Krennie Tran Tran Nguyen Five Element Acupuncture Theory and Clinical Applications • •
ACUPUNCTURE TCM-THEORY
Five element theory is one o f the major systems of thought within Chinese medicine. From a historical perspective it is an important underpinning of medical theory and serves as one of the major diagnostic and treatment protocols. In modern clinical practice the five element theory is used in varying degrees depending on the t he practitioner andstyle and style of acupuncture that acupuncture that they practice. For practitioners or Traditional Chinese Medicine, the theory may be used to help form a diagnosis when there is conflicting signs and sympto ms. Additionally, Additionally, elements o f the theory are useful for assisting patients with nutritional balancing and/or balancing and/or working through emotional issues. The theory is used extensively by Japanese acupuncturists within the five phase treatment phase treatment protocols and by Classical C lassical five element practitioners, element practitioners, such as those who follow the teachings of the late J.R. Worsley. Worsley. The information below discusses the Five Element theory and clinical c linical applications in detail.
Primary Correspondences Within Five Element Theory The Five Element theory t heory is based on the observation of the natura l cycles and interrelationships in both our environment and within ourselves. The foundation of the theory rests in the correspondences of each element to a variety of phenomena. The most common correspondences are listed in the chart c hart below:
Yin Organs
Yang Organs
FIRE
EARTH
METAL
WATER
WOOD
Heart & Heart & Pericardium
Spleen
Lungs
Kidneys
Liver
Stomach
Large Intestine
Urinary Bladder
Gall Bladder
Small Intestine & Triple Heater
Sense Organs
Tongue
Mouth
Nose
Ears
Eyes
Tissues
Vessels
Muscles
Skin
Bone
Tendons
Tastes
Bitter
Sweet
Pungent
Salty
Sour
Colors
red
yellow
white
blue/black blue/bl ack
green
Sounds
Laughing
Singing
Crying
Groaning
Shouting
Odor
scorched
fragrant
rotten
putrid
rancid
Emotions
Joy
Worry/Pensiveness
Grief/Sadness
Fear
Anger
Seasons
Summer
Late Summer
Autumn
Winter
Spring
Environment
Heat
Dampness
Dryness
Cold
Wind
Developmental Stages
Growth
Transformation
Harvest
Storage
Birth
Direction
south
center
west
north
east
Body Types
pointed pointed features small hands quick energetic
large features strong legs calm generous
triangular features strong voice meticulous, strong willed
round features tall slender strong digestion strong bones and loyal, enjoy joints movement hard workers
Five Element Cyles, Relationships and Interactions Within five element theory there are four main relationships or ways in which the elements interact. The first of these is the generat ing (sheng, mother-child) cycle. This cycle describes the ways in which eac h element, serving as a mother, promotes the growth and development of the following child element. Examples of this cycle are the t he Wood element providing the generative generat ive force for Fire, Fire providing the generative force for Earth, etc. This relationship provides the foundation for understanding five element theory and, consequently, co nsequently, where imbalances may arise within the cycle. If Earth, for example, is weakened from a poor diet and overwork you will see that more nourishment is requested from the Fire element to nourish Earth. Additionally, if Earth is weakened the Metal element may also be effected.
From a clinical perspective you may see people develop digestive d igestive issues from irregular eating, excessive worry and overwork which leads to a proliferation of dampness which then effects the Metal element. Within this case yo u may see a combination co mbination of bloating, gas and poor energy energ y with the development of Metal (Lung) symptoms sympto ms such as sinusitis or phlegm-type asthma.
The controlling (ke, grandparent-grandchild) cycle provides for a check and balance system among all of the elements. Within this cycle Earth, for example, provides a control for Water and is controlled by Wood. Woo d. An example of this relationship within the body is in cases of anxiety (Fire) which are related to LV Qi Stagnation (Wood) Stagnation (Wood) where, over time, you begin to see more Kidney (Water) related signs as the Water element attempts to control the overactive Fire.
The overacting cycle (cheng) is an imbalance within the controlling cycle where the grandmother element provides too much control over the grandchild and weakens the element. Within nature you may see Water putting out Fire, Earth soaking up Water and so on.
A clinical example of o f this relationship would be Liver (Wood) overacting on the Sp leen (Earth). In this case you have an o veractive Wood element overcontrolling o vercontrolling Earth leading to distruptions in the d igestive system.
The insulting cycle (wu) is also an imbalance within the controlling cycle where t he grandchild insults or returns the controlling force generated by the gra ndmother. Using examples from nature you can see Fire burning up Water and Water washing away Earth and so on. Clinically you may see this in cases where peo ple have long-term psychological psycho logical problems (Fire) which eventually effect the Kidneys (Water) as seen in the development of o f more Yin (Water) deficiency signs signs..
Five Element Pathology and Clinical Applications
As described in the introduction there are a variety of ways in which the theory theo ry is used clinically. Our Japanese section describes the five phase treatments phase treatments in detail and our classical five element (worsley element (worsley style) page describes the ways wa ys in which a pure five element practitioner would utilize the theory. This section describes the basic ways in which a practitioner of traditional chinese medicine applies the theory in a c linical setting. The Five Shu (transporting) Points, listed below, represent the relationship of the theory to individual acupuncture points. Our understanding of these points is based largely on t he information within the Nan-Ching: the Nan-Ching: The Classic of Diffi D ifficult cult Issues. Issues. Five Shu Points
Yin Meridians
Jing-well Ying-spring Shu-stream Jing-river He-Sea (Wood) (Fire) (Earth) (Metal) (Water)
LU
LU 11
LU 10
LU 9
LU 8
LU 5
PC
PC 9
PC 8
PC 7
PC 5
PC 3
HT
HT 9
HT 8
HT 7
HT 4
HT 3
SP
SP 1
SP 2
SP 3
SP 5
SP 9
LV
LV 1
LV 2
LV 3
LV 4
LV 8
KD
KD 1
KD 2
KD 3
KD 7
KD 10
Yang Meridians
Jing-well Ying-spring Shu-stream Jing-river He-Sea (Metal) (Water) (Wood) (Fire) (Earth)
LI
LI 1
LI 2
LI 3
LI 5
LI 11
TH
TH 1
TH 2
TH 3
TH 6
TH 10
SI
SI 1
SI 2
SI 3
SI 5
SI 8
ST
ST 45
ST 44
ST 43
ST 41
ST 36
GB
GB 44
GB 43
GB 41
GB 38
GB 34
UB
UB 67
UB 66
UB 65
UB 60
UB 40
The major point categories (i.e. jing well, etc.) described above are d iscussed iscussed in more detail here here.. For the t he purposes of this discussion discussion an extract e xtract from the chart above showing show ing only the Mother and Child Ch ild points provides a good starting point to understand t he application of the theory to acupuncture. The Mother and Child points po ints for each meridian are derived from the chart above using the following logic. According to the generat ing cycle the mother of Earth Eart h is Fire and the child of Earth is Metal. Using this information for the Y in Earth Meridian (Spleen) the mother point is the Fire point po int on the Spleen meridian SP 2 and 2 and the child po int is the Metal point on the Spleen meridian SP 5. 5. Mother & Child Five Element Points
Mother Child
Lung (Metal)
LU 9
LU 5
Large Intestine (Metal)
LI 11
LI 2
Stomach (Earth)
ST 41 ST 45
Spleen (Earth)
SP 2
SP 5
Heart (Fire)
HT 9
HT 7
Small Intestine (Fire)
SI 3
SI 8
Urinary Bladder (Water) UB 67 UB 65 Kidney (Water)
KD 7 KD 1
Pericardium (Fire)
PC 9
Triple Heater (Fire)
TH 3 TH 10
Gall Bladder (Wood)
GB 43 GB 38
Liver (Wood)
LV 8
PC 7
LV 2
A clinical example of this theory theor y would be dispersing the child point of o f the Wood meridian (Liver) - LV 2 2 - in the case of LV Fire Rising where Rising where a patient is experiencing LV signs such as anger and irritability irritability along with HT related signs such as disturbed sleep and agitation. Another example would be tonifying to nifying the mother point of the Earth meridian (Spleen) - SP 2 - in the case of SP Qi Deficiency where Deficiency where a patient is experiencing poor appetite and low energy. The example above brings up an interesting point from the perspective of a TCM practitioner. While the five element theory is a useful tool in many cases, there are times where the theory indicates a point which clinical experience has proven to be less effective than another point. In the case above, SP 2 is 2 is indicated by the theory t heory whereas SP 3 is 3 is more commonly used for this condition. Some o f the points which have varying degrees of correspondence with the theory t heory are: • • • • •
• • •
HT 9 & 9 & PC 9 9 - are most often used to clear heat. SI 3 & 3 & SI 8 8 - reduce heat, pain and stagnation but provide no tonifying effect. LI 11 11 - is typically dispersed to clear heat. TH 3 3 - has no tonification effects. ST 41 41 - is typically used to disperse fever a/or reduce abdominal distention, although it can be as a local point in a tonifying manner to increase energy flow to the foot. SP 2 2 - is not the most tonifying point on o n the SP meridian - SP 3 is 3 is a better choice. UB 67 67 - dispersive point for acute conditions. GB 43 & 43 & GB 38 38 - are both used to clear heat.
