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What is Five Element Acupuncture, Anyway?

Most people don’t realise that there are different styles of acupuncture. The one you’ll encounter most commonly is called TCM (Traditional Chinese Medicine), but there are several others, among them Five Elements. So what’s the difference?

- by Gryphon Corpus

A Little History


We’re pretty sure acupuncture originated in China, but there’s no way to know exactly when. Archaeological finds include tools which some think might have been surgical instruments, or possibly some form of acupuncture tools, as old as 8000 years, but the oldest tools that may have been needles date to some 3000 years ago. The earliest clear medical text discussing acupuncture is The Yellow Emperor’s Classic of Internal Medicine, from around 100 BCE. As far as we know, medicine was not taught in schools, but passed down in family lines, father to son. This means that there were distinct lineages, each with their own variations. Some passed to Japan, Korea, and other countries, developing into different styles there. 


In the 18th and 19th centuries more and more Europeans visited China, bringing their ideas of Western scientific knowledge. The Chinese began to see their own, deeply spiritually based, medical traditions as primitive, and wanted to imitate the Western, rationalist perspective. In 1822 acupuncture was banned from the Imperial Medical Institute by the emperor. Of course, many doctors throughout China kept the ancient knowledge alive. In 1929, acupuncture was completely outlawed. The communists also wanted to keep old ‘superstitious’ medicine out, but found that the tiny handful of Western-trained doctors in the country would be nowhere near sufficient to care for the massive population. So in 1949 Chairman Mao agreed to allow the so-called ‘barefoot doctors’ to practice traditional acupuncture and herbalism, provided all spirituality was left out. They referred to it as Traditional Chinese Medicine, and it brought together knowledge from many of the old family lineages. However, it took a very Western, non-traditional approach: if you had X symptom, set of points Y would be needled. It was easy to learn and could be practiced by relatively untrained rural doctors. Please note that the term Traditional Chinese Medicine (TCM) as currently used in the West usually refers to the Eight Principle approach to Chinese medicine, as opposed to the Five Element approach, though it may also be used to encompass all the different traditions. It doesn’t necessarily imply a practice devoid of spiritual heritage.


Acupuncture first came to Europe as early as the 17th century, but really started to gain ground in the West in the 50’s to the 70’s. Here, there haven’t been the restrictions placed by the communist regime, and practitioners, researchers, and others have sought to revive some of the ancient knowledge which was dropped in China. The lineages which developed in Japan, Korea, and Vietnam have also been studied and practiced. We now have acupuncture schools teaching the different traditions, and a licensing standard in most of the United States.


The Five Element Tradition


Over the centuries, a number of different paradigms were created to systematize diagnosis and treatment. TCM, for example, primarily uses a paradigm known as Eight Principles, in which disease is understood in terms of four pairs of opposing factors: yin and yang, heat and cold, excess and deficiency, interior and exterior. Another paradigm is that of the Five Elements, which understands the movements within people as mirroring all that occurs in nature, and basing diagnosis and treatment on natural observation. In the 1960’s the British professor J.R. Worsley began studying acupuncture from European practitioners, as well as traveling to Japan, Korea, and Taiwan, travel to China not being possible at the time. He drew from different traditions and assembled his own understanding of a classical Five Element acupuncture, creating a beautiful, coherent system which looks at each individual as a whole - body, mind, and spirit - not a collection of symptoms. Worsley organized his understanding, founded several schools, and has given rise to a modern lineage of Five Element practitioners rooted in an ancient tradition of medicine that does not throw the baby of spirit out with the bathwater of superstition. Five Element practitioners focus on seeing a person in health and looking for where they have fallen into imbalance through false beliefs, thoughts, or introjections from external sources.


The Chinese term for Five Elements - wu xing - is perhaps better translated as five phases, or five movements. ‘Element’ here should not be understood as something static. Rather, it’s all about flow and relationship. The Elements relate to each other in a cycle, each one having a specific relationship to each of the others. Here’s a very brief overview of each:




Wood is the element of Spring. Its movement is up and out, it’s all about growth and going ever upwards to the light. Wood is the pattern that lies within a seed emanating forth on its inexorable way to becoming a tree. Its time of life is youth, it bursts forth with shouting exuberance, and it is filled with decisive courage. If there’s one thing Wood can’t stand, it’s an obstacle! Wood is assertive, and its healthy response to something getting in the way of its growth is the ability to pivot and find a new path to its goal. A less healthy response might be raging to force the obstacle to move, or completely capitulating at the slightest sign or resistance. Wood is all about perspective, viewing a situation from all angles to find the best way forward. Its greatest virtue is benevolence.




Fire is Summer! In Summer growth is at its peak and everything is flowering, and flowers = sex. Fire is all about warmth and connection, love and communication. I’m a flower and I want to attract pollinators so I’m going to be big and bright and emit delicious smells and let everyone know I’m here! For Fire the primary emotion is joy, and its sound is laughter. In health, Fire knows when to open to intimacy and how much, and gives us the capacity to be vulnerable with others. Fire is the movement between the inner world of the heart and the exterior of other beings, the channel of connection, personal love, you and me. But it’s also the faculty for compassion, contacting that part of ourselves which partakes of the divine and loves everyone with an impersonal, inexhaustible love. In imbalance, Fire can get caught up in stories of betrayal, leading us to fear intimacy and shut down, or else to fling ourselves open inappropriately, looking for love in all the wrong places. Propriety is an important Fire virtue.




The season of Earth is late summer, the time of the harvest. Earth’s energy is mothering, nurturing. It’s all about abundance and comfort, a sense of home and stability and enoughness. In Earth we are in the center, firmly grounded in ourselves, able to give generously, and also to receive care and nourishment. The Earth element is associated with digestion, both physically in terms of the organs involved in taking in and breaking down food into nutrients to be appropriately distributed, as well as psychically and spiritually as we take in less tangible forms of nourishment. A balanced Earth element has a deep sense of reciprocity and the ability to absorb all the good things life has to feed us. Out of balance, Earth may show up as needy or fearful that there will never be enough, or give too much to others only to become resentful about it. Its greatest virtue is integrity. 




Metal is the element associated with Autumn. The year is coming to a close, the harvest is over, leaves are falling, all the wild growth is returning to the earth. Everything is stripped down to its bare bones, and the essence is saved from the excess that is being shed. The Metal element allows us to connect to pure spirit, to the essential nature, and to discard all that does not serve. It has a feel of open spaciousness, sacredness. It’s the feeling of being in a holy place. It gives us our sense of self-worth and meaning, as well as a sense of awe and the ability to accept things just as they are, not needing them to be perfect. In health, Metal connects us to what is important and keeps us from clinging to garbage. Out of balance, Metal can go in the direction of coldness and purity, feeling like nothing is good enough and we must cut out all that is impure, or else in the opposite direction of thinking everything is trash and nothing has any value. The virtue of Metal is appreciation.




With Water we come full circle into Winter, the time of stillness. It appears that everything is dead, nothing moves, but in that stillness stirs all the force and power of the potential for new life. Water is the undifferentiated emptiness that is the ground of all being, the limitless potential from which life flows. As that potential for life, it also holds its opposite, death. Water is the unknown, which can be terrifying and also the source of wisdom, which is ease in the face of the unknown. From Water we derive our ambition, our will to survive no matter what. In health, Water lets us be powerful to good purpose and find the wisdom to be present with whatever life brings. Out of balance, Water may be a raging torrent that overpowers everything in its way, or it may manifest in terror and paranoia. 


So how does Five Element acupuncture work?


Each of the 12 primary meridians in the body is associated with an organ (or an ‘official,’ as the classics refer to them, denoting not just the organ but all of its body/mind/spirit functions), and each of those meridians belongs to one of the elements. For example, the Kidney and Bladder officials belong to the Water element. On each meridian lie numerous points (just 9 on the shortest ones, up to 67 on the longest one), which can be needled to evoke a variety of functions. Among these, there are five element points on every meridian, so there is a holographic nature to the way they can be treated: Fire within Water, Water within Earth, etc. 


A Five Element practitioner will “diagnose” a patient as a particular element constitution, for example Fire. This means the person is, by nature, a Fire, and that Fire is the lens through which they view the world and interpret their experience. One’s constitution is the area in which one exhibits both one’s weaknesses and greatest strengths, and it points the way along the path where our biggest life lessons lie. So a Fire type is likely to interpret early life trauma in terms of betrayal, and then view most of what comes their way in life in terms of intimacy, connection, trust and mistrust. Will I be loved? Is it safe to love or be vulnerable? Can I open my heart? Is it safer to stay closed all the time? They may be incredibly skilled at communication in some settings and find themselves tongue-tied in others. Or perhaps they swing between feeling flat and joyless, and being over-the-top or even manic. Similarly, for each constitutional type, there are different spectra along which they are more likely to exhibit imbalance as well as special ability. 


A person’s constitution tells us a lot about the underlying causes of symptoms they might be experiencing. I once read the following allegory that I find helpful in explaining how we think about the source of a problem (unfortunately I can’t recall who wrote it):

Imagine 12 friends living together. Everyone has assigned jobs around the house that they do to keep everything running smoothly. The Kidney manages the budget, the Large Intestine takes out the trash, the Stomach cooks, and so on. One day the Large Intestine forgets to throw out a soda can before running out the door. The Stomach notices and, because she’s fond of the Large Intestine, she does it for him. The next day the Large Intestine thinks, ‘Huh, that wasn’t a big deal; she took care of it,’ and leaves some more trash out. Pretty soon the Stomach is doing his whole job for him and the cooking starts to suffer. Now the other housemates are affected. The Gall Bladder, he’s got a bad temper, and he starts yelling at everyone because he’s hungry. That’s a symptom - you (the household) are getting gallbladder pain and you think you need medications to treat your gallbladder. Meanwhile, the actual culprit, the large intestine, is innocently twiddling his thumbs in the corner. That’s where the treatment really needs to be aimed! 


Five Element practitioners are sleuths, looking for who started the situation. We don’t want to just treat symptoms because that doesn’t fix the real problem. Symptoms are our signposts in the wilderness, helping us figure out which way we actually need to head. When we get on the right track, they hopefully resolve themselves. (I say hopefully, because if an imbalance has gone on for a long time and there are severe physical effects, we can’t necessarily expect those to vanish overnight even if we have addressed the cause.) Just treating the symptom is like putting some tape over your car’s check engine light so you can pretend there isn’t a problem. You know eventually it will just show up somewhere else and be worse! 


It’s important to note also that Five Element acupuncture is body/mind/spirit medicine. We don’t view these things as separate. Often we see symptoms arise on more than one level under the auspices of a single ‘official.’ For instance, imbalance in the Liver might manifest with headaches, joint pain, insomnia, a tendency to anger, and a feeling of hopelessness. And because the mind/spirit/emotions shift more readily than the body, it’s easier to change things when they manifest at the subtler levels. So we encourage people to seek acupuncture treatment before they have physical symptoms, not as a last resort. 


Further reading:


Archetypal Acupuncture, by Gary Dolowich A beautiful book that discusses the dynamics of the elements as archetypes we can all recognise.


Traditional Acupuncture: The Law of the Five Elements, by Dianne Connelly A good introduction to the components of Five Element acupuncture and some of the clinical thought process.


Between Heaven and Earth, by Harriet Beinfield and Efrem Korngold Discusses the wholeness approach of Eastern medicine, and includes a fun Five Element self-diagnosis test (which should be taken with a large grain of salt, as it’s not at all how practitioners diagnose.)


Nourishing Destiny, by Lonny Jarrett For those who are deeply interested. This masterful work dives deep into Chinese Medicine as dharmic medicine. It begins with Chinese cosmogony and explores the Five Elements at a profound level. While the book is intended for practitioners, it is accessible to everyone with a serious interest in understanding the philosophy of Chinese medicine. I also highly recommend exploring Lonny’s website for a treasure trove of articles and discussions on integral medicine.



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