Session 09

Lecture – Five element treatment technique

Chinese Medicine
Five element theory

Classic of Difficulties (Nan Jing) - earliest mention of Five-phase

properties allocated to the Five Shu points.
One of the first texts to discuss point classification and prescription.
Each of the five Shu points – Jing-Well, Ying-Spring, Shu-Stream,
Jing-River, He-Sea - belong to one of the elements.
Treatments are usually focussed on balancing Yin channels.
The function of each point is directly linked to the attributes of its
corresponding element.
The theory provides a framework for tonification and dispersion
between elements. This means that you can tonify/nourish,
sedate/reduce or restrain.

(Franglen, 2013; Hicks et al., 2011; Ma et al., 2014; McDonald, 2022)

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Point functions

Water point functions: cool Heat, tonify Yin, resolve Damp &
Phlegm, regulate the water passages.
Wood point functions: strong & dynamic movement of Qi,
affinity for extinguishing Wind, treat the sensory orifices
(specifically eyes).
Fire point functions: clear Heat, drain Fire, calm the Shén.
Note: they are not used for tonifying Yang.
Earth point functions: tonify & strengthen, grounding effect,
used for digestive complaints.
Metal point functions: build Wei Qi, treat external pathogenic
attacks, tonify Lung Qi.

(Franglen, 2013)
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Pulse palpation

Pulse taking is an important diagnostic tool for identifying Five

Element patterns because the pulse reflects the movement
of Qi in the channels.
Focus on deficiency vs excess (rather than 28 pulse qualities)
Nan Jing five element diagnosis concentrates on deficiency
rather than excess (Spleen, Liver, Kidney) – need to build Qi.
Pulses are taken at regular intervals throughout treatment &
pulse response to treatment is noted and used to plan the
next treatment.

(Franglen, 2013; Hicks et al., 2011; Matsumoto & Birch, 1986)

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Pulse palpation
If treatment is working as planned, you will feel the pulses balance or
improve.
Yang pulses superficial, Yin pulses deep.
Overall fullness or emptiness is noted using a numbering system -3
to +3 on individual positions.
(Franglen, 2013; Hicks et al., 2011; Matsumoto & Birch, 1986)
Table 1

Five element pulse diagnosis

Side Depth Cun Guan Chi

Left Superficial Small Intestine Gall Bladder Bladder

Deep Heart Liver Kidney

Right Superficial Large Intestine Stomach Triple Energiser

Deep Lung Spleen Pericardium

Note. Adapted from Five Element Constitutional Acupuncture (2nd ed.). (p.224-225), by A. Hicks, J. Hicks &
P. Mole, 2011, Churchill Livingstone Elsevier. Copyright 2011 by Angela Hicks, John Hicks and Peter Mole.
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Pulse palpation
Table 2

Recording a pulse picture: example

Side Position Superficial Deep

Left Cun -1 -1
Guan +1 +1.5
Chi -2 -2
Right Cun -1.5 -1.5
Guan √ √
Chi -3 -3

√ = as expected or healthy pulse

Note. Adapted from Five Element Constitutional Acupuncture (2nd ed.). (p.224-225), by A. Hicks, J. Hicks &
P. Mole, 2011, Churchill Livingstone Elsevier. Copyright 2011 by Angela Hicks, John Hicks and Peter Mole.

CMCM311 / CHINESE MEDICINE DEPARTMENT / 20-10-2023 © Endeavour College of Natural Health

Constitutional factor (CF)

Also known as ‘causative’ factor – a primary imbalance which causes

Qi imbalance in other organs / elements.
Inherited or acquired during early childhood.
Four diagnostic signs take precedence over physical symptoms:
emotion with the most inappropriate expression in the person
the colour on the face (particularly lower temples beside the eye)
the odour emitted by the body
the sound present in the voice (particularly when tone is not
congruent with emotion being expressed)

(Hicks et al., 2011)

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Constitutional factor (CF)

Treating CF has a positive flow-on effect to other elements.

Significant effect on patient’s emotional life.
Only small number of points needed when treating if treatment
is focussed on CF.

(Hicks et al., 2011)

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Four blocks to treatment (major blocks)

1. Aggressive energy – ‘polluted’ or ‘xie’ Qi travels along the

Ke cycle (control cycle becomes destructive cycle – Yin
organ to Yin organ). Caused by EPFs or emotions.
2. Possession – ‘gui’ ghost points
3. Husband-Wife imbalance – left (husband) pulses should be
stronger than right (wife). Opposite presentation indicates
imbalance Yin/Yang.

(Hicks et al., 2011)

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Four blocks to treatment (minor block)
4. Entry-Exit blocks – 12 channels connect to each other
forming a circuit via Entry/Exit points (see order of channels
in Table 3) – complete or partial blockage of Qi flow at the
points or along whole channel.

Detected by pulse: full pulse followed by deficient pulse, pulses on

consecutive Organs/channels don’t change during treatment, OR a
similar quality pulse appears on the pulses of consecutive channels.
Detected by signs: treatment stops working, pain at site of blockage,
consecutive channel signs & symptoms indicate imbalance, or
unexpected treatment reaction.
To treat a block, use exit point of one channel and the entry point of
the next channel e.g. LR14 and LU1.
(Hicks et al., 2011)
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Entry-exit points
Table 3

Entry/exit points list in order of circulation

Entry Exit
LU1 LU7
LI4 LI20
ST1 ST42
SP1 SP21
HT1 HT9
SI1 SI19
BL1 BL67
KI1 KI22
PC1 (PC2 female) PC8
TE1 TE22
GB1 GB41
LR1 LR14

Note. Adapted from Five Element Constitutional Acupuncture (2 nd ed.). (p.224-225), by A. Hicks, J. Hicks &
P. Mole, 2011, Churchill Livingstone Elsevier. Copyright 2011 by Angela Hicks, John Hicks and Peter Mole.
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5 element treatment techniques
Tonification (most common) 2-3 seconds in total:
Needle left side of body first, then right.
Insert needle 10̊ off perpendicular towards the flow of Qi
Slow insertion to required depth as patient exhales
Obtain De Qi, rotate needle 180̊ then remove needle, seal point.
Sedation (less common) retain needles 20-30mins:
Needle right side of body first, then left.
Insert needle 10̊ off perpendicular against the flow of Qi
Rapid insertion to required depth as patient inhales
Rotate needle 360̊ anti-clockwise to obtain De Qi.
Retain until desired pulse change occurs.
Remove needle slowly, do not close the point.
(Hicks et al., 2011)
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Treatment techniques

When treating ‘spirit’ issues rather than physical issues – use

finer needles, fewer points, short or no retention, less
sensation.

(Hicks et al., 2011)

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Art of needle technique – practitioner’s internal state

Clear intention
Relaxation
Focussed attention – where the mind goes, Qi follows.
Good posture
Good rapport and sensitivity to the patient
Practice Qi Gong, Tai Ji, Yoga or soft martial art (Aikido),
meditation.

(Hicks et al., 2011)

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Element points
Element points are the points that represent the same element as
the channel it is on.
These points strengthen the energetic function of that element and
channel.
This is more useful if there is disharmony in a single element rather
than multiple elements.
Earth channel, earth points – ST36, SP3
Metal channel, metal points – LI1, LU8
Water channel, water points – BL66, KI10
Wood channel, wood points – GB41, LR1
Fire channel, fire points – TE6, SI5, PC8, HT8

(Franglen, 2013)
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Sheng cycle: Five Shu points to reinforce or reduce
Figure 1 Table 4

Sheng cycle (Generating cycle) Mother/Child Mother/Child Point selection

Reinforcing & Reducing – Nan Jing Difficulty 69
Meridian Mother Child (reduce)
(reinforce)
Lung LU9 LU5
Large Intestine LI11 LI2
Fire
Stomach ST41 ST45

Spleen SP2 SP5

Wood Reinforcing (bǔ) Earth
Heart HT9 HT7
Reducing (xiè)
Small Intestine SI3 SI8

Bladder BL67 BL65

Water Metal Kidney KI7 KI1
Pericardium PC9 PC7

Triple Energiser TE3 TE10

Gall Bladder GB43 GB38

Liver LR8 LR2

Note. Adapted from Acupuncture point dynamics volume three: Evidence-based methods of point
selection (p. 16), by J. McDonald, 2022, Acupuncture Colleges. Copyright 2022 by John McDonald.
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Sheng cycle: Two needle technique

This is the Five Element theory applied on one channel.

For excess conditions: sedate the child element point on the
excess channel.
Example: excess wood – sedate LR2 or GB38
For deficient conditions: tonify the mother point on the deficient
channel.
Example: deficient earth – tonify ST41 or SP2

(Franglen, 2013)
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Tonifying an organ

Example: tonifying Kidneys.

Use KI7 – Mother point on the Kidney channel

Plus
Water point chosen
because it matches
A Mother point on the Lung channel the Element that
you want to tonify

Either
LU5 – Child point on the Lung channel (Water point on the
Metal channel) or
LU8 – Element point (Metal point on the Metal channel)
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Tonifying an organ: Further examples

Class activity: Work in pairs to complete the table below.

Deficient Tonifying point Supporting point

meridian
Kidneys KI7 (Mother point) LU8 (Element point) or
LU5 (Child point)
Lung

Spleen

Liver

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Reducing an organ

To assist draining excess in the Liver (Wood):

Reduce the Child channel of Fire (HT, PC or SI, TE) (Sheng cycle)
Or
Sedate using the Controlling (Ke cycle) channel (tonify Metal/Lung)
to control the Wood excess.
Your point prescription may be LR2 + LU8
Or
LR2 + a sedating point on a Fire channel depending on which was
most excessive.
*Don’t drain a deficient channel – use an Element point if you need
to.

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Four needle technique

This is the Five Element theory applied on two channels.

Deficient condition:
Tonify/reinforce the Element point on the Mother channel.
Tonify Mother point on the deficient channel.

Excess condition:
Sedate/reduce the Element point on the Child channel.
Sedate/reduce the Child point on the excess.
(McDonald, 2022)
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Four needle technique
Table 5

Four Needles examples

Four needles for deficient Fire meridian Four needles for deficient Fire meridian

Reinforce HT9 (Wood point on Fire) Reduce HT7 (Earth point on Fire)

Reinforce LR1 (Wood point on Wood) Reduce SP3 (Earth point on Earth)

Reduce KI10 (Water point on Water) Reinforce KI10 (Water point on Water)

Reduce HT3 (Water point on Fire) Reinforce HT3 (Water point on Fire)

Note. Adapted from Acupuncture point dynamics volume three: Evidence-based methods of point selection (p. 17),
by J. McDonald, 2022, Acupuncture Colleges. Copyright 2022 by John McDonald.

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Four needle technique

“…a deficient meridian is treated by increasing the influence of

the Sheng (Generative) Cycle and reducing the influence of
the Ke (Controlling Cycle). Conversely an excessive
meridian is treated by amplifying the Ke Cycle and
dampening the Sheng Cycle.”
(McDonald, 2022, p. 17)

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Four needle technique to reinforce a deficient meridian
Table 6

Four needle reinforcing

Meridian Mother Mother Controlling Controlling
(reinforce) (reinforce) (reduce) (reduce)
Lung LU9 SP3 HT8 LU10
Large Intestine LI11 ST36 SI5 LI5
Stomach ST41 SI5 GB41 ST43
Spleen SP2 HT8 LR1 SP1
Heart HT9 LR1 KI10 HT3
Small Intestine SI3 GB41 BL66 SI2
Bladder BL67 LI1 ST36 BL40
Kidney KI7 LU8 SP3 KI3
Pericardium PC9 LR1 KI10 PC3
Triple Energiser TE3 GB41 BL66 TE2
Gall Bladder GB43 BL66 LI1 GB44
Liver LR8 KI10 LU8 LR4

Note. Adapted from Acupuncture point dynamics volume three: Evidence-based methods of point selection
(p. 18), by J. McDonald, 2022, Acupuncture Colleges. Copyright 2022 by John McDonald.
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Four needle technique to reduce an excessive meridian
Table 7

Four needle reducing

Meridian Son (reduce) Son (reduce) Controlling Controlling

(reinforce) (reinforce)
Lung LU5 KI10 HT8 LU10
Large Intestine LI2 BL66 SI5 LI5
Stomach ST45 SI3 GB41 ST43
Spleen SP5 HT9 LR1 SP1
Heart HT7 LR8 KI10 HT3
Small Intestine SI8 GB43 BL66 SI2
Bladder BL65 LI11 ST36 BL40
Kidney KI1 LU11 SP3 KI3
Pericardium PC7 LR8 KI10 PC3
Triple Energiser TE10 GB43 BL66 TE2
Gall Bladder GB38 BL67 LI1 GB44
Liver LR2 KI7 LU8 LR4
Note. Adapted from Acupuncture point dynamics volume three: Evidence-based methods of point selection
(p. 18), by J. McDonald, 2022, Acupuncture Colleges. Copyright 2022 by John McDonald.
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Ke cycle: Grandparent relationship

The grandparent’s role is to Figure 2

Ke (Controlling) cycle
control the behaviour of a
naughty grandchild.
Fire

If the Wood element is in

excess, tonify the Metal to Wood Earth

keep it under control.

Additionally, tonify the Earth to Water Metal

prevent the Wood excess from
invading Earth.

(Franglen, 2013)

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Five Shu points & point functions

Five element theory explains the functions of many points.

Example:
LR4 is the Metal point on the Wood channel.
On the Ke cycle, Metal controls Wood.
LR4 is the controlling point on the Liver channel. It is used to
clear Heat and stagnation affecting the Liver channel and
has a reducing effect on patterns manifesting with a Liver
excess.

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Case study 1

John, a 55-year-old male, is grieving the death of his son. He is

prone to outbursts of anger, frequent sighing and crying. His
voice is weak, and his posture is hunched over. You
determine that his Liver (Wood element) is in excess, and
Lung (Metal element) is deficient.
How might you treat him using Five Element theory?

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Case study 2

When Sarah is busy writing her assignments, she forgets to eat

properly. Her meals are at irregular times, and she focuses
on satiety rather than nutrition. She has had recurrent colds
and coughs all year and is generally feeling run down.
Sarah is diagnosed with Spleen and Lung Qi deficiency.
How might you treat her using Five Element theory?

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Practical skills

Each student write a short case study and present it to another

student.
For the case study you receive, identify the diagnosis,
treatment principle and, using 5 element theory, state your
acupuncture points for treatment.
Practice pulse taking to identify deficiency & needle appropriate
tonification points to detect pulse changes.
Practice needling techniques for Entry-Exit points.

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 Chinese Medicine Library Resource Links

APA 7th Edition Referencing Guide reference tips with examples

APA 7 FAQs questions submitted by students with examples provided by librarians
Chinese Medicine Library Guides

Databases, Journals & Web Links:

Anatomy TV
Natural Medicines
Journal of Chinese Medicine Article Archive
A Manual of Acupuncture [App]
Chinese Medicine Formula Image Database

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References

Denmei, S. (1990). Introduction to meridian therapy: Japanese classical acupuncture. Eastland Press.

Franglen, N. (2013). The handbook of five element practice. Jessica Kingsley Publishers.

Hicks, A., Hicks, J., Mole, P. (2011). Five element constitutional acupuncture (2nd ed.). Churchill Livingstone Elsevier.

Ma, Z., Jia, C., Guo, J., Gu, H. & Miao, Y. (2014). Features analysis of five-element theory and its basal effects on construction

of visceral manifestation theory. Journal of Traditional Chinese Medicine, 34(1), 115-121. https://doi.org/10.1016/s0254-

6272(14)60064-9

Matsumoto, K. & Birch, S. (1986). Extraordinary vessels. Paradigm Publications.

Matsumoto, K. & Birch, S. (1983). Five elements and ten stems. Paradigm Publications.

McDonald, J. (2022). Acupuncture point dynamics volume three: Evidence-based methods of point selection. Acupuncture

Colleges.

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