What Have the “Five Elements” Got To Do With Acupuncture?

The Five Elements Cycle by Manonastreet, reproduced according to Creative Commons licence CC0, via Wikimedia Commons.

In a recent post I talked a little about the five-element system of looking at the world. But what has it got to do with acupuncture? Well, acupuncture is a method used in traditional Chinese medicine (TCM), and as I exemplified in that post the five elements in that system have a very great deal to do with the way the body works in health and disease. One of the major classic texts of Chinese medicine, the Huang Di nei jing su wen or Inner Canon of the Yellow Emperor, describes in detail the various pathological states that are believed to arise from imbalances in the five elements.

In modern acupuncture schools five-element theory is taught as being fundamental to the practice of acupuncture. You puncture this point and you stimulate a “wood” point, that one and it’s an “earth” point and so on. There are complex methods devised to manipulate with needles the laws that govern energy transformation between the phases (“phase” is another, perhaps better word for “element” in Chinese medicine).

However, among scholars doubt exists whether these methods are actually traditional at all. One school of thought has it that for much of the history of acupuncture, points were selected on the basis of what collective experience told about what symptoms they successfully treated, rather than theoretical considerations about the five elements. According to this school of thought, the latter is a quite recent invention stemming from the “Great Leap Forward” and the “Cultural Revolution” (1950s and 60s respectively). I have also read that the relevance of the five elements to clinical practice was transplanted to acupuncture from herbal medicine, where it is more clearly applicable. That certainly makes sense to me.

My reflections on my own experience lead me to believe that five-element theory has little bearing on the success or otherwise of acupuncture treatment, and I do not base my practice of acupuncture on this theory any more.

Copyright © Robert Hale 2021.

The “Five Elements” in Chinese Medicine

Image by Parnassus, CC BY-SA 3.0, via Wikimedia Commons.

The great ancient civilisations developed philosophical models of existence that encompassed the cosmos, living beings, physiology, health, disease and medicines. They were based on fundamental “elements” that made up the universe. The Chinese had and still have a five-element system, Ayurvedic medicine also had and still has five elements, and Ancient Greek and Islamic medicine had four elements. In medicine, all these systems had several things in common, but above all it was their focus on vitality that characterised them and differentiated them from modern medicine.

Let us look at the Chinese system. The Chinese five elements are Wood, Fire, Earth, Metal and Water. These are not to be taken literally. They are more like groups of characteristics, or you could say different “personalities”. Everything that exists in the universe is made up of different combinations of these “personalities”. However, in each thing, one of them is usually dominant.

One can also consider the elements to be different forms of energy. Energy is transformed cyclically from one element to the next in a specific order. In traditional Chinese theory there are universal laws governing this transformation of energy. We won’t go into these here.

Instead, let us take one element and see how it manifests itself in the human body and mind.

The Wood “personality” is dominant in the energy of the liver and gall bladder, the tendons, the nails, the eye, and the emotion of anger. How are these things connected? The liver produces bile which is collected by the gall bladder for release into the duodenum in order for it to carry out its digestive functions. There is an energy channel called the liver meridian which begins in the foot, runs up the body through the liver and ends at the eye. So eye inflammations or other problems are associated with alterations in liver energy. Very often people with liver congestion or disease become irritable and this can easily spark into anger. What about the tendons and the nails? This is an example of association of ideas. Taut tendons and nails are thought to be woody in their appearance and physical characteristics and therefore believed to be associated with the Wood element, and by extension nourished by liver energy.

Now let us look at different kinds of liver problems in Chinese medicine:

If liver energy fails to flow and stagnates, you can experience rib pain, mood swings, nausea, acid reflux, belching, and if you are a woman, premenstrual syndrome. The stagnation may cause the energy to rise (imagine a small river that has become blocked by vegetation and fallen branches – the water rises!). This in turn causes irritability, tension around the temples, dizziness, tinnitus, dry mouth and eyes and insomnia. Liver “Fire” is even worse. The stagnated energy becomes very hot, and rising, it causes anger, headaches around the temples, a red face and eyes, thirst, a bitter taste in the mouth, vertigo, tinnitus, nosebleed, constipation with dry stools, and dark urine. If very serious excessive liver energy can cause convulsions or strokes.

Stagnated energy, as we have said, can overheat. It can also cause congestion. When this happens with the liver, it is called “Damp-Heat in the liver” and may result in jaundice, bloating, nausea and vomiting, scanty dark urine, and inflammation or infection of the genitals.

A deficiency of Yin energy in the liver can allow the liver’s Yang energy to rise, too. (If you don’t know what Yin and Yang are, see my posts here and here). This time too you can experience dizziness, tinnitus and insomnia, but also weak vision, night sweats, and thirst during the night.

Liver symptoms plus respiratory symptoms such as a chronic cough, asthma, shortness of breath, or yellow or bloody phlegm are believed to result from excessive liver energy affecting the lungs.

There is another syndrome called “Liver Blood Deficiency” which is basically anaemia together with liver symptoms like dizziness, insomnia, brittle nails, and weak or blurred vision.

Now I have said not to regard the five elements too literally. These descriptions of liver problems are a coherent way of explaining things that are nevertheless completely different to what we know from anatomy and physiology. I view them as symbolic rather than literal. One example of the difference in thinking is strokes: in Chinese medicine, symptoms of stroke like hemiplegia (one-sided paralysis) are explained by hot, rising liver energy blowing up an “internal wind”. Today we know that strokes are caused by the blockage of an artery in the brain or, less commonly, bleeding in the brain.

Copyright © Robert Hale 2021.