Re-understand the Five Element theory

This forum is for acupuncture professionals. If it is you, we presume that you have already learned the concept of the Five Element Theory, during your acupuncture school. Here we point out some mistakes in your acupuncture education, since this concept is not only a philosophy but a very important practice guide.

You know that according to the Five-element theory, the Lung belongs to Metal; Kidney to Water; Liver to Wood; Heart to Fire and Spleen to Soil. So, you also know that if patients have cough, you link it to the Lung. If patients have constipation, you may also link it to the Lung, since the problem of constipation means that the problem is in the large intestine and the Large intestine is the sister of the Lung. Then, if patients have swelling in legs, you may link it to problem in the Kidney, since it is the Kidney that controls the water metabolism in the body. You may feel, oh, it is easy for TCM assessment, when you were a TCM student. However, you will pretty soon find that it is not easy to use what you learned in the TCM textbook to handle your clinic work. Here we discuss some practical issues linked to the use of the Five-element theory in clinic.

(1). Clear reason and hidden reason for a disorder

Some times, it is easy to assess a current reason for a disorder. For example, if patient has cough, it is easy for you to tell that the problem belongs to the Lung system. If you have higher level of TCM practice, you may also be able to check if the cough is due to the constipation of the patient, since the constipation means that the problem is in the Large intestine, and the Large intestine is the sister system of the Lung system.[1] You should be admired if you could remember to check the functional status of the Large intestine system if you fail to solve the problem by correction of the Lung system.

Furthermore, you should also check if the problem in the Lung system is due to the disorder in other system, such as in the Kidney, the Liver, the Heart, or in the Spleen system. The evidence of the disorders in these systems other than in the Lung system might be clear and very dominate, but may also be hidden and unclear. No matter if the evidence for these systems are clear or not, you have to try to find the possible links between these system and the Lung system. This means that you have to use herbs to correct the disorders in these systems in order to really solve the problem in the Lung system. For example, the cough, e.g. the problem in the Lung system could be due to the stagnation of Qi in the Liver system. Patient may have strong stress, may feel something in his throat that needs him to clear from time to time. He may feel bloating in the middle stomach area or feel bitter in mouth in the morning. Then, use herbs to clear the Qi stagnation in the Liver system may help to clear the cough too. For same reason, the cough might be caused by disorders in the Kidney system (Kidney is nourished by the Lung system. It is said that the Kidney is the son of the Lung system. Disorders in the Kidney system could cause cough in the Lung system. We say that it is the Son that affects the Mother), in the Heart system (the Fire burns the Metal, the Lung system), or in the Spleen system (the Spleen system is the Mother of the Lung system. The reason for accumulation of a phlegm in the Lung system is due to the weakness of the Spleen system).  

Therefore, you should not stop an assessment of the reason for a disorder to the system that shows the problem currently. You need to find the true and the initial reasons that cause the disorder in the current system. This is a complex and tough work for a TCM doctor. It needs your great imagination and experience too.

(2). Link the initial reason to nineteen Bing Ji.

I really doubt if you learned the nineteen Bing Ji and understand how to use it in your diagnosis. Bing means a disorder. Ji means a trigger that trigger the out come of the disorder. In the textbook, the meaning of the Ji is explained to be the “reason” of a disorder. It is wrong.

You can understand the difference as this: a seed is the “reason” of a plant. But the trigger to make it start to spring is the temperature. In nature the trigger is the season: the coming of the spring. The spring season triggers the start of life in the earth. After the spring of the seed, further condition is needed to keep it grow: the water, the air, and the fertilizer, etc. Here when we talk about the reason and the trigger for a disease, they are different concept. If we talk their relationship in the conventional medicine point of view, then the reason for a bacteria pneumonia is the bacteria, but the invasion of the bacteria into the body does not mean that the body will really develop a pneumonia. The bacteria needs some trigger factor to cause the pneumonia, such as reduction of body defense system due to too hard work, physically or emotionally, or due to exposure to cold raining, etc.

For example, one of the nineteen Bing Ji is that every swelling, wetness, bloating is due to “the trigger” of disorders in the Spleen system. [2] In clinic, the swelling might be related to the disorder of the Heart (such in the heart failure), to the Liver (such as cirrhosis), to the Kidney (such as kidney failure), or to the Lung (swelling on the skin, such as emphysema). According to the nineteen trigger theory, you have to think that the initial trigger factor is the Spleen system. Especially if you have tried every means without clear improvement of the swelling, you should know that you might had better to try to work from the Spleen system.