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  • April Hulvershorn

Diagnosis in Five Element Acupuncture

Updated: May 5, 2020

A few months after setting up my private practice, I got a call from a prospective patient. Aimee was referred to me by a friend and had questions about whether or not I could help her with knee pain. Her tone was confrontational from the beginning. “What is your training? Are you certified? How much experience do you have?” she asked in a challenging manner. She seemed irritated with me from the start. I did my best to answer her questions in a straightforward manner.

When we got off the phone, a colleague popped her head in and asked what that was all about. Apparently, I had unconsciously matched Aimee’s tone – my voice was sharp and my speech staccato with force behind the words. This is not my normal way of speaking. It dawned on me that I had my first pieces of diagnostic information: the sound of her voice (shouting) and an emotion that was inappropriate to what was happening in the moment emotion (anger).

Although the actual content of what a patient says is important, in order to really understand a person and diagnose the energetic balance within them, we pay a lot of attention to four categories of sensory communication. Over the phone, two of these four are available, sound and emotion. In Aimee’s case, the sound of her voice was obvious. She was shouting during our entire conversation, her words punctuated and forceful. The emotion also came through. It was clear that she was deeply frustrated. I also became frustrated, catching her emotion.

Shouting and anger are natural expressions that we all exhibit at times. It is often understandable and appropriate to be angry. In Five Element diagnosis, what we are watching for are the inappropriate expressions of sound and emotion. The places where we are stuck; where an emotional expression does not move fluidly through our being, but is either under or over expressed. From what I experienced with Aimee on the phone, I could not draw firm conclusions, but I could take note of what I heard and felt. Only more experience with her would allow me to see if these signals would lead me to understand how to help her at a deep level.

After that phone call, I assumed that I would not be meeting Aimee in person. However, to my surprise, she called the next week to schedule an appointment. When she arrived, Aimee declined the chair I offered and paced the small room, clearly irritable and very frustrated. She told me about the knee pain she was having and how incredibly annoyed she was to be experiencing it. The doctors she had consulted were steering her toward surgery. As she moved about the room, I became aware of an odor. She smelled rancid, like oil that has gone bad or has been overheated. I also noted that there was a greenish tinge on her face.

The sound and emotion that I noted on the phone were on display in person as well. Aimee sounded frustrated most of the time and about most things, even when the conversation shifted to her sweet dog and lovely garden. It became clear that this was her default response to just about everything. Because emotions are contagious, a big clue for me is noticing how I feel when I spend time with someone. In general, I am not quick to anger, but with Aimee, it took a lot of presence of mind to not erupt.

At this point, I had enough sensory information to make a preliminary diagnosis. All four signals of sound, emotion, odor, and color pointed in the same direction. From these details, the diagnosis that her Wood Element was out of balance emerged.

She went on to tell me that she had a lot of difficulty sleeping and often relied on sleeping pills to get through the night. To compensate for the lack of sleep and grogginess from the pills, she drank many cups of coffee and relied on kick-boxing and cross-fit to keep her energy going and release emotional tension. Although she had a financially rewarding career, she jumped from job to job within her company, doing good work but then blowing up at co-workers. She was labeled “difficult” and many people at work steered clear of her. She felt stuck and hemmed in, unable to make the kind of career progress she desired and longing for more adventure and travel. She worried that pain in the knee was a harbinger of things to come – a slow physical decline that would prevent her from living fully.

Over the years that I treated Aimee, I watched as she grew into a better version of herself. As her Wood Element became more balanced, she became less irritable and frustrated. With each treatment, her voice and emotions softened and her warmth and humor were more accessible. Her mind became clear and lucid. As she regained her emotional equilibrium, sleep came naturally and she was able to let go of her medication. This in turn led to a diminished need for caffeine. As her frustration eased, tension in her body unwound and the pain in her knee and other joints lessened. She switched from her vigorous exercise routine to movement that emphasized smooth, relaxed flow.

In the beginning, Aimee's Wood Element reminded me of a tree that has grown twisted in on itself, rather than reaching up toward the sun. As the branches untangled and straightened out, she became more expansive and upright. Her clarity, vision, and directness became assets. She was more able to work cooperatively with co-workers and rarely exploded, catching herself before she boiled over and finding other ways to vent her frustrations. She eventually found a role at work that really suited her and became highly acknowledged for strategic thinking and team leadership. When she was offered a promotion and a move to Europe, she jumped at the change to expand.


Note: For me there are serious ethical quandaries involved in writing about clinical work. On the one hand, patient stories are very useful for teaching or sharing information. On the other hand, there is nothing more sacred than the trust placed in me as a practitioner and a big part of that trust is strict confidentiality. So, in all of my writing I make the people up. They may be influenced or inspired by people I have treated, but they are invented for the purposes of sharing and communication.

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