Nearly everyone who books acupuncture has a particular reason. It might be a back that has ached for years, migraines that keep coming back, or months of trying for a baby. So it can come as a surprise when a Five-Element acupuncturist asks what makes you laugh, how you cope with disappointment, or which time of year you dread. During that first conversation I am also looking at the faint colour beside your eyes and listening to the tone of your voice. Those details have a purpose: they tell this style of acupuncture where to begin.
A tradition that starts with the person
Chinese medicine has described health through five elements, or phases, for more than two thousand years: Wood, Fire, Earth, Metal and Water. Each element has its own season, organs and emotion, and its own way of showing itself in a person. Every school of acupuncture draws on this theory. Five-Element acupuncture puts it at the centre of everything.
The Five-Element style that most people meet in the UK owes a great deal to J.R. Worsley, who taught it in Leamington Spa. He drew on classical Chinese ideas and on the methods of teachers from across East Asia, and he made a person’s emotional and spiritual life as important to the diagnosis as the body.
The central idea is easy to state. Each of us has one element that has been out of balance since very early in life, often from birth. Five-Element practitioners call it the Causative Factor. In this way of thinking, it shapes how we respond to stress, where our health tends to give way, and which emotions we find hardest to handle. Many of the symptoms a person brings to the clinic, physical or emotional, lead back to that one element.
Two people can arrive with identical migraines and leave with quite different treatments, because their migraines grow from different roots. That is the main thing that sets this style apart.
Colour, sound, odour and emotion
Finding the Causative Factor is the main task of a Five-Element diagnosis, and the practitioner relies on the senses as much as on questions. The classical texts link each element to a colour, a sound in the voice, an odour and an emotion:
- Wood: a green tinge, a shouting voice, a rancid odour, anger
- Fire: red, a laughing voice, a scorched odour, joy
- Earth: yellow, a singing voice, a fragrant odour, sympathy
- Metal: white, a weeping voice, a rotten odour, grief
- Water: blue, a groaning voice, a putrid odour, fear
None of this works in a crude or literal way. A Fire colour can mean a lack of red as much as a flush of it. A Wood voice may never actually shout; it may have a pressing, clipped edge, or a striking absence of assertion. Emotion works the same way. Someone whose element is Metal may not seem sad at all. What matters is how they relate to loss: whether they move through it, hold on to it, or keep it at arm’s length.
The practitioner also feels the pulses at both wrists, twelve in all, one for each of the organ systems that Five-Element acupuncture calls the officials. Then come the questions about sleep, digestion, energy, family, work, and what life feels like at the moment.
Over a course of treatment the practitioner keeps testing that picture. Change in energy, mood and sleep matters as much as change in the original symptom, and it tells the practitioner whether the diagnosis is right or needs another look.
How it differs from TCM and Western medical acupuncture
Most acupuncture in the UK falls into one of three broad styles.
Traditional Chinese Medicine (TCM) acupuncture is the style that most colleges in China, and many in the West, now teach. It works from patterns of disharmony. A TCM practitioner might identify Liver Qi stagnation or Kidney Yin deficiency from your symptoms, tongue and pulse, then choose points to address that pattern. As the pattern shifts, the points change. It is a thorough, symptom-led way of working, and I use it a great deal for pain and injury.
Western medical acupuncture, which many physiotherapists and some GPs use, sets the traditional theory aside. It chooses points by anatomy and nerve supply, mostly to relieve pain.
Five-Element acupuncture starts from the person rather than the pattern. The practitioner directs treatment at the Causative Factor and approaches whatever the patient brings through it, whether back pain, low mood or a hormonal problem. Practitioners tend to use fewer needles, and they insert and remove many of them within moments instead of leaving them in. Moxa, a slow-burning herb, often warms a point before the needle goes in.
In my own clinic I use both Five-Element and TCM approaches. For a recent sports injury, a symptom-led TCM treatment is usually the sensible choice. For longstanding problems, especially those tangled up with energy, mood or hormones, the Five-Element view is where I tend to begin.
What the research can and can’t tell us
Acupuncture research has grown a great deal, but most trials give everyone in the study the same fixed set of points. That design suits a laboratory question, such as whether needling these points helps this symptom. It fits Five-Element acupuncture poorly, because the treatment changes from one person to the next. Very little research has looked at the Five-Element style on its own terms, and I would be wary of anyone who claimed otherwise.
The wider evidence on acupuncture is mixed, stronger for some problems than others. NICE, which advises the NHS, includes acupuncture among the treatments to consider for chronic primary pain. For many other conditions the research is too limited or too inconsistent for firm conclusions.
Five-Element acupuncture belongs alongside your wider healthcare. If you have a diagnosis, or symptoms nobody has investigated yet, keep your GP or specialist involved, and let them know you are having acupuncture.
What a first appointment involves
A first Five-Element appointment runs longer than later ones, because the diagnosis needs time. You will talk about your health, and also about your history, your relationships, your work, and what gives you energy or drains it. The practitioner will look, listen, take your pulses and ask a lot of questions. Treatment may start in that first session or at the next one.
If the questions about colour and laughter seemed odd when you first read about them, I hope they make more sense now. They are how a Five-Element practitioner gets to know the person behind the symptom, and what they learn guides every treatment that follows.