overall changes.
They may simplywant relief With this in mind, we canmakea comparison
from a shoulderpain. It was clear to me in
Chinathatpatientsmainlyexpectedrelieffrom
physicalsymptoms.It was alwaysodd to me
io r"" someofthe Chinesepatientsreturnafter
one or two treatmentslooking obviously
better, but sayingthat they were the same'
Those patients invariably began to report
improvementin their symptomsover the next
few visits.It was as if the patientand doctor
had agreed to pay attention only to the
physicalcomplaint.It is anoption' but not the
only one.
The second question concerns the
relationship between the CF and the
syndromesof TCM. Is it the sameto saythat
a patientis an earthCF andthat he is a spleen
Qi xu or spleenyangxu, or, indeed,anyofthe
spleensyndromes?The answerin one sense
appears to be'T'{o."There.itonlyoneCF, but
there can be---or have been-more than one
syndrome.Liver Wind mayhaveoriginatedvia
Liver Fire Blazing, deficient liver yin, and
deficientkidneyyrn.Or it mayhaveoriginated
from depression of liver Qi.
On the other hand, there maYbe some
overlap.What I am sayingnow is speculative-
f LA looJs at the deteriorationof a patient's
Fatttr mainly as a worseningoftheenery-gt
the-CF and its resqlting failure to noud
c- : - en q4{ !o
Fpatient becomesanearthCF at some
cyc-les.
ffige' This means,in effect,that the previous
level of functioningwill not be resumed-in
the sameway that stayingup late for several
weeks in a row can often be wiped out by
resuminggoodsleeppatterns,takingaholiday,
or whatever. This does not mean that any
deteriorationof the other elementshasto be
due to this cause-for example,taking too
many drugs will adverselyaffect the liver
independently ofthe CF.But it doesmeanthat
the most importantpatternof deteriorationis
a spreadfrom the originalweakness,the CF.
90
with TCM which will often trace one
syndromeas havingoriginatedfrom.another,
e.g.,liversyndromes from deficientkidneyyin'
Iflhere was saidto be an original syndrome,
thenwe mightbetalkingaboutthe samethings
asthe CF.
The abovespeculationis not essentialto
LA theory. It is basedon my own clinical
experience.We can now considerone other
basic policy of LA theory becauseof its
relevanceto the CF.
Levels: BodY/lVIind/SPirit
l"LA on
p3{-glgldiagnosis is to assess
*iI"i@e'6fffir
to the notion of body/mind/spirit.
In Chinesemedicinethere are various
termsthat enablea practitionerto specifythe
depthof a disease; and,whilebody/mind/spirit
in some way overlaps these notions, it is
clearlynot the same.The concepthas been
taughtmainlyby demonstration: this patientis
spirit level,that one mentallevel, and so on.
Hencewe haveno explicitdifferentiation.
The following, however,will give some
clarification:
If the symptomsandgeneralwelfareof a
patientva^rymore accordingto food intake,
temperature,or body use,thenthe body level
is indicated.
If symptomsand welfare of a patientvary
mainly accordingto mentalfactors, suchas
stress,then the mind level is indicated.Also
indicativeof mind level would be inabilityto
thinkthingsout, makenormalcauseandeffect
connections,and set and maintain ordinary
goals.
On the other hand, if the Patient's
problems center around inabilities-"I
ss1'1s"-lvhich are curiouslyunsupportedby
any lack of physicalor mentalresourcesand
whiclu therefore,seemto come more from a
lack of motivation or will, then the spirit level
is indicated.
The use ofthe distinction gives us a further
indication as to its meaning. Determining the
level affects three areas:
l. patient management,
2. the intention when needling, and
3. the selectionof points.
In one of J. R. Worsley's interviews, he
illustrated the effect of determining the level
on point selection:
q"*"t?rd pggls wherethe
lre.ngintl meant
is contmanded.
.energ'y Bythis is
not just ih" glgg ,!th. !g!Y but of
the mind arylggirit as well
@ o n e ca n reach
the deepestlevel from the command
points.The trouble is that it may take
a considerable amountoftime. Forthis
reasonwe usethe other pointson the
body which canenableus to reachthe
damagemore effectivelyand perhaps
more quickly. (Traditional
Acupuncture Society Newsletter,
October1984)
Wecan return now to lll's understandingof
the causesof disease.
Causesof Disease
TCM refers to internal, external, and
miscellaneous disease factors. For each
syndromethere are indicationsof how these
factors and alreadyexistingdisharmoniescan
causeand help maintain a This
disharmony.
91
information is used in a practical way to
understandhow a patient becameill and what
the patient can do to help herself get better'
LA also teachesthe internal and external
causesof disease,but makeslittle referenceto
the miscellaneousfactors. Most attention is
not havethe
relatestypical causesto specificsyndromes.
This may reflectthe differencebetweena CF
and a syndrome.In practice, however,LA
practitionersare often aware of, and pay
attentionto, the factors that they know are
currently contributing to their patients' ill
health.
With respectto causesof disease, thereis
one other important difference.I-g-lgrye
notion of phleg& *g!pige-I*-U44(--:td
!EE-*!tg"ps-i,9-c-94-dery-:ggq99-Qtdisease.
These may be the result of some other
energetic deficiency und ry.-!auejq-!"
treated directly. alongside treating thq
underlying deficiencv.In LA there.is no
theorA[d framework for dealing with the
resultingmixedxu/shicondition.
Wecan now go to the notion of blocksin I/1.
Thesearedifferentfronu but havesimilarities
to, the secondarycausesof diseaseof TCM.
Blocks
LA describesvarious conditions that are
impediments to thesuccessof treatmenrbased
aroundthe CF. They vary in significance, but
what they have in cornmonis that theymust be
dealt with directly. Otherwise, further
treatment,howeverappropriate, will havelittle
or no effect, or may evenhave a worsening
effect. In this respect,these conditionsare
marginallyanalogousto the secondarycauses
mentionedabove.

AGGRESSIVEENERGY,qardlgbe"!d
or "malicious"form.of
an orgarLis a "bad"
*-r- -.
energv tnat mu$ 5e withdrawn from the
personvia a very specifictreatmentprocess
which is labeled "tapping for aggressive
energy."When aggressiveenergyis present,
not only is other treatmentunlikely to be
but sometreatmentswill actually
successful,
encourageaggressiveenergy to appear in
other organs, thus worseningthe patient's
condition.
TIIE HUSB AI{D-WIFE IMBALA}{CE is
a conditionin which one"side"of thepatient's
englrygets split from the otherandthe normal
balanctand interaEoi no io-ngerexists.By
"side" is meant,on onehand,the heart,small
intestine, liver, gall bladder, bladder, and
kidney organs, ild, on the other, the
remainingorgans. Neither the manifestation
nor diagnosisof the block is easyto describe
briefly, but its effect is a severeblock to
successful treatment.Readingof the pulsesis
usually essentialto diagn6sFFtfimfiAiari on.
TIIE *INTERI{AL OR EXTERNAL
DEVILS" is a label appliedto a condition
whictr, alternatively, is referred to as
oossession.
^-e2-
The specificsof the natureof the
ifib-alance.how it manifestsand how it is
correctedare not relevanthere,exceptto say,
agaiq that it is seriousenoughto createin
many casesvery severeand often bafling
symptoms. Normal treatment will be
unsuccessful.
EKT-ENTRY blocksoccur betweenthe
end of one channel and the beginning of
another,e.g.,betweenLiver 14 andLung l,
92
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
Theaimsof LA diagnosisareto determinethe
patient's CF, the te"el of the patient's
ffiUffi;, *trether moxa is aPProPriate,
whether the patient requirestonific4lgg
sedation,andwhetherthere are anyblocksin
iiFe referredto above-
Thedffirences in theorybetweenLA and
TCM areaccompanied by variousdffirences
inthe diagnostic Althoughall schools
proce.ss.
start with looking, listening, asking, and
touching, there are important variationsin
emphasis.
There are three important differences
concerning the differential diagnosis of a
disease, tongue diagnosis, and pulse
diagnosis.
LA doesnot usea differentialdiagnosisof
a disease.If a patient comesin with facial
paralysisor dysmenorrhe4theLA practitioner
does not have at her disposal the typical
differentiation according to stagnation of
blood,stagnationofQi, accumulationof cold,
etc. The reason for this should be obvious
from what has gone before. An LA
practitionergoesfirst &,r the CF; the patient's
symptomsor the diseasedo not play a primary
role in the diagnosis.
Tongue diagnosisis simplynot used;and
the questionoften arisesas to why not? One
likely reasonis that many of the diagnostic
categoriesassociatedwith condition of the
tongue are not part of the languageof LA.
That a purpletongueindicatesblood stasisis
not useful when "blood stasis" is not a
meaningfulterm within LA.
Pulse diagnosis,on the other hand,is
used in LA and appears to be given a more
important place than in TCM. Pulses have
tlnee specific uses. One use is to read the
energetic condi$g ofthe individual organs;a
second is to determine whether the patient
requires tonirtcqfion or sedotion: a third is to
evaluateth" elfuctiu"nest o.fat atthe
"om
time of treatment or at the patient's
subsequentvisits.
The Pulses
The taking of the pulsesis different from that
in TCM. LA studentsare taught to record the
"strength" of the pulse at the different pulse
positions and at a superficial and deep level.
The position/organ correspondenceis that of
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
in the deepposition. (See "An Introduction to
Pulse Diagnosis" n The Journal of Chinese
Medicine, No. 14.) No use is made of the
basic,traditional twenty-eight pulse qualities.
The omission of thepulse qualities ls not
explained. Again, as with the tongue, the
significanceof many of the pulse qualities is
expressedin concepts not used in LA.
The use of pulsesto evaluatetreatmentis
worth some comment. Although LA does not
use the twenty-eight pulse qualities,
practitioners find it hard to pay attention only
to strength, and, therefore, inevitably record
quality. They often usea continuumfrom good
to bad quality, applyrng either to one pulse
position or to the overall quality of the pulse.
LA practitioners take pulses after or during a
treatment; and if there is an improvement in
"quality''in the above sense,this will be taken
as an indication that the treatment will be
effective. This ability to evaluatepulse quality
becomesrefined with practice and is naturally
combined with observation of chanees in
93
color, sound,emotio4 andodor. Someof the
obvious of better are the )t
smoothness,
important when the quality ofthe various pulse
positionscomesclosertogether.As with many
other aspectsoflAt the conceptof qualityhas
not beenmadeexplicit and is therefore difficult
to specify.
The Diagnosis
We can now turn to some of the overall
differencesin the processof the diagnosis.
Diagnosisin LA variesfrom TCM in several
ways. One is the relative unimportanceof
askingspecificinformationtypequestionsand
interaction
--...-_;_.-z----;;-
with the patient in order to create
meaningfulor "true" patient responses.A
fur ther oneist@to
developthe diagnosis.I will look at these
differencesseparately, althoughbriefly.
Observationand Questions. In TCM
part of anyspecificpatternof disharmonywill
not be observable in the context of a
diagnosis.Hence the importance of asking
about such things as whether there is an
aversiontocold,whenthe periodpainoccurs,
whetherthe thirst is for hot or cold drinks.
In L4 it is irypg4ant to lrave a. clear
recordof the patient'ssymptoms..partly for
coF-@sis, but more for
algesqlng the changes that o
As discussed
ttg4t!0e41!, above,symptomsare
not important in the diagnosisof the CF.
Therefore,the cruciallyimportantfactorsare
onesthat can be observedat the time of the
diagnosis- color, sound, emotion, odor,
and pulses-and theserequireacate sensory
discrimination and obsertation of non-verbal
behavior.Thisemphasis is a relativedifference
betweenLA andmodernTCM-
Anotherdifferenceis theLApractitioner's
interactionwith the patient in sucha way that
a "truer response" and therefore truer
informationis obtained.This is a largesubject
in itselfanddifEcultto explainbriefly;but it is,
nevertheless, fundamentalto the processof
diagnosis in LA.
Quality of Patient Response.Assume
that a patientis describinghermajorcomplaint
or any other aspectof her life. The way the
practitioner is responding (especiallynon-
verbally)willfeed backto the patientand be
extremelyimportant in determiningwhether
the patient expressesherself guardedlyand
from the surface or openly and from her
depths.In LA" the aim ofthe practitioneris to
respondwith sufficientemotionalflexibility so
that closerapport is obtainedandthe patient
revealsherselfinan openandunguardedway.
This impliesthe ability to create a variety of
emotionalcontextsin responseto the patient
andis clearlya skill that takestime to develop.
It does,however,promotea differentquality
of responseand informationfrom the patient.
In thecontextoffinding the patient'smost
inappropriateemotiorqthis processhasbeen
labelled"emotiontesting." The practitioner's
responses canbe consideredas questionsand
the patient's responsesas answers. This
processis an importantpart of LA diagnosis.
Treatment and Further Diagnosis-
Another assumptionin LA is that treatment
itself canfurtherthe diagnosis.Although it is
important for the practitioner to commit
herselftoa diagnosisbeforetreatment,it is an
ideal attributed only to the mature and
experiencedpractitioner that a complete
diagnosistakesplacefirst and that treatment
merelycarriesout the diagnosis.For example,
the practitioner may know that there is a
seriousblock to treatment,but be unableto
labelit either"aggressiveenergy''or "devils."
The treatmentto removeaggressiveenergJ,
94
which will not harm the patient,is a way of
sorting out the diagnosis.Pulse and-patient
,"rpoir" to the treatment are used in the
assessment.
Another exampleariseswhen the CF is
first treated.Assumingthereare no blocks,it
is expectedthat all pulsepositions-except,
perhaps,the CF-will improvein quality and
quorttty.If they do not, thenquestionsarise
suchas "Is this elementreally the CF?" "Is
therea block that hasnot been recognized?"
This illustratesthe useof feedbackat the time
of treatmentand the diagnosisas an ongoing
process.
Similarly,it is a principlein LA to grve
minimal treatment."How muchis minimal?"
can often only be revealedby the treatment
itself. So, again,carefulassessment of how a
patientrespondsis itself informationthat will
be usedin determiningfuturetreatment.
A relatedpoint is the importancein LA of
continuing the diagnosis throughout
treatment.In J. R. Worsley'swords:
During these subsequenttreatments
this is what we should alwaYs be
doing, to keeP questioning and
communicatingwith the Officials ..-.
All thesequestionsshouldarisesothat
eachtreatmentis not just a movingon
but a questionand answerwith the
OfEcials. (Traditional Acupuncture
SocietyNewsletter,October1984)
These are the major differencesbetween
modernTCM andLA diagnosis'
We can now look briefly at treatment and
treatmentPlanning.
TreatmentPlanning and Treatment
The answer to the question""How is LA
treatmentdifferent?"followsfrom the theory