The following was originally written as a class assignment on Five Elements Acupuncture in my otherwise TCM focused Energetics of Acupuncture Points class. It is a very poorly referenced paper, apologies to Lonny Jarrett and Neil Gumenick, from whom the basis of the following was written, and whose own writings would constitute a much more thorough explanation of the required techniques and protocol, which would be necessary before undertaking needling. Needling, of course, should only be done by a registered acupuncturist or someone (e.g. a student) who is practising under the purview of a registered practitioner.
We know that the foundation of Five Elements is that each person has a fundamental constitution. We acquire our constitution in movement away from the Dao, upon our cognition that we are separate from the rest of the universe. We may or may not recall this specific moment but this thread weaves a tapestry of what it is we look for to feel whole and how we interpret events- both favourable and unfavourable. Our constitution can be perceived as our biggest weakness and greatest strength and is understood psychologically in terms of five emotions: anger, joy, sympathy, grief and fear. Illnesses, or qi stagnation, can manifest if we become stuck in one of these emotions, in patterns specific to one’s constitution. For instance, Fire-out-of-balance folks will compulsively enter into relationship after relationship, in a search for and in avoidance of intimacy.
According to this mode of inquiry, we would assume that if a patient was overeating it was because they have an Earth constitution, and are trying to satisfy a lack-of-sympathy with nourishment. A simple, elegant and empirical observation. Except when you become aware of Exit/Entry Blocks you realize that a patient, or a teacher manifesting symptoms of an oral fixation, by obsessively drinking tea, could actually be suffering from an Exit/Entry block between the Spleen and Heart meridians. Jarrett suggests that in this instance, an oral fixation could, in fact, be an insubstantially nourished heart crying out for love.
With Exit/Entry blocks, a patient will not manifest specific patterns! But pattern differentiation is the basis of our practice! How will we diagnose Exit/Entry blocks? Simple! It’s a matter of pulses. Except, pulses no longer have qualities like ‘a pearl rolling in a bowl’ or ‘dancing across grass’ but rather quantities. Pulses are rated from -3 (super weak) to +3 (super strong). If there is a variation greater than 1 point between pulses whose meridians meet, there exists an exit/entry block! These are most commonly diagnosed if, after several treatments using other Five Element protocol, a patient’s pulses haven’t changed.
Okay, so how do we clear it? Easy! You needle the last point on the meridian that is full and the first point on the meridian that is empty (the second point isn’t always necessary). You use a tonifying technique: a quick, shallow insertion and 180 degree clockwise turn.
I did this once for a friend who had a classic ‘liver/lung’ block as evidenced by her inflated Liver pulse and wimpy Lung pulse. She’s one of the healthiest people I know but had just broken up with her boyfriend and expressed a need to ‘bring herself into the world’. I needled Liver-14 “Gate of Hope” to open to Lung-1 “Central Treasury”. She gasped. I was sure that I must have pneumothoraxed her but decided to be sophisticated and waited to hear what she had to say. She explained to me that when I needled this point it was as a secret chamber had opened and her lungs had become longer. She compared it to the discovery of “King Tut’s Tomb.” But the name of LU-1 is Central Treasury! This was an amazing moment. To hear a person, who knew nothing of the name of a point, say the essence of the name of a point made me appreciate the therapeutic importance of knowing the names, rather than the numbers, of points.
So, where exactly would an Exit/Entry block between the Liver and Lung arise?
To answer this, let’s pose a question that some of you might be familiar with: “Where does the Lung Channel Begin?”
a) In the first intercostal space
b) In the Stomach
c) In the Lungs
d) In the thumb
If you answered b). In the Stomach, you got this question totally wrong. The Lung channel does indeed have an internal pathway which begins in the Stomach. However, when we work with exit-entry blocks we are working with the Wei Qi, which runs on the most superficial aspect of the meridians, or, the part which has points.
Some other E/E block notables:
-Exit/Entry blocks can arise from external causes: physical injuries, like scars or long-term illnesses or from internal causes: our constitutional factor, our lifestyle, behaviour or long-term emotional suppression. Lonny Jarrett has this really fantastic case study of an E/E block that has both physical and emotional causes in his book ‘Clinical Practice of TCM’. Read it, if you’re interested. If a patient continually manifests Exit/Entry blocks between two meridians, for example, between Spleen and Heart, Jarrett suggests that this is because they are likely of one of those two constitutions.
-Exit/Entry blocks exist more commonly between two elements than between two organ officials (i.e. we are more likely to have an E/E between Spleen (Earth) and Heart (Fire) than between Heart (Fire) and Small Intestine (Fire)). In these instances, protocol would suggest a Guest/Host point selection.
– Exit/Entry blocks may effect more than one set of meridians. That is, the Spleen/Heart E/E may show up as an inflated Spleen, weak Heart and continue on to a weak Bladder pulse. Exit/Entry blocks run along the meridians in the order in which we have learned the meridians run.
-Exit/Entry points do not always correspond to the first and last points on the meridian.
-Exit/Entry blocks can also occur between the Ren and Du channels. These are considered to be caused by severe trauma, injury or sexual abuse. In this instance there is no definitive excess or deficiency in the pulse but could be perceived as a further imbalance to Husband/Wife Imbalance. Other indications of an E/E block in these meridians would be a weak pulse with no energy problems or perhaps the patient’s energy is okay but they don’t “feel right.” It is often a last resort (no wonder why!) and is used when there have been many treatments with no improvement. Continue to check the pulses after needling each point, when the pulses are regulated then treat the source point on their CF channel.
-Exit/Entry blocks tend to have interesting correlations between their locale on the body and their manifestation. That is, E/E blocks between Yang Officials are situated on the face. They tend to be effected by external reality, mental stagnation and how we receive information. E/E blocks between Yin Officials are on the chest. They tend to be effected by our internal reality, circulation in the chest, circulation in general and real or perceived betrayal of intimacy. Jarrett explains that the presence of the E/E blocks are often created by, and in turn contribute to, erroneous interpretation of reality as it occurs both internally (who one is) and externally (what happens to one). For the mind and heart to function as one it is imperative that any diagnosed E/E blocks are cleared early in the course of treatment. When this is done, the virtues of the five elements: benevolence, wuwei, reciprocity, righteousness and wisdom will emerge.
Lonny Jarrett. The Clinical Practice of Chinese Medicine.
Angela and John Hicks and Peter Mole. Five Element Constitutional Acupuncture.
Neil Gumenick. Exit and Entry Points and Blocks. http://www.acupuncturetoday.com/mpacms/at/article.php?id=30339