FIVE ELEMENTS AND MEDICAL ACUPUNCTURE
FIVE ELEMENT ACUPUNCTURE
Five Element theory has been part of Chinese Medicine from the 10th century B.C. These concepts first appeared in several books on philosophy such as the Shu Ching, the Li Chi and the Guan Dzu.(1) The first medical writings on the Five Elements were found in the Nei Ching Su Wen written around 200 B.C. Further discussion was found in the Ling Shu and the Nan Ching. The Five Element concepts are part of not only medical theory, but are an integral aspect of all ancient Chinese cosmology and philosophy.
The Five Element system divides human experience into five distinct groupings or Elements. The Five Elements include Wood (liver and gall bladder), Fire (heart, small intestine, triple energizer, pericardium), Earth (spleen, stomach), Metal (lung, colon) and Water (kidney, bladder). These Elements act as maps which reflect all levels of human function, including but not limited to, the anatomic and physiologic functioning of the organ systems. The levels of function range from biochemical processes to the function of the organism as a whole, and includes behavior, psychological state, relationships and career choices. Using the Five Element 'map' dysfunction occuring on any of these levels can be placed in the appropriate context.
The assessment of the Five Elements in a clinical setting is done through the use of the system of correspondences. Each of the Elements has a series of correspondences involving the macrocosm, season, time of day, climactic condition, the microcosm, tastes in food, emotional state, color, body odor, body orifice, sense organ, body tissue and organ system (zang and fu). The continuim of correspondences from macrocosm to microcosm is discussed in the ancient classics as seen in this passage from the Nei Ching Su Wen (2) regarding the Wood element, "the East creates the wind; wind creates wood; wood creates the sour flavor; the sour flavor strengthens the liver; the liver nourishes the muscles; the liver governs the eyes; the eyes see the darkness and mystery of Heaven and they discover Tao, the Right Way among mankind."
Pathological conditions are also associated with each Element. Medical diagnosis of organ dysfunction is only one of several correspondences which are used to establish an acupuncture diagnosis and treatment approach. The following are examples of pathological conditions which can reflect a dysfunction in a specific Element but do not identify the acupuncture diagnosis per se:
Wood: headaches, migraines, conjunctivitis, myofascial pain, ligamentous injuries, sexual dysfunction, hemiplegia, gall bladder disease, hepatitis, fatigue, insomnia and hypoglycemia.
Fire: insomnia, hearing problems, Bell's palsy, trigeminal neuralgia, CVA, anemias, fatigue and sexual dysfunction.
Earth: GYN problems, headaches, functional bowel syndromes, gastritis, sinusitis, eating disorders.
Metal: asthma, colitis, allergic rhinitis, eczema.
Water: hypertension, gastritis, hearing disorders, spinal disorders, cystitis, lumbar syndromes.
Further correspondences include external factors such as climate (wind), internal states such as tastes (sour), physical aspects (eyes, musculature) and a broader and more psychological or even spiritual sense (the ability to discover the "Tao, the Right Way" in the darkness). The emotional state is of great clinical usefulness in assessing the Elements. The abnormal emotional aspects are the following:
Wood: anger, frustration and anxiety
Fire: lack of or excessive joy
Earth: excessive need for sympathy, excessive introspection, obsessional thinking
Metal: grief, sadness, melancholia
To fully assess the functioning of the Elements it is necessary to look at the correspondences which reflect a more global, behavioral level of function in the person. These are called the Officials. Porkert (3) describes the Official as "defined not by physical properties, but by its specific roles in the processing, storage, and distribution of vital energy and thus the maintenance of life." The Officials give us the ability to use a 'wide angle lens' to look at the life style that a person has created as a reflection of the functioning of the Elements.
Table 2 has a list of the Officials and the corresponding Element and organ.
TABLE 2: The Twelve Officials and Their Descriptive Names
|Fire||Small Intestine||Official in control of transforming matter, of separating pure from impure|
|Water||Bladder||Controller of the Storage of Water|
|Water||Kidney||Controller of Water|
|Fire||Pericardium||Heart Protector and Circulation-Sex Official|
|Fire||Triple Energizer||Official of Balance and Harmony|
|Wood||Gall Bladder||Official of Decision Making and Wise Judgment|
|Wood||Liver||Controller of Planning|
|Metal||Lung||Controller of Receiving Pure Ch'i from the Heavens|
|Metal||Colon||Controller of Drainage and Dregs|
|Earth||Stomach||Official in Control of Rottening and Ripening|
|Earth||Spleen||Controller of Transport|
In the case of the Wood element, the two Officials are the "Official of Decision Making and Wise Judgment" (the Gall Bladder), and the "Controller of Planning" (the Liver) (4) . The Gall Bladder is "responsible for what is exact and just.î Determination and decision stem from it." (5) The liver "holds the office of general... assessment of circumstances and conception of plans stems from it." (6) When these officials are poorly functioning, the effect might be indecisiveness, lack of initiative, anger and frustration or hypochondria with constantly changing symptoms. Decisions relating to career or relationships might be repeatedly flawed and lead to stress and agitation. The ability to make appropriate plans are affected and disturbance in the 'blueprint' for functioning on a cellular level (i.e. diabetes) or a global level (i.e. drug addiction) might be the outcome. This might be more significant than the physical manifestation such as headaches, dizziness, myalgias, chest pain or eye disorders which are often attributed to Gall Bladder and Liver.
As the Nei Ching discusses, the Wood Element provides the ability to "discover the Tao, the Right Way," which allows for healthy decision making, planning, and a balanced and well coordinated life style. The Wood element is associated with the Spring, with new ideas, new growth and the sense of renewal that goes with this season. The emotion attributed to the Wood in the Nei Ching is anger. This is generated by the frustration of being blocked in setting out on these new paths. Anger in this situation also stems from loss of a sense of control over life's events, and often manifests as aggressive behavior. Some of the other correspondences can be seen in the following from the Nei Ching, "...of the colors they create the green color...and they give to the human voice the ability to form a shouting sound...in times of excitement they grant the capacity for control...and of the emotions they create anger."
The assessment of each Element and its Officials is dependent on an accurate and complete history and the ability to interact with the person through the traditional diagnostic skills of seeing, palpating, smelling and hearing. The Traditional diagnosis calls for the examiner to be an active participant in the experience. This entails testing the five emotions, voice qualities, odors and colors in an interactive way. It is not sufficient to ask a person if they get angry inappropriately when assessing the emotional correspondence of the Wood Element. One needs to present a situation where the emotion of anger can actually be seen to characterize how it reflects the health of the Wood. In the same way the voice quality and the overall demeanor of the person can be much better assessed though an interactive approach.
When an imbalance occurs in a significant way within an Official, the history will often reflect this in a chronological order. Illness occurs when the Officials are unable to overcome either internal (excess emotions), external (injuries, surgery, climactic conditions) or inherited perverse energies. What appears to a physician as the "onset of the present illness" is often the culmination of a long sequence of energetic disturbances in the Officials and the Elements.
The physical examination in the Five Element system focuses on the correspondences available to observe in the patient: the facial color, the sound of the voice, the emotion expressed, the odor of the torso and the general presentation of the patient. Most important is the traditional pulse diagnosis with emphasis on the individuation of the Twelve Officials. The history must be thorough and complete and emphasize chronological events. The goal of this evaluation is to determine the Official which is the Causative Factor, i.e. the aspect of the energetic system which is the root imbalance for the overall symptomology.
The Causative Factor is either inherited or acquired. If acquired it is often the result of early childhood experiences which create a disequilibrium. Traumas of a physical, emotional, infectious or climactic nature will then bring the Causative Factor into a pathological state and the onset of symptoms might occur. It is here that the laws of acupuncture determines what the configuration of the patient's symptoms will be. These laws include: Law of Creation (Shen cycle), Control (K'o cycle), Midday-Midnight, and Mother-Child. The most important of these laws are the Shen and K'o cycles (see Figure 1).
The creative cycle (also called engendering, productive, Shen) is best understood using the macrocosmic Images of the Elements. Unschuld discusses the Shen cycle in the following way: the water produces plants/trees, that is wood; wood brings forth fire; fire produces ashes, that is soil (earth); soil brings forth metal; when heated metals produce steam, that is water. (6) The controlling cycle (K'o) is illustrated as follows: water overcomes fire; fire melts metal; metal, in the form of a knife, overcomes wood; wood as in a spade overcomes soil (earth), soil as in a dike subdues water. (7) These two sequences form the basis for health or the understanding of an illness.
In illness, the poor functioning of one of the elements leads to symptoms within itself or other elements according to these cycles. In the example of the Wood, an imbalance in this Element could cause symptoms to be seen in the Wood, Fire (Shen cycle), or the Earth (K'o cycle). The correspondences of these elements and Officials will clarify which of the sequences is most dominant in any one situation.
LEVEL OF ILLNESS
One further discrimination is necessary in treating patients in the West and that is the consideration of the level of illness. This concept has been discussed by J.R.Worsley (8) and is most applicable to our current practices. The levels reflect the depth of illness within the person: physical, mental or spiritual. In our society there are many patients who have chronic illness on what would be called a spirit level. These patients appear to be unable to change, seem empty of purpose or commitment and create a deep drain on the practioner. Patients with mental level illness are constantly in the process of trying to figure out their problems and often are obsessed with the need to understand what is happening. Physical level illness actually represents the smallest percentage of patients seen.
Once the Causative Factor is established, the level of illness understood and the laws of acupuncture comprehended, treatment will proceed in a very effective manner. In the case of the Wood element, what might be expected is improved judgment and healthier decision making processes. There might be less hostility, less need for control and clearer vision of future needs. From these changes, a myriad of physical or psychological pathologies can improve as the Wood element returns to normal functioning on all these levels. The improvement in the function of one Official or element can lead to dramatic changes in the individual's level of well being. When the twelve Officials are all in a relative state of balance, then one is well suited to deal with the challenges of the human condition. This is the Su Wen, or the highest goal of Five Element acupuncture.
In the practice of acupuncture in the West, the concepts based on the laws of the Five Element have much to offer. The physician dealing with the complex patient with a multi-faceted problem, is challenged to place the information in a context that can lead to effective treatment. It is in this aspect that the Five Element approach is most persuasive. The modern ideas of psychoneuroimmunology are seen within the Five Element concepts of causative factor, officials, and level of illness. The system of correspondences aids in the understanding of the diverse information gathered from the patient. Both physical and emotional symptoms can be placed within this diagnostic framework. The most significant of all the aspects of Five Element approach is that it allows us to treat the person who has the disease as well as the symptoms themselves.
1 Matsumoto,K,Birch,S. Five Elements and Ten Stems,Paradigm Pub.,Higganum,Conn. 1987
2 Veith,I. trans.Nei Ching:Yellow Emperor's Classic of Internal Medicine,Univ of Calif. Press Berkeley,Ca. 1972
3 Porkert.M. The theoretical foundations of Chinese Medicine,M.I.T. Press,Cambridge,Mass.1974
4 Chinese Medical Classics: Nei Ching(Su Wen nad Ling Shu) and Nan Ching Trans.by Occidental Inst. of Chinese Studies Miami 1979
5 Larre,C. The Secret Treatise of the Spiritual Orchid,British Register of Oriental Medicine,East Grinstead,England 1985
6 Unschuld.P.Medicine in China,Univ. of Calif Press,Berkely 1985
8 Worsley,J.R. Talking About Acupunture in New York,Element Books,Leamington Spa,U.K.1982