
clarity that defeatsthe purposeof the CF." I find therewereseveraltreatmentsI did inthe
109
CF.
truly know?I don't think so.
Each healingart has its diagnostictools'
MIRAIIDA MARLAI{D, B' Ac' (IK)
The cardiologist has the stethoscope,the Portland,Maine
radiologist,the x-ray machine.The diagnostic
tools that leadthe acupuncturistto the CF are
the senses. If I wish to grow asa practitioner, Look at underlYingissues.
I haveto develoPthesesenses'
Over the yearswhat I seemyselfdoingin
the work is very slowly tuning my sensory
mechanisnr" which is my diagnosticinstrument,
so that gradually I am able to perceivethe
diagnosticcriteria of color, sound,odor and
emotionwith more precision-At this point I
transformation ....
can't perceivethese accuratelybecausemy
instrument is crude and unrefined' So What are the issues underlYing the
confusion-instead of threateningchaos- discussionof the CF concept?They may
becomesa familiar companionthat givesme includethe relationshipthat the Traditional
importantinformationaboutwhereI needto' AcupunctureInstitute and somepractitioners
work on myself or get help from other havi with the parent(J. R. Worsley),issuesof
practitionersat key momentsin my learning independence andcontrol,andresentmentthat
process. is aroused when only the "maste/' can
Theauthorsaskwhethera personcanhave reconcileandact asfinal arbiter. (tlow easyit
morethanone CF.In reviewingtheircasesthe seemsto forsakethe roots for the flowers')
faculty at the Traditional Acupuncture These issues certainly seem relevant and
Institute found, as I have found, that in deservingof consideration.
additionto the patientswho havebeentreated Concerningthe "areas of inquiry" about
on only one CF, there is a group of patients causative factor mentionedin the article:
who have been treated on two or more 1. Causation, central focus, design
elements,and anothergroup of patientswho factor....Let'slook at what'sinside,primarily
seemto benefit from a modality other than recognizingthat what we eachseeis part of
acupuncture. Instead of seeing this as ourself.This conceptof causativefactor was
empiricaldata which leadsme to reevaluate never intended as a static or singular
the conceptof CF, I seethis phenomenon asa description:to takeit assuchis to misinterpret
reflector of the limited precision of my it. It seemsto me that the elementor official
diagnostictools at this time. that is moststaticin the individualis what the
We eachhaveour own way of regarding CF is mostlyabout;the CF itself is not static'
this work, and mineis that the conceptof CF Causemaynot beaveryChinese word,butwe
neitherlive nor practice in China' You might
astaughtis an excellentmodelin thetreatment
room and has brought great benefit to my like to characteize the phenomenonas
ll0
synchronousrather than causal,whole rather person. If we treat someone where we see
than separate-and in doing so you may be them to be in the future, ignoring where they
substituting one side of the patient for the are now, then we only treat our image' If one
other. The West finds it difficult to shake practitioner treatsdifferently than you do, who
handswith the East; Newton couldn't shake is right? Look at your patients, and they will
hands with Einstein; and we are in a problem tell you; look at yourself and understandthe
to hold the hands of all of them. Cause and difference.
synchronicity both exist. Can we hold them
both? GARY KLAPMAN, MD., C.A.
2. Practitioner, patient and causative Aptos, California
factor. The patient is as he is. If the
practitioner can touch all of the patient's CF "an idea unnatural to ancient Chinese
elementsand officials and find the placewhere thinking. . ."
the patient is most significantly affected,at the
level the patient responds best, then the Causativefactor is one ofthe concepts
practitioner can be with the patient and I most dislike in acupuncture theory' Yet I
facilitate his or her movement to a healthier think it is amazing how well such a flawed
place. When the patient doesn't move, we as concept works in practice. I use it, though not
practitioners must question the situation, always, since sometimes it seems to work
ourselves,and again the patient. Do we have better than anything else. I would feel more
the facility and versatility to approach our comfortable with it, however, if the way we
patients differently, to really reachthem where thought about what we do made more sense.
they are, not where we are? What you want to Such a disjunctivediscrepancybetweentheory
call this place- CF, DF, X, Y or Z-seems and practice cannotbe ahealthy stateof affairs
less important. for us as practitioners. Causativefactor is an
3. Is there a secondary causative factor? idea unnatural to ancient Chinesethinking as
Of course, and a tertiary one also. In fact, the well as to contemporary alternative or holistic
mannerin which all twelve officials interact on thinking. I will go on to consider how the
each level is significant. concept originated and what exactly is wrong
4. Dnamic relationship among elements with it.
and causative factor. The CF is a dynamic I am under the imPression that Jack
concept. Knowing more about our patients, Worsley invented the idea of causativefactor
observing the manner in which the elements and it bothers me that he does not take credit
and officials interact, is certainly helpful. We for it. One of the forum commentators
also need to know more about attributes the concept to him as "one of his
ourselves-especially when our patients are major contributions." He has always claimed
not getting better. to his classesthat it was part of a long oral
5. Causativefactor for W? CF is only a tradition-a view I do not understand.Why
tool to better contact our patients.Whetherwe wasn't it ever written down? China has after
contact them on the same CF or someplace all, an enorrnously long written tradition.
else seems less important than contacting Indeed the Chineseinvented the printing press!
them. There is no formula; eventhe CF cannot There is nothing so secretiveor preciousabout
be pigeonholed. it that should keep it out of the classics.There
6. Causativefactor and seeing the whole is no mention of it in any of the acupuncture
nl
Thefirst commentatorinthe CFforum
literature.Very strange.I am left with the
conclusionthat causativefactor is JR's baby, comparesthe CF conceptto Jung's idea of
even if illegitimate and disowned' (Can a syniuonicity. The way that Jung intends the
conceptbe a bastard?)In 1977,whenI wasan term synchronicitY, however, ls ln
acupuncturestudentliving in Oford, one of contradistinctionto the meaningof causality'
the first Americangroupsto havetrainedat Jung's booh Synchronicity,is subtitled'4n
Aciusal ConnectingPrinciple' The notion of
curious to discuss matters such as the

causative factorwith peoplefurtheralongthan
myself.Most peoplein that group had never acupuncture,and is a way of understanding
heardof the conceptof CF, andwere hearing them without resortingto causativefactors'
it thenfor the first time despitebeingalready
trainedandin practice.That would makethe
idea aboutten yearsold. Whereverit comes
from, or howeverold, asthe centralthemeof
acupuncture diagnosisit needsto be seriously factoris thereforetheworst namethis concept
scrutinized.It shouldbe fortified by its merits could be calledand revealsa deepconfusion
andcriticizedfor its weaknesses. Beforenow andmisunderstanding.
it has stood on an anti-intellectualpedestal, Furthermore,searchingfor causative
like'anidol pretendingto be a lost icon from factorsin acupuncture diagnosisis inevitablya
history, untouchable and beyond heretical reductionistexercise.Here, agarn,we have
doubt.As for its merits, I have alreadysaid takenthe worst of westernscienceon board'
that it doeswork. But then I am remindedof We move from a philosophyof interaction,
a play by Dennis Potter (England's interdependence and interrelation of
outstandingplaywright), called Treacle and elements-elementsthatholdwholeworldsof
Brimstone, where the Devil slips into an associations in flux-to onestaticelement:the
unsuspecting householdon falsepretenses and causativefactor. This createsimbalance.It
givesthe impressionthat he loves and feels givesa higherstatusto oneelementagainstthe
movedto care for a helplessyoung girl. She others and stops dead the movement of
has lost control over her bodily movements intertwiningenergies.This conceptforcesthe
and speechafter a tragic car accident-In practitioner's thinking to stop the flow of
privatehe cruellyteasesthis patheticcreature movement and change, the ingredientsof
and repeatedlyrapesher until ultimately the transformation, and categoize and objectify
full honor of her situationshocksher backto the patientto whom it is applied.This doesnot
her senses.She screamsout, and in a mind- mean that transformationcannot happenin
bogglingtwist her speechis restoredand her practice,becauseit does.But it suggeststhat
body unwinds from its former spasmsand our thinkinggetsout of stepwith it. It happens
contortions. She is thus ironically and despiteus-amazingly. Considerhow we use
inadvertentlycured by her tormenter-cum- causativefactor for diagnosis.What mental
saviour.All normal valuesgo up in smoke. operationsare involved?We weigh up the
Significantly,the playwasbannedfor tenyears featuresthat we regardasmost inappropriate
andonly recentlyreappeared. (whateverthat means)in our patientsat that
tt2
point in time, and deducefrom our knowledge concept. I believe this is at the heart of the
of the officials who is the most likely culprit. error. This needfor an enrichedconceptpoints
Then that's it. The CF does not change,only to some sort of poverty in acupuncturetheory
exceptionally. If it doesn't worb we have or in ourselves. Chinese acupuncture, as I
probably guessedwrong, being imperfect and understand the spirit of the Nei Jing, is not
unmasterful.Guess again. about constructing clever concepts that then
In western medicine the situation is tell us what to do. Rather the richnesslies in
quite similar. The patient comes in feeling the contact we make, the quality of our
badly. Maybe it's a recognizable condition involvement with patients.The emphasisis not
(readimbalance),maybenot. The doctor says. on the what (what is the CF?) but on how
"It's a virus," or "It's an infectiorq"or (how we meet, how we treat, how that makes
ifno clearphysicalcause,then "It's stress."Of us feel). The enrichmentand skill we seeklies
course, allopathic medicine has more within our attunement and sensitivity to each
sophisticatedmoments-as we do-but at the other, even if we like to think in elemental
crudest level the mental operationsinvolved in terms. It is poverty to think of only one
such diagnosesare the same.How different is element when we are infinitely rich in
that from "It's wood" or "It's an earthCF" or possibilities. Just think of the other
even a complex relationship like "water person-then how we do what we do follows
drowning fire"? Does anyone really believe . . . naturally.
this adequatelydescribesthe essenceof a
person's suffering? JAN RESNICK
Presumably,the point of treatmentis London, England
for these "factors" to change, for patients to -o-
move on, for new issues to emerge. I think
healing meansnot having a causativefactor. Among the oral responsesto the article
And shouldn't we as practitioners be fluid and on causativefactor, we receivedthe following
perceptiveenough to view the freshnessand commentthat deservesparticular attention."It
difference in our patients from one sessionto shouldbe underscoredthat ProfessorWorsley
the next? The great strength and beauty of does indeed work with all five elementsin a
Chinesediagnosisis its opennessto what is dynamic interaction. His way of working with
happening in the present without recourse CF is sometimesmisunderstood-people may
necessarily to other people's past (as in think that he treats only the CF element. In
western medicine) or the crude syndromesof fact, according to Dr. Worsley, there may be
the other school of acupuncture (which is no short or long periods of time when a person
better). Philosophicallyandpracticallywe need needs treatment on another element. One
only begin with what we find before us as it knows that this other elementneedstreatment
unfolds. If the past is signfficant, it will be becauseit is visible in the present moment
presentto us. How we treat dependson how through color, sound,odor, emotionandother
someonefeels and is (with us). The person's such signs."@ditors)
ordinary experienceshould be our focus and
point of depiuture for treatment. But it has no
diagnostic categoriesnor causativefactors. This article is printedwith permission from the Editor
The Journal's forum on causative 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 -
factor concludes that we need an enriched
113
Why Do PeopleGet Sick?
The ChineseView
EdnaBrandt,Lic.Ac.
Equilibrium
betweenthe bodyandthe outsideworldandalsowithinthe bodyitself.

Thereis a normalstateof equilibrium
The bodyis homoeostatic organism,not fixedat any onepointbut in a relativebalancethat adjustsitself'
Chinesephysiology is notcausal;thereis no cause.
Ways to break balance
1. Bodynotsufficientlyadaptableto intemalor extemalchanges

too strongor powerfulfor bodyto adapt
2. Externalor intemalinfluences
Qi:the body'sabilityto fightoffthingsandkeepthe balancein the body. lt is onefocusfor

Anti-pathogenic
especially
treatment, preventivetreatment. Any diseasereflectsthe body'sresponseto a pathogenic
whichcan be extemal,likecold,or intemal,likeanger.
influence.
lnternal Causes External Causes Other(Miscellaneous)

Causes
Anger Wind itY/CF

Constitution/hered
Joy Cold Trauma/injuries/oPerations
Pensiveness/worry Damp Parasites/poisons/ePidemics
Sadness/melancholy Dry Wrongtreatment
Grief Summerheat Lifestyle
Fear Fire OverworUfatigue/usinguP
Fright reserves
Underwork
Exercise
Sex
Diet
Patient Education
We can reallyservepeopleby helpingthemto understand the causesof disease.Takinghealthout of the

handsof professionalsand puttingit in the hands of the meansteachingthemto avoidthe causes
patients
of disease.For we
instance, can teach them thattheir worryor anger to their illness'We can
is contributing
remindthemnotto lay on thecoolgrassaftersweatingin a tennisgame.
Lifestylecan makethe differencebetweengettingwell and not gettingwell'
ll5
Times We Can ChangeOur HealthMore Readily
Any transitiontime has potentialfor increasedchangein health
1. Puberty(lotsof changesgoingon)
2. Startinga big relationship(maniage,for instance)
3. Pregna-ncy (by restingat'leasta month,in china they "dothe month")
4. Menopause
lnternalOrigins of Disease
Emotion Directionof Qi and Blood Damages
Even if not the CF
Anser Liver
too
XfrIill;'tl?,ffiglllr"nt'"nt
Joy UPward,scatters,slowsQi Heart
(worry)
Pensiveness Round and round, stagnation, spleen
stuckness
knottedness,
Sadness(melancholy) pressurein chest

Downward, Heart'Lung
Grief Downward, morethan sadness Lung

not lettinggo
Slowlydown,morementallevel Kidney
Fear
suddendown,morebodyexperience Heart(sudden)
Fright(shock) panicattacks,Qi deranged,chaotic Kidney
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

knowsthatdamageis happening(becauseheartholdsour consciousness). For instance,the Heart
knowsthatangeris damagingliver,thoughliverdoesn't know it.
Theseintemalpathogensinjurethe organs. tnjurymay comewhenthe pathogencomesabruptly

for a longtime.
(tragedy).Injurymai comewhenan emotionis excessor deficientor inappropriate
gmotiohscan ne especiallydamagingwhenthey are not expressedor acknowledged-
You 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
medicines,like purgatives,
werethe norm.
ll6
As the causesof diseasebecomemoreintemal(heartattack,stroke),we are losingthe battleagainst
disease.Westemmedicineis magnificent for treatingextemalcauses.Eastemmedicineis usefulfor
treatingintemalcauses,becauseit treatsenergyratherthanform.
Theseinternalpathogens
area majorcauseof endogenous diseases(diseases formedwithinthe body).
to theirdisease.
We mustteachpeoplethattheirangeror worryis contributing
External(Exogenous)Originsof Disease
Thesearethe emotionsof theworld.Thesecan be an actualinvasion(theinfluence of the environment
touchesthe bodysurfaceandenters the orifices)OR they can be signsand manifesting
symptoms
in
intemally the body. In other an
words, actual invasionis not necessary.
Our mothers were right (oldwivestalesreflectcausesof disease)
Don'tsit on dampground(damp)
Don'tgo aroundwithwet hair(damp)
Don'teatstandingup
Don'targuewhenyoueat (emotional causes)
Don'tgo into the waterrightafteryou eat
Don'tgo s,wimming withyourperiod
Don'tget you feet wet with yourperiod(footmeridiansconnectwith uterus)
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
Weather,air conditioning, (goingin andoutof air conditioning)

fans,changein environment
Yang
Drivesthingsintothe boy (spearheadof disease)
Affectsskin and Lungsfirst
Makesthingsshakeands,.lay(tremors,convulsions)
Arisesquicklyand movesfast (symptomschangerapidly)
Combineseasilywith heatand cold
tt7
Gold
Yin
Consumes yangQi
lmpairsmoving ano warming,contractsand makesobstruclions
-pain
Makessevere (imagineholdinga snowballin yourhand)
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
Consumesbodyfluids(heatprostration,
heatstroke)
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)
EXemal causesare likelyto be the explanationwhenthe illnesshassuddenonset,whereasa longer

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.
Extemalpathogenscan affectthe bodyif a climaticchangeis unseasonable or extremeor suddenor if

the body'sresistanceis low or out of balance.The form of the disease depends on whichinfluenceand
also the disharmonywithinthe person. A given person may be vulnerable
especially to certaincauses.
For instance,theseweaknesses make us more susceptible to certainextemalpathogens:
1. Yangxu, especiallyKidney(cold)
2. Spleenxu (damp)
3. Intemalheat (fire)
4. Woodimbalance(wind)
5. Old injuryor overusedpartallowingpathogento invade
118
Any exogenousfactorcan transformintoothers;for instance
' coldcanenterand go to lungsandtum to heat
. heatcanenter,bum up fluids,tum to dryness
. extremeheatcan makewind
Other (Miscellaneous)Originsof Disease

We musthelpour patientsunderstand theseimportant causesof disease.Thesecan be an important
sourceof homewoikfor the patient,
since can
lifestyle makethe differencebetweengettingwell and not
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
Contagious diseases
ozone
Pollution,
4. Wrong treatment
Morelikelywith herbsthanwithacupuncture
Possiblewith acuPuncture
5. Lifestyle(the big one)
(using up reserves)
A. OvenrrrorUfatigue
Work whilefatigued
Heavywork, liftingandstrainingcausestagnation
Repetition (carPaltunnel)
Longhours
Dissatisfaction
Sittingin one Placetoo long
B. Undenryork
No self worth
No challenge
C. Exercise
Needbalanceappropriate to age
Healthdependson adequatemovement(haveto stir the soup)
Insufficient(Qi and blooddon'tcirculate,resistancedecreased,breedsdamp,bonesand
tendonsget soft)
Too much (exhaustion, consumesvital energy,weakensantipathogenic Qi)
Usingone areaof bodytoo much
Exercisingtoo muchwhenyoung
ldealis to supportthe insideandthe outside(walkingandtai chi)
119
D. Sex
Too much(spendKl essenceandyuanQi and Kl OD
Givingbirthconsumesjing and blood
Sex whentoo Young
Too littlesex
E. Diet distention
Overeating(SP/STcan'tprocess,so foodstagnates(belching,sour regurgitation'
and Painin abdomen)
(fastfood/eaiingdisorder/insufficient
Malnutrition weakensSP and ST; deficient
nourishment
ei anddeficientbloodbecausenot enough to
nourishment makeit; lessantipathogenic
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 OampformingtooOsiOairy, irieO,alcohol,s$/eets,juices,oil, ice cream)
in excesswi1 dimage ifr" org"n it pertainsto; smatlamountof foodwill tonifyit
"nb
Any flavor
Huniedeating(SP can'tfunction)
Eatingwrongconditions(angry,lateat night)
Unsanitaryfood (foodPoisoning)
See Qurnfessence article,LateSummer,1994
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)
A. "My unOerstani]ng tells me that X wouldhelpyou. What X woulddo
of you,from my Oiagnosis,
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.
r20
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
TreatmentPrinciple TreatmentPossibilities
Clear Internal (IDs) or External Demons @Ds) IDs: MasterPt belowCV 15,ST25,ST32,ST4l
MasterPt below CVl5, ST37,Master
IDs il depression:
Pointbetween 5T36 and ST37,ST4l
EDs:GV20. BLtl, BL23, BL6l
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 Sowcepoin! commandpoint, junction point' xi cleft point,

@lement or Official) 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 Commandpoint: Tonificationpoint, sedationpoint,

from areasof relative excessto relative deficiency) 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

at the sametime points, andjunction points)
Treat elementsother thnn CF element Sourcepoint, conect akabanes, tend pulseqrraliliss,

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 !4!$ ElernsntBooks,1982'by
J.R Worsley.
Reconsideringthe CF: Reconsiderpossibility of:
I
E-n3rgeticBlocks:
Before changing a CF, considerthe list of I Vtaior
possibilities on the right. 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 etc. Japan has produced manY level, depending on how the
acupuncturist could face in the renownedpractitioners,like lvlanak'4 practitionerandthe patientchooseto
presentationof a patienf how many Ito, Yanagiya, etc. whose theories frame the healingwork they embark
paradigmsindicate the besr point provide practitioners with many on together.
prescription for the disorder? A paradigms from which to choose. Aside ftom the generalgoal of
patient complains of asthma and And this does not exhaust the treatment, and the rationale
interviews three acupuncturists. possibilities.Practitionersin Korea, underlying the treatment strategies
Onepractitioner usesthe paradigms Vietnarn, France, Russi4 and the of eachtradition, what is the nature
of TCM to diagnoseand choose United States. to name a few, of the knowledgewe use regarding
poins mirroring the diagnosis. continue to expand our under- eachpoint? Treatrnentrarely relies
Another practitioner trained in the standing of the potential beyondthe on the use of a point by itself. The
traditionformulatedby J.R Worsley points when they serve as gateways more points use4 the more difficult
frames the diagnosis, and chooses to a vast mystery. This diversity is it is to isolate which point triggers
points accordingto the perceptionof not new. A multitude of ac'upuncture specificresponses.A combinationof
the patieng and an understandingof traditions span the history and points will reflect a treatment
the points which reveals a logic expiurse of China many dating strategy, and the evaluation of a
quite different from the story told in before acupuncture was even responsewill reflect the treatment
the language of TCM. A third practicedoutsideof China. goals. This createsabias, a selective
practitionerfollowing theexperience With various traditions perceptionofchanges that occur in
of a renownedJapanesepractitioner choosingfrom amongthe samesetof the patient, and the practitioner may
perceives the picture of the acupuncturepoints,forvery different only see the kinds of things for
imbalance associated with the reasons,what are the implications in which he or sheis looking. However
asthma from a third point of view, termsof ourknowledgeof the points, helpfirl modern researchtechniques
which requires the use of points andwhat is the logic which givesour may be, the clinician inmersed in
drawn from extensive clinical un6srctanding somecoherence? the flux of practice still faces the
experience with similar cases in A practitioner's reasons for sameproblemour predecessors faced
Japan. Each practitioner believes choosinga point not only reflect the tryrng to identif the actions and
that he or she has made the best tradition in which he or she is effects of an individual Point.
choices. trained, but the goal of treatment. Historically points have been
The same paradox of The immedixfs eim may require describedin many ways:
paradigmsand points occwswithin acute, symptomatic treatment in . specific indications in terns of
each tradition. Within TClvI, one orderto relieveseveresuffering. The symptomsor in relation to areasof
can diagnoseaccording to patterns long term aim rnay require the the body;
associatedwith: the Six Stages,the treatment of chronic disorders, . general channel and organ
Channels, the 8 Principles, etc. cultivating a balance on the dynamicsin relation to symPtom
Within the Worsley tradition, constitutional level. The treatment pattems associated with Jng
difierent practitioners may perceive ofacute or chronic disorderscan also Well, Ying/Spring, Shu/Streaul
an imbalance in terms of: energy be aimed at growt\ development JinglRiver, He/Sea, XilClefi,
blockagesthat require use of Entry and firlfillrnent on a spiritual level. Yuar/Source, Lou/Connecting,
and Exit points, the Husbandand Every practitioner,in all traditions, Shu/Back Associated.Mu/Alarm
Wife Law, Possession by Demons, has the potential to treat at every points;
t23
white/Lung, and the useof SPleenI presume that where there's
. general functional tenns like
as a Ghost Point treating mental contradiction,somethingis not right'
thoseusedin the herbal tradition
disorders. We strive to integrate and balance
(tonifies yin, drains damPness,
The recognitionof new Patternsrn our lives, to understand the
etc.);
. analogiesto the namesof a Point; groupsofpoints continuesto expand contradictions that confound us, to
our understanding of the Points' resolve the Paradoxof which we are
to namebut a few of the waYsin
Lou/Connecting pointsgenerallywill a part. The practitioner'schoiceof a
which pointshavebeendescribed.
have indications for mental or point often imPliesa choicemadein
emotional complaints, that were not the face of blatant contradictions'
For any one Point, SPleenl, for
mentionedin the classics' JingiVell The practitioner either lives with a
example, specific indications vary
points generallyhaveindicationsfor thorn in his or her side, or rigtdlY
depending on the source. SYmP-
fwer, exceptfor SPleenl. believes ttnt there is only one tlue
toms that involve bleeding are the
How reliable are these"command paradigtrl"with no Paradoxes.
most conrmon. ActtPuncture a
points" for indications associated The legacl of Aristotle has
ComprehensiveText, addsinfantile
with eachgrouP like Well, SPring, somethingto do with this dilemma.
convulsions.ChineseActtpuncture
Streanu River and Se4 or for With regard to contradictions and
and Moxibustion adds dream
indications associated with the 5 logic, Aristotleput it this way: If you
disturbed sleep; Felix Mann adds
Elements as pathogenicfactors? A havetwopropositionslike"everyA is
severevomiting; and Dr. So adds
generalsurveyof the Command B" and "some A is not B," then one
epilepsy,etc.
The general channel and organ must be true and the other must be
The practitionereither liveswith a false. Without thinking of Aristotle'
dynamics also varY dePending on
the source. as described in the thom in his or her side, or rigidlY the acceptanceof his assertion is
classics.NanJing Chapter68 states believesthat there is only one true responsiblefor the thorn in the side
that a JinglWell point like SpleenI paradigm,with no paradoxes. of the practitioner aware of the
is indicated for frrllness below the choiceshe or shemakeseverydaY. It
heart. Ling Soz ChaPter 44 states points comparingtheoreticalindica- is said that every JingAVell Point
the JingAVell points shouldbe used tions with clinical indications in treats a fullness below the heart - not
during the winter to treat the 5 Yin Chinese Acapuncture and Moxi- true. It is said the 5 Element
organs. bustion andActtpuncturea Compre- associationswith pathogenicfactors
In termsofthe energeticdYnanics hensive Text revealsthat they agree alwaysapply - also not true. General
relatingto 5 phasstleory, SPleenI rouglrly 6OYo of the time How frrnctions like Toni$ Yin or Drain
as a JingAVell Wood poing would appropriate are point descriptions Dampness may onlY aPPIYto one
effect the Wood/LiverAVind in using general functions like those indicationout ofa dozenindications
general. According to YanagiYa, used in Chinese herbal theraPY? associatedwith a point. The nameof
SpleenI shouldbeused(with Liver Perhapsonly 25%;o if the points have the point occasionallybearsquite an
l, Lung 8, and Spleen 5) to treat general functions related to the ma- obscure relationshiP to the
excessin the Spleen. jority of specific indications associ- indications of the poing like "Hidden
When using general functional ated with the point in clinical prac- White" for SpleenI.
terms like those used in Chinese tice. Spleen I would serve zrs a Accepting Aristotle's assertion
herbal therapy,SpleenI is said to: positive examPle. [1 Qsateinstlte suggeststhat ifall ofyour experience
Regulate and Toni$ the SPleerl Blood asseenin specificindications, doesn'tfityour logic,your logic must
Contain the Bloo4 Calm the SPirit, like: abnonnal uterine bleeding, be faulty. But our exPerience is
and Clear the Brain. bleeding in the digestive tract, con- riddled with contradictions, the
Finally, when Spleen I is called tinuous nosebleedand blood in urine heritageof the omnipresentparadox.
by name,that name may be Yin Bai or stool. The paradigms we relY on as
(translatedas Hidden White), Gui The paradox of Paradigms and practitionerscomewith a long history
Lei (GhostPile),or Gui Yan (Ghost points threatens to bewilder and of successfirl clinical application
Eye). Most points have been given overwhelm the modern snrdent which sustainstheir life in practice,
more tlran one name over the years. searching for a logic that provides even thougb Paradigtrl A and
Interpretationofthe nameswill vary coherence and understanding. paradigp B apparentlY contradict
and suggesta possible relation to Western cultures have come to eachother.
t24
The life of logic in China application of procedures with remember the flY that caught his
developeddifferent applicationsand reliable outcomes,whether the logic eye, or in our case, OrePoints that
provided different insights than applies in all casesor not. A logic triggered a healing for a Pattern -
thoseengenderedby Aristotle. The that applies only some of the time glimpsedin the lives of our patients.
Chinese were concerned with requires the recognition of those Patternsemerge from the darkness,
practicaland moral problems,and a cases in which it aPPlies, and its and a line of logic maY retneve
mystical interpretation of life. For limitations, and thosecasesin which thenu but the darkness remains
example, the Dao contains and it does not. It makes life more undefinedwith bright momentsof
includes contnrdictions, and para- complex when it is not Presumedto creation.
doxically createsa dynamic balance be black and white, right and wrong.
in the process. In order to The challengeis to be true to our
encompassthe range of experience, expenence. Note: This article is printed with the
the logic of the Dao includes the The right logic at the right time permission of the author, StePhen
irrational. Daoiss were generally can serve the practical PurPoseof Howard, Lic. Ac. It was originallY
contentto co-existwith other points hooking slippery memoryat the end printe d in the @ ci etv-eI
of view like thoseof the Confusions of a line of experiences. A Pattern Massachusetts Newsletter. #6, MaY
and Moists. leapsout from the murky waters of r 995.
The limitations of our experience, like a rainbow trout
explanations need not limit the breaking water, and you need to
t25
AS METAPHOR
POSStrSSION
by Vicki CohnPollmd
When I was trained in five-element acupuncture, experience.As I grow and change,what I am able
I was taught how to treat a particular blockage to see about each of the elements,about each
of energycalled"possession"- ths metaphorto patient, and about the world, expands-As above,
describe this block. As an acupuncturist for so below.
twelve years, I have explored this metaphor, In this article I wish to sharea bit of my journey
finding that each new level of understanding with one of the metaphors of the five-element
reveals a new layer of mystery. Possession-as- system-possession.In 1978, when I first heard
metaphor is still a central theme in my work. the word "possession" in my beginning
Metaphors are like parablesor Zen koans;they acupunctureclasses,my imagination was off and
are teaching stories. They lead us to an running into pictures of Hollywood and the
understandingthrough our "hearts," our inner Catholic Church. We were being taught how to
experience,rather than our minds. The beauty of diagnosethe energeticblock calledpossession.It
the five-elementtradition of acupuncture is that is a difficult block to determine, partly because
much of what we learn lies within the realm of one needsto move beyond some of the images
metaphor. There is richness and poetry h our evoked by the word itself. The two primary ways
descriptions of people, disease, health, and to diagnosepossessionare, first, to look into the
nature.Each ofthe elementsofChinese medicine person's eyes, ascertaining whether or not
is a metaphor.A personwe treat as having a Fire "anyoneis home"; and second,to determinefrom
causativefactor, for example, is not literally "on talking to the person whether he or she is fully
fire." Each of the laws is also a metaphor. In the there-or whether "someone else" is in charge.
Law ofMother-Child, we are given an imagewe I was intimidated by the enormity ofwhat I was
can relate to, and we then can understand the being prepared to diagnose.I had no faith that I
workings of energy by returning to that image. could even look directly into a person's eyes,
The namesof the points, too, are metaphors.As much less detect an absence.The whole notion
we usethem, we learnmore deeplythe "spirit" of seemedbizarre to me. In additiorg when I was
the points signaledby their metaphoric names. taught the points that are used to treat this
Metaphor is both the beauty of our systemand blockage, I quickly saw that they are difficult to
the fulcrum ofthe work. As a student, I hearthe find. The points, known collectively as the Seven
words spokenby our teacher, J. R. Worsley. I Dragons, must all be located precisely for the
write them down on paper; therq in my practice, treatment to work. If even one needle is
I make the words come alive for me. I make the misplaced,the treatment won't go through.
teachingsmy own, allow them to live inside of Added to all this, I couldn't quite dispel the
me. I discovermeaningfor myself, from my own notion that perhapsstrangeguttural voices would
comeout of a possessed person'smouttqalong wasa reasonshehad survivedthis accident,that
with a little fire flaring from the nostrils end therewaswork shewas meantto do, andit was
demons' horns poking up through the hair' timefor herto get on with doingit. Shewas(and
Basically, I began my journey certain that if is) quiteremarkable. Theonlyproblemwasthatin
anyonecameto seeme possessed, that person the difficulty of integratingher experience,she
would just haveto staYPossessed- attributedher entirerebirth experiencesolelyto
held as
It took a few yearsfor me to get comfortable the powers of her surgeon,whom she
with this process.During the clinicalpart of my almost supernatural in his ability to put her
earlytraining,orily onepersoncameto the clinic destroyedbody back together. She fantasized
with the condition called "possession " and I about leaving her husbandof thirty years and
didn't participatein any of her treatments.In moving to the city to be near this doctor. She
later training, however, a man who was imaginedhewasthe only personwho understood
possessed wasseenby ourwholeclass.Thisman her. Sheturned him into her deity, externalized
had one of the most dramaticresponsesto the the locusof her recovery,andin so doing,lost a
insertionof the SevenDragonneedlesthat I've part ofherself.
everseen.His eyeswidened,thennarrowedback WhenI learnedfrom J. R. Worsleythat Marilyn
and forth severaltimes. His body shook. He was possessed, I could not have been more
seemedto be in battle with whatever was shocked.I burstout crying.How couldthis truly
keepinghim from beingwholeandhealthy' anazng woman be possessed?I was deeply
While this treatmentwasextraordinaryfor hinq disturbedthat I couldfeel suchcloserapportwith
the dramaof his clearinggot in the way of my her and didn't have a clue that she was absent
understandingthis metaphor.For quite a time from herselfin someessentialway.
after that, wheneverI did this dragontreatment, During the ensuingweeks,asI steppeddeeper
I worried that nothinghad happenedbecauseI into the meaningof my experience,deeperinto
did not seesucha visceralreaction.Nevertheless, the metaphor,I sawthat in truth -I had Imown.I
I was beginningto learnaboutthe metaphor. knewthateverytimeshespokeaboutthissurgeon
My first major leapforward in learningabout in largerthan life ways, I cringedinside.I knew
possession waswhenI took a patientto Boston that when I offeredher the possibilityof taking
in 1982for a consultation with J. R. Worsley.I responsibility for her own life, for her own
had absolutelyno ideasheu/aspossessed. In my miracle,rather than giving it all to hirn, I bumped
consciousmind, the reasonI took her was that into a mile-high wall. When I expressedmy
she was physicallyone of the most vulnerable dismaytoProfessorWorsleyfor not knowingshe
peoplein my practice.SheandI had developed waspossessed, he pointedout to me that, in fact,
a strong connectiorqand I wantedher to have I hadtold him aboutit whenI expressed my deep
the best treatments possible. The woman, concernthat she was allowing her fantasy of the
Marilyn, had been in a head on automobile surgeonto take over her life-
collisionthat hadmutilatedher body, insideand I was beginningto learn what this metaphor
out. looks like. As I grew in my ability to discern
It wasatrue miraclethat shewasalive,andshe possessiorlI sometimesjust "kneu/' a personwas
was deeplyaware of that. Through a mystical possessed whenwe met for the first time.WhenI
experience,she cameto understandthat there am certainthat quickly, I think it showsin the
128
person's eyes and on the person's face. was well known in the state as one of the
Sometimes I know without words. I sensethe outstanding therapists doing work with incest
wall of darknessand feel a ripple of fear. With survivors. She herself was a survivor and was a
many of the people I diagnoseas possessed,I pioneer in offering survivor groups, doing public
feel uncomfortable; I know something is not speaking and education work throughout the
right. region. When she began working with me, I
What is more difficult is when possessionlooks assumed that, for the most part, she had
normal. A person who is possesseddoes not completed her healing from her horrendous
appear demonic.He or she may be respected, childhood.
competent, excited about life, and growing in Rebeccaand I had great rapport. I respectedthe
many ways. But there will be at least one area of work shedid and was eagerto hear her reports of
this person'slife wherethereis no growth. There the ways she was helping people' In my
is an impenetrabledarkness.The situation can,in enthusiasnqI blinded myself to the fact that she
some ways, resemble that of an addict: the was getting sicker and sicker within herself' She
person may spendmany hours each day living a continually was getting into relationships that
perfectly normal and productive life, but when didn't work. Her body was deteriorating.Shewas
the addiction takes over, there is no wayto reach sadandlonely, sick and tired. Finally I understood
him or her. In the personwho is possessed, this that in some major way, despite the years and
stuck place-this darkness-ultimately prevents years of work she had done, Rebecca still was
spiritual growth. stuckin her incestexperience-possessed,in fact.
InMarilyn's case,her adoration ofher surgeon I did the SevenDragons treatment. Her whole
closely resemblednormal behavior.Most of us body shook and shook. Immediately after the
have occasionswhen we idolize peoplewho have treatment, a tremor that had always been present
helped us. This is part ofthe transferenceprocess in Rebecca's voice disappeared,and it has not
which helps us grow and be more like that returned. She didn't know the nature of the
person. But for Marilyn, this situation was not treatment, but she spoke eloquently of her
about growth; shecouldn't move on from it. She treatment experience.She told me it cameto her
had lost her senseof her own divinity. She had that her father owned herbody, that he was ln her
lost touch with her Self. body-notjust that he had sexually assaultedher,
Most peoplewho come to seean acupuncturist but that he had ownedher body, lock, stoclg and
present themselvesas fairly healthy. It can be barrel.
difficult to know the depth of a person's pain When I sawRebecca agal.;lshereportedthat on
when she isn't telling us outright. The the evening ofthe treatment she had gone to bed
practitioner's work is to be thorough enoughin at7.30, exhausted.During the night she had the
the seeing, the hearing, the touching, and the samedream seventimes. "Each dreamwas about
asking ofthe personthat such a major block does fighting with a benevolent demon. Each demon
not get hidden in the healthy aspects or was a shadowy thing. Each was a different
compensatingbehaviors the person brings to color-all darlg but all diferent. It was scary,yet
treatment. not scary.We were fightittg with paddedmaterial,
I learnedabout hidden blocks with a womar\ like taffy. The fighting was about resistance,
Rebecca. I had heard about Rebeccabefore she pulling-not fighting to the death."
came to see me for acupuncture. She was an Since therg Rebecca reported, "I can confront
outspoken leader of the lesbian community. She the reality of my father's abuse. It's not me any
129
more. The treatmentmadethat separationfor where they treated each other miserablyand
me.Onecan't confrontthe abuseif the parentis neitherwas ableto leave.In her childhoodwith
still inside.I couldn't deal with my father-he two completelydysfunctionalalcoholicparents,
sheendurednightmarishexperiences. When she
wasme.He was in mYbodY."
in herlife wet her bed,for example,her mother lockedher
Rebeccahasmadenumerouschanges
and now is in a satisfying and committed in the basement with rats.Throughthe years,she
relationship.We both believethat her flexibility had done--and continued to do--various
to be different from her previouspersonais a psychologicaltherapies.She was h deeppain,
signof healthandhealingfor her. searchingfor a way out.
My journey of discoveryaboutthis possession The day I did the traditional diagnosis,I felt
metaphorhasbeenanexciting,up anddown,and instant rapport with her. Her struggle to be a
continuingprocess.It hasmanyfacets.Learning healthywomanwasquitemovingfor me.I began
to seepossession in people'seyesis an ongoing treatmentwith a great deal of enthusiasm.It
processfor practitioners.J.R. Worsleydescribes wasn't long, though, before I began to feel
it this way: "Whenyou look in the eyes,thereis discouraged.Sometimessheseemedbetterafter
no one home." I have searchedfor ways to treatments;moreoftenshefelt no changeor even
describemy own experiences, difficult asthat is felt worse.I couldn't figure out what was doing
to do, andthesearethe words that cometo me: wrong. I tried absolutelyeverything--exceptthe
Possession looks back at me with a,wall of SevenDragontreatment,ofcourse!I didn't know
coldness, hardness, a look of dismissal. I could whatto do.
neversmileback at the look that comes at me An opportunityarosefor me to take Annato a
from thoseeyes.I want to shudder,to shakeoff seminarwhere shewouldbe examinedby amaster
theexperience. In contrast,lookinginto theeyes acupuncturist.I thought it might be helpful if I
of someonewho is not possessed, I seespark, could see her from a completely different
aliveness, warmth.I rememberhearingRamDass perspective.This teacherwas extraordinarywith
say one time, "If I look deeplyinto your eyes,I her, showing himself as a deep and powerful
seeGod looking back at me." With possession, healer.He examinedher thoroughlyfor a total of
I don't seeGod. about six hours.I learneda greatdealabouther
To havedirect eyecontactwith someoneis an from his wisdom. He taught everyonein the
intenseexperienceof intimacy.In order to be seminarhow he would proceedwith treatments
proficientat this skill andto betterevaluatewhen for her. I usedthe suggestionshe gaveme that
someoneis possessed,I now practicelooking had meaningwithin my five-elementcontext.
into people'seyeson a regularbasis. At first I was excited. She seemedto be
My most recent learning about possession experiencingsomerelief. But soon things were
remindedme that the peoplewe work with are right backwherethey hadbeen.Up to this time,
alwaystelling us what is going on with them. shehadbeenutterly faithfulin her commitmentto
Often it takes time to hearthem. That was the thistreatmentprocess.Now shebeganto question
casefor me with Anna. She cameto me with whether acupuncturecould help her. I was
serious physical problems. She had seen dismayedanddepressed. I decidedit wastime to
numerousWesterndoctorsandhadgonethrough suggestttrat she stop treatment.It felt unfair to
seven surgeriesin the recent past, since her keepher coming.
husbandhad come close to having an affair. Themorninga^fterI madethat decision,I awoke
Their relationshipwas stuck in a hellishregion and sat bolt upright.I lcnewshewas possessed.
130
The minute I had the thought, I was absolutely As I write this article, describing my journey to
certain. I couldn't wait to do the treatment. And, understandthe metaphorof possession,I seethat
of course, that was the answer- What has I still have questions.I am excited by that. I feel
happenedto Anna sincethen is nothing short of that I am in the presence of a very powerful
miraculous. The first thing she said when she metaphor (one of many in the five-element
camefor her follow-up treatmentwas "I feel like tradition) and will continue to work with it and
the old me." IIer symptomsaregreatly alleviated, grow in my understanding for the rest of my
some almost gone. She is sleepingwell for the days.That's why I love this work.
first time in years. The relationship with her
husbandhas altered dramatically. She ironically Vicki Pollard practices acupuncture in a small
reported at one point, "He isn't the sameperson town in Maine. The founding president of the
he was three weeks ago." They have sincegone Maine Association of Acupuncture and Oriental
away for a two-week vacation, something they Medicine, she is on thefaculty of the Traditional
hadn't done for years. Acupuncture Institute's graduate education
'\V'orsley
These examples of possessionwere powerfi'rl program nd the Institute of Classical
teachers for me, helping me understand and Acupuncture.
appreciate this metaphor from our healing
tradition. Our work is about transformation"
helping people live their lives more fully. The This article is printed with permission from the Editor of
Meridians. The original article was published in fu
SevenDragons treatment is a unique tool in this
Joumal of Traditional Acapuncture. Autumn, I99 I '
worh allowing breakthroughs that otherwise
would seemimpossible.
13l
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 in treatment. He is a Fire CausativeFactor (Wood

Enerry-when it appearsand who showsit. This is a brief within), runs his businesslike a general-verypowerfirlly'
reviewof someexperiencesand insightsfrom my practice. When his father died quite suddenly,he was shockedand
A 36-year-oldwomaa psychologistwith a successful thendevastated.This wasquite apparentwhen I sawhim
practiceand a fairly balancedlife comesfor a Traditional for his next treatment. I tappedfor aggressiveenergyand
Diagnosis. Sheis mainly interestedin "balancing," feels found it on D( (Lung) and V (Ileart Protector)- It cleared
fairly healthy in general,and has a goodfriend who bas in about halfan hour. Becausethe Heart Protector had
benefittedfrom treatment. Physical function is generally been hit by AE, I tested I (Heart) for AE in the next
good; a few minor achesand pains. She is in a good treatment. (fhe Heart should not be tested at the same
relationshipand relatively happyin her life. I am tempted time as the other officials.) He had a small but distinct
not to testfor AggressiveEnerry. Shehad a hard time as erythemaon tle AEPs of the Heart that lasted lessthan
a child, with tremendouslyunstablefamily dynamics. She ten minutes. The aggressiveenergyhad barely begunto
suwived, and after a geatdeal of self inquiry hasbecome affectthe Heart. Thesetreatmentswere someof tlte most
quite a strong person. Nonetheless,I check for AE as I significant in his experience. He felt a distinct relief of
routinely do with new patients, and find three officials the intensity of emotionalPain.
with a very clear erJthema, indicating the presenceof A patient was robbed at gunpoint- She came for
aggressryeenerry. Eeatment a week later still lsoking quite shaken. I
It is amazing to seehow peoplevary in how they cope checkedfV (Kidney) for AE. Before I had takenmy hand
with and relate to how they feel inside. This woman awayfrom puning the needlesuL she had developedan
learnedearly on that it wasn't worth complaining. It was erythema the size of a quarter, which rapidly grew to
more traumatic to see the reaction of the family to her silver dollar size. This took two hours to drain.
unhappinessand fears than to put the stressofit out of Sometimes a person is severely shaken by such
sight. Shedid this quite literally and as an adult carried obviously traumatic events. However, I have found it
a geatdeal of tensionburied deeply. After that treatment important to watch for a person'sreaction1s sssmingly
and subsequenttreatments she felt much better. She minor events.
hadn't known that the inner tension she had learned to A secretarywho is very conscientiouswas upsetabout
live with could be dispelled. a work situation. Although it didn't appearto me to be a
This exampleillustrates how elusiveaggressiveenergi big issue,clearlyit wasfor her. Sheis an Earth Causative
canbe. Severalother examplescometo mind particularly Factor. Treatmentwas going quite well. A few weeks
of thosepatiens already in treatment who experiencea after the work incident, it seemedthat shefelt aggravated
severeshockor loss. after treatment rather than bener. I testedfor AE. She
A 37-year-old man with a zuccessfirlbusinessand had it on VItr (Liver) and )flI (Spleen-Pancreas).Since
migrainesasa maincomplainthas improvedsignificantly then she has done beautifirlty and has changedhow she
133
related to certain peopleand sinrationsat work. location. I still find it very myst€rious' The detectionand
AE may also appearfrom excessiveuse of drugs or draining of AE can make a world of difference in tlte
alcohol. Whencomplicatedby the presenceof internal or courseof treatment.
external Devils, the AE may not drain at first. After the
Devils treatmenLit is necessaryto retestfor AE' Jennifer DownsFlickinger is practicing acttpuncturein
There have been times when I missedAE; when I Baltimore. Sheis a PastVicePresidentof theMaryland
discover it later, I review events around the time the AcupunctureSocietY.
personstartedto feel worse. Inevitably, somethingwill
emergethat could havebrought it on.
Locating the AE points is obviously crucial to testing Thisarticle is printedwith permissionof the author'
accurately. It is worth moving the needlesseveraltimes Theoriginal article waspublished in the Marvland
tobe surepointlocationiscorrect. I h av e fo u n d ActtpunctureSocietvJournal' Spring, I 990'
aggressiveenergy to be a major obstacleto healing. It
forcesus to refine our skills ofdiagnosis and alsoofpoint
EDITOR'S COMMENT ON AGGRESSIVEENERGY
While N4s.Flickinger provides excellent insight into the meridian, may stimulate yang generally, enabling the
clinical procedure and efrectivenessof the aggressive patient's active energies to overcome patterns of local
energytreatment,in my mind clinical resultsalwaysraise stagnationor inhibition.
theoretical questions. Why is this treatment effective? 6-. The presenceof erythemaon the acupunctue point
How doesit work? The following thought may provide a when a nearby nonpoint shows none suggests that
focus for further reflection.
l. Shallow needle insertion of long duration
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 certain conditions, accounting for the increased
particular. The nahfe of the trauma may determinethe microcirculatory exchangewhen stimulated.
organ and particular body zone affected; i.e., death of a ?. I have found that points other tban sftz points may
spouseto theHeart orlung orbs. The result of circulatory develop erythemaswhen stimulated. These also may
inhibition would be a constant low level discomfort and benefit with treatment. However, there is a clear
dysfirnaion. The AE treatments' relaxing and draining theoretical and practical relationship between the five
characteristics may release this microcirculatory organshu points basedon Five-Element diagnostics. We
inhibition. haveclinically corroboratedthe(o cycle dynamic in the
2. The shallow insertion in the area of the principle movementof toxic enerry and find that the AE treatment
spinal nervesto major organsmay give a mild stimulation corrects this perverse movement of energy. Ms'
to the functioning of the organ and its correspondingzone Flickinger points out that the characterofthe traumadoes
or meridian complex. A strong stimulation in the reflect in tlre presenceof AE on coresponding points'
presenceof pre-existing trauna might exacerbatethe Thesepatternsofconnection canbe verified in the pulses'
sensitivity. 8. I describe AE as treatment for environmentally
3. The shallow insertion suggestsan activation of the induced neurosis. In my country practice I find that very
Iilei chi (defensiveenergy) tlat moves just above and few peoplehaveAE, wen patientswith a history of severe
below the skin. trauna. t beliwe that AE may developamongpeoplewho
4. The sftzpoints lie in ttre zone of the parasympathetic live more in their mental ratler than physical
nerve ganglia and may stimulate a parasympathetic environments: people who have high strung nervous
response.This would clearly explain why the ueatmentis systemsand thosewho are bracedwith constantlow level
effective in counterbalancing the extreme sympathetic stress(especialtyftom over-crowding) with consequent
activity inducedby trauma. behavioral guarding'
5. StimulationoftheBladdermeridian"which is ayarg ri/irtiam r4tadsworth
134
Moxa StickUsage
SherrySmith,Lic. Ac.
feeling'
Moxa sticks are used for treating local areaswhere there is coldnessor an aching
too much energy in
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
the skin and should be
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
if the lower chou is
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
This is expected
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
-herselffor home use, caution her to
Though you may give a moxa stick to a patient
else do the treatment. A person using moxa on may become too relared, lose concentration
and burn herself.
Observethe contraindications listed for moxibustion.
135
ForbiddenPoints
ilI t2
il18 6h month vlt 2 1t' month
ilt 16 6h month x4 1tt month
I ilt 56 xil1 l"t month
2 tv1 8h month xil2 1"1month
5 tv 11 tv2 8n month
o tv4 3tdmonth
30 V1 lv7 8h month
(Women 3'd month
50
Women 3'o month
51
vt 8 4n month 3'd month
54
62 vt 19 3d month
vt 20 4s month
3d month 4d'month
vlt 3 4n month 46 month
vil 18
1srmonth 5h month
vilt 12 4h month
2d month 6h month
x13 66 month
6h month 6h month
15
xl 17 7h month 6b month
22
33
cv8 th month 7n month
42
cv 17 1srmonth
? th month lv1 Sdtmonth
8 GV7 tv2 86 month
10 GV 1O 5h month lv7 8d'month
11 GV 11 8h month xl 36 8s month
GV 17 6h month
GV 24 X2
1s month x10
1trmonth xll 6
XI th month
XI
XI
XI
XI
XI
GV6
GV7
GV 15
GV 16
GV 17
GV 18
GV 25
GV 28 O Regina Norton, 19EE
137
Meridian Namesand Abbreviations
Meridian Abbreviation Number
LU, LU IX
Lung LI, CO X
Large Intestine ST, St )il
Stomach SP,SP )(II
Spleen FIT, Ht, He I
Heart SI II
Small Intestine BL, UB ilI
Bladder K[, Ki IV
Kidney PC,TIP,CS,CX V
Pericardium (tleart Protector) TE, TB, TTL SJ VI
Triple Heater (Triple Energizer) GB VII
Gall Bladder LR, LV, Liv VIII
Liver CV, RenMo, RenMai )ilI
ConceptionVessel GV, Du Mo, Du Mai )ilv
Governor Vessel
PulsePositions:
BladderMeridianNumbering:5E/TCM
5E TCM
BL 1-35 Same
BL 36-49 B L 4 T -5 4
BL 50-54 BL 36-40
139
Index
21,30
AccumulationPoints
AE 50,52, 54-56,58,61, l2l, 133
21,35
AEPs
AggressiveEnergy 50-52,54-56,58,61, 121,722,133,134
.. ...62
Akabane
21,36
Alarm Points
42
Antique Points
21,35,127
AssociatedEffect Points
21,35
Back ShuPoints
35
Back Transporting Points
47, 49,91,122
Blocks
AggressiveEnergy 5 0 , 5 1 , - 5 6 , 5 8 , 6 112l
5 4 ,
61
Akabane
62,l2l
AkabaneImbalance
50,122
AkabaneImbalance
50,64
CV/GV . .
EDs 5 0- 53,l 2l
Energetic 50,51
Entry/Exit 50,65
r22
External Dragons
50-53
Heavy Metals
50
ife
Husband/W 57- 59,l 2l ,122
IDs 5l-53,121
Internal Dragons
50-53
Lifeswle 50,122
Patient Dependenceon Illness
50
Pulse Quality 50, r2l,122
63
Qualityon the Pulses
Spirit 50,66
Structural 50,122
Types 50
UmbilicalPulse 50,60,12r,722
CausativeFactor 44,62- 64,66,87,103,109,121
1l, 13,14,17,28,35,37,39,
Causesof Disease 1 6 , 1 7 , 5 1 9, 1 , 1 0 0 ,1 1 5
CF I l, I 3, 14,17,28,35,37, 39, 44,62-64,66,87, 103,109
Cheng Cycle
8
ChineseClock 10,31
CleanNeedleTechnique 70,7r
r43
CommandPoints 21,22,t2l
Element Points 2l
Horary Points 2l
JunctionPoints 2l
SedationPoints 2l
Tonification Points 2l
Conception Vessel 21,32,33,64
7
ControlCycle
CreativeCycle
CrossingPoints 21,45
CSOE 52,55
CVPoints t21
CV/GV Block 64
Dan Tien 60
Diagnosis 5r, 54,57,60,61,64-66,92
JJ
DirectingVessel
Disease,Causes 1 7 ,5 l
Dispersion 7l
Dragons,External 51,52
Dragons,Internal 52
Du Mai 34
Du Mo 34
EDs . 51- 53
ElementPoints 2l-23
Horarv Points 21,24
SedationPoints 21,26
TonificationPoints 21,25
Elements 1 , 5 - 1 , 8 51, 0 0 1, 0 1
Emotions 17
EnergeticBlocks 47
Entry/ExitBlock 65
EntrylExit Points 21,31,64,65,r 2l
ExternalCausesof Disease 1 7 ,l 1 5
ExternalDragons 5l
ExtraordinaryMeridian 32
First Aid Points 21,46, l2l
Five ElementAcupuncture. . .. 1,83,97
Five ElementPoints 42
Five Element Treatment Principles tzl
ForbiddenPoints 21,46,137
Four NeedleTechnique r22
Front CollectingPoints 36
Front Mu Points 21,36
Fu.. 35,36,41,43
t44
21,41
Gathering Points 5
G e n e r a t i n g C y c l.e. . . 34
Governing Vessel
21,32,34,64
GovernorVessel tzl
G V P o i n t s. . . .
21,43
He SeaPoints
2r-24,127
Horary Points
57-59
Husband/TVife Block
5 1-53
IDs
2r, l2l
InfluentialPoints
39
Inner BladderLine .
9
InsultingCycle
t7, 115
Internal Causesof Disease
21,43
Jing River Points
42
Jing Well Points
2 r , 2 2 , 2 76
, 2,74
Junction Points
9
Ke.. I
Ke Cvcle
t2
Law of Cure
13,57-59
Law ofHusband-Wife
11
Law ofleast Action
10
Law ofMidday-Midnight . .
6,25,26
Law ofMother/Child
Il, 1 2,14,122
Level of Treatment
21,43
Lower Uniting Points
27
Luo ConnectingPoints . . .
139
MeridianAbbreviations. .
Meridians
JL) J)
ConceptionVessel
33,34
Extraordinary. .
32,34
GovernorVessel
39
Inner BladderLine .
Miscellaneous Causesof Disease
t7, l t 5
Moxa
72,r22
135
Moxa Stick
72
Moxibustion
41
Nan Jing
70,71
Needle Technique
69,71
Sedation
69,70
Tonification
6l
Neuropathy
Outer BladderLine 21, 39,66,r2l
8
Over-actingCycle
Point Classification
t9
t45
Point Use . .
t23
2l
Points
Accumulation
21,30
Alarm 21,36
42
Antique
21,35
AssociatedEffect
Back Shu 21,35
Command
21
ConceptionVessel 21,33,34
21,45
Crossing
2L
CV/GV
Element
21,23
Entry/Exit 21,31
First Aid 21,46
F i v e El e me n... t 42
Forbidden 21,46
F r o n t M u. . . . . . 21,36
''l A1
' LL' ar
Gathering
GovernoiVessel " ' 21,32-34
He Sea " " 27' 43
il )4
Horary ""LL''a
)LL
1
Influential
InfluentialPoints nr
A1
JingRiver 21,43
JingWell 21,42
Junction 21,27,62,74
Lower Uniting 43
Luo Connecting . 27
OuterBladder 21,39,66
Reunion 2r,45
Sedation 21,26
ShuStream 21,42
Source 21,28
Spirit 21,37-40,66
Tonification . . . 21,25,74-76
Transporting 2r,42,43
UpperKidney 21,37,66
Windowsofthe Sky . . 21,44
X Cleft 21,30
Ying Spring . . 21,42
Possession 51,52,5 5,127- l 3l
5)
Ren Mai
JJ
Ren Mo
Reunion Points 21,45,121
t46
34
Seaof Yang Channels JJ
Seaof Yin Channels 69,71
Sedation
2l-23,26
SedationPoints 5l
SevenDevils 5l
SevenDragons
5-7,23,25,26
ShengCycle 21,42
ShuStreamPoints
27, 28, 29, 44,62, 63, l2l
SourcePoints 66
SpiritBlock
SpiritPoints
21,39,66
OuterBladderLine
21,37,66
UpperKidney
83,97
TCM
69,70,74
Tonification . . .
2l-23,25
TonificationPoints 74
tonificationProcess 61
TraditionalDiagnosis(TD)
122
74- 77, 79,80,
Transfers
21,4 2,43,l 2l
TransportingPoints
21,43
He Sea
21,43
JingRiver
21,42
Jing Well
21,43
Lower Uniting
21,42
ShuStream
21,42
Ying Spring
21
Typesof Points
6l
UmbilicalPulse
21,37
Upper KidneyPoints . . .
t6
Upright Qi
9
ViolationCycle
69
Vital Force
3l
Wei Qi
21,44, l2l
Windowsof the SkyPoints
Worsley, JR . .
37,44,54,5'.1,73
7,9
21,30,r2l
21,42
Ying SpringPoints
28
YuanQi...
28
Yuan Source Points
35
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

trainedwith J.R.WorsleyinRoyalLe'amington Spq England,andcompletedthe Clinical
Integrationcoursewith JohnandAngelaHicks, and attendedworkshopsand seminars
rorrJ.ing topics such as GynecologicalAcupuncturewith Govanni Maciocia, Pulse
Diagnosiswith Lonnie Jarrettandthe ExtraordinaryMeridianswith JeremyRoss-
Ms. Smithis a memberofthe NationalAlliance,theNationalAssociationofTeachers

of Acupunctureand OrientalMedicineandthe MarylandAcupunctureSociety(MAS);
sheservesasthe treasurerof MAS. Shehasa privatepracticein Columbia,Maryland.

The Five Element Acupuncture Handbook PDF

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

The Five Element Acupuncture Handbook PDF

Загружено:

Авторское право:

Доступные форматы

The

SharonM. Smith,L.Ac., Dipl.Ac.(NCCAOM)

Thehandbookconsistsoffour sections: Concepts, EnergeticBlocks,and

Someof theinformationincludedis not from Worsley'sFiveElementtraditioq for example,

The majorbenefitof this handbookon acupuncture theory is to providea coherent

Llltimately,this handbookis intendedto serveas a referenceand guidefor students.The

The five elementsarewood, fire, eartlqmetal,andwater. Eachelementrepresents a

The inter-relationships of the five elementsis important. Eachelementaffectsandis

Eachelementis associated with a setof correspondences. Emphasisis placedon the

The roots of the traditionofFive ElementAcupuncturego backto ancientChina.Using

Energy moves in a clockwise direction on the cycle-

Explainshow the Qi flows, essentialto both diagnosisand treatment planning.

Symptomsmay show up in the Mother and/or the Child.

In diagnosis,to discern the health of the Mother and Child.

The Ke cycle exists simultaneouslywith the Shengcycle.

Metaphorically: Earth guidesWater

To discernthe influence of the Grandmother on the Child.

two-hour time period

Providesa guide to observedaily cycles-

In diagnosis,this is the time when a patientmay feel best or worst.

Treat the Btadder/Ill lvleridian just before5PM sun time and

Do aslittle aspossibleto initiatethe desiredeffect.

A simpletreatmentmakesclearthe specificeffect of a treatment.

. in reverse chronological order, from most recent to oldest

To identify the Law of Cure after acupuncturetreatments:

The Law of Cure in action indicates effective treatment-

Pulsesof the Officialson the left side belongto the Husband.

On the left side:

Pathologt existswhenthe right sidepulsesare strongerthanthe left sidepulses.

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;

CF is the elementthroughwhich the patientreceivesthe most supportand makesthe most

pathogensand keep the balancein

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

Internal Causesof Disease:The Emotions

External Causesof Disease:Climate n Eat;lL 4 za+e- N-(

Knowing the causeof diseasewill influencethe choiceof treatment.

Include horary, tonificatiorq and sedationpoints'

The nature or energy of each elementbecomesaccessibleat thesepoints'

Thepointon eachmeridianthat correspond to its elementwhenusedaccordingto the Law of

Powerfi.rlbecausethe energyof a meridianis moreaccessible duringits horarytime.

Usedto treat the meridianat its most accessibletime.

Metal. LU8 MeridianGutter 3AM-5AN4

The elementpoint of theprecedingelementon the Shengcycle,i.e.,the Mother point in the

Canbe usedasa tonificationpoint only whentheMother hasrelatively moreenergythanthe

Use of a tonification point requires understandingof the Law of Mother/Child.

LU9 Very GreatAbyss

Use of a sedation point requires understandingof the Law of Mother/Child.

points that connectandmove energybetweenthe yin andyangmeridianswithin an element.

Typicallythejunction point on the relativelymore deficientmeridianis tonified.

Usedto balancethe energybetweenpairedmeridians.

' LIJ 7 Narrow Defile

Are safe, simple, gentle, and powerfi.rl.

A treatment using sourcepoints is often the first CF treatment on a patient.

On the Yin Meridians, thesepoints correspond to the Earth points.

The Chinesecharactermeansa cleft or fissure.

PlaceswhereQi andBloodrTconvergeand accumulate.

Entry points are where the energy enters the meridian.

LU I Middle Palace LU 7 Narrow Defile

Along with the otherextraordinarymeridians,the Conception(CV) andGovernorVessels(GV)'n

Often usedfor their spirit andtheir locationin anatomicalareasor in proximityto corresponding

Reinforce treatment on the twelve meridians.

This meridianrunsup the anteriormidlineof the body.