What Have the «Five «Elements» Got to Do with Acupuncture?

In a previous post I talked a little about the five-element system of looking at the world. But what has it got to do with acupuncture? Well, acupuncture is a method used in traditional Chinese medicine (TCM), and as I exemplified in that post the five elements in that system have a very great deal to do with the way the body works in health and disease. One of the major classic texts of Chinese medicine, the Huang Di nei jing su wen or Inner Canon of the Yellow Emperor, describes in detail the various pathological states that are believed to arise from imbalances in the five elements.

In modern acupuncture schools five-element theory is taught as being fundamental to the practice of acupuncture. You puncture this point and you stimulate a “wood” point, that one and it’s an “earth” point and so on. There are complex methods devised to manipulate with needles the laws that govern energy transformation between the phases (“phase” is another, perhaps better word for “element” in Chinese medicine).

However, among scholars doubt exists whether these methods are actually traditional at all. One school of thought has it that for much of the history of acupuncture, points were selected on the basis of what collective experience told about what symptoms they successfully treated, rather than theoretical considerations about the five elements. According to this school of thought, the latter is a quite recent invention stemming from the “Great Leap Forward” and the “Cultural Revolution” (1950s and 60s respectively). I have also read that the relevance of the five elements to clinical practice was transplanted to acupuncture from herbal medicine, where it is more clearly applicable. That certainly makes sense to me.

My reflections on my own experience lead me to believe that five-element theory has little bearing on the success or otherwise of acupuncture treatment, and I do not base my practice of acupuncture on this theory any more.


Copyright © Robert Hale 2021. Image: The Five Elements Cycle by Manonastreet, reproduced according to Creative Commons licence CC0, via Wikimedia Commons.

Robert Hale is an osteopath, acupuncturist and naturopath in Santa Eulalia del rio, Ibiza. / Robert Hale es un osteopata, acupunturista, y naturopata en Santa Eulalia del Rio, Ibiza.

Holistic Medical Systems Do NOT Treat the Cause

I am going to say something controversial. Holistic health systems do not «treat the cause». It is so often stated that they do, in contrast to conventional («allopathic») medicine which «just dispenses drugs and surgery». This is not true. «Finding the cause» is proper to good conventional medicine.

You are feeling weak and tired and your complexion is dull and pale. Your doctor arranges blood tests and it turns out that your blood lacks iron and your red blood cells are few and small. Your doctor prescribes an iron supplement and you begin to feel better. Your doctor has correctly diagnosed that iron deficiency anaemia is the cause of your symptoms. Your doctor goes further. Why are you lacking iron? Is your diet providing sufficient iron? If you are a woman, are your periods very heavy or are you bleeding between periods? Have you abdominal pain? Is there blood in your stools? These are all questions for good conventional medicine. The way it is practised is not always good. But the fact that a doctor may not be thorough does not damn the discipline of medicine as such. Its aim and its technical abilities are geared to finding out a cause. That is its strength and also its blind spot.

It is a blind spot because health and ill health, life itself in fact, are not that simple. To speak of «the cause» is frequently a distorted portrayal of reality. To do so habitually is a symptom of a deeply ingrained, distorted view of the world. Just say that you continued the «why game». Your anaemia, your doctor has found out, has its origin in a bleeding duodenal ulcer. That is successfully treated, but why was it there? From that point on it often becomes a complex interplay of genetic, environmental, behavioural and emotional factors. There is no one cause, it is multifactorial. At this point it should be a question of assessing influences then joining the dots rather than looking for a single cause. But here conventional medicine is inclined to stop in its tracks with a prescription of omeprazol.

Do holistic systems manage better? Perhaps the one that comes closest is true naturopathy (not the mix-and-match assortment of «techniques» that often passes for it), which focuses on diet and lifestyle. A criticism that might be levelled against the typical naturopathic mindset however, is a reluctance sufficiently to acknowledge psychological factors. I believe this to be on the one hand a reaction to the perceived tendency in conventional medicine to brand any unexplained symptoms as «psychological», and on the other the ego tendency of some naturopaths (untrained in clinical psychology or psychotherapy) to convince themselves that with their special insights they can be all things to all people.

What of other disciplines? I will speak of those I know best: osteopathy and acupuncture. The truth is, these systems do not seek out and treat «the cause», instead they find ways of:

  • Reducing strain in the organism so that it can free up resources for self-healing.
  • Improving function in certain parts, systems or domains of the organsim.
  • Improving the body’s interaction with its environment, and its resilience to environmental stressors.
  • Providing psychological cues which promote healing.

But many osteopaths also have a naturopathic mindset and many acupuncturists also have a rounded knowledge in diet and lifestyle from a traditional Chinese perspective, so all in all, they can set up a context for healing both within and without the body.

Copyright (c) Robert Hale 2022. Public domain image from Pixabay.com.

Robert Hale is an osteopath, acupuncturist and naturopath in Santa Eulalia del rio, Ibiza. / Robert Hale es un osteopata, acupunturista, y naturopata en Santa Eulalia del Rio, Ibiza.

An Approach to Chronic and Complex Health Problems

I have a special interest in the treatment of chronic and more complex problems. The word «chronic» means that a problem has been present for a long time, technically more than 6 months.

Some problems, such as generalised osteoarthritis, have a naturally chronic course. In the case of osteoarthritis, this is because joint degeneration is, to an extent, part of the natural ageing process. Note however, the phrase «to an extent», the corollary of which is that to an extent it is not, and to that extent there are some very useful things we can do to help prevent it. We can also help to prevent the inflammatory response which makes the damaged joint painful.

Other problems become chronic because they never properly resolved after their first appearance. If you strain a joint, a series of reactions are set up in the body to heal any tissue damage that has occurred, but also postural and behavioural adaptations occur to favour the strained joint by removing load from it. If the healing inflammatory response is effective, the necessity for these adaptations is short-lived, and soon everything returns to normal. If however, the healing response is inadequate, pain and inflammation linger on and postural and behavioural adaptations become more and more «fixed». At this stage they are interfering with the proper function of the joint that was injured originally, thus adding to its problems in the long term.

But why should the initial inflammatory response be inadequate? One reason may be a general lack of vitality. Another frequent reason is that the strain is only the final result of years of development of postural and movement patterns that have rendered the local area vulnerable. In this context the body’s healing response has the odds stacked against it.

How may chronic problems be effectively treated? Simply working to relieve local strain may give temporary relief, but it is not a long term solution. To achieve long-term improvement, it is necessary to improve the way in which the whole body distributes the load placed upon it, as well as removing unnecessary load from the body. Furthermore, taking off the strain means removing load, or improving the organism’s handling of it, in various spheres, not just the mechanical one. For example, psychological stress, smoking and junk food can also contribute to the demands (the «load») placed upon the organism. Only by addressing all these aspects can the organism’s self regulatory mechanisms be fully adjusted towards their maximum healing potential.

This takes quite a long time. In conditions which have evolved over several years, a few manual treatments plus some brief advice is not enough. An ongoing effort is required over at least eighteen months to achieve what can be achieved. There are several points to bear in mind before embarking on such a journey:

  1. One cannot prioritise healing – the body itself does that. For example, you may consider your neck pain to be a priority and wish that to be treated first. Unfortunately, it does not work like that. All we can responsibly do is help the organism into the right conditions for healing responses to occur. The body will then decide on its priorities.
  2. A corollary to this is that we do not treat «problem X», we treat the whole person. In some circumstances, we may not even directly «treat» the symptomatic part at all, but treat the context in which it is found.
  3. Some things may get worse before they get better. It is as if the body needs an acute response to resolve the chronicity.

Palliation of symptoms does not bring long term solutions, and can even make matters worse. One reason for this is simply that by smothering a symptom, underlying causes are ignored and left unchecked. Another reason is that the treatment itself may cause long-term damage. Two examples: (1) If heavy manipulation is repeatedly used to batter a vertebra «into place», firstly that vertebrae may become unstable, and secondly the body will find another way of compensating for its underlying problems. (2) The use of non-steroidal anti-inflammatory drugs (commonly used to treat pain) in the long-term treatment of osteoarthritis, has been shown actually to increase the rate of joint degeneration.

On the other hand, the holistic treatment of chronic problems is not all plain sailing, but it is the approach which goes furthest to restoring general health.

Copyright (c) Robert Hale 2022.

Image: The original uploader was Harrygouvas at Greek Wikipedia, Creative Commons licence CC BY-SA 3.0 , via Wikimedia Commons.

Robert Hale is an osteopath in Santa Eulalia, Ibiza.

Spinal Pain: An Alternative Approach

Without doubt the most frequent kind of problem with which I am asked to deal is pain coming from the spine. This can manifest as pain in the areas near the spine (the back and the neck) or in areas connected to the spine by nerves (frequently the legs, the arms or the thorax and chest). Sometimes there are other, associated symptoms in these connected areas, like tingling, pins and needles or numbness.

My approach to these problems is based on an osteopathic view of health and illness. It follows that it differs in fundamental ways from the usual approach of orthodox medicine or physiotherapy.

The medical approach to spinal pain

As medicine is generally practised it:

  • Allows little time for the doctor to spend talking to and examining the patient.
  • Aims to identify a distinct pathological cause (i.e. a “disease”).
  • Makes frequent use of x-rays, scans and blood tests to do this.
  • Tends to regard the painful or diseased part in isolation.
  • Uses the principal strategy of suppressing symptoms.
  • Relies on drugs as first line treatment, physiotherapy as second line, surgery as third line.
  • Physiotherapy reflects these characteristics of the medical approach.

My approach to spinal pain

In contrast, as an osteopath, I:

  • Allow as much time as is necessary for talking to and examining the patient.
  • Am more interested in why you have become unwell than in the name of your disease. Generally the kind of treatment you receive is not greatly affected by your medical “diagnosis”. It is determined much more by how your body is working mechanically, the factors in your life which are preventing you from getting better, and your general state of health.
  • Find only secondary and relative value in x-rays, scans and blood tests. That is because in most cases of uncomplicated spinal pain, they are not relevant to your treatment or management.
  • Try to relate your problem to what is happening in your whole body, your mind, and your life.
  • Believe that suppressing symptoms can cause bigger problems (symptoms are often a necessary part of the body’s healing response), preferring instead to remove any obstacles to healing.
  • Rely on manual treatment, lifestyle changes and counselling: this is usually sufficient and complete treatment.

A complex system

The spine is not just a column of bones. It could be likened to an extremely sophisticated robotic machine controlled by extremely sophisticated computer circuitry. There is immense potential for glitches in its workings even with no sign of anything that might be labelled medically as a “disease”. Osteopaths call such glitches in spinal workings “dysfunction” or sometimes “osteopathic lesions” (an older term).

I use manual treatment to remove or reduce these «glitches», helping the spine to return to as near normal functioning as possible. Clearly, if joint or disk degeneration have significantly altered the basic shape or quality of the tissues of the spine, improvement may take longer or be incomplete. However, moderate improvements in function can turn a painful spine into a largely pain-free one even in the presence of what doctors call “disease” (for example, arthritis, disc hernias, etc.)

Craft, expertise, and modern science

In my experience the osteopathic approach, well practised, is clearly beneficial for patients who suffer from spinal pain. Osteopathy is a craft. I have been learning this craft for nearly three decades, and I am still learning. Nothing that I have learned so far has led me to doubt the basic principles underlying its usefulness as a therapeutic discipline. However, scientific knowledge of the workings of the spine and its problems is constantly expanding. As an expert in the care of patients with spinal problems, I keep myself continually abreast of the most recent research, in order to ensure that I am able to deliver the best care.

Copyright (c) Robert Hale 2022. Photo by Marco Verch, via Flickr. Creative Commons CC BY 2.0 licence.

Robert Hale practises osteopathy in Santa Eulalia, Ibiza.

What You Need to Be an Osteopath

1. Anatomy. An excellent knowledge of how the body is made is essential. For an osteopath there are three kinds of anatomy. The first is the theory, that is the names, locations, and forms of every body part. The second is what we call functional anatomy, or ‘what things do and how’. Another word for this is ‘physiology’, but I like the term ‘functional anatomy’ because it relates function with form, which is one of osteopathy’s basic principles. The third kind of anatomy is palpatory anatomy, that is, what all the parts of the body feel like to the hands.

2. An appreciation of relationships. Relationships between body parts, between form and function, between each part or function and the whole, between the body and the mind, between the body-mind and the outside world. The inseparability of all of these. This is what osteopaths deal in.

3. Problem-solving. The ability to analyse a situation, to see its essential elements, and to understand how we may most effectively induce changes, is fundamental.

4. Manual skill. We need to attain the same kind of skill level that one sees in expert musicians, for example.

5. Medical knowledge. This enables us to know what not to do in treatment in specific cases, what lifestyle advice is most appropriate, and when to refer a patient to a medical practitioner.

6. Humility. We know the lesser part of how the body works. Therefore we must use a general plan that is tolerant of our ignorance. And each of us has our personal limitations, so we must acknowledge them and work to our strengths.

Copyright Robert Hale 2021. Image by Piotr Siedlecki, from PublicDomainPictures.net.

Robert Hale practises osteopathy in Santa Eulalia, Ibiza.