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Classical Five-Element Acupuncture

Marcy Goldstein, M.D., A.P. Introduction
Acupuncture is one of the oldest forms of healing, for it has been used for almost two thousand years. The fact that it is still used today speaks for the validity of this form of treatment and for the principles on which it is based. These principles relate to the way the universe works and underlies the whole eastern culture and classical eastern medical thinking. These principles were first recorded about 2000 B.C. in the Nei Ching (The Yellow Emperors’ Classic of Internal Medicine) which explains how to live ones life in accordance with the natural law of the universe. This book examines the normal functions of the human body, bodily diseases and their causes as perceived by the physicians at that time. The book describes for the first time the theory of acupuncture and the meridians (which concerns the flow of the life force energy through the body). So that each of these organs and functions may be healthy and working properly and in harmony with each other, the Chi must be flowing freely, in correct strength and quality, through the meridians. Again, health is a state in which the body energies are in balance with equal amounts of good quality energy in each of the meridians and therefore the organs. Illness is a sign that this energy is out of balance. Symptoms of illness can be considered as “red flags” indicating an imbalance and correcting these imbalances relieves the symptoms. Symptoms may also be relieved by going after the symptom directly and treating the affected area. This does not correct the cause of the imbalance. The original symptom, or others, may soon recur. The ancient Chinese keenly observed nature and observed that all things were always changing and that people were inevitably affected by these changes. They felt that man was the microcosm of the macrocosm. The energy of creation was always moving between two extremes, as with day and night, summer and winter, life and death. This can be like energy moving between the positive and negative poles of a battery where one cannot exist without the other. The Chinese called these polarities Yin and Yang. Yang is the positive poles representing the sun, heavens, warmth, expansion, day, heat and male, while Yin can be represented by the negative pole, night, cold, stillness, earth and female, etc. As in a battery, both poles are necessary. It is important to understand the balance between Yin and Yang. One is no better than the other. Both are always changing, always flowing and moving and balancing each other. We see day flow into night, sunshine into shadows, etc. This intermingling and changing of Yin and Yang is everywhere and in everything. If either of these become overly dominant in a person, the person becomes unhealthy.

How Acupuncture Works
Acupuncture (the insertion of very fine needles into specific points on the body) and moxabustion (the burning of the herb Artemisia Vulgaris Latiflora on the acupuncture points) treatment assists nature by influencing this energy in such a way as to return it to a normal flow and balance, thus allowing the body, mind and spirit to return to a state of health. At this time, how acupuncture works is not clearly understood. No western physiological paradigm can fully account for the effects of this form of Chinese medicine. Work done by scientists to explain the observed effects tries to break the process down into the smallest individual parts, but the whole is much more than the sum of the parts. Therefore to understand acupuncture, I believe one must move from the usual scientific viewpoint and observe the process as the eastern mind does. Classical Chinese medicine states that it is the vital force, (the life force, the Chi) in the body that controls the workings of the organs and systems of the body. This Chi circulates from one organ to another along channels or pathways called meridians, always following a fixed route. There are twelve of these paired meridians, each feeding one of the main organs or functions of the body, i.e. the heart, small intestine, bladder, kidney, circulation-sex, three heater, gall bladder, liver, lungs, colon, stomach and spleen.

The Five Elements
The Chinese then took their observations a step further. They noted five cycles of the seasons: spring, summer, late summer, fall and winter. These are the five major changes in the quality and function of the energy throughout the year. We readily see that spring is the season of birth and growth. Summer with it’s warmth encourages fullness and maturity. Late summer is the time for harvest when we reap what we have sown. Fall is the time when plants discard their leaves and fruits in preparation for the following year. Winter is the time of withdrawal, with slow life activity and a time for rest. This is again the balance from Yin to Yang and back to Yin again. From stillness to activity and back to stillness again, from death to birth to growth and back to death again. All done in an orderly fashion as it moves through the five stages of the seasons. The Chinese called these five steps of the creative energy the five elements.

Marcy Goldstein, M.D., A.P. is an Acupuncture Physician with the Acupuncture and Holistic Health Center.


Jacksonville Medicine / January, 2000

Thus wood, fire, earth, metal and water was around them. Table 1 summarizes aspects of the five elements. All elements are of equal importance. We can see how each element conveys the appropriate qualities. The wood is the spring expressing itself in birth and growth and in hope of future harvest. We can see in each of us our birth, growth, hopes for the future and the ability to give birth to ideas and projects. In summer the energy expresses itself in a special way that they called fire. In Summer warmth is from the sun and in people the inner warmth is joy, love and compassion. The quality of the earth phase, late summer, is that of the mother — mother earth, a caring and loving provider. The fall is a metal time of year when the trees let go of their leaves when their work is done for the year. Humans feel a need within to discard what is done and await the new work in the spring. Metal is the internal element responsible for receiving the pure Chi from the heavens and for the removal of wastes and poisons from the body. The qualities of the water element can be seen in the winter. This element is responsible for the collection and storage of fluids. As the rains fall and water runs down the mountainsides and are channeled into rivers and reservoirs to provide us with water throughout the following year, so does the water element provide our bodies with all the necessary fluids and secretions.

everything, but certain aspects of the elements are particularly useful in giving very direct information to the acupuncturist about the state of the element. These are the emotions, the sound of the voice, the color of the face and the odor of the body. To illustrate these points we look to the specific meridians and the organ functions to evaluate the balance in each element. Two of the twelve meridians are under the dominion of the wood energy. The two wood organs are the liver and gall bladder. Wood also controls the eyes and vision and the state of our nails, ligaments and tendons. Emotionally, wood controls anger. They compare the controlling function of an element to a Minister of the State. Each meridian is under the control of a special Minister. Thus, the Ministers for the wood element meridians are the Official of Planning (liver) and the Official of Decision Making and Judgement (gall bladder). The sound of the wood voice is shouting, the color of the face is green and the odor of the body is rancid. Four of the twelve meridians are under the dominion of the fire element. The two fire organs are the heart and small intestine. The two functions in the fire are circulation/sex and three heater. As Ministers of the State, the heart is the Emperor or Supreme Controller and the small intestine in control of separating the pure from the impure. Circulation/ sex Official as Prime Minister/Heart Protector and Controller of circulation and internal sexual hormone secretion, and the triple heater controls body temperature. The emotion associated with the fire is joy and if the fire element is in balance, there is a normal amount of love, joy and happiness. If out of balance, there would be a lack of joy or inappropriate joy.

Organ Functions
Briefly, each of the five elements expresses itself in

Table 1. Correspondences Of The Five Elements Element Season Climate Power to Color Sound Emotions Orifices Bowel Fortifies tissues Supplies firstly (yin) Supplies Taste Flavor Odor Wood Spring (Yang) Wind Birth Green Shout Anger Eyes Gallbladder Ligaments Liver Gall Acid Sour Rancid Fire Summer (Yang) Heat Mature Red Laugh Joy Ears Small Intestines Arteries Heart and constrictor Small Intestine Sharp Bitter Scorched Fragrant Earth Late long summer Humidity Decrease Yellow Sing Sympathy Nose Stomach Muscles Spleen Stomach Sweet Metal Fall (yin) Dryness Balance White Weep Grief Mouth Large Intestine Skin and hair Lungs Colon Hot Pungent Rotten Putrid Water Winter (yin) Cold Emphasize Black Groan Fear Lower Three heater and bladder Bones Kidneys Bladder Salty

January, 2000/ Jacksonville Medicine


The two organs in the earth element are stomach and spleen. The ministerial function of the stomach is the Official responsible for rottening and ripening of the food (digestion) and the spleen is the controller of transport. The emotion associated with the earth is sympathy, the color of the face yellow, the sound of the voice singing and the odor of the body fragrant. The two organs in the metal element are lungs and the large intestine. The ministerial function of the lungs is the receiver of the pure Chi from the heavens and the large intestine is responsible for drainage and the dregs. The emotion associated with metal is grief/sadness, the color of the face white, the sound of the voice weeping and the odor of the body putrid. The organs in the water element are bladder and kidney. The ministerial function of the bladder is the controller of the storage of water and the kidney the controller of water. The emotion associated with the water is fear, the color of the face blue, the sound of the voice groaning and the odor of the body putrid.

Seeing the color or hue of certain areas of the face indicates the element that is the causative factor. In a fire red, in an earth yellow, in metal white, in a water blue and in a wood green. Feeling the patients skin for moisture and temperature and texture gives information as to where the body is imbalanced. But feeling does not only mean just physically. When the practitioner is with the patient they can get a feel or sense of what sort of person he or she is, a sense of their emotional makeup, a sense of whether their spirit is high or low and so on. Feeling also means feeling the pulse. Not just rate and rhythm, but doing the most important procedure in all classical Chinese diagnosis: “Taking the pulses”. Through touch, the classical practitioner differentiates twelve pulses on the radial artery, six on each wrist. From feeling these pulses, one is able to read the exact state of the Chi that is flowing through each of the twelve meridians. Although it is hard to accept that this is true, it is. The experience of feeling the pulses change after each acupuncture needle insertion soon verifies the validity of this diagnostic procedure. At the completion of the traditional diagnostic procedure, the practitioner has a knowledge of the energetic or elemental cause of the patient’s illness or imbalance and is then prepared to insert the acupuncture needles into the appropriate acupuncture points to begin to rebalance the patient’s energy. This rebalancing usually requires multiple treatments over an extended period of time to allow the changes made in the patient’s energy pattern to become permanent.

Diagnostic Procedures
The acupuncture practitioner’s method of diagnosis is different from the allopathic/ western physician. The acupuncturist is not seeking to diagnose the manifest physical or emotional disease syndrome, but to discover the energetic imbalance that has given rise to that syndrome. The disease/symptoms is not of particular importance itself, but it does provide useful information, although not directly, for the basic energy diagnosis. To know the disease does not tell the practitioner how to treat the cause. Diagnosing the primary elemental imbalance or causative factor is not simple because the patient rarely has just a one-element imbalance. To identify the causative factor, the major weakness, the practitioner must elicit the history and description of the problem in detail. To asses the patient’s state of mind, their likes and dislikes relating to the elements must be known. The patient is asked, for example, how he or she feels about the seasons of the year, about different times of day, about the weather, about different flavors of foods, about their emotions. This full evaluation commonly takes about two hours. Hearing and evaluating the actual sound of the voice can help to clarify the primary imbalance. The sound of the voice in a fire causative factor is laughter, in earth singing, in a metal weeping, in a water groaning and in a woods shouting — or lack thereof.

Healing, with the resultant relief of symptoms, requires cooperation between the acupuncture practitioner and the patient. The patient needs to do those things that will help their body heal. They should eat fresh and healthful foods, drink adequate amounts of water, get enough rest and do those things that will diminish stress in their lives. Through this cooperative effort, balance can be achieved and healing can occur in body, mind and spirit.
REFERENCES 1. 2. 3. 4. Worsley JR. Is Acupuncture for You?” Worsley JR. and Worsley JB. England; 1999. Veith I. Nei Ching: The Yellow Emperor’s Classic of Internal Medicine. University of California Press, Berkeley, CA; 1972. Connelly D. Traditional Acupuncture: The Law of the Five Elements. Traditional Acupuncture Institute, Columbia, MD Second Edition; 1994. Worsley JR. Classical Five Element Acupuncture Volume III. The Five Elements and the Officials. Worsley JR. and Worsley JB.; 1998.


Jacksonville Medicine / January, 2000