Defining Five Element Acupuncture for Practitioners of Chinese Medicine: The Elusive CF

What is CF?

Is it the Causative Factor described by the late J.R. Worsley, father of Classical Five Element acupuncture as it is practiced in the West. Is it the Central Focus described by Dr. Gary Dolowich and similarly described by many other leading Five Element practitioners in an attempt to remove the cause and effect implication of CF? Either way, what does it mean to us as practitioners and why does it matter so much in this medicine? How do we discover this elusive CF anyway? Why is it so slippery to diagnose?

First things first, no matter how you slice it, Causative Factor (CF) is the central diagnosis made by a traditional acupuncturist. To the best of my understanding, J.R. Worsley used this concept to describe the initial imbalance that occurs in a human being — most likely happening early in childhood. This primary imbalance is sometimes described as our first break from original nature en route to becoming individuals. Causative Factor can be caused by any imbalanced reaction to a certain wanted or unwanted stimulus. We can respond to affection by “going overboard” with joy and then react with total lack of joy when the affection is removed. Anger may arise upon contact with an unwanted stimulus. Similarly, inappropriate fear, sympathy, or grief may also present itself. J.R. Worsley taught that it is the CF that is the cause of the patient’s current imbalance no matter how far removed from that original reaction we may be, and J.R. adamantly advocated treating the CF of the patient exclusively.

Other practitioners interpret CF more loosely. Gary Dolowich likes to use the acronym CF to describe something he calls the Central Focus. In his line of thinking, Causative Factor comes too close to implying that this initial imbalance causes all of our imbalances and diseases – a concept far too linear and western in thought for him to accept as “ancient Chinese wisdom”. In this line of thinking, CF is still the central diagnosis of disease but is defined a little differently. To Dolowich, CF is determined by considering a set of seemingly unrelated observations and symptoms to see what factor they have in common — not so much what caused them. We then use that CF as the basis for treatment. Either way, Worsley and Dolowich both advocate treating the CF to bring the whole person into balance. Dolowich however, does find exception to this guideline.

CF is important to traditional acupuncture practitioners because in addition to being our diagnosis, it provides the hub around which a much greater treatment is focused. CF can be looked at as not simply an imbalance but also the purpose, challenge and “cause” we must work at in this life. Acting in accordance with this inner purpose is what five element practitioners consider “fulfilling our destiny”. Like the central theme of a novel, our lives too have a central theme that can offer us a glimpse the special manifestation of divinity present within each of us. This is the reoccurring theme that we will continually return to throughout the novel of our lives. Our specific destiny cannot be known as this is as unknowable as the universe itself, but by knowing the central theme of our lives we can utilize the divine within us to help move us from patterns of disharmony to harmony. By knowing our patient’s CF, we are able to treat that patient in a way that speaks to their being most directly.

By treating on the CF we are going straight to the core of that person as opposed to treating the periphery. It’s like the final scene in Star Wars: Return of the Jedi where Luke Skywalker annihilates the Death Star by flying into its interior and destroys its core. Now of course we are not trying to “destroy” anyone in the treatment room, but try and see the analogy as a metaphor for going to the source of an imbalance. Surely with all of their firepower, the Jedi fleet could slowly chip away at the exterior of the Death Star and could perhaps weaken the enemy enough to disable the Death Star. So too can an acupuncturist treat a patient on many different points and see benefit due to the inner-connectedness of the energetic pathways running through the human bodies, but by going to the core of the imbalance (treating on the CF), the acupuncturist can expect the most potent treatments. Luke affected change via the most direct and potent path and instantly rid the galaxy of the evil empire. Correctly diagnosing the CF and treating the patient on that CF is analogous to finding the well-hidden core of the Death Star and directly destroying it. It took the Jedi the entire film to figure out where to find and how to take out the core of the Death Star. Why is finding this core imbalance so hard for both the Jedi and acupuncturists? How do we diagnose CF and what makes it so tricky?

The how to diagnose sounds quite simple. First, we look at four points of observation. I’ll call them CSOE from now on: The Color emanating from a patient, the Sound quality of a patient’s voice, the Odor of a patient and the least appropriate Emotion they present. Any aspect of CSOE can show the influence of more than one of the five elements but should have one element that dominates what we are observing. Of these basic CSOE properties, we can make a diagnosis as long as the dominant element revealing itself is the same for three of the four CSOE properties. This sounds simple but is actually quite difficult for novice practitioners for a few reasons.

First, all of these CSOE observations are quite subtle. Color, for example, is not the obvious color of the skin, but is better described as the color of the sheen of the skin. Odor is not the obvious body odor or the odor created by perfumes and fragrances but is actually the odor beneath the perspiration, shampoos and fabric softeners. To observe these subtle realities in a patient, a practitioner must refine his powers of observation far beyond what he is accustomed to observing. This takes time and practice.

The other complication in diagnosing the CF is that what we observe about the basic properties is constantly in a flux. The colors that express themselves are dancing and shifting, and the sounds in the voice are many and are influenced by culture and situation. All of the CSOE observations have this complexity. It takes experience to know what is being expressed least appropriately.

Just as a Jedi is trained for all of her life before she is ready to take on the Empire, so too must a practitioner be well practiced before she will be particularly effective at observing and affecting the Empire within. It is interesting to note that the training of a Jedi is very similar to the training and practice of a good practitioner of traditional acupuncture. In addition to the knowledge and skills necessary to be a competent healer or Jedi warrior, there must also be an inner practice that cultivates morality, concentration, and wisdom. It is this inner practice that propels an acupuncturist to perceive the subtleties of CSOE and therefore to treat the CF…and hopefully be around to see the patient destroy the evils in his own personal empire and live to fulfill his destiny!