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.

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.