Acupuncture & TCM Articles
Neil R. Gumenick is the founder and Director of The Institute of Classical Five-Element Acupuncture. Neil is a Worsley certified advanced teacher of Classical Five-Element Acupuncture and a practitioner with over 27 years of private practice experience. Neil holds three degrees from the College of Traditional Acupuncture (U.K.), and he participated for 10 years in the Master Apprentice Programô, led by Profs. J.R. & J.B. Worsley. Neil has taught at the USC and UCLA Schools of Medicine, the Worsley Institute of Classical Acupuncture, the Traditional Acupuncture Foundation, California Acupuncture College, Santa Barbara College of Oriental Medicine, and Pacific College of Oriental Medicine. He has been a Professor at Emperor's College of Traditional Oriental Medicine and SAMRA University of Oriental Medicine. Neil is co-author of The Art of Practice Management for Acupuncture Health Care Practices
Diagnosing the Three Levels of Imbalance
By Neil Gumenick, MAc (UK), LAc, Dipl. Ac
It is a basic tenet in Classical Five-Element Acupuncture that a person's symptom(s) can be the result of imbalance in any element or any of the 12 Officials (organs/functions).
Every human being is born with, or develops early in life, an imbalance in the natural functioning of the Five Elements. This imbalanced element, called the Causative Factor or CF, becomes the underlying cause of illness. The Causative Factor is assessed by way of sensory information provided by the patient. Each of the elements has a corresponding odor, color, sound, and emotion, which can be perceived when a particular element is out of balance. Accurate diagnosis and treatment of the Causative Factor is the key to Classical Five-Element Acupuncture.
In addition, this system recognizes that the health of each unique individual's body, mind and spirit must be taken into account to fully understand and treat the cause of illness. Symptoms, therefore, can also be the result of imbalance at any of these three levels: physical, mental, or spiritual. A person will have a primary elemental Causative Factor and a level at which he or she is most affected. Thus, we might designate an individual as an Earth CF, mental level, meaning that Earth is the primary source of imbalance and the mind is the level at which the imbalance primarily manifests. As the elemental imbalance does not change to another element during a person's life, neither does the affected level, though it can be strengthened, harmonized, and restored by proper treatment. An imbalance at one level will and must affect the others, as we are one interconnected whole. Physical pain must affect the mind and spirit. Mental preoccupation and worry will take its toll on the body and spirit. The spirit, which fuels both the body and mind, will certainly affect their functioning, as well.
The emotions are not considered to be a "level" in this system of medicine, but play an integral part in diagnosing, as each element has a corresponding emotion which will express appropriately or inappropriately in a given set of circumstances. How the emotions express themselves will be perceived as primarily coming from either the mental or spirit level.
The Three Levels
The Physical Level
The physical level refers to the physiological functioning and structure of the body systems. While many patients seek our aid for relief of physical pain and malfunction, rarely in our age and culture is the source of the pain, resistance to disease, or the body's ability to recover entirely physical.
In pre-industrial societies, most imbalances and sickness were due to physical causes: external pathogenic factors. People who worked the land or hunted tended to be exposed to excessive periods of heat, cold, rain, wind, dampness, and the like. If they got wet, they generally stayed wet. Homes were poorly heated and air conditioning was unheard of. If the harvest was inadequate, so was their diet, as there were no supermarkets from which to replenish stores of food. These, and many other kinds of physical assaults, took their toll on the bodies of people who lived (and, in third-world countries and impoverished areas, continue to live) in such conditions. They experienced disease as a result.
What such people lacked, generally, were the internal causes of disease that are so much a part of the modern Western society: the stress, the competition with our fellow men and women, the obsession to get ahead, the attachments to material gain and its accompanying envies, jealousies, rivalries, power struggles, and isolation rather than cooperation.
Nowadays, in the Western world, most people are fairly well housed and well fed. Laws exist which prohibit workers from spending all day exposed to harsh extremes of weather. There are usually dry clothes available, sufficient water to drink, food to eat, and the like. With all of this, there are more sick people now than ever, particularly at the levels of mind and spirit.
The Mental Level
When disease reaches the level of the mind, it affects one's ability to think clearly - to see cause and effect relationships - to follow a line of reasoning logically. There may be confusion, mental obsessiveness, even desperation as the mind wages war within itself. We may find it hard to "follow" a person who is imbalanced at the mental level. We may feel confused in their presence, as their ideas, like pieces in a puzzle, seem not to connect.
Mental level people may be quite high spirited, determined, strong and unstoppable in their resolve. I liken a mental level person to the classic television character, Lucy Ricardo, on "I love Lucy." Her schemes were hair-brained and often ridiculous and illogical, but there was never a question of her giving up. You always knew, as did Lucy, that somehow, some way, she and her sidekick Ethel Mertz would find the way out of any predicament. Yes, Lucy would cry, get angry, and feel hurt, but she never resigned. Her spirit always shone through.
I emphasize that one cannot analyze and categorize any particular behaviors or spoken words and conclude a patient's level. This can only be perceived from within ourselves, based upon our interaction with the patient at all levels. Patients' words are far less important than how they are expressed: with sound and emotion, with non-verbal communication (e.g. physical contact, body language, breathing, facial expression, etc.). In this system of medicine, we use our curiosity to lead in our questioning of a patient, one question often leading us to another at a deeper level. In questioning a mental level patient, we often find that as our inquiry penetrates deeper, we perceive a strength and solidity at the core, rather than a deep void or emptiness at the core of those whose imbalance is at the spirit.
The Spirit Level
Our culture places great importance on the development of body and mind. We proudly report that our babies have grown inches and put on pounds. From early childhood, schools have classes in both mental and physical education. Sports and exercise opportunities abound throughout our lives, which are certainly important and healthful. Mental capacity becomes the measure of our success as we excel in school, or not. Parents brag about their children's academic progress, SAT scores, college choices, and career opportunities. More education is seen to be the way to success.
Rarely do we ask or speak about the spirit. When we meet a friend or relative with children, we ask, "How are the kids?" Good news has to do with the child being physically healthy, growing robustly, and doing well in school - bad news is the opposite. We rarely ask, "How is the spirit of the child?" It is the most neglected level in our society and the one most imbalanced and in need of healing. In a quarter century of practice, I have yet to see one patient who is predominately imbalanced at the level of the body, in spite of the presence of physical symptoms. I estimate 2 percent are mental, while the remaining 98 percent are spirit level imbalanced.
When imbalance reaches the spirit, it affects us at our very core: at the level of self-identity - who we are, and what we believe we are. We can create a robot to move physically and a computer to "reason" and manage data, which is akin to thinking.
What makes us uniquely who we are is our spirit. It is the Divine Spark that fuels and animates both the mind and body.
To speak about the spirit is to use the mind to wrap language around something that cannot be conveyed or described in words, yet colloquial English makes many references to spirit that we all easily understand. We all know about school spirit, team spirit, Christmas spirit, community spirit and "esprit de corps." We know what is meant when we report a friend "recovering, and in good spirits." Further, we know what it feels like when our own spirit is reached - beyond the level of the thinking mind.
Professor J.R. Worsley, in Traditional Acupuncture: Traditional Diagnosis, described spirit as "...the inherent essence in all things, the essence which enlivens all things and makes them grow and thrive. To the Chinese, spirit was in everything, the air, the trees, the water, the ground, the animals, the plants, the human being, every single thing."
What does a person feel when his/her spirit is imbalanced? Resigned, purposeless, lifeless, depressed, frustrated, anxious, worthless - to use a few labels. The body may be alive and functioning; the mind may be functioning, but the person may be spiritually dead, or struggling - perhaps using all manner of compensatory outlets to numb or mask the pain. These could include, food, drugs, sex, overwork, etc.
Developing Rapport Skills to Diagnose the Level of Illness
We can only perceive the patient's level and the specific needs within it, from that same level within ourselves. We can determine the level of a patient only by our experience of the patient. We experience the mind of a patient only with our own mind. Similarly, we can only experience (communicate with, reach, and understand) the spirit of another via our own spirit. It is not enough to merely identify a patient's level as being mental or spiritual. Our job is to determine, from the whole of ourselves, not only the level that is in most trouble, but exactly what the trouble is, and to select the exact points to reach the root of the problem. If the body is suffering and the cause is a mental or spiritual level imbalance, treating the physical level alone will only palliate. It will not cure.
How then can we experience, not simply think about, the whole of the patient with the whole of ourselves? Professor Worsley taught that there is no such thing as diagnosing another person, for we can experience another only via our own senses. What we smell, see, hear, and feel is perceived in us, and nowhere else. Without the interference of the mind, we can sense with pristine accuracy. With the mind in the way, we perceive only its chatter, not the patient. Fortunately, it is impossible to be in our senses and think at the same time. It is like the experience of going outdoors and feeling a cold wetness splash on our faces. That is a sensory experience. Following that comes the thought, "it's raining." The thought is not the sensory experience, but a description of the sensory experience. In the same way, we experience, via our senses, the odor, color, sound, emotion, and level of a patient. Then, the mind can be rightly used to describe or label what our senses have perceived.
To this end, we must be "at one" with the patient, neither analyzing nor thinking, but simply "being" with the patient. We call this state "rapport." Being "at one" further implies neither expectation nor striving on our part - not trying to "get it right," ask the "right" questions, figure anything out, or make a good impression. All of these are thoughts, which shut our senses down and leave us stuck in our heads. Professor Worsley summed it up by saying, "Coming from your senses, this system of medicine is very easy. Coming from your head, it is nearly impossible."
Our Comfort Zones
Being fully present, without expectation, available to receive any sensory impressions stretches out of our familiar "comfort zones" into the unknown. This is the curious and exciting innocence we all had naturally as children. Yet as adults, we carry the pain of our past experiences and project them into the future. Instead of acting and reacting spontaneously and naturally, we fear certain "bad" imagined outcomes (i.e. rejection, disappointment, criticism, looking foolish, etc.) and insulate ourselves within a zone of comfort that we imagine will protect us. Thus, there are certain behaviors: emotions, ways of speaking, gesturing, making or not making physical contact that we deem "off limits" We hide inside ourselves and do not venture outside our imaginary comfort zone, if at all possible. When we feel challenged by a situation in which we depart from our comfort zone, we generally react with alarm, quickly try to "fix" the problem, and get back into the comfort zone.
Learning and growth, however, only occur from a level outside the comfort zone. To the degree that we are willing to let the discomfort be, and even increase (but not to the point of injury), we learn and grow. Rather than being frightened by discomfort, if we face it directly with an attitude of curiosity, allowing ourselves to stretch beyond what we thought were our limits, we expand and transcend those limits. We find we can "be" with anyone, perceive who that person is, what he/she needs, and what points are being called for.
The mistake is believing that the comfort zone is safe. Professor Worsley taught that love is our best protection. At first hearing that, many of his students didn't know what he meant. I had patients I didn't even like! We learned a whole new definition of love. Practicing this system of medicine compels us to develop real love, which has nothing to do with "liking or disliking" or getting anything "back" from another. It has to do with a genuine desire to help and is entirely unselfish. It is the experience (not the thought) that the patient and I are connected by a single energy. When we perceive that connection, we are "in love" or "in the energy." In that unity is real safety.
And the Answer Is...
We are protected when we take our eyes off ourselves and focus fully on the patient. Then the separate "I" disappears. Only consciousness remains. There is no "I" to be protected, to be confused, or to figure anything out. In this state of empty receptivity, we feel the patients' imbalances as jarring. We can perceive the odor, color, sound, and emotion as well as the level and what it needs. We feel and sense, rather than think. We follow the patient's track, not our own. When we are focused on ourselves, we are not with the patient.
We do have control over our focus. It's either on us, or on the patient. With our attention on ourselves, we are basically recycling the same 65,000 thoughts (estimated!) that we thought yesterday. In my experience, this gets pretty boring. Equally boring is striving for perfection and trying to get "it" right. However, humility and serving others is utterly fascinating, always new, often challenging, and never boring!
The moment you notice you are not "with" the patient, reconnect. Make physical contact. It is a way to "plug in" your sensing meter. Change position (yours or the patient's) if you feel "stuck" and ask that question that you are genuinely curious about. Notice what you feel in you as your senses resonate with the patient's energy. If you are truly led by curiosity (like a child), with no other agenda, you will feel what the patient feels. You can perceive the Causative Factor, level, and the exact need of the patient. From the pulses, you can know precisely the state of the patient's energy in all 12 Officials. This, combined with the foundational knowledge of Classical Five-Element Acupuncture (including the spirits of the points, natural laws, blocks, etc.) allows you to treat at the level of cause.
After the patient has gone, review the moment(s) that you were not present. Ask yourself where you were. What emotional "buttons" in you were pressed? What did you choose to avoid? How did you distract yourself, and with what thoughts? This is the brutally honest and courageous work we must all do on ourselves to become better and more refined instruments of Nature, entrusted with the handling of the most precious commodity of all: the body/mind/spirit of a human being.
The Art of Practice Management for Acupuncture Health Care Practices
What you will find in this book is a specific, comprehensive approach that gets to the root cause of success in practice.
This new book presents acupuncture practice as art from the standpoint of centering, qi, and wholeness. It builds on the premise that practices succeed from bridging inner and outer aspects of the self. It is an inquiry into the self and addresses clear understandings and approaches to reputable patient care and practice qi. It brings in the five elements and work with the seasons of practice from training and start-up to growth, stability, expansion and transformation. The authors artfully bridges the essence of both patient and practitioner well-being without excluding the practicalities of financial well-being. This book very specifically and extensively shows how the different parts of practice nourish and feed one another and are interdependent on one another for the qi to flow synchronistically.
It explores the dual nature of procedures that work and those which do not in acupuncture health care practice, returning again and again to the delicate balance of practicality and spirituality.