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Asian Medical Theory - Five Elements
Origins and Approach   |   Yin and Yang   |   Five Elements  |   Vital Substances   |   Zang-Fu Organs

"Formerly, when religion was strong and science weak, men mistook magic for medicine;
 now, when science is strong and religion weak, men mistake medicine for magic."
- Thomas Szasz

Five Elements

yin yang Of the many principles of traditional Asian medical theory, a few fundamental ones will be discussed. These are:
  • Yin and Yang Theory
  • Five Elements Theory
  • Vital Substances Theory
  • Zang-Fu Organ Theory
  • External Causes of Disease
  • Internal Causes of Disease

  • Together with the theories of Yin-Yang, Vital Substances, and Zang-Fu Organ Relationships, the theory of the Five Elements (also known as Five Phases) comprise the most important basic foundation of traditional Asian medicine (TAM) and traditional Chinese medicine (TCM) theory. The theory of elements was also espoused in Greek and Indian philosophies, but with variations in interpretation of their natures, behaviors and associations to matter and natural phenomenon. The Five Element theory summarized here presents the Asian concept.

    According to Chinese texts, Five Element theory is said to have originated at about the same time as that of Yin-Yang theory and was first published in 'Shang Shu' dating back to the Western Zhou dynasty (1000-770 BC). The same philosophical school that developed the theory of Yin-Yang is credited to have developed the Five Element theory. This school was called the 'Yin-Yang School' or the 'Naturalist School'. The birth of Yin-Yang and Five Element theories, and their application to medicine, signify a movement away from the shamanistic view of supernatural causes of disease to the empirically scientific approach based on observable, inductive and deductive methods of patterns differentiation.

    The Five Elements are Water, Fire, Wood, Metal and Earth. Each Element is an emblem that represents a category or dimension of related qualities. There are many dimensional aspects of the theory. The main ones applicable to traditional Asian medicine involve their relationships and correspondences to natural phenomenon, organ systems, movements and seasons, as well as the interrelationships among them.

    Five Elements in Natural Phenomenon

    The Five Elements as a category of inherent qualities and states of natural phenomenon are:
    • Wood: Solidity and Workability; can be bent and straightened
    • Fire: Heat and Combustion; flares upwards
    • Earth: Nutrition; enables sowing, growing and reaping (also represents a balanced and neutral state)
    • Metal: Solidity and Moldability; can be molded and hardened
    • Water: Liquidity and Fluidity; can moisten and flow downwards

    Five Elements in Direction and Movements

    The Five elements also represent five directional movements of natural phenomenon:
    • Wood: East; Expansion
    • Fire: South; Upwards
    • Earth: Center (represents a neutral center); Stability
    • Metal: West; Contraction and downwards
    • Water: North; Downwards

    Five Elements and Tastes

    One of the inherent qualities of things in nature involve the five tastes. Each taste is associated with one of the five elements. The tastes are more similar to their chemical composition in modern terms, and their behavior in traditional Asian medicine terms, than with actual flavors. The five elements tastes are especially applicable in the herbal and nutrition therapy realms as they have certain effects on the body.
    • Wood: Sour/Astringent absorbs, consolidates and astringes.
      • Sour generates fluids and Yin.
      • As an astringent it controls perspiration and diarrhea.
      • Sour goes to the nerves and if taken in excess, it can upset the Liver.
      • It should be used sparingly if one suffers from chronic pain.
    • Fire: Bitter clears Heat, disperses and dries damp.
      • Bitter clears Heat in the body, sedates excesses, and hardens.
      • Bitter goes to the bones and if taken in excess, it can damage the bones.
    • Earth: Sweet and Bland:
      • Sweet tonifies deficiencies, balances and moderates
      • Sweet strengthens deficiencies and stops pain.
      • Sweet goes to the muscles and if taken in excess, it can cause muscle weakness.
      • Bland promotes diuresis.
    • Metal: Pungent disperses and circulates.
      • Pungent scatters and expels pathogenic factors.
      • Pungent scatters Qi and it should be avoided in Qi Deficiency.
    • Water: Salty softens and dissolves hardness.
      • Salty taste flows downwards and softens hardness. It is used to treat constipation and swelling.
      • Salty can dry the Blood and it should be avoided in Blood Deficiency.

    Five Elements in Organ Correspondences

    In medicine the Five Elements are associated with specific Yin-Yang organ pairs. The Five Element-Organ correspondences provide a comprehensive model of relationships between the organs, various tissues, sense organs, and so on. These correspondences are clinically significant in understanding the Qi functions related to the paired organ systems.

    • Organs are: Liver (Yin organ) and Gall Bladder (Yang organ).
    • Sense organs: Liver moistens and nourishes the Eyes.
    • Tissues: Liver moistens and nourishes Sinews and Tendons.
    • Emotions: Anger.
    • Pathogen: Wind
    • Liver controls the free flow of Qi in all directions. 
      • If Liver Qi becomes stagnant (obstructed and non-moving) there will be stagnation of emotions as well as stagnation of Vital substances.
    • Organs are: Heart (Yin organ) and Small Intestines (Yang organ); Pericardium (Yin organ) and San Jiao (Yang organ).
    • Sense organs: Heart opens to the Tongue to provide speech.
    • Tissues: Heart controls the Blood Vessels.
    • Emotions: Joy.
    • Pathogen: Fire, Heat
    • If Fire is excessive, Heart Fire flares up to cause irritability, red face, red eyes and thirst. 
    • Heart also houses the Mind (referred to as Shen).
      • If Heart is imbalanced it cannot root the Mind and the Mind will lack vitality resulting in insomnia and mental disturbance.
    • The Pericardium is the outer housing or encasing of the Heart.
    • San Jiao (also referred to as the Triple Burner) has no western organ equivalent. 
      • The San Jiao is more similar to a channel system linking the chest, middle and lower abdomen. 
      • This channel system controls the circulation of the body's Original Yuan Qi and regulates water metabolism and excretion.
    • Organs are: Spleen (Yin organ) and Stomach (Yang organ).
    • Sense organs: Spleen opens to the Mouth and Lips to enable tasting.
    • Tissues: Spleen controls the Muscles.
    • Emotions: Pensiveness (over-thinking, excessive study).
    • Pathogen: Dampness.
    • The Spleen and Stomach system represents the source of non-constitutional, food-derived Qi as they are the organs responsible for transforming and transporting food Essence for transformation into Qi. 
    • Also, the Spleen controls ascending of Qi while its counterpart, the Stomach, controls the descending of Qi. 
      • If Sp Qi cannot rise there will be diarrhea. If Stomach Qi cannot descend there will be acid regurgitation, belching and hiccups.
    • Organs are: Lung (Yin organ) and Large Intestine (Yang organ).
    • Sense organs: Lungs open to the Nose to enable smelling.
    • Tissues: Lungs dominate the Skin to ensure their moistening.
    • Emotions: Worry, Sorrow, Sadness.
    • Pathogen: Dryness.
    • Lungs dominate and control the skin which contains the organs (contraction). 
    • Lungs also descend Qi downwards to the lower organs including the Kidneys, Large Intestine and Bladder. 
      • If Lung Qi does not descend there is coughing and wheezing.
    • Organs are: Kidneys and Urinary Bladder.
    • Sense organs: Kidneys open to the Ear to enable hearing.
    • Tissues: Kidneys govern the Bones to ensure growth and development.
    • Emotions: Fear.
    • Pathogen: Cold.
    • Kidneys grasp the Qi sent down by the Lungs and have a downward function of excreting urine. 
      • If Kidneys are weak there will be urinary incontinence or retention of urine

    Five Elements in Seasons

    Each of the Five Elements represents a stage in the yearly cycle. Corresponding with each stage is a behavioral aspect of nature associated with that season. The element Earth is not associated with any season of its own but reflects a period of 18 days at the end of each season.
    • Wood: Spring; time of birth
    • Fire: Summer; time of growth
    • Earth: Late Season (final 18 days of each season); time of transformation
    • Metal: Autumn; time of harvest
    • Water: Winter; time of storage

    Five Elements Pathogens

    Each season is associated with a particular external pathogen that predominates and becomes most active during the season.

    Wood (Spring): Wind
    • Wind is a Yang pathogen characterized by an upward and outward movement.
    • It easily invades the Yang areas of the upper body (head and face) and the exterior (skin). Upper body symptoms include those associated with the common cold and flu. Skin symptoms include itching and either excess or lack of sweating.
    • Wind attacks rapidly; its symptoms move from place to place; its character is one of continuous movement and it undergoes rapid change.
    Fire (Summer): Fire & Heat
    • Fire is a Yang pathogen that burns and rises upward to manifest on the head and face with symptoms like high fever, restlessness, red face and red eyes.
    • Fire consumes and injures Yin fluids causing dryness, scanty urination and thirst.
    • Fire speeds up metabolism and blood circulation and when severe it forces blood out of the vessels to cause bleeding.
    Earth (Late Season): Dampness
    • Dampness is a Yin pathogen and is characterized by heaviness and turbidity.
    • Dampness is manifested as heaviness of the body and joints, turbidity of fluids, and purulent skin sores.
    • Dampness causes stagnation of Qi resulting in digestive and urinary difficulties.
    • Dampness infuses downward to affect the lower body manifesting as swelling and edema.
    Metal (Autumn): Dryness
    • Dryness is a Yang pathogen that consumes Body Fluids to cause dryness of the mouth, throat, skin, hair, constipation and reduced urination.
    • Dryness also impairs Lung function producing cough with sticky scanty sputum.
    Water (Winter): Cold
    • Cold is a Yin pathogen that consumes Yang Qi (warm energies) and impairs the warming functions of the body producing cold limbs, cold body, impaired digestion with diarrhea and clear urine.
    • Cold contracts and causes stagnation manifested as spasmodic contraction of muscles, tendons and meridians as well as impaired circulation of Qi and Blood.
    • The main manifestation of Cold is the sensation of pain.

    Five Element Interrelationships

    five elements

    The various interactions among the five elements are the most important aspect of the Five Element theory as it is applied in Asian medicine. These relationships explain the relative behavior of each elemental organ within a balanced harmonious cycle as well as in pathology. Thirty-six arrangements and relationships are possible but five are most significant to TAM. These relationships are known as sequences.

    Cosmological Sequence
    cosmological sequence The elemental configuration of this sequence differs from the other four sequences in that this is a square configuration with Earth as the central pivot point. The other four sequences assume a pentagram design. The cosmological sequence emphasizes three important concepts:

    1. Earth is a neutral center in the flow of Qi and in the cyclical transition of the elements. As depicted by the arrows, Qi flows from one element to the Earth element before proceeding to the next element. As a result, Earth acts as a transitional phase and nourishing center to energize Qi before sending it along to the next element in the cycle. In the relationships of the organ systems, the Spleen and Stomach (Earth) are the source of post-constitutional Qi derived from the transformation and transportation of food.

    2. Fire and Water represent opposite poles along a vertical axis. Fire also represents Heaven and Water represents Earth (the land rather than the element). There is a direct line of communication between them and this direct relationship reflects the fundamental balance of Yin (Water) and Yang (Fire). This concept is important in physiology as Physiological Water (Yin) must balance Physiological Fire (Yang), and vice versa, in order to maintain life.

    3. At the center is Earth which represents Man, the neutral center of axis. This vertical axis also represents a direct relationship between the Essence (Water) - Qi (Earth) - and Mind (Fire). Thus the important concept of the Mind-Body-Spirit is directly linked.

    Generating Sequence
    generating sequence This Generating Sequence (green arrows) represents the normal transformational cycle of natural phenomenon. In this sequence, one element generates the next element which generates the next and so on, in a cyclical fashion. Generating can be thought of as a mother element nurturing and promoting the development of the child element. This is also known as the Mother-Son sequence. The generating element is the Mother and the element that is generated is the Son.

    If an element is deficient, its Mother element can be tonified (strengthened, nourished). In tonifying the Mother element, the Mother will better nourish her deficient Son. For example, if the Lungs (Metal) are weak the Spleen (Earth), its Mother organ/element, can be tonified along with the Lungs to provide nourishment and Qi to the Lungs.

    Controlling Sequence
    controlling sequence The way in which each element is kept in check from becoming overly active or too powerful is represented by the Controlling Sequence (blue arrows). This is also called the Grandmother-Grandson sequence because the Grandmother element controls the Grandson element. For example Fire (Grandmother) controls Metal (Grandson), Earth controls Water, Metal controls Wood and Water controls Fire.

    This sequence ensures that a balance is maintained among the Five Elements. It is a form of checks-and-balances mechanism to prevent the overgrowth of any one element. This is part of a healthy and balanced state. It is only when the control becomes excessive and overacts that an imbalance occurs and the sequence becomes pathological.

    Overacting Sequence
    overacting sequence The Overacting Sequence (orange arrows) has the same directional flow as the Controlling Sequence except that, here, the controlling element (Grandmother) is overwhelming and causes the element that is controlled (the Grandson) to decrease and weaken. As this occurs the Grandmother becomes excessive in relation to the Grandson. This is a pathological state as the two elements are imbalanced.

    In pathology for example, the Liver may be imbalanced. One of the manifestations of an imbalanced Liver is that the Liver Qi may stagnate. If the Liver Qi stagnates its energies become excessive as it builds in potential energy. In this case the Liver can overact on the Spleen and Stomach systems causing them to become weak and deficient. If the Spleen Qi is weak it cannot ascend and there will be diarrhea. If Stomach Qi is weak it cannot descend and there will be abdominal fullness, acid regurgitation and belching.

    Insulting Sequence
    insulting sequence The Insulting Sequence (red arrows) is the reverse of the Controlling Sequence. Here, the Grandson element has become excessive and attacks the Grandmother element. This is also a pathological state resulting from an imbalanced state.

    In pathology for example, the Spleen may be overcome by its abhorred pathogen, Dampness, causing the Spleen to become excessive. If excessive, Spleen (Grandson) can attack the Liver (its Grandmother) and impair the Liver's ability to carry on its main function of ensuring the free flow of Qi. If this happens there will be discomfort in the hypochondrium area (below the ribs), emotional symptoms such as irritability or depression, and menstrual irregularities.

    The Five Element theory provides an important construct for working with patterns of pathological relationships between the internal organs, as introduced above. However, there are many more complex relationships not discussed here as they are not conducive to discussion at a high level. Also, the Five Element model is only one of many theoretical models available to the clinician, along with many others, for diagnoses and treatment modeling.

    The main difference between this and the Yin-Yang theory is that Five Elements provide one-to-one correlations between phenomena while the Yin-Yang and Internal Zang-Fu Organs theories espouse taking a larger, holistic patterns discernment.

    For example, if the Liver is diseased, Five Element theory expects that the Liver's related sensory orifices, the eyes, will also manifest symptoms and that the tissues it governs, the tendons and sinews will also be diseased. In many cases these symptoms may not arise. Or, if there are eye and/or tendon related symptoms they may be the result of other organ or Channel causes, not the Liver. As a result, the Five Element theory is viewed as providing a simplistic and rigid view of pathology. When applied in conjunction with other theories, however, it provides the practitioner with a multifaceted approach to clinical practice.

    Origins and Approach   |   Yin and Yang   |   Five Elements  |   Vital Substances   |   Zang-Fu Organs

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