Five Element Acupuncture
Husband Wife Imbalance and Bipolar Disorder:
A Case Report

Charles A. Moss, M.D.


Five Element Acupuncture provides an understanding for the assessment and treatment of complex medical problems. The identification and treatment of major energetic blocks such as the Husband Wife imbalance provides potent therapeutic effects for people with serious medical problems. The Husband Wife imbalance is a global distortion of the energetic balance between the Elements represented on the left radial artery pulse (Husband) and the right radial artery pulse (Wife). The patient discussed here has bipolar disorder, which was in a manic phase and demonstrated the characteristics of a Husband Wife imbalance. The diagnosis and response to treatment is representative of the results that can be seen with this acupuncture approach.


Five Element Acupuncture, Bipolar Disorder, Husband Wife Imbalance, Pulse Diagnosis


The concept of blocks in the movement and balance of energy is implied in all traditional acupuncture systems. Five Element acupuncture is a traditional system organized around the movement of energy through the Elements along the Shen (creative) cycle and the Kío (controlling) cycle. (See Figure 1)

In Five Element acupuncture, there are several unique concepts, which describe energetic blocks. Among the major blocks in Five Element acupuncture are Aggressive Energy, Internal and External Devils, and the Husband Wife imbalance. The Husband Wife imbalance is frequently encountered in patients with chronic physical symptoms or significant emotional stress. It can also occur in generally well compensated people in times of chronic or acute stress. To understand the Husband Wife imbalance, the Law of Husband Wife first needs to be explored.


A fundamental energetic equilibrium exists between the six yin-yang pairings of the Officials, which are represented in the radial pulse at the wrist. (In Five Element acupuncture the term Official describes the entire range of functional correspondences of each organ and its meridians.) The three paired pulses of the left hand are Bladder and Kidney, Gall Bladder and Liver, and Small Intestine and Heart. These are the Husband Officials. The three paired pulses of the right hand are Three Heater and Master of the Heart, Stomach and Spleen, and Large Intestine and Lung. These are the Wife Officials.

The Law of Husband Wife states that the total energy, as expressed by the pulses, should be greater in overall quality and quantity on the left hand than on the right hand. The radial pulse reflects the energy of the Elements and the Officials. As a reflection of the functions of the Elements, the energy of the Elements and Officials represented in the left hand pulses (Husband) should be greater in quality and quantity than the energy of the Elements and Officials of the right hand pulses (Wife). This is a law of Nature that applies to both sexes. In this context, the Elements and Officials are reflecting the energetic dynamic that is essential for the healthy functioning of the body-mind-spirit and the maintenance of the life force.

The graphic representation of the Law of Husband Wife includes a vertical line (running from north [below] to south [above]) which divides the Five Element circle into 2 halves and reflects how the energy system is represented in the pulses (see figure 2).

The left side pulses begin in the north and start with Water in the proximal position, and then, following the Shen Cycle, go to Wood in the middle position, and left hand Fire (Heart, Small Intestine) at the south in the distal position.

The right side pulses begin in the south with right hand Fire (Master of the Heart, Triple Heater) in the proximal position, then Earth in the middle position, and Metal in the distal position. The placement of the pulse anatomically, follows the natural direction of movement of the Elements in the Shen Cycle. The positioning of the Elements in the radial pulse is significant.

The energy systems represented by the left hand (Husband) pulses, Water, Wood and left hand Fire (Heart and Small Intestine Officials), create the movement from winter to spring to summer and are the ascendant, rising yang energies of birth, rebirth, regeneration, repair and healing. These are the yang energies of the creative, motivating, expanding and activating energies of "Heaven", and in the maintenance of life they have to be slightly stronger than the receptive energies represented in the right hand pulses.

The energy systems represented by the right hand pulses (Wife), right hand Fire (Master of Heart and Triple Heater Officials), Earth, and Metal, create the movement from summer to late summer and then to fall, reaching the winter solstice. These are the yin energies of "Earth"(in the Earth/Heaven dichotomy) which are more dense, resorbtive, catabolic, downward and inward moving. (See Figure 3)

The following chart summarizes the qualities of the Husband Officials.

Water Wood Fire
Winter Spring Summer
adrenals, bone marrow wei chi, detoxification circulation, blood, immunity
will for survival, constitution, strength and power, jing activity , fear and fearlessness anger (action), fight for self (wei chi), ability to reorganize and heal love and self-love, joy, creativity; overall control of healing by relaxation and integration
zhi hun shen
"will" manifestation of our true path and destiny essential higher self
Faith: in ourselves and our healing; our constitutional ability for healing Hope: our sense of a future; future plans, new possibilities for healing Spirit: connection with life and healing

The three Husband Officials in effect are the seats of the key physical, emotional and spiritual resources for healing. The qualities these Officials represent in the healing process are frequently seen as the critical factors in the profiles of people with successful outcomes in serious and life-threatening illnesses. In a situation where these energies collapse, such as chronic stresses or acute crisis, the individual can enter a spiral of disintegrative influences and very quickly move into serious health problems.

The Elements and Officials in the right hand or "wife" side of the energy system, the Fire, Earth, and Metal, relate to aspects of immunity and circulation, nutrition and assimilation, oxygenation and elimination. They relate to love and relationship, self-nourishment and acceptance, self-esteem and the letting go of old, stale energies. In the emergence of a Husband Wife imbalance, these Elements and Officials can become hyperactive and imbalanced. This hyperactivity, as well as a collapse of the left hand energies, is often responsible for the genesis of the Husband Wife imbalance.

The two sides tend to respond differently to chronic stress. The left side, upward moving, and yang energies can become exhausted, collapsed and resigned from chronic stress, or a series of acute crises. The right side, downward, denser, yin energies become increased and compressed as stress accumulates. Finally, this compressed, held-in energy moves into an excess state. At a certain critical point, due to the interconnecting links of the Elements and Officials, these shifts and disturbances move through the system establishing the Husband Wife imbalance.


The patient is a 41 year old white female with a 20 year history of bipolar disorder. Her current medications include Lithium 300mg and Effexor 25 mg. Her first manic episode occurred at age 21 and led to hospitalization and subsequent treatment with Lithium. She has had numerous manic episodes since the onset of the illness. In the past if she recognized the onset of a manic episode, she would increase her medication. The response to the medications often would take several weeks to occur, during which time she would become dysfunctional, unable to work and creating significant difficulties in her relationship.

We initiated a course of Five Element acupuncture during a time when there was a moderate degree of lability in her mood. After two treatments including clearing Aggressive Energy (see below) and treating points
on Small Intestine (her root constitutional factor) and Heart, she returned and reported that she was clearly entering a manic phase. She had slept very little for several days, was writing incessantly, and had not been able to work. She had not yet increased her medications to treat the mania.

When I saw her for her third treatment her pulse diagnosis had dramatically changed. The right hand pulse including Lung, Colon, Spleen, Stomach, Master of Heart and Triple Heater had a full, aggressive, hard, tight and excess quality while the left hand pulse were uniformly deep, deficient, empty, flat and collapsed. She appeared mildly agitated and talked very rapidly with pressured speech. She brought in a detailed diary of her previous week, which highlighted the manic behavior and thought patterns. Even though she was aware that she was entering a major manic episode she wanted to avoid increasing her medications if possible.

The pulse diagnosis and her history were consistent with a Husband Wife imbalance which correlated with the onset of the manic episode. The treatment was aimed at tonifying the left hand pulses particularly Kidney, Bladder, Small Intestine, Heart and Liver by transferring the excess energy from the right hand pulses, specifically Colon, Lung, and Spleen. The points chosen were used in traditional tonification technique in the following order bilaterally: Bladder 67, Kidney 7, Kidney 3, Liver 4, Small Intestine 4, Heart 7 and direct moxibustion and needling of Kidney 24. The treatment had an immediate effect on the pulse pattern with the clearing of the abnormal quality and excess of the right hand pulses, and significantly increasing the overall energy of the left hand pulses.

The treatment had an immediate calming effect. The manic episode disappeared within 24 hours. Her emotional lability improved and she felt a significant increase in her sense of emotional and mental stability. This was the first time that she was able to resolve a manic episode this quickly and without increasing her medications. When she was seen one week later the pulse diagnosis confirmed that the Husband Wife imbalance was resolved and we resumed the on going treatment of her root factor.


Bipolar disorder is a common psychiatric illness with incidence reported from 0.4% to 1.6% of the population. It is characterized by recurrent manic episodes in more than 90% of patients with this diagnosis. Lithium tends to reduce the incidence of manic episodes, though there is a wide range in the frequency of recurrence. The average person has four episodes in 10 years though there are those described as rapid cycling who suffer with frequent episodes. Most people are fully functional between episodes, however up to 30% of patients with bipolar disorder continue to display mood lability and interpersonal difficulties.

The occurrence of the Husband Wife imbalance at the onset of a manic episode has not previously been reported. The coincidence of the Husband Wife imbalance with the onset of a major manic phase is of a great interest. It is possible that the energetic dysfunction contributing to a manic episode is frequently this major energetic block. The patientís behavior during a manic phase can be interpreted in the context of the Husband Wife imbalance. She describes herself as being driven by a force that feels like a whirlwind and having a 'manic monster' constantly at the controls of her mental state. This correlates with the breaking down of the energetic balance of the Law of Husband Wife.

In the Husband Wife imbalance there is a reversal of the normal dominance of the Husband Officials (Kidney, Liver and Heart as the Yang ascending and expanding energy) in relationship to the Wife Officials (Lung, Spleen and Master of Heart as the Yin, descending, grounding and stabilizing energy). The symptoms seen in this patient of the dominance of the manic behavior over her normal personality is a clear example of the outcome, which can occur when the Husband Wife energetic pattern is disrupted. In this case the domination of Wife energy leads to a loss of emotional control and a distortion of her personality. This disruption of the energetic balance can lead to a loss of normal function on any level including mental, physical and spirit. The inability to reorganize the energetic architecture and to recover from stress in a normal fashion, which in this situation led to the manic episode, is a frequent occurrence in the Husband Wife imbalance.

The breaking down of the Law of Husband Wife and the development of the Husband Wife imbalance is not an uncommon occurrence in the population seen in a medical acupuncture practice. The etiology of the Husband Wife imbalance includes a wide variety of circumstances with a consistent theme of high level stress. The stress can be from a sudden event such as an accident, an assault, or the death of a loved one, or more commonly from a gradual breaking down of the ability to adapt and cope with stressors. The Husband Wife can occur in patients who are currently being treated with acupuncture who suddenly begin to regress or decompensate. A Husband Wife imbalance can occur in any patient and is not dependent on certain diagnosis or complaints, though there is more likelihood to see this in seriously ill patients.

It is also common to see this problem emerge when people are struggling with different aspects of their inner self. A typical example would be a women who is ambitious in her career but finds herself in a role such as homemaker or mother and resents the limitations. Her Husband energy which is to be expansive, creative and yang is being overcome by the necessity to nest and pull inwards which augments the Wife energy. It can also be seen frequently in the stress of relationships that are out of balance, a literal Husband Wife imbalance. There often can be a Husband Wife imbalance in serious illness when there is a rapid deterioration in either the mental or physical condition of the patient.

The movement of the energy through the Shen cycle requires the movement from Metal to Water as we move from Fall into Winter. This part of the circle of life is a time of moving deeply within, letting go of loss and grief (Metal) and connecting to our deepest nature in Water. If we are not able to let go and resolve our issues in Metal the energy will not be able to move into Water to initiate the cycle of renewal which starts in Winter and moves into Spring with the Wood Element. It is the 'breaking' of the energy circle which leads to further disruptions and the inability to recover from physical, emotional or spiritual challenges. Spiritual despair can be very profound as a loss of belief in one self and in oneís sustaining beliefs and values occurs.

The Husband Wife treatment can reconnect the movement through the Shen cycle and restore the equilibrium between the Husband and Wife energies. Often this treatment will be successful in restoring this balance. Once reestablished, the patient has a greater chance to improve with the subsequent treatment course. The Husband Wife treatment will at times have to be repeated if the pulse diagnosis reveals the same pattern reoccurring. Though this treatment is traditionally used in the context of Five Element Acupuncture, if done precisely it can be interspersed with other acupuncture treatments. The Husband Wife treatment should be the only treatment done at the time, with the patient returning within one week to assess the pulse and repeat the treatment if required.

The diagnosis of the Husband Wife imbalance is dependent on the pulse diagnosis and the history, appearance and presentation of the patient. Indications of the Husband Wife as noted previously include a change in the severity of symptoms, a non response to treatment, a giving up, agitation, a sense of hopelessness, and the inability to overcome relationship or social stress. They have lost faith and trust (Water), their inner truth and vision (Wood), and the connection to their passion and love and Self (Fire). The key to diagnosis is the imbalance presented in the pulse diagnosis.


The treatment of the Husband Wife imbalance involves a set sequence of points utilizing the tonification technique employed in Five Element acupuncture. The tonification method involves a rapid insertion into the acupuncture point, recruitment of the chi sensation, a clockwise 180 degree turn, rapid removal, and sealing of the point. The treatment can be employed at any point in the treatment course when a Husband Wife imbalance is suspected. It is required to test and treat Aggressive Energy prior to using the Husband Wife treatment.

Aggressive Energy is treated by placing needles superficially in the back shu points of all the yin organs and observing for erythema. If the erythema is at least 7 mm in size, the needles are retained until the redness clears. You may then proceed with the Husband Wife treatment on the next visit.

The goal of the Husband Wife treatment is to restore the left/right pulse balance through taking energy from the Wife side and pulling it into the Husband side, restoring the balance of yin and yang. It is not uncommon to repeat this treatment over several sessions if the effect does not persist as measured by the pulse diagnosis. The treatment sequence is as follows:

Tonify the metal points of Water to bring energy from Metal to Water (Bl 67 & Ki 7).

Tonify Ki 3, to bring energy from the Earth to the Kidney.

Tonify Liv 4 to bring Metal into Wood.

Tonify the source points of Small Intestine and Heart (SI 4 & Ht 7). This is not an energy transfer as such, but it does then touch on all the left hand Elements. These two key Fire Officials are needed to complete the transition from the chaos of the H/W block. The Small Intestine allows a clear sorting of the pure from the impure elements of the person's life, and the Heart, the Supreme Controller, is put back in the position of being in command of the life process in the individual. The source point Ht 7, Spirit Gate, opens into and reconnects the person back to the light of their spirit. As such, it is a completion of the reawakening of the Elements and Officials of the left side.

To complete the treatment, using 5 direct moxas and then needling of Ki 24 (Spirit Burial Ground), restores the connection with one's 'buried spirit'. In effect, it resurrects the spirit and brings it back to sustain and illuminate the life process.


Five Element acupuncture is a powerful tool for deep transformation and restoration of the normal energetic architecture of the body, mind, and spirit. Treatment of the major energetic disruptions such as the Husband Wife imbalance can be life saving, helping the person regain their lifeís path. The occurrence of the pulse changes which reflect the Husband Wife imbalance implies that the person was not able to restore their energetic equilibrium with their normal homeostatic mechanisms. In a person with energetic resilience the Husband Wife imbalance can frequently self-correct with any well designed acupuncture treatment which effectively brings balance within the energetic system. However, in the situation where the depth of the imbalance prevents a response, the specific Husband Wife treatment is required. This treatment can be included within other acupuncture systems as well, but needs to be used as a freestanding treatment.

Manic depressive disorder is a graphic example of the disruption of the Law of Husband Wife. It is not possible however, to assume that all patients with manic depressive disease requires, or will benefit from, this treatment. The fact that the Husband Wife changes correlated with the onset of a manic episode warrants further documentation. In general, the most effective acupuncture treatment is individualized for the patientís specific constitutional pattern.


Worsley J.R. Traditional Acupuncture, Vol.2 Traditional Diagnosis College of Traditional Acupuncture, U.K. Royal Leamington Spa, U.K. 1990

Moss, C. Five Elements and Medical Acupuncture AAMA Review Vol.3 No 2, Fall 1991

Moss, C., Puhky R. Five Element Acupuncture for Physicians Syllabus La Jolla 1998


Charles A. Moss, M.D. is in private practice in La Jolla, California specializing in medical acupuncture, integrative medicine, and family practice. Dr. Moss is co director of the Five Element Acupuncture for Physicians Training Program and a frequent lecturer in Five Element acupuncture. He is a founding member of the AAMA.

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