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The Five Elements According to a Bioengineer Turned Acupuncturist

Updated: 6 days ago

Contents



Introduction

Together with Yin-Yang theory, the Five Elements theory (五行, Wu Xing) constitutes the basis of Chinese medical theory. Despite its fundamental importance in Eastern philosophy, this theory is unfamiliar to most modern western cultures. In the context of the Five Elements, the character “行” (Xing) has been translated to “elements;” however, in this context, Xing can also mean “phases,” “movements,” and “forms” (among other translations). As such, the Five Elements represent not only basic constituents of nature, as the word “element” is currently understood in the west, but also fundamental qualities and dynamics observed in nature. While this understanding of elements is foreign to modern westerners, the concept of elements as the basic forms of natural phenomena that can generate and transform into one another also has roots in the west; according to Aristotle, “Earth and Fire are opposites also due to the opposition of the respective qualities with which they are revealed to our senses: Fire is hot, Earth is cold. Besides the fundamental opposition of hot and cold, there is another one, i.e., that of dry and wet: hence the four possible combinations of hot-dry [Fire], hot-wet [Air], cold-dry [Earth] and cold-wet [Water]…the elements can mix with each other and can even transform into one another…thus Earth, which is cold and dry, can generate Water if wetness replaces dryness.” [1] Aristotle’s interpretation of elemental theory is very similar to the concept of elements in the Five Elements theory. The purpose of this article is to introduce the Five Elements theory and to illustrate how it is applied in clinic.



Sequences of The Five Elements


The Five Elements are Water (水, Shui), Fire (火, Huo), Wood (木, Mu), Metal (金, Jin), and Earth (土, Tu), each representing a basic constituent, quality, and movement of natural phenomena, as well as a stage of a seasonal cycle. Water represents fluidity, downward movement, and winter; Fire represents heat, upward movement, and summer; Wood represents flexibility, growth/expansion, and spring; Metal represents solidity/malleability, contraction, and autumn; Earth represents nourishment/stability, center, and periods of seasonal transition. [1] The various interactions among the Five Elements are expressed in several sequences. The balance or imbalance of these sequences of interactions is the key to the Five Elements theory in TCM.


The Generating Sequence


In the generating sequence, each element is generated by one and generates another. Wood generates Fire; Fire generates Earth; Earth generates Metal; Metal generates Water; Water generates Wood. This sequence is cyclical and is represented by the circular pattern in the Five Elements diagram (Figure 1).


The Five Elements Acupuncture Traditional Chinese Medicine

Figure 1. Diagram of the Five Elements. [2]


The Generating Sequence in Nature


Ancient Chinese philosophers developed the Five Elements theory by observing nature. Naturally, the various interrelationships among the elements are exemplified in nature. Wood generating Fire is exemplified by the burning of wood. Fire generating Earth is exemplified by fire turning organic material into ash, which becomes a part of the earth and makes it fertile; additionally, Fire generating Earth can be thought of as the heat energy from the sun warming the earth, enabling it to sustain life. Earth generating Metal is exemplified by the metallic mineral ores found in the earth. Metal generating Water is exemplified by minerals enabling water to be absorbed by living organisms (distilled water is not absorbed with nearly the efficiency of regular water). Water generating Wood is exemplified by water being necessary to the process of photosynthesis, allowing plants to grow.


The Generating Sequence in TCM


In addition to a basic constituent, quality, and movement of natural phenomena, as well as a stage of a seasonal cycle, each of the Five Elements also represents a pair of TCM Internal Organs* – a Yin Organ and its corresponding Yang Organ. Wood represents the Liver and Gallbladder; Fire represents the Heart and Small Intestine, as well as the Pericardium and San Jiao (三焦, Triple Burner); Earth represents the Spleen and Stomach; Metal represents the Lungs and Large Intestine; Water represents the Kidneys and Bladder. The generating sequence is described as a Mother-Son relationship in TCM; the element by which any particular element is generated is referred to as the Mother, and the element that is generated by any particular element is referred to as the Son. For example, Earth is the Mother of Metal, and Metal is the Son of Earth. In the Five Elements diagram (Figure 1), the element that precedes any particular element in the generating cycle is the Mother, and the element that succeeds the same particular element is the Son. For example, Fire is the Mother of Earth, and Metal is the Son of Earth. This Mother-Son relationship represents the supportive relationships among the functions of the Internal Organs. Disorders can occur when this relationship falls out of balance. For example, Earth is the Mother of Metal; therefore, the Spleen and Stomach are the Mothers of the Lungs and Large Intestine. In clinical practice, one of the functions of the Spleen and Stomach equates to the function of the digestive system, which is to absorb and transform consumed food into usable energy. One of the functions of the Lungs and Large Intestine equates to the function of the immune system, which is to protect the body from external pathogens; in TCM, the Lungs regulate the Defensive Qi (卫气, Wei Qi) and the skin; in modern medicine, the large intestine is known to house a significant portion of the immune system in the form of the gut microbiome. This relationship is demonstrated in the fact that patients who have unhealthy diets and eating habits tend to be more susceptible to pathogens like the common cold and the flu. In these patients, the Spleen and Stomach are weakened by their dietary habits, and, therefore, the Lungs and Large Intestine and, by association, the immune system are weakened as well. In TCM, these patients are treated by tonifying both the affected Organs (i.e., Lungs and Large Intestine) and their Mother Organs (i.e., Spleen and Stomach).


* Note that the Internal Organs in TCM differ from the conventional understanding of internal organs; the Internal Organs each represent a complex of functions and physiological processes. For example, the Kidneys in TCM may include the functions of the kidneys, adrenal glands, and other organs, as well as a multitude of physiological processes that are involved in water regulation, genetics, bone health, etc. In this article, I will differentiate the TCM Internal Organs from conventional organs by capitalizing the TCM Internal Organs.


The Controlling Sequence

In the controlling or overcoming sequence, each element is controlled by one and controls another. Wood controls Earth; Earth controls Water; Water controls Fire; Fire controls Metal; Metal controls Wood. The controlling sequence is also cyclical and is represented by the star-shaped pattern in the Five Elements diagram (Figure 1).


The Controlling Sequence in Nature


As with the generating sequence, the controlling sequence can also be observed in nature. Wood controlling Earth is exemplified by tree roots holding the soil in position. Earth controlling Water is exemplified by bodies of water being contained within earthen boundaries. Water controlling Fire is exemplified by water limiting the spread of fire. Fire controlling Metal is exemplified by fire melting metal. Metal controlling Wood is exemplified by metal being used to restrict the growth of trees.


The Controlling Sequence in TCM


In TCM, the controlling or overcoming sequence is described as a Grandmother-Grandson relationship. The element that controls another element is referred to as the Grandmother, and the element that is controlled by another element is referred to as the Grandson. For example, Water is the Grandmother of Fire, and Fire is the Grandson of Water. The Grandmother-Grandson relationship of the controlling sequence builds on the Mother-Son relationship of the generating sequence. For example, Water is the Mother of Wood, which is the Mother of Fire; Water is, therefore, the Grandmother of Fire. This Grandmother-Grandson relationship represents the restricting relationships among the functions of the Internal Organs. In its normal state, the controlling sequence acts as a system of checks and balances. Disorders can occur when this relationship falls out of balance. Imbalance between Grandmother and Grandson can occur in both directions, and these are represented by the overacting sequence and the insulting sequence.


The Overacting Sequence


The overacting sequence follows the same sequence as the controlling sequence, but the Grandmother overcontrols the Grandson. This may be caused by the Grandmother being too strong, the Grandson being too weak, or both.


The Overacting Sequence in Nature


The overacting sequence can have damaging effects when it is observed in nature. Wood overacting on Earth is exemplified by overcrowded tree roots depleting the soil of nutrients. Earth overacting on Water is exemplified by the formation of natural dams restricting the flow of water. Water overacting on fire is exemplified by water extinguishing fire. Fire overacting on Metal is exemplified by fire burning metal. Metal overacting on Wood is exemplified by metal being used to cut down trees.


The Overacting Sequence in TCM


In clinical practice, the overacting sequence is when the Grandmother Organ overcontrols its Grandson Organ. For example, when the Liver (Wood) is in a state of excess due to stress (for more information on the relationship between emotions and the Internal Organs, see our article “The Mind-Body Connection”), it overcontrols the Spleen (Earth), resulting in poor digestion as well as a craving for sweet foods (as seen in the Five Elements table of correspondences in Figure 5). The Liver, according to the Mother-Son relationship of the generating sequence, can also cause the Heart (Fire) to enter a state of excess, causing insomnia. The Heart, then, in turn, can overact on its Grandson Organs, the Lungs and Large Intestine (Metal), resulting in a decreased immune system. These examples are commonly experienced in daily life; when we are stressed, our digestion suffers, and we crave sweets; then, when we are unable to fall asleep due to the stress, our immune system suffers, and we get sick more easily. Patients suffering from an overacting sequence disorder are treated by reducing the Grandmother Organ (in this case, the Liver and Heart) and tonifying the Grandson Organ (in this case, the Spleen and Lungs).


The Insulting Sequence


The insulting sequence is just the opposite of the overacting sequence; so, the Grandson rebels against and “insults” the Grandmother. This may be caused by the Grandson being too strong, the Grandmother being too weak, or both.


The Insulting Sequence in Nature


The insulting sequence can result in disaster when it is observed in nature. Water insulting Earth is exemplified by flooding and erosion. Earth insulting Wood is exemplified by rock and mudslides. Wood insulting Metal is exemplified by the breaking or wearing down of a blade against a sturdy tree. Metal insulting Fire is exemplified by a metal with an exceptionally high melting point exhausting a furnace. Fire insulting Water is exemplified by raging fires that cannot be extinguished.


The Insulting Sequence in TCM


In clinical practice, the insulting sequence is when the Grandson Organ insults its Grandmother Organ. For example, when the Heart (Fire) is in a state of excess, insomnia ensues. Consequently, the Kidneys (Water) are weakened. In TCM, a primary function of the Kidneys is to store life Essence (精, Jing). Just as fire evaporates water, the excess of the Fire Organ (the Heart) can “evaporate” the Essence stored in the Water Organ (the Kidneys), resulting in accelerated aging. This makes sense in the context of our daily experience. If we do not get enough restful sleep, naturally, we are going to age more quickly. Patients suffering from an insulting sequence disorder are treated by reducing the Grandson Organ (in this case, the Heart) and tonifying the Grandmother Organ (in this case, the Kidneys).


Simultaneous Sequences


As we have already seen in the example of the overacting sequence, multiple abnormal sequences can manifest simultaneously. The reason for this is clearly evident if the Five Elements diagram is viewed as a sort of tensegrity structure (Figure 2). In a tensity structure, “a discontinuous set of compression elements is opposed and balanced by a continuous tensile force, thereby creating an internal prestress that stabilizes the entire structure” [4]; in Figure 2, the compression elements are represented by the struts, and the tensile forces are represented by the lines connecting the struts. If one of the struts is disturbed, then the disturbance will also be transferred to the other struts along the lines of pull, destabilizing the entire structure.


Figure 2. Diagram of a tensegrity structure. [3]


Similarly, in the Five Elements diagram, the state of each element affects the state of all of the other elements. When each of the elements is in a normal state, the generating and controlling sequences are balanced, and the structure is stable. However, if one or more of the elements is in an abnormal state of excess or deficiency, then the sequences are unbalanced, and the structure is unstable. In Figure 3, Wood is in a state of excess. Because Wood is the Mother of Fire, Fire also enters a state of excess. Because Wood is the Grandmother of Earth, the excess Wood overacts on Earth, causing it to become deficient. Because Earth is the Mother of Metal, the deficient Earth is unable to nourish Metal, causing it to also become deficient. Because Wood is in a state of excess and Metal is in a state of deficiency, Wood insults Metal. Because Fire is in a state of excess, it can also insult Water. Because Earth is deficient, Water insults it; although Water may be in a normal state, relative to Earth, it is in excess. As all of the elements are interrelated, an abnormal state of one element can lead to complete imbalance in the entire system.


Figure 3. Unbalanced Five Elements. [2]


Simultaneous Sequences in TCM


Similarly, an abnormal state of one Organ can affect all of the other Organs. Again, for example, stress causes the Liver (Wood) to enter a state of excess, which causes the Heart (Fire) to enter a state of excess, resulting in insomnia. The Liver overacts on the Spleen (Earth), which causes it to become deficient, resulting in indigestion and fatigue. The Spleen is unable to nourish the Lungs (Metal), so it also becomes deficient, resulting in breathlessness and a compromised immune system. The Heart overacts on and the Liver insults the Lungs, which further compromises the immune system. The Heart insults the Kidneys (Water), affecting water regulation and accelerating the process of aging. The Kidneys insult the Spleen, inhibiting water absorption. For patients suffering from such a pattern of symptoms, it is crucial to address the root cause, which, in this case, is stress, while also tonifying the deficient Organs and reducing the excess Organs. Simply treating the symptoms individually will lead to nowhere as long as the patterns of imbalance remain.


The Cosmological Sequence


The cosmological sequence is a lesser-known arrangement of the Five Elements. In this sequence, the elements are laid out in the four cardinal directions with Earth at the center (Figure 4). Notice that the cardinal directions are opposite from how they are usually arranged (with North on top, South on the bottom, West on the left, and East on the right). The reason for this is fivefold. One, South is traditionally thought of as the direction of good fortune; ancient Chinese rulers sat on south-facing thrones in south-facing palaces. This may be because in China, which is in the northern hemisphere, the sun is in the southern half of the sky. As such, Fire is associated with South. Consequently, the cardinal directions in the cosmological sequence are arranged as if on a compass when facing South. Two, Water is referred to as the foundation of the other elements, so it is on the bottom. Three, Earth is in the center because Earth grounds the other elements. Also, “China” in Chinese is 中国 (Zhong Guo), which literally translates to “center nation.” The ancient Chinese believed that China was the center of the world, so Earth represents the center of the compass. Four, Wood is associated with East because it is also associated with spring. Spring is to the seasonal cycle as sunrise is to the diurnal cycle, and the sun rises in the East. Five, Metal is associated with West because it is also associated with autumn. Autumn is to the seasonal cycle as sunset is to the diurnal cycle, and the sun sets in the West.


Figure 4. Diagram of the Cosmological Sequence [2]


The Cosmological Sequence in TCM


Although the cosmological sequence of the Five Elements is often overlooked, it is very meaningful in clinical practice. First, as stated above, Water is the foundation of the other elements. As Water pertains to the Kidneys, the Kidneys are also the foundation of the other Organs. In TCM, the Kidneys store Essence and the Gate of Life (命门, Ming Men), also referred to as Original Yin and Original Yang, respectively. As such, in clinic, Kidney-Yin deficiency often induces Liver-Yin and Heart-Yin deficiency, resulting in irritability and insomnia, and Kidney-Yang often induces Spleen-Yang and Lung-Qi deficiency, resulting in edema and breathlessness. Second, the cosmological sequence illustrates the intimate relationship between the Kidneys and the Heart. In the diagram, Water and Fire are directly related along the vertical axis; this reflects the most basic and important balance in the body, that of Yin and Yang. Unlike the standard Five Elements diagram, which shows a controlling and overacting relationship between the Kidneys and the Heart, the cosmological sequence diagram shows a relationship of mutual support and nourishment. If Kidney-Yin is deficient, then Heart-Yin will also become deficient, resulting in insomnia. This also reflects the relationship between Essence, which is stored in the Kidneys, and the Mind (神, Shen), which is housed in the Heart. The Essence is the material basis of the Mind; if Essence is deficient, naturally, the Mind will also suffer. Third, Earth at the center reflects the central importance of the Spleen and Stomach. The Spleen and Stomach are the source of Post-Heaven Qi as well as the origin of Qi and Blood. As such, they nourish all of the other Organs, and tonifying the Spleen and Stomach also indirectly tonifies the other Organs. Fourth, Earth, as the center, supports Fire; this reflects the Spleen and Stomach as the primary support for the Heart. If the Spleen and Stomach are deficient, then the Heart will also become deficient. If the Heart is deficient, then the Spleen and Stomach must also be tonified. Fifth, the vertical axis of the cosmological sequence diagram, Water-Earth-Fire, symbolizes Essence-Qi-Mind (精气神, Jing Qi Shen), which is the complex of physical and mental phenomena that forms the basis of human life. Sixth, Earth at the center represents its role in the seasonal cycle. Each of the other elements is associated with a season (Fire to summer, Water to winter, Wood to spring, and Metal to autumn). This can be seen in the Five Elements table of correspondences (Figure 5). Earth is the “neutral pivot along which the seasonal cycle unfolds.” [1] Earth represents the transition period at the end of each season. Therefore, during this period, particularly at the end of winter, it is important to tonify the Spleen and Stomach. [1]



The Five Elements Correspondences


The Five Elements system of correspondences links many different microcosmic and macrocosmic phenomena and qualities under the realm of each element. Ancient Chinese philosophers identified associations among seemingly unrelated phenomena that “resonate” with one another, unified by an indefinable common quality. [1] Figure 5 lists several of the main Five Elements correspondences; however, there are many more than just these.


Figure 5. Five Elements Table of Correspondences. [1]


The Five Elements Correspondences in TCM


A common theme in TCM is the resonance among phenomena in nature and in the human body, stemming from the belief that human beings are one with nature and the universe as a whole. Accordingly, each element encompasses numerous phenomena in the universe and the human body that are attributed to that particular element. As in the theory of Internal Organs, each Organ represents a sphere of influence that encompasses many functions and physiological phenomena beyond the organ itself. In this way, the Five Elements theory provides a clinically useful model of relationships between the Organs and various tissues, sense organs, etc., as well as between the Organs and various external phenomena, such as seasons and climates. [1] The Five Elements correspondences most relevant to TCM diagnosis are colors, emotions, sounds, tastes, tissues, sense organs, and climates.


Colors


Colors displayed on the body, particularly on the face, are often used in TCM diagnosis. The prevalence of one of the colors indicates an imbalance in the corresponding element: a greenish complexion in the face indicates an imbalance in Wood, possibly due to stagnation of Liver-Qi; a reddish color indicates an imbalance in Fire, possibly due to excess heat in the Heart; a sallow, yellowish color indicates an imbalance in Earth, possibly due to Spleen-Qi deficiency; a whitish color indicates an imbalance in Metal, possibly due to Lung-Qi deficiency; a dark, purplish color, indicates an imbalance in Water, possibly due to Kidney-Yin deficiency. Sometimes the complexion can indicate complex interactions between multiple elements. For example, a person with a very pallid-white face with red cheeks may indicate Fire overacting on Metal. However, in some cases, the complexion may not coincide with the symptoms exhibited. In these cases, the color of the complexion often shows the root cause of the imbalance. For example, if a patient exhibits symptoms of Spleen-Qi deficiency (i.e., fatigue, loose stools, reduced appetite, etc.) and has a greenish complexion, it may indicate that the Liver (Wood) is overacting on the Spleen (Earth). [1]


While the Five Element color correspondences can be very useful in TCM diagnosis, they must be used critically and not mechanically. In evaluating the color of the complexion, a TCM practitioner must not only consider the Five Element theory, but other TCM diagnostic principles as well. For example, according to the Five Elements theory, a reddish complexion indicates an imbalance in the Fire Organ (i.e., the Heart), but, according to the Eight Principles, it may also indicate Heat, which could affect any Organ. This demonstrates that, in TCM diagnosis, it is not always possible to make a direct, one-to-one correlation between two phenomena; even though symptom A is associated with pattern B, A does not necessarily indicate B. Rather, each phenomenon must be evaluated in the context of the pattern as a whole. For example, a reddish face manifesting simultaneously with a bitter taste in the mouth, insomnia, mouth ulcers, and palpitations does, in fact, indicate an imbalance in the Fire Organ (i.e., the Heart); however, a reddish face manifesting along with rapid breathing, a cough, and yellow mucus indicates an imbalance in the Lungs. [1]


Emotions


The Five Elements emotion correspondences is important in TCM diagnosis. In TCM, the emotional and mental state are intimately connected to a person’s physical state of health. Someone who is prone to outbursts of anger would manifest symptoms of Liver (Wood) imbalance. Joy corresponds to Fire and the Heart. Of course, a state of joy that is characterized by a state of healthy contentment is not a source of disease but a beneficial mental state that promotes the smooth-functioning of the Internal Organs and their associated mental faculties; however, a state of joy that occurs suddenly (e.g., when receiving good news unexpectedly) and/or is characterized by excessive excitement and craving can be harmful to the Heart. Pensiveness corresponds to Earth; overthinking and mental fatigue may cause or indicate an imbalance of the Spleen. Sadness corresponds to Metal and may cause or indicate an imbalance of the Lungs. Fear corresponds to Water and may cause or indicate an imbalance in the Kidneys and Bladder. [1] For a more in-depth exploration of the effect of emotions on health, see our article “The Mind-Body Connection.”


Sounds


Sounds produced by a patient and the tone of voice can also be useful in TCM diagnosis. If a patient sighs excessively or often shouts in anger, then Wood, which also corresponds to anger, may be imbalanced. If a patient often laughs without apparent reason, then Fire, which also corresponds to joy, may be imbalanced. Nervous singing or a singsongy tone of voice may indicate an imbalance in Earth, which also corresponds to pensiveness. Excessive crying may indicate an imbalance in Metal, which also corresponds to sadness. Groaning or whimpering may indicate an imbalance in Water, which also corresponds to fear. [1]


Tastes


The Five Elements tastes correspondences are a relatively minor component of TCM diagnosis. Experiencing or craving a particular taste may indicate an imbalance in the corresponding element. For example, a sour taste in the mouth or craving for sour foods may indicate a Liver (Wood) disorder; a bitter taste may indicate a Heart (Fire) disorder, a sweet taste may indicate a Spleen (Earth) disorder; a pungent taste may indicate a Lung (Metal) disorder; a salty taste may indicate a Kidney (Water) disorder. [1] Overconsumption of foods of a particular taste may also cause the corresponding Organ to enter a state of imbalance.


Tissues


A pathological state of various tissues may also indicate imbalance in their corresponding elements. For example, tight tendons may indicate a Liver (Wood) imbalance; a blood vessel disorder may indicate a Heart (Fire) imbalance; muscle weakness or atrophy may indicate a Spleen (Earth) imbalance; skin disorders and spontaneous sweating may indicate a Lung (Metal) imbalance; bone degenerative diseases, like osteoporosis, may indicate a Kidney (Water) imbalance. [1]


Sense Organs


Disorders of the five senses may also indicate imbalances in their corresponding elements. For example, blurred vision may indicate a Liver (Wood) imbalance; a problem with the tongue or sense of taste may indicate a Heart (Fire) imbalance; a problem with the mouth and/or lips may indicate a Spleen (Earth) imbalance; frequent sneezing or a problem with the sense of smell may indicate a Lung (Metal) imbalance; hearing problems may indicate a Kidney (Water) imbalance. [1]


Climates


Sensitivity to various climatic conditions may also indicate an imbalance in their corresponding elements. For example, a sensitivity to wind may indicate a Liver (Wood) imbalance; heat-sensitivity may indicate a Heart (Fire) imbalance; a sensitivity to dampness may indicate a Spleen (Earth) imbalance; a sensitivity to dryness may indicate a Lung (Metal) imbalance; cold-sensitivity may indicate a Kidney (Water) imbalance. These climatic conditions may also cause their corresponding Organs to enter a state of imbalance. [1]



Application of the Five Elements Theory in Clinic


While the Five Elements theory can be a very powerful clinical tool, ultimately, it is just a model of the qualities of and interrelationships among the Internal Organs and their corresponding phenomena. As with any model, the Five Elements theory cannot possibly contain within it all of the intricacies of the actual subject of the model, which, in this case, is human physiology. Naturally, it has many limitations (as mentioned in the discussion on the Five Elements color correspondences). Nevertheless, when applied critically, the theory has wide-ranging applications in clinic. Let us illustrate this with a case study.


Case Study


A 42-year-old male postal worker presented with fatigue, lassitude, indigestion, constipation, loose stools, and insomnia. He also reported a distending sensation in his hypochondrium, mild edema in the ankles, mild breathlessness, and “stress-eating” with an unusual craving for sweets. He had also been fighting a particularly tenacious cold, which had lingered for several weeks. He exercised regularly and consumed a balanced diet. His right-side radial pulse was thin and weak, while his left-side radial pulse was comparatively forceful and slightly wiry; his tongue was mostly pale and slightly scalloped, but the tip was red. His demeanor was lethargic and slightly irritable. His complexion had a slight greenish tinge. His symptoms began about three weeks after he began divorce proceedings with his wife and about six weeks prior to his initial consultation at Rise. This patient had also consulted his primary care physician, who conducted a physical exam and ordered bloodwork, including a complete blood count (CBC), a complete metabolic panel, and a broad thyroid panel. The physical exam revealed no significant findings; aside from a slightly elevated blood pressure, all other vital signs and laboratory results were within normal ranges. Assessment of this patient at our clinic revealed patterns of Spleen-Qi deficiency, Lung-Qi deficiency, Liver-Qi stagnation, and Heart-Fire. Although his primary symptoms coincided with Spleen-Qi deficiency, as his lifestyle habits were healthy, the origin of the pathology was determined to be stress and anxiety due to his divorce. For this patient, the etiology and pattern of symptoms could be explained using the Five Elements theory: stress caused the Liver (Wood) to enter a state of excess (Liver-Qi stagnation), manifesting as a feeling of distension in the hypochondrium, irritability, constipation, a wiry pulse, and a greenish tinge in the complexion; this caused the Heart (Fire) to enter a state of excess as well (Heart-Fire), manifesting as insomnia and a red tip of the tongue; the Liver overacted on the Spleen (Earth), which caused it to become deficient (Spleen-Qi deficiency), manifesting as indigestion, loose stools, fatigue, and a craving for sweets; the deficient Spleen was unable to nourish the Lungs (Metal), so it also became deficient (Lung-Qi deficiency), manifesting as breathlessness and a compromised immune system (as indicated by the lingering cold); the Heart overacted on and the Liver insulted the Lungs, which further compromised the immune system; the Heart insulted the Kidneys (Water), affecting water regulation and manifesting as edema; the Kidneys insulted the deficient Spleen, inhibiting water absorption, also manifesting as edema.


For this patient, suffering from a complex pattern of symptoms, it was crucial to address the root cause, which, in this case, was stress, while also tonifying the deficient Organs and reducing the excess Organs. Because the root pathology was Liver-Qi stagnation, the primary treatment principle was to move Liver-Qi. According to the Five Elements theory, in addition to reducing the Wood Organ, the Son (Fire) also had to be reduced, and the Grandmother (Metal) tonified; hence, Heart-Fire had to be cleared, and Lung-Qi had to be tonified. Once the symptoms of Liver-Qi stagnation had abated to a certain extent, Spleen-Qi had to be tonified as well. Following these treatment principles, the patient was treated using a combination of acupuncture, manual therapy, herbal medicine, meditative exercises, and lifestyle modifications. Acupuncture, herbal medicine, and meditative exercises, such as mindful breathing and Qi-Gong, were employed to reduce stress and increase his body’s ability to produce energy. To select appropriate acupuncture points, the Liver, Heart, Spleen, Stomach, Lung, Large Intestine, Kidney, and Bladder meridians were palpated; the following points were found to be particularly tender, indicating activation (for an in-depth explanation of acupuncture point activation, see our article “What is Qi? – A Scientifically-Minded Acupuncturist’s Perspective”): LR-3 Taichong, HT-7 Shenmen, SP-3 Taibai, SP-6 Sanyinjiao, ST-36 Zusanli, LU-9 Taiyuan, LI-4 Hegu, BL-13 Feishu, BL-15 Xinshu, BL-18 Ganshu, and BL-20 Pishu. The herbal formula Rambling Powder (逍遥散, Xiao Yao San) was first prescribed to move Liver-Qi; once Liver-Qi stagnation was resolved, the Four Gentlemen Decoction (四君子汤, Si Jun Zi Tang) was prescribed to tonify Spleen-Qi. While the source of his stress (namely the divorce proceedings) could not be eliminated, meditative exercises were used to help this patient reduce stress and center his emotions, making him less susceptible to the negative effects of stress on his health. Manual therapy to the scalp and forehead was primarily applied to reduce stress and improve the quality of his sleep. Structural integration was applied primarily to open the breath. Although his lifestyle was generally healthy, some adjustments were made to his diet, exercise routine, and sleep schedule to optimize his energy levels.


Post-treatment evaluation of this patient revealed a 70% improvement in the symptoms of insomnia, hypochondrium distension, irritability, and constipation, and 30% improvement in energy levels after the first treatment. The lingering cold, edema, and fatigue completely resolved within eight treatments. After ten treatments, the patient reported and demonstrated 90-100% improvement of all symptoms. He continued this course of treatment until he completed his divorce proceedings. After this course of treatment, which totaled eighteen treatments, the patient returned monthly for reassessment and maintenance treatments. He maintained a 90-100% improvement of all symptoms, depending on his stress levels and level of compliance with lifestyle modifications.



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Our mission at Rise is to provide our patients and clients with a holistic and effective approach to healing, as well as the knowledge to proactively prevent illness and injury. We work tirelessly to ensure that our patients/clients receive the care, tools, and knowledge to restore balance to their lives. We take pride in going above and beyond for those who choose us as their healthcare providers. We are committed to serving our community with integrity, professionalism, respect, compassion, and love. In doing so, we hope to improve the overall health and well-being of our entire community by promoting healthy lifestyle choices, as well as mental and emotional health. To this end, we regularly host free seminars and workshops on topics ranging from nutrition to therapeutic meditative exercises; among these topics includes the application of the Five Elements theory to achieve balance in daily life. If you are interested in attending these events, subscribe to our mailing list at the bottom of this page and/or follow us on social media.



References


[1] Maciocia, Giovanni. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Edinburgh: Churchill Livingstone, 1989. Print.


[2] Wu Xing. Wikipedia, 23 Sept. 2013, Wu Xing. (2013, September 23). [Illustration]. https://commons.wikimedia.org/wiki/File:Wu_Xing.png#/media/File:Wu_Xing.png. Accessed 12 Nov. 2021.


[3] Sultan, Cornel & Stamenović, Dimitrije & Ingber, Donald. (2004). A Computational Tensegrity Model Predicts Dynamic Rheological Behaviors in Living Cells. Annals of Biomedical Engineering. 32. 520-30. 10.1023/B:ABME.0000019171.26711.37.


[4] Ingber, Donald E., and Misia Landau. Tensegrity. Scholarpedia, 2012, http://www.scholarpedia.org/article/Tensegrity.

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