567284533.

doc

Classical Worsley Acupuncture

Our article contains the following sections:

o Foundations of Classical Five Element Acupuncture

o Diagnosis in Classical Five Element Acupuncture

o Treatment Protocols in Classical Five Element Acupuncture

o -- intro and major energetic blocks - internal and external dragons, aggressive energy

o -- entry exit blocks

o -- spirit points

o -- command points

o Case Study

Foundations of Classical (Worsley) Five Element Acupuncture

Posted June 26th, 2006 by Chad Dupuis

Classical five element acupuncture, as taught by the late Professor J. R. Worsley, is thought to have had its base in

ancient acupuncture theory from the period of around 200 BC. It was through this era that the idea of the elements

and their corresponding character types is first thought to have surfaced. Over the last 50 years Worsley had

combined this with ideas from other schools of acupuncture to create what is now known today as classical five

element acupuncture.

Although sharing much with modern TCM it is also very different in theory and aim and encompasses more than

the commonly taught Five Phase Theory. To understand this school of thought and the way a five element

acupuncturist views treatment there are certain protocols which must be understood.

The diagnostic foundation of classical five element acupuncture is the theory of the causative factor or CF. The CF is

thought to be the root cause for most of a patients presenting symptoms. It is thought that through birth or early

childhood a constitutional weakness develops in one of the elements. Over time, this weakness has an effect on the

other elements through the Sheng (mother-child) cycle. The CF is the element which is the foundation for the

imbalances a person may experience and becomes the focal point of the treatment.

As an example lets look at a patient who's CF is Metal. This diagnosis means that Metal (the mother) has been hit

hardest in childhood. This can be either through environmental or emotional causes but eventually it will affect its

1
 567284533.doc

ability to pass on energy to the Water element (the child). The Water element will now also be distressed and show

symptoms as it struggles from the weakened preceding element. In time, following the Sheng cycle, this lack of flow

continues around the cycle until all the five elements are struggling, the patient is in distress and arrives at the

clinic with their list of symptoms. Instead of chasing this list of symptoms coming from the distressed elements, the

acupuncturist goes right for the heart of the problem - the CF - which in this case is Metal.

Once a CF is determined the acupuncturist can choose points on the effected meridians (in this case the Metal

meridians - lung and large intestine) which will impact all the other meridians through the sheng cycle. By

strengthening the CF the patient should see improvements in their Metal related symptoms as well as those arising

from other effected elements.

Determing the correct CF, then, is a crucial part of classical five element acupuncture. The skill required of the

acupuncturist is through thorough questioning, listening and observing to ascertain which of the symptoms is

primary and which are secondary, which are coming from the mother and which are coming from the child, which

element is the causative factor?

2
 567284533.doc

Forming a Classical Five Element Acupuncture Diagnosis

Posted June 26th, 2006 by Chad Dupuis

Diagnosis, which entails determing the causative factor, is primarily done through the
observation of a persons colour, sound, odour and emotions or CSOE.

  FIRE EARTH METAL WATER WOOD

Colors red yellow white blue/black green

Sounds Laughing Singing Crying Groaning Shouting

Odor scorched fragrant rotten putrid rancid

Emotions Joy Worry/Pensiveness Grief/Sadness Fear Anger

The initial consultation with a patient is usually a one to two hour meeting where a thorough history of the patient

is taken. Each of the elements are tested, the person questioned, listened to and observed. Physical routines are

noted; sleep, appetite, alcohol intake is all looked at as a part of an extensive list. The colour of their face, the sound

of their voice, their odour is all observed. What colour comes up on their face through which questions? What is

their body language telling you? How do they answer the questions? Which of the elements do they feel most at

home in or do they respond to as you portray. Everything is information, it is an opportunity to get a feel for the

person as a whole.

The patients emotional and physical well being are also equally important when attempting to determine a persons

causative factor. How they function in the world is important. What was their childhood like? Do they remember it?

What is their ability to have relationships? How is their work history? What are the things they like about people,

what are the things they don't? The answers to these questions all point to an elemental type.

Parental style may also point towards the CF. Parents who over parent, enmesh or abandon can contribute to a

Earth CF. Parents who control the child's behavior with fear can contribute to a Water CF. A household where the

child is not honored, their real being is not respected can indicate a Metal CF. Parents who over control either with

3
 567284533.doc

discipline or too much structure can produce a Wood child. A child who experiences life as an attack, whose

childhood has a lot to do with hurt may show up as a Fire CF.

The process in which a practitioner gets in touch with a patients CF involves many things, including experience.

Developing rapport, or connecting with the patient, is very important. It is also important to watch the way they

interact with you in general. Do they react to the sympathy of Earth, the respect of Metal? Even though it may not

be your own home element does the patient relax when you portray Water, feel safe when you give them the

structure of Wood? Below are a few of the things that you look for when searching for the CF element.

FIRE

A Fire CF will want to have relationship, will want to be equal with you. They may either lack joy or have an excess.

Their colour can range between ashen gray to quite red. The colour will manifest under the skin at the level of the

blood. Even the most ashen gray or joyless Fire CF will occasionally rise like a fire into laughter. Their voice will

have a sense of laughter even when discussing quite grave topics. You can gain rapport with this element either by

going up to the laughter and having a good time or by going down into the lack of joy or sadness. The Fire CF will

feel this to be normal as this is where they live most of their lives. Sometimes the person may show a shy nature or

you may feel they are keeping you at bay with their laughter.

Earth

An Earth CF carries a deep sense of emptiness. The emotion of earth is sympathy and they may convey a sense of

neediness. They will either be the type of person who really wants you to understand all they have been through or

expresses that they "do not need anyone." Their voice will have a sing to it; the colour on their face will range from a

gray yellow to a bright banana colour. This colour will manifest in the flesh. They will have an odour that is sweet,

of blossoms that are slightly off.

Metal

The Metal person wants respect. The emotion of Metal is grief. This is a sense of loss, a feel for what could have

been. This is different than the sadness of Fire. The colour of metal is white; this will show on the skin. It may look

like they have a white powder on. The odour is rotten, like the smell of a butchers shop or of the Large Intestine.

They want to know you are not going to feel better than them. It will feel normal for you to be at a physically lower

4
 567284533.doc

position to them in the room. The space will have the quiet feel of respect, like a church. Any laughter will be at

your expense.

Water

Water is the element of Fear. These people will either be frozen like ice or raging like an over flowing stream. These

people are driven, maybe manic or quiet like a still pond. The colour will show on top of the skin as a ruddy

red/blue. Their odour is putrid, the smell of the Kidneys and Bladder. A Water person lives on the edge of fear

where they have a love/hate relationship with the emotion. A Water CF wants reassurance. Their voice will groan,

have a continuous maybe monotonous feel to it.

Wood

Wood is the element of determination, assertion, of anger. Their main emotion will range between a sense of

frustration to hopelessness. They want to know that you are in control so they can relax. They may feel pushy and

want you to push back. Their voice will have shout or a sense of assertion to it. The colour green will float above the

skin nearly like a glow. Their odour is rancid, similar to that of oil that has gone off; as though the body is not

digesting fats.

Through observing the Colour, Sound, Odour, Emotion and gaining rapport with the person the CF element will

show itself. After that determination is made most of the treatment is used to address a deficiency in that element

and therefore the person. This way it is thought, you can help the whole person grow and change.

5
 567284533.doc

Treatment Methods in Classical Five Element Acupuncture

Posted June 26th, 2006 by Chad Dupuis

Intro and Major Energetic Blocks - Internal and External Dragons, Aggressive
Energy

Once a persons CF is decided upon, the acupuncturist may begin treatment. Within classical five element

acupuncture there is a relatively standard protocol which practitioners follow. Some of these protocols will be

unfamiliar to TCM or Japanese style acupuncturists. Outside of the concept of a CF, these protocols provide the

foundation of what is unique in classical five element acupuncture.

Before a persons CF is directly targeted, there are a few major blocks which - if present - need to be cleared before

the CF will improve with treatment. These are listed below in the order in which they are usually used. If a person

does not exhibit the signs of a particular block, they will not be treated for that imbalance. In some cases, none of

these blocks are present and the first treatment will involve direct work on the patient's CF.

A quick note about needling in five element acupuncture is also appropriate. Generally speaking, needles are not

retained for a significant duration during treatments as in TCM style treatments. The idea behind needling is

similar to that in Japanese style treatments in that you want to use the minimal amount of stimulation on the most

potent points to create the largest effect during a given treatment. Points are tonified by inserting with

the flow of the meridian, twisting it 180° clockwise and then retaining or removing

immediately and sealing the point. Sedation is the contrary, you insert against the flow

of the meridian, rotate 180° counterclockwise and then retain or remove immediately

not sealing the point.

Internal & External Dragons:

These blocks have to do with a relatively significant disruption in the connection between a persons body, mind and

spirit. The Internal Dragons (ID) have more to do with internal causes of disease, whereas, the External Dragons

(ED) have to do with external causes.

6
 567284533.doc

Symptoms:

A patient who has internal a/or external dragons may be experiencing a lack of control over aspects of their body,

mind or spirit. From a practitioners perspective, this is usually experienced as an inability to communicate directly

with the patient, even feeling uncomfortable around the patient. If you cannot look directly into their eyes and

speak with them, if you feel you are not getting honest responses to your questions, if you feel they are not quite

connected with themselves - these may indicate this particular block.

This may show up, but not necessarily so, in patients with histories of drug and/or alcohol abuse, in patients who

indicate that they feel "out of control," or in patients where other treatments have proven unsuccessful.

External Dragons are specifically noted when a patient has the above symptoms and has experienced extreme

weather or climates or an external trauma such as an accident or trauma prior to experiencing these symptoms.

Treatment Points
External Dragons Internal Dragons

GV 20 1/4" below CV 15

UB 11 ST 25

UB 23 ST 32

UB 61 ST 41

Treatment Protocol:

You usually begin with the ID treatment unless it is not called for. All needles should be inserted from right

to left, top to bottom with perpendicular insertions. After the insertion they should be dispersed in the

order they were inserted. What you are looking for is a noticeable change in the patient, in their colour, sound,

odour, emotion and shen. Once you see the change you are looking for, the needles should be removed. If there is

no change after 15 minutes, you should tonify the needles from left to right and top to bottom removing them as

you go and continue the treatment with the ED points.

7
 567284533.doc

Aggressive Energy

The aggressive energy block is another foundational block in the sense that, if present, it is likely that other

treatments will be unsuccessful until it is cleared. This treatment is usually performed after the Internal or External

dragons are cleared, if they were present or suspected in the patient.

Symptoms:

Aggressive energy is considered when a patient has experienced strong psychological a/or emotional stressors. If

suspected it will be confirmed by the appearance of an erythma or redness around the needle insertions.

Treatment Points:

Treatment Points Correspondence

UB 13 Lung Shu

UB 14 Pericardium Shu

UB 15 Heart Shu

UB 18 Liver Shu

UB 20 Spleen Shu

UB 23 Kidney Shu

plus test points at each level inside or outside of redness should be darker at associated shu point than at test
the bladder meridian needles for confirmation

Treatment Protocol:

The patient should be comfortable as the duration of the treatment depends on how long the redness takes to

completely clear or "drain." The needles should be inserted at each of the points listed above bilaterally from right

to left and top to bottom into all of the points except for UB 15 which is inserted after having tested for aggressive

8
 567284533.doc

energy on all of the other points first (i.e. tested alone). The test needles should be inserted after the shu points

have been needled.

If aggressive energy is present you will see an erythema (redness) that appears surrounding the needle which is

different in nature than any change near the test needles. The needles should be retained until this redness clears. If

you do not see any strong changes, retain the needles for a few minutes, remove them and then move on with the

next step in the treatment.

Entry Exit Blocks

After the major blocks described above are cleared, or if they were not present to begin with, the first stage of

treatment involves treating entry/exit blocks. These blocks pertain to the Wei level of the body's energy, the

superficial flow of energy commencing at the Lung and proceeding through the 12 main meridians to the Liver. This

flow and the associated entry exit points (in red) are illustrated in the graphic below:

9
 567284533.doc

The Classical Five Element Acupuncturist looks carefully for blocks along this flow. They are most often seen

between meridians which connect, as opposed to yin/yang pairs such as LV/GB or ST/SP. That is, for example,

between the Liver and Lung not between the Gall Bladder and Liver. The main 6 Entry/ Exit blocks are between

the:

o Spleen (SP) & Heart (HT)

o Small Intestine (SI) & Urinary Bladder (UB)

o Kidney (KD) & Pericardium (PC)

o Triple Heater (TH) & Gall Bladder (GB)

o Liver (LV) & Lung (LU)

Entry/Exit blocks are found by looking at the quantitative differences between the pulses. That is a score noted

between a +3 pulse down to -3 measuring strength. The pulse strengths are concentrated on in classical five

element acupuncture as opposed to the qualities which are used more in TCM. You may also see/hear blocks

described as a IV/V or 4/5 block which is the result of a meridian numbering system used by some practitioners.

The meridians are numbered as such:

1. Heart

2. Small Intestine

3. Urinary Bladder

4. Kidney

5. Pericardium

6. Triple Heater

7. Gall Bladder

8. Liver

9. Lung

10. Large Intestine

11. Stomach

12. Spleen

10
 567284533.doc

A Spleen & Heart Entry/Exit (12/1-XII/I) block can be seen in the example below:

  Left Arm       Right Arm  

  Yang Yin   Yin Yang  

SI/HT -1.5 -1.5   -1 -1 LU/LI

GB/LV -1 -1   +.5 +.5 SP/ST

KD/UB -1 -1   -1 -1 PC/TH

The Entry/Exit blocks are best explained as a dam between the flow of connected meridians. In a Spleen/Heart

block the Spleen pulse will be a zero or slightly plus and the Heart pulse will be weak (-). The Spleen pulse will have

a fairly full, percussive or pushy feel to it. Using the Entry/Exit points clears these blocks. In the case of an Sp/Ht

Block you would first tonify the Exit Point of the Spleen, which is SP 21 Encircling Glory. Next you would tonify the

Entry Point on the Heart meridian, which is HT 1 Utmost Source. Once the blocks are cleared you would expect all

the pulses to be even and balanced.

Treatment Points:

Entry Exit Points

Those entry exit points that are not the first or the last points on the meridian are marked with
an * and the first or last point is within parentheses

  Entry Exit

LU LU 1 LU 7 *(LU 11)

LI LI 4 *(LI 1) LI 20

PC PC 1 PC 8 *(PC 9)

11
 567284533.doc

TH TH 1 TH 22 *(TH 23)

HT HT 1 HT 9

SI SI 1 SI 19

SP SP 1 SP 21

ST ST 1 ST 42 *(ST 45)

LV LV 1 LV 14

GB GB 1 GB 41 *(GB 44)

KD KD 1 KD 22 *(KD 27)

UB UB 1 UB 67

Treatment Protocol:

Once you determine the entry/exit block that you would like to treat you will tonify the exit point of the

preceding meridian and then tonify the entry point on the following meridian.

Spirit Points

The second step in a treatment is planning of the Spirit Points. In five element acupuncture each of the points has a

Spirit name that is heavily relied upon to decide which point is appropriate for the patient. For example, KD 25 is

termed "Spirit Storehouse." KD 25 is used when the person is spiritually depleted, who use their stores up as soon

as they get them. It is for patients who see no joy in being alive. Another example is LV 14 - Gate of Hope. This point

is for a Wood CF who is feeling like things are hopeless. When they are ready to give up, you open the Gate of Hope

to help them move on. With a few exceptions these points are always chosen from the patients CF Meridians. When

tonifying a point it is thought to be important to hold the Spirit of the Point in mind and summon that energy from

the point. That is, your intent when needling should match the intent of the point.

12
 567284533.doc

Some of the more common spirit points used in classical five element acupuncture are:

o Kidney Points on the Chest

o Bladder Points on the Outer line

o Spirit Points on the patients CF

o CV a/or GV

Kidney Points on the Chest

Point Spirit/Usage

"Through the Valley"

KD 20

full of fear, feeling trapped, feelings of negativity, someone facing death, suicide a/or loneliness
"Dark Gate"
KD 21
everything appears as "dark" or negative
"Walking on the Verandah"
KD 22
lacking a sense of protection or safety in the world, cannot walk freely
"Spirit Seal"
KD 23
lack of connection with ones own spirit or identity/self, low spirit
"Spirit Burial Ground"
KD 24
depleted spirit, depression, deep loss of sense of self
"Spirit Storehouse"
KD 25
spirit requires nourishment
"Amidst Elegance"
KD 26
lack of sense of beauty or grace, self respect
"Storehouse"
KD 27
depleted spirit, helps to tonify the spirit of a person

13
 567284533.doc

Bladder Points on the Outer line:

Point Level Spirit/Usage

UB 42 (37) T3/LU Shu metal cf, issues of grief or sadness, experiences of trauma

UB 43 (38) T4/PC Shu fire cf, weakness from chronic diseases, generalized fatigue

UB 44 (39) T5/HT Shu fire cf, spirit issues, emotional/psychological trauma, anxiety, insomnia

UB 45 (40) T6/GV Shu strong experiences of grief, cannot let go of past events a/or losses

T7/Diaphragm
UB 46 (41) issues related to breathing, counterflow qi (hiccups)
Shu

wood cf, issues of anger a/or resentment, lack of sense of purpose in life, depression,
UB 47 (42) T9/LV Shu
drug a/or alcohol abuse issues

UB 48 (43) T10/GB Shu problems with making decisions

UB 49 (44) T11/SP Shu earth cf, obsessive thoughts, overthinking, eating disorders

UB 50 (45) T12/ST Shu similar to above, digestive issues

UB 52 (47) L2/KD Shu water cf, lack of willpower, sense of hopelessness, weakness from overwork

14
 567284533.doc

Appendix

Four Blocks to treatment

JR Worsley taught that there are four important ways that a patient's qi can become
pathological. If any of these 'blocks' are diagnosed then they should be cleared before
the CF is treated.15

'Aggressive Energy'. This method of diagnosing the presence and clearing

xie qi (more usually translated as 'perverse' or 'evil' qi) probably derives
from an oral Taiwanese tradition.16 Worsley taught that patients should
have the back shu points of the yin organs very superficially needled in
order to clear any 'Aggressive Energy' present. If present in an organ it can
affect the yin organ across the ke cycle in a destructive way. 'Aggressive
Energy'  can cause severe problems, physically and/or psychologically.

Husband/wife Imbalance. This imbalance is regarded as extremely serious

and potentially life-threatening. It can also be the cause of severely
disturbed psychological states, especially deep resignation and/or extreme
anxiety. It is diagnosed from the pulses and the condition of the person. The
pulses of the left hand (husband side) should be slightly stronger and
qualitatively superior to those on the right hand (wife side). Transfers of qi
are carried out between the organs diagnosed on the pulses of the right
hand to those on the left until the left hand pulses are fuller.17

Possession. Two treatment protocols can be used when the patient's spirit is
no longer fully under their control. Obsessive thoughts, 'psychic
disturbance', the feeling that 'the lights are on but nobody is at home', or a
deadness or glazed expression in the eyes can all be indications of
'possession'. Psychological trauma or extremely intense emotions are the
usual causes. Either the '7 Internal Dragons' (points on the front of the body)
or the '7 External Dragons' (on the back of the body) are treated to clear the
'possession'.

Entry-Exit Blocks. In Ling Shu, Chapter 16, a circuit of qi is described that starts
in the lung channel, flows through the 12 organ channels and finishes in the liver
channel. Blocks can arise between channels or, less commonly, in a channel. The
point of entry and/or the point of exit is treated in order to clear the block, which if
present, can lead to a significant improvement in the patient's health.18

15