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Daisy Vance

Mind-Body Acupuncture
Summer 2014

Autism Spectrum Disorder and the Five Elements

Autism Spectrum Disorder (ASD) is an illness that is characterized by the presence of


certain behaviors. For this reason, in Western medicine it is classified as a mental illness and in
Oriental medicine as a disorder of the spirit. It is defined as a spectrum disorder because the
presentations can vary significantly from patient to patient. Still, there are certain defining
characteristics of Autism, outlined in the Diagnostic and Statistical Manual of Mental Disorders
(DSM), that shed light on the types of imbalances present from the perspective of the five
elements in Oriental medicine. The Water and Earth elements play the largest role in the root of
ASD while Fire has the biggest impact on the branch symptoms with some involvement of the
Metal element. Since all the elements affect each other, imbalances in Wood are also commonly
seen in patients with Autism, but because the characteristics associated with Wood imbalances
are not described as part of the diagnostic criteria for ASD, they will not be discussed in this
paper.
At the most basic level, ASD is an impairment in a childs cognitive development. In the
five elements, this is directly linked to a deficiency of the Water element, and more specifically
the aspect related to the Kidney energy system, which is responsible for a persons growth and
development especially in-utero and during the first 3 years after birth (Hammer, 111). The Yin
aspect of the Kidneys, including the Kidney Essence or Jing (loosely equated to a persons
genetics), has the role of supplying the material marrow necessary for the Central Nervous
System (CNS) to develop and function properly. As Leon Hammer puts it, Parenchymal and
functional integrity, on all levels of the central nervous system, depend upon the ability of the
Kidney essence to create and maintain it, (105). Therefore, the primary root of ASD, as a

Daisy Vance
Mind-Body Acupuncture
Summer 2014

developmental disorder of the CNS, can be seen as a constitutional Kidney Yin deficiency which
leads to an impairment in the growth and development of the CNS.
There is also evidence of Kidney Yin deficiency in some of the behavioral presentations
of Autism. The first component of the second diagnostic criterion for ASD (B-1) is stereotyped
or repetitive movements, speech, or use of objects. (See Appendix for the complete diagnostic
criteria for ASD from the most recent, 5th, edition of the DSM.) These behaviors often result
from a significant deficit in the material essence that makes up the central nervous system,
Kidney Yin. Dr. Hammer explicitly states that, Kidney Yin Deficiency sometimes creates
palpable central nervous system deficits in which repetitive, stereotypical behavior is
common, (121) further supporting a deficiency in the Water element in those afflicted with
Autism.
Kidney Yin deficiency can also lead to a condition called Literalism which is
reminiscent of the second component of the second diagnostic criterion for ASD (B-2):
insistence on sameness and inflexibility such as rigid thinking. Literalism is defined as an
impairment in abstract thinking so that there is difficulty modifying established rules to fit
certain contexts (Hammer, 124). Hammer gives an example of a man who accepted a rule not to
kill plants and therefore refused to do a job involving cutting grass and vegetation along
highways (125). Similarly, those afflicted with Autism often have a hard time understanding the
different expectations that come with different contexts, leading to insistence on sameness. This
core constitutional deficiency in the Water element of those suffering from Autism further
affects the integrity of the other elements in the Five Element system.
The Earth element is in charge of the digestion of food and thoughts into a form that can
be assimilated by the body and mind. It is also responsible for a persons ability to form

Daisy Vance
Mind-Body Acupuncture
Summer 2014

meaningful bonds (Hammer, 226). It has a reciprocal relationship with the Water element when
it comes to the development of a child. Water relies on Earth for the digestion of food into
nutrients that can be used for the development of the CNS, and Earth relies on Water to supply
the energy necessary for its digestion of food and thoughts. If one of the elements is deficient,
the other will suffer, hindering a childs growth and development. As Dr. Hammer explains,
The two systems (Earth and Water) are thereby functionally reciprocal, so that a developmental
affliction of the central nervous system may involve an impairment in one or both as etiologic
factors in varying degrees, (229). By the time they are born, children with Autism have a
constitutionally weak Water element which led to a deficient Earth element through their
reciprocal relationship causing a developmental delay in the growth of their central nervous
system.
The damage to the Earth element in children with ASD is compounded by the fact that,
there is a wide spectrum of autistic states with which children are born that limit contact and
communication, (Hammer, 239). Because of this, these children are unable to accept the
nurturing efforts from their mothers which is necessary in those formative 3 years after birth to
support the evolution of the childs Earth element. This leads to a deficiency in the bonding
energies of Earth, or what Hammer calls the Oral Character. Similar to some of the behaviors
seen in Autism, the personality type associated with the Oral Character can include, compulsive
behavior, which often becomes outwardly quite bizarre, involving, for example, the constant
rearranging of objects into a certain inexplicable order, (Hammer, 241). The second component
of the second diagnostic criterion for ASD (B-2) includes ritualized patterns of behavior, and the
first component of this criterion (B-1) includes stereotyped and repetitive use of objects such as
lining up toys. While there are other elemental imbalances at play in these two features of ASD,

Daisy Vance
Mind-Body Acupuncture
Summer 2014

they are suggestive of the compulsive behaviors Hammer describes above as an Oral
characteristic due to a deficiency in the Earth element during the first 3 years of life.
Water and Earth energies play the strongest role in the root of Autism because of their
major involvement in a childs development in-utero and the first 3 years after birth. Fire, on the
other hand, plays the strongest role in Autisms branch symptoms. Along with many other
functions, the Fire element is responsible for an individuals relationship with others. As
Hammer puts it, Fire energies [are] in the center of all interpersonal considerations, (174).
This relates to the first and main diagnostic criterion for ASD: social communication and
interaction deficits. The two primary Fire element organ imbalances that seem to be involved in
Autism are the Heart and Pericardium.
In the realm of interpersonal relationships, the Heart, and especially its Yin aspect, has to
do with a persons appreciation of other people, the experience [of] joy and celebration of the
existence of others, (Hammer, 175). This seems to be lacking in people with ASD, who show
little interest in peers (diagnostic criterion A-3) and who show deficits in social-emotional
reciprocity (A-1). Hammer describes the personality type associated with Heart Yin deficiency
as an inclination to be, happy in areas of living more involved with things than people, (177).
Similarly, those afflicted with Autism are often uninterested in and even avoid contact with other
people.
Another aspect of the Heart Yin deficient personality is the inability to accept that the
truth may change depending on the point of view. Those with a deficient Heart Yin, can
entertain no sense of the transient nature of the truth as we are capable of knowing it and must
believe that the current or past truth is the absolute truth, (Hammer, 176). This is similar to the
case of Literalism described above as a result of Kidney Yin deficiency, and is often seen in

Daisy Vance
Mind-Body Acupuncture
Summer 2014

Autism where rigid thinking patterns are common (diagnostic criterion B-2) along with
impairments in understanding that other people may have different interpretations of the same
situation, leading to difficulty developing and maintaining relationships (A-3).
Another interesting correlation between a Heart Yin imbalance and ASD has to do with
interpretation of external stimuli. Sometimes people with Autism have hypersensitive senses and
therefore have a hard time dealing with certain sounds, lights or textures, for example. This is
outlined in the fourth component of the second diagnostic criterion (B-4). Hammer describes a
similar situation in the context of Heart Yin excess where there is, a greatly enhanced awareness
of the constantly impinging sensory and emotional stimuli from the outer world, (187).
Conversely, this same diagnostic criterion mentions the possibility of a lowered sensitivity to, or
an abnormal interest in sensory input. While Hammer makes no mention of a case of diminished
sensory perception, the Hearts role as the organ that perceives all external stimuli and brings
them into awareness implies that this symptom of Autism is related to an imbalance in Heart
energies.
Where the Heart is involved in the value a person places on interpersonal relationships,
the Pericardium is the avenue through which these interpersonal relationships can materialize.
The Yin aspect of the Pericardium is involved in how guarded a person is when it comes to
revealing their inner thoughts and feelings, and the Yang aspect has to do with how a person
relates or connects to others. When it comes to the diagnostic considerations of ASD, there
seems to be more of an imbalance in Pericardium Yang than in its Yin. Dr. Hammer describes
the person whose Pericardium Yang energies are deficient as having the, inability to [express
ideas] when and with whom it counts in a convincing fashion. due to the weakness of his
presentation, (213). This description brings to mind the second and third components of the

Daisy Vance
Mind-Body Acupuncture
Summer 2014

first diagnostic criterion for Autism (A-2 and A-3): deficits in understanding and using nonverbal communication such as gestures or facial expressions, and deficits in maintaining and
understanding relationships such as adjusting behaviors to fit certain social situations. Both of
these deficits make it very hard for a person with Autism to convincingly express their ideas to
others, as is the case with Pericardium Yang deficiency. The Heart is the center for love and the
desire to connect with other people and the Pericardium, surrounding the Heart, protects it and
provides a gateway for its expression. A person with Autism has a deficiency in both Heart and
Pericardium energies leading to a disinterest in connecting with others and a social awkwardness
when those connections are attempted.
Finally, Metal energies are responsible for the transformation and expansion of existing
bonds (Hammer, 259). Specifically, the Yin energies are involved in the transformation of
bonds into more meaningful relationships, and the Yang energies are involved in their expansion.
A deficiency in Metal Yin energies is present in ASD where there is a difficulty maintaining
relationships (A-3). Hammer mentions that a Metal Yin deficiency results in a failure to
establish age appropriate liaisons, (268). Similarly in Autism it is initially difficult to form
bonds with other people because of Fire and Earth imbalances, and then even if some bonds are
formed, it is rare for them to transform into something significant.
Metal Yang deficiencies are also present in ASD where there is a lack of expansion of
bonds not only with people but also with objects, ideas and beliefs, (Hammer, 275). This results
in behaviors similar to those described in the third component of the second diagnostic criterion
(B-3): highly restricted, fixated and perseverative interests. Hammer even describes the
cognition of a person with Metal Yang deficiency as being, characterized by perseveration,

Daisy Vance
Mind-Body Acupuncture
Summer 2014

(275). This Metal Yang deficiency in people with ASD make it very hard for them to let go of
and expand their interests.
The diagnostic criteria defining Autism Spectrum Disorder in the DSM gives insight into
the core elemental and energetic imbalances from the perspective of Oriental medicine,
indicating central imbalances in the Water, Earth and Fire elements with some involvement of
Metal. Along with many other of the mental or spiritual disorders, the imbalances seen in
Autism are on a more energetic level than a physical one. Because of this, Oriental medicine, as
a medicine of energetics, can provide much more profound understanding and ability to treat
Autism and other spiritual afflictions. As Dr. Hammer admits in reference to Autism, The use
of acupuncture and herbs to open these energy pathways might be a productive path to
investigate, (126).

Daisy Vance
Mind-Body Acupuncture
Summer 2014

Appendix

Diagnostic Criteria for 299.00 Autism Spectrum Disorder


A. Persistent deficits in social communication and social interaction across multiple contexts, as
manifested by the following, currently or by history (examples are illustrative, not exhaustive;
see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social
approach and failure of normal back-and-forth conversation; to reduced sharing of
interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for
example, from poorly integrated verbal and nonverbal communication; to abnormalities
in eye contact and body language or deficits in understanding and use of gestures; to a
total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understand relationships, ranging, for
example, from difficulties adjusting behavior to suit various social contexts; to
difficulties in sharing imaginative play or in making friends; to absence of interest in
peers.
Severity is based on social communication impairments and restricted, repetitive patterns of
behavior.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two
of the following, currently or by history (examples are illustrative, not exhaustive; see text):

Daisy Vance
Mind-Body Acupuncture
Summer 2014

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple


motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of
verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same
food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong
attachment to or preoccupation with unusual objects, excessively circumscribed or
perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the
environment (e.g. apparent indifference to pain/temperature, adverse response to specific
sounds or textures, excessive smelling or touching of objects, visual fascination with
lights or movement).
Severity is based on social communication impairments and restricted, repetitive patterns of
behavior.
C. Symptoms must be present in the early developmental period (but may not become fully
manifest until social demands exceed limited capacities, or may be masked by learned strategies
in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important
areas of current functioning.

Daisy Vance
Mind-Body Acupuncture
Summer 2014

E. These disturbances are not better explained by intellectual disability (intellectual


developmental disorder) or global developmental delay. Intellectual disability and autism
spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder
and intellectual disability, social communication should be below that expected for general
developmental level.

Bibliography

"Diagnostic Criteria for 299.00 Autism Spectrum Disorder." Centers for Disease Control and
Prevention. Centers for Disease Control and Prevention, 24 Mar. 2014. Web. 07 Aug.
2014. <http://www.cdc.gov/ncbddd/autism/hcp-dsm.html>.

Hammer, Leon. Dragon Rises, Red Bird Flies: Psychology & Chinese Medicine. Barrytown,
NY: Station Hill, 1990. Print.

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