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Krennie Tran Nguyen

Five Element Acupuncture Theory and

Clinical Applications
Five element theory is one of the major systems of thought within Chinese medicine.
From a historical perspective it is an important underpinning of medical theory and
serves as one of the major diagnostic and treatment protocols. In modern clinical practice
the five element theory is used in varying degrees depending on the practitioner and style
of acupuncture that they practice.

For practitioners or Traditional Chinese Medicine, the theory may be used to help form a
diagnosis when there is conflicting signs and symptoms. Additionally, elements of the
theory are useful for assisting patients with nutritional balancing and/or working through
emotional issues. The theory is used extensively by Japanese acupuncturists within the
five phase treatment protocols and by Classical five element practitioners, such as those
who follow the teachings of the late J.R. Worsley. The information below discusses the
Five Element theory and clinical applications in detail.
Primary Correspondences Within Five Element Theory

The Five Element theory is based on the observation of the natural cycles and
interrelationships in both our environment and within ourselves. The foundation of the
theory rests in the correspondences of each element to a variety of phenomena. The most
common correspondences are listed in the chart below:


Heart &
Yin Organs Spleen Lungs Kidneys Liver
Small Intestine
Yang Organs Stomach Large Intestine Urinary Bladder Gall Bladder
Triple Heater
Sense Organs Tongue Mouth Nose Ears Eyes
Tissues Vessels Muscles Skin Bone Tendons
Tastes Bitter Sweet Pungent Salty Sour
Colors red yellow white blue/black green
Sounds Laughing Singing Crying Groaning Shouting
Odor scorched fragrant rotten putrid rancid
Emotions Joy Worry/Pensiveness Grief/Sadness Fear Anger
Seasons Summer Late Summer Autumn Winter Spring
Environment Heat Dampness Dryness Cold Wind
Growth Transformation Harvest Storage Birth
Direction south center west north east
triangular features round features tall slender
features large features
strong voice strong digestion strong bones and
Body Types small hands strong legs
meticulous, strong loyal, enjoy joints
quick calm generous
willed movement hard workers

Five Element Cyles, Relationships and Interactions

Within five element theory there are four main relationships or ways in which the
elements interact. The first of these is the generating (sheng, mother-child) cycle. This
cycle describes the ways in which each element, serving as a mother, promotes the
growth and development of the following child element.

Examples of this cycle are the Wood element providing the generative force for Fire, Fire
providing the generative force for Earth, etc. This relationship provides the foundation for
understanding five element theory and, consequently, where imbalances may arise within
the cycle. If Earth, for example, is weakened from a poor diet and overwork you will see
that more nourishment is requested from the Fire element to nourish Earth. Additionally,
if Earth is weakened the Metal element may also be effected.
From a clinical perspective you may see people develop digestive issues from irregular
eating, excessive worry and overwork which leads to a proliferation of dampness which
then effects the Metal element. Within this case you may see a combination of bloating,
gas and poor energy with the development of Metal (Lung) symptoms such as sinusitis or
phlegm-type asthma.

The controlling (ke, grandparent-grandchild) cycle provides for a check and balance
system among all of the elements. Within this cycle Earth, for example, provides a
control for Water and is controlled by Wood. An example of this relationship within the
body is in cases of anxiety (Fire) which are related to LV Qi Stagnation (Wood) where,
over time, you begin to see more Kidney (Water) related signs as the Water element
attempts to control the overactive Fire.

The overacting cycle (cheng) is an imbalance within the controlling cycle where the
grandmother element provides too much control over the grandchild and weakens the
element. Within nature you may see Water putting out Fire, Earth soaking up Water and
so on.
A clinical example of this relationship would be Liver (Wood) overacting on the Spleen
(Earth). In this case you have an overactive Wood element overcontrolling Earth leading
to distruptions in the digestive system.

The insulting cycle (wu) is also an imbalance within the controlling cycle where the
grandchild insults or returns the controlling force generated by the grandmother. Using
examples from nature you can see Fire burning up Water and Water washing away Earth
and so on.

Clinically you may see this in cases where people have long-term psychological problems
(Fire) which eventually effect the Kidneys (Water) as seen in the development of more
Yin (Water) deficiency signs.

Five Element Pathology and Clinical Applications

As described in the introduction there are a variety of ways in which the theory is used
clinically. Our Japanese section describes the five phase treatments in detail and our
classical five element (worsley style) page describes the ways in which a pure five
element practitioner would utilize the theory.

This section describes the basic ways in which a practitioner of traditional chinese
medicine applies the theory in a clinical setting. The Five Shu (transporting) Points, listed
below, represent the relationship of the theory to individual acupuncture points. Our
understanding of these points is based largely on the information within the Nan-Ching:
The Classic of Difficult Issues.

Five Shu Points

Jing-well Ying-spring Shu-stream Jing-river He-Sea

Yin Meridians
(Wood) (Fire) (Earth) (Metal) (Water)
LU LU 11 LU 10 LU 9 LU 8 LU 5
PC PC 9 PC 8 PC 7 PC 5 PC 3
HT HT 9 HT 8 HT 7 HT 4 HT 3
SP SP 1 SP 2 SP 3 SP 5 SP 9
LV LV 1 LV 2 LV 3 LV 4 LV 8
KD KD 1 KD 2 KD 3 KD 7 KD 10
Jing-well Ying-spring Shu-stream Jing-river He-Sea
Yang Meridians
(Metal) (Water) (Wood) (Fire) (Earth)
LI LI 1 LI 2 LI 3 LI 5 LI 11
TH TH 1 TH 2 TH 3 TH 6 TH 10
SI SI 1 SI 2 SI 3 SI 5 SI 8
ST ST 45 ST 44 ST 43 ST 41 ST 36
GB GB 44 GB 43 GB 41 GB 38 GB 34
UB UB 67 UB 66 UB 65 UB 60 UB 40

The major point categories (i.e. jing well, etc.) described above are discussed in more
detail here. For the purposes of this discussion an extract from the chart above showing
only the Mother and Child points provides a good starting point to understand the
application of the theory to acupuncture.

The Mother and Child points for each meridian are derived from the chart above using
the following logic. According to the generating cycle the mother of Earth is Fire and the
child of Earth is Metal. Using this information for the Yin Earth Meridian (Spleen) the
mother point is the Fire point on the Spleen meridian SP 2 and the child point is the Metal
point on the Spleen meridian SP 5.

Mother & Child Five Element Points

Mother Child
Lung (Metal) LU 9 LU 5
Large Intestine (Metal) LI 11 LI 2
Stomach (Earth) ST 41 ST 45
Spleen (Earth) SP 2 SP 5
Heart (Fire) HT 9 HT 7
Small Intestine (Fire) SI 3 SI 8
Urinary Bladder (Water) UB 67 UB 65
Kidney (Water) KD 7 KD 1
Pericardium (Fire) PC 9 PC 7
Triple Heater (Fire) TH 3 TH 10
Gall Bladder (Wood) GB 43 GB 38
Liver (Wood) LV 8 LV 2

A clinical example of this theory would be dispersing the child point of the Wood
meridian (Liver) - LV 2 - in the case of LV Fire Rising where a patient is experiencing
LV signs such as anger and irritability along with HT related signs such as disturbed
sleep and agitation.

Another example would be tonifying the mother point of the Earth meridian (Spleen) - SP
2 - in the case of SP Qi Deficiency where a patient is experiencing poor appetite and low

The example above brings up an interesting point from the perspective of a TCM
practitioner. While the five element theory is a useful tool in many cases, there are times
where the theory indicates a point which clinical experience has proven to be less
effective than another point. In the case above, SP 2 is indicated by the theory whereas
SP 3 is more commonly used for this condition. Some of the points which have varying
degrees of correspondence with the theory are:

• HT 9 & PC 9 - are most often used to clear heat.

• SI 3 & SI 8 - reduce heat, pain and stagnation but provide no tonifying effect.
• LI 11 - is typically dispersed to clear heat.
• TH 3 - has no tonification effects.
• ST 41 - is typically used to disperse fever a/or reduce abdominal distention,
although it can be as a local point in a tonifying manner to increase energy flow to
the foot.
• SP 2 - is not the most tonifying point on the SP meridian - SP 3 is a better choice.
• UB 67 - dispersive point for acute conditions.
• GB 43 & GB 38 - are both used to clear heat.