The «Five Elements» in Chinese Medicine

The great ancient civilisations developed philosophical models of existence that encompassed the cosmos, living beings, physiology, health, disease and medicines. They were based on fundamental “elements” that made up the universe. The Chinese had and still have a five-element system, Ayurvedic medicine also had and still has five elements, and Ancient Greek and Islamic medicine had four elements. In medicine, all these systems had several things in common, but above all it was their focus on vitality that characterised them and differentiated them from modern medicine.

Let us look at the Chinese system. The Chinese five elements are Wood, Fire, Earth, Metal and Water. These are not to be taken literally. They are more like groups of characteristics, or you could say different “personalities”. Everything that exists in the universe is made up of different combinations of these “personalities”. However, in each thing, one of them is usually dominant.

Image by Parnassus, CC BY-SA 3.0, via Wikimedia Commons.

One can also consider the elements to be different forms of energy. Energy is transformed cyclically from one element to the next in a specific order. In traditional Chinese theory there are universal laws governing this transformation of energy. We won’t go into these here.

Instead, let us take one element and see how it manifests itself in the human body and mind.

The Wood “personality” is dominant in the energy of the liver and gall bladder, the tendons, the nails, the eye, and the emotion of anger. How are these things connected? The liver produces bile which is collected by the gall bladder for release into the duodenum in order for it to carry out its digestive functions. There is an energy channel called the liver meridian which begins in the foot, runs up the body through the liver and ends at the eye. So eye inflammations or other problems are associated with alterations in liver energy. Very often people with liver congestion or disease become irritable and this can easily spark into anger. What about the tendons and the nails? This is an example of association of ideas. Taut tendons and nails are thought to be woody in their appearance and physical characteristics and therefore believed to be associated with the Wood element, and by extension nourished by liver energy.

Now let us look at different kinds of liver problems in Chinese medicine:

If liver energy fails to flow and stagnates, you can experience rib pain, mood swings, nausea, acid reflux, belching, and if you are a woman, premenstrual syndrome. The stagnation may cause the energy to rise (imagine a small river that has become blocked by vegetation and fallen branches – the water rises!). This in turn causes irritability, tension around the temples, dizziness, tinnitus, dry mouth and eyes and insomnia. Liver “Fire” is even worse. The stagnated energy becomes very hot, and rising, it causes anger, headaches around the temples, a red face and eyes, thirst, a bitter taste in the mouth, vertigo, tinnitus, nosebleed, constipation with dry stools, and dark urine. If very serious excessive liver energy can cause convulsions or strokes.

Stagnated energy, as we have said, can overheat. It can also cause congestion. When this happens with the liver, it is called “Damp-Heat in the liver” and may result in jaundice, bloating, nausea and vomiting, scanty dark urine, and inflammation or infection of the genitals.

A deficiency of Yin energy in the liver can allow the liver’s Yang energy to rise, too. (If you don’t know what Yin and Yang are, see my posts here and here). This time too you can experience dizziness, tinnitus and insomnia, but also weak vision, night sweats, and thirst during the night.

Liver symptoms plus respiratory symptoms such as a chronic cough, asthma, shortness of breath, or yellow or bloody phlegm are believed to result from excessive liver energy affecting the lungs.

There is another syndrome called “Liver Blood Deficiency” which is basically anaemia together with liver symptoms like dizziness, insomnia, brittle nails, and weak or blurred vision.

Now I have said not to regard the five elements too literally. These descriptions of liver problems are a coherent way of explaining things that are nevertheless completely different to what we know from anatomy and physiology. I view them as symbolic rather than literal. One example of the difference in thinking is strokes: in Chinese medicine, symptoms of stroke like hemiplegia (one-sided paralysis) are explained by hot, rising liver energy blowing up an “internal wind”. Today we know that strokes are caused by the blockage of an artery in the brain or, less commonly, bleeding in the brain.

Copyright © Robert Hale 2021.

Robert Hale provides acupuncture treatment in Santa Eulalia, Ibiza.

Treatment of Pain by Osteopathy and Acupuncture

Pain relief is a large part of most health professionals’ work. In my profession as a healthcare provider, the treatment of pain is one of my areas of special interest. Let me tell you a little bit about pain and how I approach it.

There are two general kinds of pain:

  1. Pain coming from some damaged part of the body («nociceptive pain»).
  2. Pain generated by the nervous system without any damage to the body («neuropathic pain»).

Whoa! Wait! How can there be pain without damage? Well, here are a couple of ways. First example: There may have been damage which has now healed, but the nervous system has not adjusted back to normal. Second example: The nervous system may have become sensitised by numerous previous physical or emotional traumas, so that it produces pain response to minor physical stimuli. Note here that all pain is produced in the brain, even though it is felt in the foot, or stomach or head. The difference is that in the first case it is related to actual current damage and in the second case it is not.

The first kind of pain (nociceptive pain) can be further broken down into pain coming from the outer body like skin, muscles and joints («somatic pain») and pain coming from the inner body organs («visceral pain»). The latter can be confusing because it is often first experienced in the muscles of the outer body. The osteopath is uniquely prepared to distinguish between these kinds of pain, a distinction which is critical in their treatment.

Above I said that the treatment of pain was one of my areas of special interest. That is not exact. It would be more accurate to say that the treatment of the person in pain is my area of expertise. The difference is that as a holistic practitioner I treat people, not symptoms or disorders. By treating the person, the symptom goes away or at least gets better, indicating an improvement in any underlying disorder.

The disciplines that I practise, osteopathy and acupuncture, are excellent at treating people suffering with pain. In my experience osteopathy is the treatment of choice for most kinds of common pain complaints, while acupuncture is sometimes preferable for certain kinds of neuropathic pain and some kinds of inflammatory arthritis. In the latter case I would also make use of my knowledge of herbal medicine.

My formal studies have well equipped me to recognise conditions which require conventional medical treatment or which would best be managed by other health professionals. For example, my great interest is helping people with chronic pain (pain that has been present for months or more), a condition in which there are always psychological and behavioural factors involved. When I recognised this, I took a three-year masters degree in health psychology in order that I may help these people better. Nevertheless I am not a qualified psychologist, and if there are issues of serious trauma or depression, deep emotional conflicts, or addiction then I would refer to a competent health professional for this aspect of the person’s care.

Most Common Pain Complaints

  • Spinal pain (back pain or neck pain caused by strains, minor injury or degeneration)
  • Muscle tension
  • Headaches (from spinal problems or muscle tension)
  • Tendinitis (of the shoulder, elbow e.g. tennis elbow, wrist, knee, hip and ankle e.g. Achilles tendon)
  • Frozen shoulder
  • Osteoarthritis (affecting the hip, knee, ankle, shoulder, elbow, fingers)
  • Foot pain (e.g. plantar pain, metatarsal pain)
  • Sciatica
  • Brachial neuralgia (nerve pain in the arm)
  • Strains and sprains
  • Pain around the rib cage


Copyright (c) Robert hale 2021.
Photo by Nick Youngson via Picpedia, reprosuced according to Creative Commons CC BY-SA 3.0 licence.

Robert Hale provides treatment for pain by osteopathy and acupuncture in Santa Eulalia, Ibiza.

Is acupuncture effective in treating pain?

Acupuncture and its allied technique, moxibustion (the application of heat to acupuncture points), have been used to treat pain for thousands of years. Until recently, scientific evidence for its effectiveness was lacking. However, in recent years, the sheer numbers of people who have reported gaining relief from pain through acupuncture have stimulated a tsunami of research to find out if acupuncture really works and if so, how.

Is acupuncture effective in treating pain?

Now we have evidence that acupuncture helps with pain, and that evidence is rated “good” or “moderate”, depending on the kind of pain. The kinds of pain for which there is good or moderate evidence of effectiveness include spinal pain, sciatica, headaches, shoulder pain, tennis elbow, osteoarthritis of the knee, heel pain, pelvic pain, and jaw joint pain (see the table below).

From: McDonald J and Janz S (2017). The Acupuncture Evidence Project: A Comparative Literature Review. Published by the Australian Acupuncture and Chinese Medicine Association Ltd.

How does acupuncture help pain?

The plain truth is that while we know that it does, we are not all that clear about how, at least in Western medical terms. Traditional Chinese explanations focus on the circulation of Qi (vital energy) around the body. Pain can occur in an area if this circulation is blocked or altered, for example if there is too much Qi gathering in an area causing stagnation, or if there is not enough Qi circulating to an area. Pain can also occur if our normal flow of Qi is blocked or shocked by invasions of energy from outside the body, such as heat, cold, damp or wind.

In the Western scientific view, it is believed that acupuncture changes the way pain signals are produced, transmitted and processed by the nervous system. For example, it may reduce pain by stimulating the production in the brain of our own natural pain-killing chemicals such as opioids and cannabinoids. It can also work by reducing muscle tension, thus releasing joints from strain, and it can de-activate “trigger points” – small areas of excessive sensitivity in muscles, tendons and ligaments that produce pain and maintain muscle tension.

So, we know now that acupuncture can help relieve pain, and there is some evidence pointing to mechanisms by which this effect is achieved.

Copyright © Robert Hale 2021. Photo de Adobe Stock Images.

Robert Hale provides acupuncture treatment for pain and other ailments in Santa Eulalia, Ibiza.