This case study is an exploration of some of the emotional issues surrounding fertility and conception as well as the wider questions of conception and destiny. The study outlines a patient's presentation for treatment and how the issue of conception arose as part of the ongoing narrative of her health and her wellbeing. The telling of the case progresses according to the tradition of Five Element Acupuncture, and an understanding of the elements as a textured presentation of qi, strongly influenced by qi gong teachings. The discussion acknowledges some of our contemporary professional approaches to fertility and explores how we as practitioners might cultivate, perhaps even facilitate, the impossible dialogue of destiny surrounding childbirth.
Introduction Angela came for treatment for general health and wellbeing, having received acupuncture treatment previously. She contacted me on the basis of a referral from another practitioner, having recently moved to the area in which I practise. Not being new to acupuncture, the ‘main complaint’ that I would have usually enquired about did not arise especially, as those immediate concerns she had originally presented for had expanded into a wider understanding of wellbeing. But that being so, at the initial consultation we did review her case history, and some of the emotional challenges that she had encountered with regards to her family history. These centred upon a traumatic close bereavement when she was 19 years old, and of which she said, “The experience stayed potent, I didn’t think it could go, and I carried it around in my chest.” She spoke of how “treatment helped shift things”, and that she was “more at peace with things now”.
Angela was successful in her work and had been able to relocate to a different area of the country with a capacity to work from home. She was in a long-term relationship and was happy in that. Whilst the potency of grief that she had carried in her chest had moved on, her main concerns centred around an ongoing anxiety about “a fear of failing, of disappointment, of not being well received, always the fear that something is going to go terribly wrong.” Whilst Angela’s traumatic bereavement at the age of 19 had triggered the “potency” in her chest, it was also clear that there had been a history of emotional challenges earlier on in life. This, she related, was her anxiety as a child who “wouldn’t say anything” (file note [i] of acupoint Bl 43 shen tang – strength of heart/’dignity of knowing the deep peace of boundaries’ [ii]).
Physically, Angela was generally healthy. She was tall and inhabited her height well, although tension in her shoulders was probably both stress induced as well as postural. Her menses were within a normal range, and her other systems and diet were unremarkable save a tendency to low blood sugar, which probably greatly contributed to the “irritability” that she complained of.
Finally, Angela reported that she was “not able to understand death” and had a “fear of losing life” (file note of acupoint Du 4 ming men – initial foundation of life/’balance of primal and eternal fires’ [iii]).
Diagnostic criteria As with much of Five Element Acupuncture practice, the narrative of a patient’s story and the detail of their symptoms are considered within the overall quality and nature of their qi. This is profiled through the element of the causative factor (CF) and the elements within, and for Angela this was fire (metal) (water). This is normally diagnosed through the colour, sound, odour and emotion of the patient and detected by the heightened perceptual skills of the practitioner. Thus, Angela displayed a red colour, a laughing voice, a scorched odour and a joyful emotion in an indication of her CF being one of fire. The subtlety of that diagnosis, however, and how it told both of her symptoms and her story came through in the elements within the CF, and the texture of the qi itself [iv]. Radiance is a general feature of those with a fire CF but presents very individually. Angela’s colour and radiance flushed quite readily across her cheeks, but was not the malar flush of an empty fire. Instead, it had the texture of strong petals (like tulips) and a fire that had substance to it when it flared whilst also being rooted in a constancy of warmth. Her odour was the expected warm scorched, but had a delicate airy flow evoking the rotten [v] of the metal within her fire. Her sound was equally delicate, and in reflecting more of the weep, had the kidneys’ quake of water within that.
My diagnosis, that Angela had a fire causative factor, with metal and water ‘within’ was in some aspects inherited from her previous practitioner. This ‘inherited’ diagnosis also included various models of treatment including specific point combinations and ‘dosages’ (how extensive any treatment was in terms of numbers of points and the number of direct moxa used). I largely agreed with that diagnosis, but as is quite usual in practice, the artistry of which points are used, how they are combined, and how they are integrated into the wider ‘guidance’ given during sessions is quite individual, beyond the more objective presentation of blocks and imbalances in the shi er guan officials. [vi]
Treatment Angela’s presentation as a fire CF was predominantly through the functioning of the Heart Master official in its mediation of intimacy and emotional confidence and boundaries. Whilst this was apparent in the narrative history of a close bereavement, it also presented as an impeded flow in her overall qi in how she described her “shoulds” and “can’ts” (file note of acupoint TH 7 hui zong – the need for unconditional support and authority of ancestors/’vast support of the ancestors for our momentum and vitality’ [vii]). Angela’s first four treatments with me [viii] that are detailed here are profiled as a background to the turning point that occurred in the fourth treatment.
Treatment 1 attended to some of the immediate tension in Angela’s shoulders as well as acknowledging the source point of the Triple Heater to begin to establish a dialogue with the yuan qi: • TH 15 tian liao ∆5┴• (needling sensation: good, soft de qi, letting qi emerge, inviting rather than pushing). • TH 4 yang chi ┴• (big pulse change, pulse quality as if a rushing dam – again impression of Du 4 ming men and of deep waters, more local impression of Morgan le Fey [ix]).
At Treatment 2 Angela returned having “felt less bothered about anxiety” and having had “more resilience”. I applied moxa and then needled seasonal horary points: • TH 6 zhi gou ∆3┴• • P 8 lao gong ∆3┴•
At Treatment 3 Angela reported the issue of her “shoulds” having been very present. The treatment was designed in order to support the integrity and authenticity of her fire at a number of levels: • TH 10 tian jing ∆3┴• • Ren 14 ju que ∆3┴• • Ht 6 yin xi ┴•
At Treatment 4 Angela commented that after the last treatment she felt “really nice, physically nice in chest, very warm.” She had also revisited her “teenage shame, didn’t want to bring it back. Don’t want to dwell on it.” Treatment was designed to further antidote the inner criticality that was an aspect of Angela’s fire. • TH 12 xiao shuo ∆3┴• • Bl 43 gao huang shu ∆3┴• • P 7 da ling ∆3┴•
Outcome It was towards the end of this fourth treatment that the turning point arose. At the very first session Angela had spoken of how she and her partner had over the preceding months spoken of having children, but were deferring the decision until their lives were more settled and they had moved house. After having completed the above treatment and upon taking the pulses at the end of the treatment, I was listening to the earth pulse [x] and particularly that of the spleen, and I was struck by the ‘abundance’ and ‘pregnancy’ of the pulse itself [xi]. I reflected this to Angela, and asked if she had got any further with the dialogues she and her partner had been having regarding children. Things were as they had been before and Angela commented that she had been holding back with regard to progressing their conversations, for the sake of the evolution of their developing plans about work and where they lived. I reflected that there was a persistency about the pulse, and Angela did go further and say that she was feeling broody and had been holding back on sharing this with her partner for the sake of the logistics of their lives. This seemed to unlock something in the pulse, as if the nexus point of all the constraints to her qi that led to the tense shoulders, the “potency” in her chest, and that between the “shoulds” and “oughts” she found a moment of authenticity and freedom.
That was it. The next session, some weeks later, she returned commenting that she might be pregnant. The exact timing we never found out and I continued to treat throughout the pregnancy and there is now yet another beautiful baby in the world.
The critical aspect of the treatment was the turning point where the rhythms of Angela’s qi were not quite in tune with the expectations that she and her partner had about the “scheduling” of any planned pregnancy, and the recurrent “shoulds” and “oughts” that bedevilled her. Our dialogue at the end of treatment 4, in response to my intuitive wondering from the pulse quality on earth, seemed to encapsulate the timing of a well-delivered question that revealed and released a deeper truth to Angela’s experience.
It is this aspect of childbirth that I wonder might be in danger of being omitted from our collective understanding. If we locate the ‘active agent’ of effective acupuncture for fertility in formulaic responses to common physiological pathologies, then we may be in danger of not attending to the wider rhythms of conception as they arise in the expression of life. We might frame this in a very concrete way by looking at how stress reduction aids fertility, but there is, I believe, a deeper question of how any of us understand our place along the roads we take, whether we name this as destiny or not.
The character ming is usually translated as either “life” or “destiny”. Its etymology [xii] shows a seal/contract together with the ideogram for a mouth under the canopy of heaven. Thus, life and destiny are understandable translations, but a useful explanation might also be a “dialogue of destiny with heaven”. Whether this dialogue of destiny is either explicit or conscious, the dynamics of qi involved are the natural expression of a life finding its own way, neither without compass nor without movement.
Discussion Much of our professional dialogue about fertility has concerned the specific issues relating to supporting infertility, particularly assisted conception. A relative backwater to such dialogue has been the context of such specialised patient concerns within the breadth of general practice. This is more that just a polarity of the specialist and the generalist. It is an awareness that some of the most potent treatment interventions within a specialist treatment area arise from their context within the more general context of the rhythms of life. This is where practical wisdom and clinical judgement take precedence over formulaic treatment, and has wider implications in terms of acupuncture education, as well as the immediate concerns of how we communicate our skills and medicine to the public.
Different experts within our profession promote a variety of approaches to fertility, pregnancy, childbirth and post-natal care. Debra Betts, for instance, chooses to focus on using acupuncture to prepare mothers for childbirth rather than expecting to be present at the birth itself. Other practitioners do in fact promote this as an aspect of what acupuncture can help with. Equally, we are undertaking a discussion about the notion of specialisms in our profession, and what patients can fairly come to expect when they seek help from an acupuncturist. Because of the increasing use and visibility of acupuncture in supporting IVF treatment, this has come to form the vast majority of how acupuncture is known to support fertility. And yet within our profession, debate is beginning to grow with regard to the appropriateness, even, of acupuncture support for IVF treatment (McGrath, 2006). At the same time, a standardisation of treatment protocols for supporting IVF is accompanying a broader public profile of acupuncture’s effectiveness in fertility treatment [xiii].
Chapter one of the Su Wen famously charts the progress for men and women as we tread our way through the yearly cycles of seven and eight from birth to old age. It describes the age at which both men and women become fertile and then lose fertility through the growth and spending of our jing essences. It also, however, describes how: The adepts of the Way Are capable, even when old, Of preserving their physical integrity. Even in this state Of advanced age, They are quite able to have children. Su Wen 1 (Larre,1994:93)
Whether our current development of technological support for conception is a collective adaptation of being an ‘adept of the Way’ is a question that has not quite been framed. Some, I am sure, would suggest that the two are mutually opposed. It is clear, however, from the classics, that the rhythms of life as they unite in yin and yang are at the heart of conception, and whether assisted conception features as part of our ongoing evolution as a matter of course, a dialogue with heaven, in the form of engaging our own authenticity, may yet contribute to the conception of our children.
References Hougham, P. (2006). The Atlas of Mind, Body and Spirit. London: Gaia Press. Jarrett, L.S. (1998). Nourishing Destiny, the Inner Tradition of Chinese Medicine. Massachusetts: Spirit Path Press. Kohn, L. (1989). Taoist Longevity and Meditation Techniques. Ann Arbor: University of Michigan Center for Chinese Studies. Larre, C. (1994). The Way of Heaven. Neijing Su Wen, chapters 1 and 2. London: Monkey Press. McGrath, H. (2005). The Spirit and IVF. BAcC News. Nov 2005: 28. Wieger, L. (1915-1965). Chinese Characters. London: Dover.
Footnotes [i] Here, acupoints are used to ‘paint’ the landscape of a patient’s qi, not necessarily as a therapeutic intervention, but as a descriptive diagnostic language shaping the landscape of a patient’s qi that can be balanced according to yin yang and the five phases as climatic conditions and natural environments. [ii] Hougham 2006:157. [iii] Hougham 2006:171. [iv] With students, I find it useful to ask them to engage their latent subtlety in perceiving the texture of a patient’s qi by asking how their patients might strike them as a landscape, an actual representation of the elements themselves in nature. Whilst this might appear a pastoral simplification of the elements rather than a universal expression of phases of qi, (and therefore a more correct translation), this device is incredibly useful in somatising diagnostic practice in order to rescue it from an overly cognitive approach to diagnosis. [v] Here, we must remember that the English translations of the odours for each of the elements can be highly deceptive in their accurate description of the pleasantness or otherwise of the odour itself. Thus the ‘fragrant’ of an earth CF can be distasteful (smelling, for instance, of vomit) just as the ‘putrid’ of a water CF can be beatific (smelling, for instance, of fresh rain or waterfalls). [vi] Thus, when working with considerations of dosage, the factor of the potency and profile of the practitioner’s own qi needs to be taken into account in sculpting the treatment. [vii] Hougham 2006:163. [viii] After being transferred from another practitioner. Had she initially presented to me for treatment having not received acupuncture before, my protocols would have been different. [ix] When teaching students the disciplines of landscaping the qi of patients alongside a combination of points according to their spirits, one inspired contributor provocatively commented that such an approach seemed akin to a “cosmic soap opera”. This echoed Volker Scheid’s query, when suggesting all acupuncturists should learn Chinese, as to whether the hun travel, in commentating upon the cultural relativity of our jing, qi and shen. Whether the hun travel or not, the transformations of the five elements and yin yang will find their own reflections in any native mythology, wherever acupuncture has planted itself around the world. Thus, Morgan le Fey holds a strong connection with the ‘waters’ of Britain and in presenting itself as an image of the patient’s waters suggested (to me) a depth and potency. [x] This quality of listening is often an opportunity to hear what is not being ‘spoken’ by the patient directly. Lonny Jarrett is very eloquent about this area of practice: “The practice of Chinese medicine proceeds best according to a delicate balance of theory and intuition… you must distinguish between the superficial information and the deeper thematic messages emanating from the patient’s heart that are striving for expression… you must also listen attentively for the messages that spontaneously arise through the intuitive function of your own heart… When appropriate, follow up on your intuitions by substantiating the accuracy of your insights you have gained in this manner. In this way you may remain grounded by verifying your intuition… Over time, your aim will become increasingly accurate… each session provides you with the opportunity to cultivate the highest aspects of diagnosis, which is merely to ‘look and know’.“ Jarrett (1998) 380-1. [xi] In this approach to practice, the pulse qualities correspond less to the standardised classifications that arise from Chinese herbal medicine’s diagnostics, but more from figurative depictions of qi that take as their reference points the highly illustrative traditions of yang sheng nourishing life and nei dan inner alchemy. See Kohn L. (1998). [xii] Wieger 1915-1965:47. [xiii] For example, the Acupuncture for Childbirth Team has been operating in Oxford since 2000, the Acupuncture Fertility Network since 2005 and the Zita West clinic franchise since 2008.
Paul Hougham Paul Hougham is the Principal of CTA - The College of Traditional Acupuncture, Hatton, Warwickshire (formerly Leamington). CTA is the longest established college teaching Five Element Acupuncture in the UK and was founded by JR Worsley in the 1960s. Paul has been central to the recent development of a validated MA in Traditional Acupuncture at CTA as well as a renewal of the BA Hons programme, where a focus on the five element style of practice is embedded comfortably within a pluralist history of acupuncture traditions. Paul was previously Vice-Principal of the School of Five Element Acupuncture in London, a past member of the British Acupuncture Accreditation Board and past President of the British Acupuncture Council. He is also the author of The Atlas of Mind, Body and Spirit, published by Gaia Press.
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