17. EXAMINATION OF THE ABDOMEN. Although LA does not employ examination of the tongue, which plays such an important role in TCM, it does make use of two procedures which occupy an equally important place in Japanese traditions, but are conversely less important in TCM. The first of these is examination of the abdomen, or Fukushin, also known as Hara diagnosis (Matsumoto and Birch, pps. 46-47). Originally a Chinese idea mentioned in the Nan Jing (Chapters 16 and 56), it later flowered in Japan where numerous methodologies and interpretations were developed by practitioners of both the herbal Kampo and acupuncture traditions. In examining the abdomen, different areas are associated with the various Organs and palpatory findings correlate to their associated Organs. The locations on the abdomen in LA which correspond to the various Organs are essentially the same as those taught in Meridian Therapy, and are based on the Nan Jing. Hashimoto and Schmidt were largely responsible for introducing this procedure in Europe.
18. THE AKABANE TEST. Perhaps the clearest evidence that the style of acupuncture I have designated as LA could not possibly be identical to that practiced in antiquity, as its founder has claimed, is its inclusion of the Akabane Test, a procedure named after the twentieth century Japanese practitioner who devised it. The test uses a burning stick of incense to test the patient’s heat sensitivity at the terminal nail points of the Meridians, for symmetry between the left and right sides. Any asymmetry found indicates an imbalance or malfunction of the associated Meridian or Organ, and can be corrected by one of several treatment protocols. LA specifies the treatment of choice as tonification of the Luo or Connecting Point of the involved Meridian on the deficient side (i.e., the side less sensitive to heat). The test was developed by Akabane Kobe (see Figure 158) one of the numerous practitioners Schmidt met in Japan, and whose works Schmidt publicized in Europe. The inclusion of the Akabane Test in LA is one of the more compelling arguments for identifying Schmidt as the German physician who had strongly influenced Worsley’s thinking. Worsley was fascinated with the Akabane Test, and there were a number of occasions when the author observed Worsley predicting in advance which Meridians in a given patient would exhibit an Akabane imbalance, and on which side they would be deficient. Although Worsley gave no explanation for how he did this, the most likely explanation would appear to be that he was perceiving asymmetries in the Elemental colors on the two sides. The existence of imbalances between the left and right halves of a single Meridian had been described prior to the discovery of the Akabane Test, and in Niboyet-2, pages 68 to 71, their identification by pulse diagnosis is explained in detail.
19. THE CAUSATIVE FACTOR. Having ascertained that LA was developed syncretically from many sources, it should not be surprising that the component teachings of LA have themselves evolved over time. Thus, based on interviews with a number of Worsley’s early students from the U.S. and U.K., it appears to the author that the notion of the Causative Factor was one of LA’s more recent developments. The Causative Factor, or CF, is now the basic diagnostic finding in LA, specifying the Element or Official which will receive the most attention in the formulation of acupuncture treatment for each patient. In the earliest days, the conceptualization of diagnosis seems to have been the least developed aspect of LA. In those early days, treatment was aimed at rebalancing the patient’s energy based on the color, sound, odor, emotion and pulse findings, but there was initially no presumption that all of these findings on examination would point to one Element or Official–indeed it was common for examination findings to point to two, three or more different Elements. With the introduction of the concept of the CF, there has been a gradual tendency for LA examinations to show more coherency around a single Elemental imbalance. The technical definition of the CF is that it is the Element or Official whose chronic state of imbalance can not be completely corrected by nature itself, and which in turn is responsible for producing or at least allowing imbalances to develop and persist in the other Elements or Officials. The CF thus becomes the primary focus for acupuncture treatment. A pragmatic rule for identifying the CF was developed by one of Worsley’s American students, Jim McCormick, a rule which he called the “three legs of the stool.” By this rule, at least three findings from color, sound, odor and emotion should point to the same Element in order to establish it as the CF. This rule is not without exceptions, the author having observed Worsley himself deciding on a CF with less than three corroborating legs, and in one case identifying a CF in a patient who had no “legs” at all associated with the CF! These latter cases are, however, the exception rather than the rule, but they do indicate that perhaps the concept of the CF still awaits a clearer articulation. While TCM has no concept strictly paralleling that of the CF (although its syndromes do most commonly focus on one Organ), other traditions with a more predominant Five Element basis do. Thus, the various schools of Meridian Therapy in Japan and the Korean Constitutional style of acupuncture all specify a particular Element and Organ as the focus of treatment for each patient based on Five Element considerations, although they differ in regard to beliefs about when this predominant imbalance becomes established in life, and how invariant or changeable it may be over time. LA does not establish any dogma about when the CF originates, although it is almost always determined before childhood is over, and does not change over time (Worsley-3, pps. 29-30). Fukushima employs the concept of akashi in a manner that closely parallels the notion of CF, but in the case histories cited in his book, the akashi does occasionally change over time. For Honma, constitutional types, a parallel concept, were fixed, and in the Korean Constitutional Acupuncture style taught by Kuon Dowon, the constitutional types are not only fixed, but genetically inborn. The question of constitutional types has a very long history of discussion in Oriental medicine and was originally mentioned as early as the Nei jing (Ling Shu, Chapter 64). As a final comment on Worsley’s inclusion of the concept of the CF in LA, I should once again mention the occurrence of this term in the writings of the Protestant missionary W.R. Morse, who also mentioned the Five Elements, the Officials and the phrase “Body, Mind and Spirit,” each of which appears as an entry in this appendix. It would not be surprising, therefore, if Worsley took some inspiration from Morse in formulating his concept of the CF.
20. ELEMENT WITHIN ELEMENT. To a first approximation, the identification of the CF establishes the diagnosis in LA. There are, however, two further levels of diagnostic specificity that can be useful in understanding the symptomatology, and in choosing the most appropriate treatment. The first of these is called “the Element within.” Each of the Five Elements is conceptualized as itself being composed in turn of all of the Five Elements, so for example, Wood is composed of Wood, Fire, Earth, Metal and Water. This level is called the Element within the Element. Thus, a patient diagnosed as a Wood CF might be further diagnosed as having Fire within, meaning the Fire is out of balance within the Wood. The basis for diagnosing the Element within is the same as for diagnosing the CF–it is reflected in the patient’s color, sound, odor and emotion. According to Worsley, the Element within causes a shading of the predominant color, sound, odor and emotion rather than a second distinct color, sound, odor and emotion. Thus in a Wood CF, Fire within, the green color would be a slightly reddish green, the odor would be a slightly scorched type of rancid, etc. The element within is itself in turn composed of each of the Five Elements, and in LA, diagnoses are formally specified to this third level: Element within Element within Element. For example in the previous case the complete Elemental diagnosis might be Earth within Fire within Wood–meaning Wood CF (primary), Fire within (secondary) and Earth within that (tertiary). Again the process for determining the tertiary diagnosis is analogously based on color, sound, odor and emotion. Without going into details, it is easy to see that the secondary level, or Element within, has a physical correlate in the Meridian system: Each Meridian corresponds to one Element, and also has a Point for each of the Five Elements along its trajectory. Thus the Liver and Gallbladder Meridians corresp
onding to our hypothetical Wood CF each have Fire Points (the Element within), Liver-2 and Gallbladder-38, that might be the most effective Points to employ at a given stage in this patient’s treatment using the Element within Element approach, which is an advanced level of treatment.technique in LA. Some strategies for employing the concept of Element within Element, based on passages in the Nei Jing and Nan Jing, can be found in the article by Leung, and this issue is frequently alluded to in the various schools of Meridian Therapy. Strategies for employing the tertiary level of Elemental diagnosis have not as yet been articulated, as far as I know.
21. BODY, MIND AND SPIRIT. The second type of further diagnostic specificity in LA relates not to the Elements, but to the level of Body, Mind or Spirit that is the focus of the patient’s imbalance. Bodily imbalances are usually the result of simple physical trauma–a sprained ankle for example. Mental and Spiritual imbalances can also present with physical complaints that can mimic Bodily imbalances, as for example in many cases of arthritis of the ankle. The distinction is not in the nature of the symptom, but in the underlying cause which can only be discovered by a holistic evaluation of the patient’s overall state of health–is their thinking appropriate and coherent on the Mental level, and are their values and goals those of someone in balance with themselves, their family, society and their environment on the Spiritual level? The diagnosis of the level involved has implications not only for understanding the severity of the patient’s illness (prognosis) but also in the choice of treatment strategies. Certain Points have more powerful effects on the Mental level while others act more powerfully on the Spiritual level (see the entry on Spirit of the Points). While the terminology of Body, Mind and Spirit would appear to reflect the influence on Worsley of Western authors such as Morse, it also appears in the quotation from Ohsawa cited previously, “You can determine the stage or depth of the illness, evaluate the degree of physical, physiological, mental or spiritual disease. This latter category of illness is the hardest to cure, but unfortunately it’s very widespread. Spiritual blindness is a much worse affliction than mere physical blindness.” (Ohsawa-1, p. 38). One might add that in fact spiritual blindness can be the cause of physical blindness. LA, in its emphasis on diagnosing the Elemental imbalance (CF) and level (Body, Mind or Spirit), employs a non-symptomatic approach to diagnosis (reflected in a non-symptomatic approach to treatment as well). Thus blindness, for example, tells us no more about the essential diagnosis (CF, level) than would a swollen painful ankle. Both complaints might even be expressions of an identical diagnosis! Similar non-symptomatic approaches to diagnosis and treatment were described by both Bach in the Western literature, and by Ohsawa who wrote that, “One should never try to simply eliminate (the patient’s) suffering, pain or other symptoms.... Symptomatic treatment is actually complicity in the original violation of natural law which was responsible for the problem in the first place.” (Ohsawa-1, p. 92). Ohsawa’s comments reflect the impact of Shinto and Daoist lineages on LA.
22. ENERGY TRANSFERS. It is only in the realm of treatment that the tenets of LA become relatively more objective that subjective. Thus the exact location of a Point, the state of the pulses, the identity of the CF and the level affected in a given patient may all be open to disagreement between practitioners, but given a specific pulse pattern there are clear-cut treatment protocols in LA that will help to restore balance, even if the CF and level are unknown. These protocols in fact formed the basis for treatment in LA prior to the development of the concept of the CF. For this reason I have called these rules for achieving balance by transferring energy, the “central dogma” of LA. Curiously, this most objective component of LA is the one with the least clearly articulated historical precedent. Even as early as the Nei Jing, the concept of transferring energy from where it is Excess to where it is Deficient is clearly implicated (e.g. Ni’s interpretive translation of Su Wen Chapter 5 states, “If there is a qi deficiency in a particular location or channel, the qi can be conducted or guided from other channels to supplement the weakness,” while Lu’s more literal translation simply reads, “energy deficiency should be treated by the energy induced from other regions”), however none of the early classics described any specific methods for carrying out these transfers. The use of energy transfers depends on knowledge of both the Five Element cycles of Creation and Control, and the Command Points of each Meridian. The Five Element cycles are described and illustrated in Chapter Two and operate via Secondary Vessels as indicated in entry No. 4 of this appendix. The Command Points constitute that category of Points with predictable actions on the energy balance within and between Meridians, and includes the Tonification and Sedation Points as special cases of the Five Element Points, the Source Points, the Connecting (Luo) Points, the Alarm (Front Collecting or Mo) Points, the Associated Effect (Back Shu) Points, and the Entry and Exit Points. The concept of Command Points, so crucial to an understanding of energy transfer strategies, was apparently first mentioned in the West in Niboyet-1, p. 167 (1951). Niboyet’s source for these aspects of his teachings (not derived from Soulié de Morant) was an anonymous Chinese instructor, and although no definitive lineage can be established for the various energy transfer protocols, they do appear to be Chinese in origin. The British College of Acupuncture with Worsley as Chairman, taught this methodology from its inception, i.e., before Worsley’s first visit to the Orient (it is mentioned in the Acupuncture Association Newsletter, July 1965) and as such it represents an early stratum of the material which later became incorporated in LA. The most obvious source for the presence of these teachings in the BCA would be Jacques Lavier, who taught Worsley along with most of the other BCA faculty members in 1963. Lavier published some details of energy transfers via the Five Elements in his translation of Wu Wei-p’ing’s textbook, but I have been unable to corroborate any of the various hypotheses for where he had learned this material, including his own claim of its Taiwanese origin. I have indicated in the text my reasons for favoring the hypothesis of Ed Wong from Singapore as his most likely Oriental source. Two other treatment strategies, the use of Horary Points and the Four Needle technique, point to earlier methods based upon which the idea of transfers might have developed. Horary Points are the Points on a given Meridian that correspond to its own associated Element, especially when used during its associated (two hour) time period. These Points which are commonly used in LA are associated with the biorhythmic (zi wu liu zhu fa) and phase energetic (wu yun liu qi) schools of Chinese medicine, which started at least as early as the Tang dynasty. Important contributors to these schools of thought, whose work laid a foundation upon which energy transfer methods could have been developed, would include Dou Han-qing and his son Dou Gui-fang (who described the use of the Five Element Points in phase energetics), Hua Shou (who described the open and closed times of the Command Points in biorhythmic treatment) and finally, Xu Feng and Gao Wu (who developed the concept of Tonificiation and Sedation Points as special cases of the Five Element Points). The Four Needle technique, while employing Horary Points and effectively though indirectly transferring energy, is derived from a different acupuncture tradition having been proposed initially by a Korean Buddhist monk, Sa Am, in the 1600’s. Conceptually, it strengthens Deficient Meridians and sedates Excess Meridians directly, although the new state of balance it engenders can be thought of as equivalent to an energy transfer. In keeping with its disparate origin, it entered LA not through Lavier, but via the published work of Mann. The Four Needle technique is still commonly used by practitioners in Japan and Korea as a repeated protocol for “root” treatment, while the transfer treatments used in LA are generally not repeated, since the pulse pattern upon which LA treatment is based is felt to be much more variable from session to session than it is in these other styles. Worsley adapted the Four Needle technique for use in LA in the special circumstance of a Husband-Wife imbalance, in which case it can be repeated until the H/W is broken. Future investigators are cautioned to clearly distinguis
h the conceptual differences between energy transfer strategies and those akin to the Four Needle technique in trying to further elucidate the origin of the former. The logical place to look for some mention of transfers would be in the Great Compendium of Yang Ji-zhou which has not been translated into English yet. The only definite mention, with specific examples, of energy transfers in the Oriental literature of which I am aware is in the book by Fukushima (p. 161) where the Chinese term “shu” is used–the same term which is the collective name for the Five Element Points, and is more commonly translated as “transport.” Fukushima describes transfers in the same sense as in LA, meaning a technique that is applied to a Deficient Meridian to attract energy to it from an Excess Meridian. The examples he gives include treating coupled Meridians and those in Control cycle relationships. One final point about the transfer protocols, is that there is no universal agreement among the various sources that describe them. The most common areas of difference concern the manner of use of the Connecting (Luo) Points and the Points to transfer energy via the Control cycle, while everyone seems to agree on the protocol to transfer energy via the Creative cycle. The whole subject is far too complex for a thorough presentation here, but the basic protocols employed in LA are as follows:
In the Footsteps of the Yellow Emperor Page 26