Five Element Constitutional Acupuncture 2nd Ed

Gives a clear, detailed and accessible presentation of the main features of constitutional five element acupuncture treatment. It covers the context and history of this form of acupuncture, as well as the relevant Chinese medicine theory. After examining the elements themselves, and the functions of the Organs, the book explores the basis of diagnosis in five element acupuncture, possible blocks to treatment, and the treatment itself. It puts this style of treatment into the context of other styles of acupuncture treatment - especially Traditional Chinese Medicine (TCM) as it is used in the West today.

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FIVE ELEMENT CONSTITUTIONAL ACUPUNCTURE
by Angela Hicks, John Hicks & Peter Mole
Churchill Livingstone, hardback, 300 pages, £34.99

While interviewing a number of different colleagues at the recent annual international conference for Chinese medicine in Rothenburg, Germany, it became clear quickly that this is a book that many have been waiting for. Students, practitioners and teachers of Chinese medicine alike expressed enthusiasm and appreciation for the book and gratitude to the three authors for writing this thoroughly researched, well-documented and skilfully organised book. It is the first comprehensive textbook that makes Five Element Constitutional Acupuncture accessible to both those familiar and those unfamiliar with this particular style. At the same time the authors make a great effort to embrace the idea of diversity within the practice of acupuncture. The book reflects the successful integration of their studies and clinical work with J. R. Worsley with their own long-term clinical experience.

A glance at the table of contents reveals the clear structure and easy accessibility of the book, with larger sections and smaller chapters making it easy for the reader to identify specific subjects. The summary at the end of each chapter will be particularly appealing to students.

A long and impressive stream of quotes from the classics runs through the entire book documenting the authenticity of this style of acupuncture. In the first section, the reader is introduced to the foundations of the Five Element approach. The authors take us back to the origins of Five Element Constitutional Acupuncture during the Han dynasty, introducing Naturalism, Daoism and the ‘Three Treasures’ as well as basic ‘Five Element Theory’ outlining the ‘Sheng’ and ‘Ke’ cycles. The idea of ‘Spirit’ is introduced as well as a brief discussion of the ‘Five Shen’, which is revisited in greater detail in the description of the individual Elements in Section Two. In this section, the concept of the ‘Constitutional Factor’, central to this particular style of acupuncture, is discussed in great detail, anticipating (perhaps critical) questions that the reader might have. This is followed by a discussion of the causes of disease emphasising the internal causes, specifically the five emotions associated with each Element, as is the tradition in this style.
Few books put so much emphasis on the relationship between practitioner and patient and recognise that rapport is essential in the development of this relationship. The final chapter of the first section is dedicated to ‘the inner development of the practitioner’. The authors’ deep commitment to assist the practitioner/student in cultivating virtuosity (‘linghuo’) shines through in this part of the book. It goes way beyond the abstract idea of the “supreme physician” and gives practical guidelines about the interaction with a patient and the development of true presence, awareness and compassion. In later chapters, the issue of self-development is revisited and the authors give a series of practical exercises in order to facilitate greater rapport.

Section 2 gives an introduction to the Five Elements and does so in a clearly differentiated way: Each Element is described in a series of three chapters. The first of the three chapters discusses the Chinese character for the Element and the element’s ‘resonances’. This is a new, very elegantly chosen term replacing the idea of ‘correspondences’ or ‘associations’ in order to imply an energetic link between the Element, the ‘primary resonances’ (colour, sound, odour and emotion) and the ‘secondary resonances’ (season, stage of development, climate, sensory orifice or organ, tissue, residue and taste). The second of the three chapters associated with each Element describes the functions of the related Organs, emphasising the classical descriptions given in Su Wen Chapter 8. Great emphasis is placed on the spiritual aspect of the associated Organ (e.g. Liver – Hun). The third chapter explains several aspects of the behaviour typical of the Constitutional Factor associated with each Element. The authors clearly state that these associations do not derive directly from classical texts but are mostly based on observations from modern clinical practice.
The descriptions are meticulous and spiced with small case examples in order to illustrate particular behavioural patterns.
The third section of the book is dedicated entirely to diagnosis: how to record a case history and make a diagnosis, more on “developing rapport”, and then great detail on the four pillars of diagnosis (observation of colour, odour, sound and emotion) all the while making helpful suggestions and introducing exercises in order to learn the “tricks of the trade”.

This is a particularly playful part of the book. One chapter in this section on diagnosis has the beautiful title ‘Golden Keys’ educating the practitioner to pay close attention to significant expressions or behavioural patterns of a patient that are often indicative of a particular imbalance in one of the Elements.

A rather fascinating section of the book is the one dedicated to so called ‘Blocks to Treatment’ which are described as factors that potentially ‘can have a profoundly negative effect on the person’s psychological or physical health unless they are cleared’. The four specific blocks are explained (‘Aggressive Energy’, ‘Possession’, ‘Husband-Wife Imbalance’ and ‘Entry-Exit Blocks’) in great detail. Each ‘Block’ is described in light of its historical context as well as its contemporary significance; how to detect and treat such an imbalance, with a number of case examples. With their accessible writing style, the authors have effectively demystified such a delicate subject as ‘possession’ that undoubtedly has the potential to lead to much confusion and misunderstanding, especially among those not familiar with this particular style of acupuncture.

The section of the book covering different types of points discusses those that treat the spirit quite extensively but limits discussion of specific points organised by channels to those frequently used by Five Element Constitutional acupuncturists and refers readers to other publications for information on the actions and indications of other points.

The section on treatment guides the reader gracefully through three stages of treatment planning. Following this, eight case examples are given to ‘pull it all together’ and demonstrate the application of this style of treatment, all the while reminding the practitioner of the importance of minimal intervention based on a correct diagnosis on one hand and the fact that the diagnosis remains ‘a working hypothesis’ demanding flexibility on the other.

The final section of the book is dedicated to discussing the integration of traditional Chinese medicine and Five Element Constitutional Acupuncture, illustrated by a number of carefully outlined case histories. At the heart of this approach is the long-standing clinical experience of the three authors and their profound commitment to place the patient centre-stage: ‘All medicine has to adapt to the environment, culture and needs of the people it serves.’ The reader is invited to explore the differences and similarities between the different styles of treatment, emphasising the fact that the strengths of each system superbly compliment each other and therefore give the practitioner a wider range of treatment possibilities.

A fair reviewer should mention a few aspects of a book that could be improved. Admittedly, this has been challenging. If there is anything that could have been added to the book it should be in this section. Understandably and perhaps to avoid controversy, the authors chose to focus on the strengths of traditional Chinese medicine and Five Element Acupuncture. It would have been helpful to mention that there are some limitations inherent to each style of acupuncture; and that in fact, the weakness of one system is complemented by the strength of the other.

The authors deserve sincere approval for collaborating to write this book. They are making a tremendous contribution to the possibility of increasing dialogue within the acupuncture community far beyond the integration of Five Element Constitutional Acupuncture and TCM.

Sybill M.B. Huessen, M.S. TCM, Winterswijk, The Netherlands

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SECTION 1: THE FOUNDATIONS
Chapter 1: The Philosophical Foundations of Five Element Acupuncture
Naturalism and Daoism

Nature as inspiration

Humanity stands between Heaven and Earth
The Three Treasures
Chapter 2: Five Element Theory

The Five Elements

The Five Element Resonances

Five Element Inter-Relationships
The Sheng Cycle

Mother-Child relationship
The Ke Cycle

The Elements 'insulting' each other

Treating the Constitutional Imbalance

The Organs or 'Officials'

The Chinese Clock
Chapter 3: The Importance of the Spirit

The Primacy of the Spirit

Diagnosing and Treating the Whole Person
The meaning of Mind and Spirit
What do we mean by spirit?
What do we mean by mind?
The shen in Chinese Medicine
Chinese Medicine's Approach to the Spirit and Health
Using acupuncture to treat the spirit
The 'Five Shen'
An Overview of the five shen
The Spirit and the Emotions
Chapter 4: The Constitutional Factor
The Concept of the Constitutional Imbalance in Chinese Medicine

How does a practitioner diagnose the CF?

The Four Diagnostic Signs

The importance of diagnosing by signs
Diagnosis by Assessing the Emotion
Confirming the Diagnosis of the CF

Elements within Elements

How does our Constitutional Factor affect us?
The Effect of the CF on the Emotions
Positive characteristics arising from the CF
Treating the CF
Nourishing the Root

The importance of Minimum Intervention

Preventive treatment

Fulfilling our Potential
Harmonising our qi
Chapter 5: The Causes of Disease
History of the Causes of Disease
The causes of disease
The internal causes of disease
Emotions as a cause of disease
The movement of emotions
The Seven Internal causes of Disease
Anger - nu
Joy - xi le
Sadness - bei
Grief - you
Overthinking - si
Fear - kong
Shock - jing
Movements of qi that resonate with the emotions
The Five Emotions and the Role of 'Sympathy'.
Diagnosing the emotions
Other causes of disease
Not Living In Harmony With Nature

An unfulfilled life as a cause of disease
Discussion of aetiology with patients

Chapter 6: The Inner Development of the Practitioner
Why is Inner Development Important?
Diagnosis.
Treatment
Maximising rapport and increasing the efficacy of treatment
Cultivating Virtuosity

SECTION 2: THE ELEMENTS AND ORGANS

Chapter 7: Introduction to the Five Elements
Introduction
The First Chapter - the Element and the Resonances

The Elements
The Resonances
Key or Primary Resonances
The Secondary Resonances

The Second Chapter -The Functions of the Organs

The Third Chapter - The Behaviour Typical of Each CF

Behavioural patterns

What is meant by Behaviour?
How does an Imbalance in an Element Manifest in Behaviour?

What behaviours will manifest as a result of an Elemental imbalance?
Chapter 8: Wood Element - Key Resonances
Wood as a Symbol
The Wood Element in Life

The Wood Element in relation to the other Elements

The Key Wood Resonances
The colour for Wood is green

The sound for Wood is shouting

The odour for Wood is rancid
The emotion for Wood is anger
The Supporting Wood Resonances

The season of Wood is spring.
The power of Wood is birth
The climate of Wood is wind
The sense/orifice for Wood Tissue and body parts for Wood - ligaments and tendons
The taste for Wood is sour.

Chapter 9: Wood - The Organs
Introduction

The Liver - The Planner

Su Wen Chapter 8
The Spirit of the Liver - the Hun
The functions of the hun

The Gall Bladder - The Decision Maker

Su Wen Chapter 8
Time of Day for the Organs

How the Liver and Gall Bladder Relate

Chapter 10: Wood Constitutional Factors
Patterns of behaviour of a Wood CF
Responses to the issues
1 Assertive and direct - passive and indirect
2. Seeking justice - apathy
3. Rigid - over flexible
4. Over-organised - disorganised
5. Frustrated and defiant - over obedient

Chapter 11: Fire - Key Resonances
Fire as a Symbol

The Fire Element in Life

The Fire Element in Relation to the Other Elements

The Key Fire Resonances

The colour for Fire is red
The sound for Fire is laughing

The odour for Fire is scorched

The emotion for Fire is joy
The Supporting Fire Resonances
The season of Fire is summer
The power of Fire is maturity
The climate of Fire is heat
The sense organ/orifice for Fire
The tissues and body parts for Fire are Blood and blood vessels
The residue for Fire is hair
The taste for Fire is bitter
Chapter 12: Fire - Key Organs

Introduction

The Heart - The Supreme Controller
Su Wen Chapter 8
The Spirit of the Heart - the Shen
The functions of the shen
The Pericardium - the Heart-Protector
Su Wen Chapter 8

The function of the Heart-Protector

Small Intestine - Separator of Pure from Impure
Su Wen Chapter 8
The functions of the Small Intestines

The Triple Burner - The Official of Balance and Harmony

Su Wen chapter 8
Warming the body
The Time of Day for the Organs
How the Heart, Heart-Protector, Small Intestines and Triple Burner relate
Chapter 13: Fire Constitutional Factors
Patterns of behaviour of a Fire CF
The main issues for a Fire CF
Responses to the issues
Compulsively cheerful - miserable
Open and overly sociable - closed and isolated
Clowning - earnest
Vulnerable - over protected
Volatile - flat
Chapter 14: Earth Key Resonances
Earth as a Symbol
The Earth Element in Nature
The Earth Element in life
The Earth Element in relation to the other Elements
The Key Earth Resonances
The colour for Earth is yellow
The sound for Earth is singing
The odour for Earth is fragrant
The emotion for Earth is overthinking, worry and/or sympathy
The Supporting Earth Resonances
The season for Earth is late summer

The power for Earth is harvest

The character for Harvest is ren
The climate of Earth is dampness or humidity
The sense organ/orifice for Earth
The tissues and body parts for Earth are muscles and flesh
The residue of the Earth is fat
The taste for Earth is sweet
Chapter 15: Earth - The Organs
Introduction
The Spleen - Controller of Transforming and Transporting
Su Wen chapter 8

The Spirit of the Spleen - the Yi

The functions of the yi
The Stomach - The Controller of Rotting and Ripening

The time of day for the Organs

How the Stomach and Spleen relate

Chapter 16: Earth Constitutional Factors
Patterns of behaviour of an Earth CF
The main issues for an Earth CF
Responses to the issues
Smothering/mothering - not supporting
Feeling needy - repressing needs
Excessive dependency - over-independence
Uncentred and dispersed - heavy and stuck
Over dependent on the security of the home - inability to put down roots
Chapter 17: Metal Key Resonances

Metal as a Symbol

The Metal Element in Life

The Metal Element in Nature
The Metal Element in relation to other Elements
The Key Metal Resonances
The colour for Metal is white

The sound for Metal is weeping

The odour for Metal is rotten
The emotion for Metal is grief

The character for grief

The Other Metal Resonances

The season for Metal is autumn

The power for Metal is decrease
The climate for Metal is dryness
The sense organ/orifice for Metal is the nose
The tissue and body part for Metal is the skin
The residue for Metal is body hair
The taste for Metal is pungent
Chapter 18: Metal - The Organs

Introduction

The Lung - Receiver of Qi from the Heavens

Su Wen Chapter 8
The Spirit of the Lung - the Po

The Functions of the po

Large Intestine - The Drainer of the Dregs

Su Wen Chapter 8

The Time of day for the Organs
How the Lung and Large Intestine relate

Chapter 19: Metal Constitutional Factors
Patterns of behaviour of a Metal CF
The main issues for a Metal CF
Responses to the issues
Fragile - unyielding
Cut-off - seeking connection
Resigned or inert - overworking and achieving
Craving quality and purity - feeling messy and polluted
Deeply moved - nonchalant
Chapter 20: Water - Key Resonances
Water as a Symbol

The Water Element in Nature

The Water Element in relation to the other Elements

The Key Water Resonances
The colour for Water is blue/black
The sound for Water is groaning
The odour for Water is putrid
The emotion for Water is fear
The Other Water Resonances:
The power of Water is storage
The climate of Water is cold
The sense organ/Oorifice for Water is the ear
The tissues and body parts for Water are the bones
The residue for Water is the teeth
The taste for Water is salty

Chapter 21: Water - the Organs
Introduction

The Kidneys - Controller of Water

Su Wen Chapter 8

The Ming Men
The Spirit of the Kidneys - the Zhi
The functions of the zhi
The Bladder - Controller of the Storage of Water
Su Wen Chapter 8

The Time of day for the Organs

How the Kidney and Bladder Relate
Chapter 22: Water Constitutional Factors
Patterns of behaviour of a Water CF
The main issues for a Water CF
Responses to these issues
Risk taking - fearing the worst/over cautiousness
Distrusting - trusting
Intimidating - reassuring
Driven - no drive.
Agitation - paralysis
Chapter 23: Some common Confusions between different CFs
Wood and Fire
Wood and Earth
Wood and Metal
Wood and Water
Fire and Earth
Fire and Metal
Fire and Water
Earth and Metal
Earth and Water
Metal and Water

SECTION 3: DIAGNOSIS
Chapter 24: Diagnosis - Purpose and Process

Introduction to the Diagnosis Chapters
The Purpose of making a Diagnosis

Diagnosing the patient's CF

Diagnosing the other Elements
Diagnosing possible blocks
Diagnosing the level of treatment
The Process of Making a Diagnosis
Recording the main complaint, systems and other information
What a diagnosis does not involve

The Overall Stages of a Diagnosis

The context of treatment

The two levels of activity during a diagnosis

The stages of taking a case history

Getting rapport
Taking the main complaint

Questioning the systems or 'The ten questions'
Personal health history, family health history, relationships and present situation
To feel
To see

Pulling it all together

Rapport

What is rapport?
How does a practitioner make rapport?
Matching and diagnosis
How much rapport do we need?
Chapter 25: Diagnosis - The Key Methods
Introduction

Colour

The difference between seeing and labelling
Seeing facial colour
Labelling colour
Odour
Smelling and labelling odours

Sound

Voice tone and emotion
Descriptions of the sounds The Content and emotional context

Emotion
Background
Emotional language

Assessing a patient's emotions

The stages of emotion-testing

The testing process for each Element
A testing process for Wood and anger

A testing process for Fire and joy

A testing process for Earth and sympathy
A testing process for Metal and grief

A testing process for Metal and respect.
A testing process for Water and fear

A testing process for Water and reassurance
Chapter 26: The Body Language of Different CFs
Introduction

The Wood Element: Facial Expression, Postures and Gestures

The Fire Element: Facial Expression, Postures and Gestures
The Earth Element: Facial Expression, Postures and Gestures
The Metal Element: Facial Expression, Postures and Gestures
The Water Element: Facial Expression, Postures and Gesture

Chapter 27: Levels and Golden Keys
Introduction

Diagnosing Level - Body, Mind or Spirit

The purpose of determining the level
Clarifying the terms body, mind and spirit

Making the diagnosis of the level
Diagnosing through response to treatment

The Golden Key Approach to Discovering CF's

Traditional and non-traditional resonances

What is the method?
Chapter 28: Diagnosis by Touch

Introduction

Pulse diagnosis

The purpose and value of taking the pulses
How to take the pulses
Pulse changes during treatment and the overall change

Feeling the Chest and Abdomen

The three jiao

Abdominal diagnosis
Palpating the front mu or alarm points

Akabane test

SECTION 4: BLOCKS TO TREATMENT

Chapter 29: The Five Element Blacks to Treatment
Introduction
The Four Blocks
Treating the blocks
Results of treatment
Order of treating the four blocks
Chapter 30: Aggressive energy
What is Aggressive Energy?
Its nature
How Aggressive Energy develops
The aetiology and pathology of Aggressive Energy

Diagnosis of Aggressive Energy

Factors that may indicate the presence of Aggressive Energy

Testing and Treating Aggressive Energy

When to check for Aggressive Energy
The testing process
Signs of the presence of Aggressive Energy
Procedure if Aggressive Energy is present
Reactions to treatment
Subsequent treatment
Chapter 31: Possession
What is Possession?

The nature of Possession

Possession in ancient China

Vulnerability to Possession

Conditions leading to Possession
The Diagnosis of Possession
Signs and symptoms of Possession
Choosing the internal or external dragons

The Treatment of Possession

The seven dragons treatment
Position of the patient
Carrying out the treatment
Reactions at the time of treatment
Changes from treatment
Discussing the treatment with the patient
Repetition of the treatment
Chapter 32: Husband-Wife
What is a Husband-Wife Imbalance?
The use of the term 'Husband-Wife'

Diagnosis of a Husband-Wife Imbalance

Pulse diagnosis of a Husband-Wife imbalance
Other signs and symptoms of a Husband-Wife imbalance

Treatment of a Husband-Wife imbalance

Frequency of treatment
Reactions to treatment
Chapter 33: Entry-Exit Blocks
What are Entry and Exit points?
What is an Entry-Exit block?
The Entry-Exit points
Diagnosis of an Entry-Exit Block
Pulse diagnosis to detect an Entry-Exit block
Other signs and symptoms of an Entry-Exit block
Treatment of an Entry-Exit block
Needle technique
Reactions from clearing Entry-Exit blocks
Ren and Du channel blocks

SECTION 5: TREATMENT TECHNIQUES
Chapter 34: Needle Technique
The Art and the Mechanics of Needle technique
When to use each technique
Needle technique for physical vs spirit level
The mechanics of needle technique
Tonification technique
Sedation technique
Breakdown of stages of needle technique
Needle sensation when contacting the patient's Qi
Needle technique for transfers of qi
Needle shock
The art of needle technique
The practitioner's internal state
Clear intention
Relaxation
Focusing the attention
Good posture
The practitioner's self development
Chapter 35: The Use of Moxibustion
What is moxa?

When is moxa used?

How is moxa used

Deciding to use moxa or not
Deciding if moxa is appropriate or not
Testing using moxa

Making moxa cones
How to use moxa cones
A moxa stick
Contra-indications

SECTION 6: THE USE OF POINTS
Chapter 36: The Use of Acupuncture Points in Five Element Constitutional Acupuncture
Overview of the Use of Points

The Use Of Points According To Traditional Usages

Command points
Other points with specific uses
Command Points
Element points

Tonification points

Sedation points
Transferring qi across the ke Cycle
Yuan source points
The Luo junction points
Horary points
Other Points with Specific Uses
The back shu or 'associated effect points'

Entry and Exit points

Ren mai and Du mai
Front mu or alarm points
Chapter 37: Using Points to Treat the Spirit
Treating the Spirit in Five Element Constitutional Acupuncture
Treating at the appropriate level
Health and the spirit
Choosing spirit points
Reaching the spirit level
The choice of points
Using points according to their names.
The use of points by location
The practitioner's repertoire of points

Specific Groups Of Spirit Points
The 'Windows of the Sky'

The Kidney chest points

The outer back shu points
Other points that treat the spirit

Conclusion - using points to treat the spirit level

Chapter 38: Lung and Large Intestine Points

Introduction
The Lung Points
The Primary pathway of the Lung Channel
The Large Intestine Points
The Primary pathway of the Large Intestine Channel
Chapter 39: Stomach and Spleen points
The Stomach Points
The Primary pathway of the Stomach Channel
The Spleen Points
The Primary pathway of the Spleen Channel
Chapter 40: Heart and Small Intestine points
The Heart Points
The Primary pathway of the Heart Channel
The Small Inbtestine Points
The Primary pathway of the Small Intestine Channel
Chapter 41: Bladder and Kidney points
The Bladder Points
The Primary pathway of the Bladder Channel
The Kidney Points
The Primary pathway of the Kidney Channel
Chapter 42: Pericardium and Triple Burner points
The Pericardium Points
The Primary pathway of the Pericardium Channel
The Triple Burner Points
The Primary pathway of the Triple Burner Channel
Chapter 43: Gall Bladder and Liver points
The Gall Bladder Points
The Primary pathway of the Gall Bladder Channel
The Liver Points
The Primary pathway of the Liver Channel
Chapter 44: Ren and Du points
The Ren Points
The Primary pathway of the Ren Channel
The Du Points
The Primary pathway of the Du Channel

SECTION 7: TREATMENT

Chapter 45: Treatment Planning

Introduction
The three main stages of treatment planning
Summarising the Diagnosis

Forming an overall treatment strategy
Planning the individual treatments

Some Guidelines for Treatment Planning

Clearing Blocks First
Correcting left/right imbalances

Treating the CF
How many points to use in one treatment?

If treatment is not sufficiently effective, what are the possibilities?
Responding to a patient's lack of progress

Prognosis

Taking Feedback

Chapter 46: Treatment - Pulling it Together
Patient 1 - Andrew
Patient 2 - Bernice
Patient 3 - Caroline
Patient 4 - David
Patient 5 - Elisabeth
Patient 6 - Feli"city"
Patient 7 - Gordon
Patient 8 - Holly
Conclusion

SECTION 8: INTEGRATION
Chapter 47: Integration with TCM - A Brief introduction to how a Practitioner can Integrate the Two Styles
Why integrate?
The similarities and differences between Five Element and TCM styles of treatment
What do the two styles have in common?
How are the two styles different?
Integrating the Strengths of Both Styles
The benefits of integration

The Main Strengths of Five Element Constitutional Acupuncture and TCM Treatments

The main strengths of Five Element Constitutional Acupuncture
The main Strengths of TCM

The Patterns of Integration

Chapter 48: Case histories Illustrating Integrated Diagnosis and Treatment
Case History 1 - Howard
Case history 2 - Patricia
Case history 3 - Ellena

Appendix A Different Terms to Describe the Spirit
Appendix B External and Miscellaneous Causes of Disease
Appendix C Four Needle Technique
Appendix D Blocks from Scars
Appendix E Treatment Reactions
Appendix F Checklist for a Traditional Diagnosis
Appendix G Outcomes for Treatment
Glossary
Biblography