Classical Five Element as taught by Prof. J. R. Worsley is thought to have has its base in ancient acupuncture theory from the period of around 200 BC.  It was through this era that the idea of the Elements and their corresponding character types is first thought to have surfaced.  Over the last 50 years Worsley has combined this with ideas from other schools of acupuncture to create what is now known today as Classical Five Element.

Although sharing much with modern TCM it is also very different in theory and aim and encompasses more than the commonly taught Five Phase Theory. To understand this school of thought and the way a Five Element Acupuncturist views treatment there are certain protocols that are best explained first.

Causative Factor or C.F. In Classical Five Element Acupuncture there is thought to be one main or root cause for most of a patients presenting symptoms.  It is thought that through birth or early childhood that a constitutional weakness develops to the point where, through the law of Mother -Child it impedes the flow of energy around the Sheng or creative cycle.  This weakness is one of the Five Elements, an element that is causing the presenting symptoms and stopping the growth of the person as a whole.  This weakened element is known as the persons Causative Factor or C.F.

As an example lets look at a patient who’s C.F. is Metal.   This means that Metal (the Mother) has been hit hardest in childhood.  This can be either through environmental or emotional causes but eventually it will affect its ability to pass on energy to the Water Element (the child).  The Water Element will now also be distressed and show symptoms as is struggles from the weakened preceding element.  In time, following the Law of Mother / Child, this lack of flow continues around the cycle until all the Five Elements are struggling, the patient is in distress and arrives at the clinic with their list of symptoms.  Instead of chasing this list of symptoms coming from the distressed Elements, the acupuncturist goes right for the heart of the problem, the C.F.  In this case Metal.

The acupuncturist knows once blocks are cleared, points chosen on the Metal Meridians will affect the whole Sheng cycle. The effect will flow on to the other 10 meridians from the strengthened Lung and Large Intestine.  If the acupuncturist has diagnosed the right C.F. this same effect will show in the pulse picture. That is any Metal points treated will affect all of the twelve meridians.

The skill for a C.F.E. Acupuncturist is through thorough questioning, listening and observing to ascertain which of the symptoms is primary and which are secondary.  Which are coming from the Mother, which are coming from the Child.  Which Element is the Causative Factor?

This is primarily done through what is known as C.S.O.E. or Colour, Sound, Odour and Emotion.
The Traditional Diagnosis is a one to two hour consultation where a thorough history of the patient is taken.  Each of the Elements is tested, the person questioned, listened to and observed. Physical routines are noted; sleep, appetite, alcohol intake is all looked at as a part of an extensive list.  The colour of their face, the sound of their voice, their odour is all observed.   What colour comes up on their face through which questions?  What is their body language telling you?  How do they answer the questions?  Which of the elements do they feel most at home in or do they respond to as you portray.  In the T.D. everything is information, it is an opportunity to get a feel for the person as a whole

The patients emotional and physical are equally important when ascertaining which Elements has been hit hardest.  How they function in the world is important.  What was their childhood like?  Do they remember it?  What is their ability to have relationships?  How is their work history?  What are the things they like about people, what are the things they don’t?   These all point to an elemental type.

Parental style can point towards the C.F.  Parents who over parent, enmesh or abandon can contribute to a Earth C.F.  Parents who control the child's behavior with fear can contribute to a Water Causative Factor.  A household where the child is not honored, their real being is not respected can indicate a Metal C.F.  Parents who over control either with discipline or too much structure can produce a Wood child.  A child who experiences life as an attack, whose childhood is a lot to do with hurt may show up as a Fire C.F.  There are also differences in Heart/ Small Intestine Fire and Heart Protector/Three Heater Fire C.F.s

In C.F.E.A. rapport is the skill of making contact with the patients C.F. Element.  Seeing which one of the elements they respond to or feel most at home in.  In the Traditional Diagnosis do they react to the sympathy of Earth, the respect of Metal?  Even though it may not be your own home element does the patient relax when you portray Water, feel safe when you give them the structure of Wood? Below are a few of the things that you look for when searching for the C.F. Element.

A Fire C.F. will want to have relationship, will want to be equal with you.  They may be either lack of or excess joy. Their colour can range between ashen gray to quite red. The colour will manifest under the skin at the level of the blood.  Even the most ashen gray or lack of joy Fire C.F. will rise like a fire into laughter for some time. Their voice will have a sense of laughter even when discussing quite grave topics. You can gain rapport with this element either by going up to the laughter and have a good time or going down into the lack of joy or sadness. The Fire C.F. will feel this to be normal as this is where they live most of their lives. Sometimes the person may show a shy nature or you may feel they are keeping you at bay with their laughter.

An Earth C.F. carries a deep sense of emptiness.  The emotion of earth is sympathy and they may covey a sense of neediness.  They will either be the type of person who really wants you to understand all they have been through or to goes into “I don’t need anyone”.  Their voice will have a sing to it; the colour on their face will range from a gray yellow to a bright banana colour. This colour will manifest in the flesh. They will have an odour that is sweet, of blossoms that are slightly off.

The Metal person wants real contact. The emotion of Metal is grief.  This is a sense of loss, a feel for what could have been.  This is different to the sadness of Fire.  The colour of metal is white; this will show on the skin.  It may look like they have a white powder on.  The odour is rotten, like the smell of a butchers shop or of the Large Intestine.  They want to know you are not going to feel better than them.  It will feel normal for you to be at a physically lower position to them in the room.  The space will have the quiet feel of respect, like a church.  Any laughter will be at your expense.

Water is the Element of Fear.  These people will either be frozen like ice or raging like an over full stream. These people are driven, maybe manic or quiet like a still pond.  The colour will show on top on the skin as a ruddy red/ blue.  Their odour is Putrid, the smell of the Kidneys and Bladder.  A Water person lives on the edge of fear where they have a love / hate relationship with the emotion.  A Water C.F. wants reassurance.  Their voice will groan, have a continuous maybe monotonous feel to it.

Wood is the Element of determination, assertion, of anger.  Their main emotion will range between a sense of frustration to hopelessness. They want to know that you are in control so they can relax. They may feel pushy and want you to push back.  Their voice will have shout or a sense of assertion to it.  The colour green will float above the skin nearly like a glow.  Their odour is Rancid.  Similar to that of oil that has gone off; as though the body is not digesting fats.


Through observing the Colour, Sound, Odour, Emotion and gaining rapport with the person the C.F. Element will show it self.  After that determination is made most of the treatment is used to address a deficiency in that element and therefore the person. This way it is thought, you can help the whole person grow and change.

Most points are tonified.  That is the needle is inserted at a 15-degree angle supporting the flow of the meridian, once the Qi is reached, turned 180 degrees and withdrawn. Left side point is tonified first, then right side.  This is reversed in sedation.   Most Five Element treatments use this technique, as the C.F. is a deficient condition.  Direct Moxa is used on most points. Sometimes when appropriate, sedation is used. 

.  The first stage of a treatment is clearing the Entry/ Exit Blocks.  These blocks pertain to the Wei level.  The superficial flow of energy commencing at the Lung and proceeding through the 12 main meridians to the Liver.  The Classical Five Element Acupuncturist looks carefully for blocks along this flow.  They are most often seen between the Element pairs.  That is for example between the Liver and Lung not between the Gall Bladder and Liver.  The main 6 Entry/ Exit blocks are between the Spleen/ Heart, Small Intestine/ Bladder, Kidney/ Heart Protector, Three Heater/Gall Bladder and finally Liver / Lung.  They are found on the pulses as a quantitative difference.  That is a score noted between a plus pulse down to minus three.  A C.F.E. Acupuncturist notes pulses as a volume, qualities are not often used for treatment planning.  A typical Sp/Ht block can be seen in figure 1.  These blocks are best explained as a dam between the Elements.  In a Spleen/ Heart block the Spleen pulse will be a zero or slightly plus and the Heart pulse will be maybe a minus 2½.  The Spleen pulse will have a fairly full, percussive or pushy feel to it.  Using the Entry/ Exit points clears these blocks.  In the case of an Sp/Ht Block you would first tonify the Exit Point of the Spleen, which is Sp. 21 - Encircling Glory.  Next you would tonify the Entry Point on the Heart meridian, which is Heart 1 - Utmost Source.  Once the blocks are cleared you would expect all the pulses to be even and balanced with none missing.

The second step in a treatment is planning of the Spirit Points.  In 5 Element Acupuncture each of the points has a Spirit name that is heavily relied upon to decide which point is appropriate for the patient on the day.  For example Kidney 25 - Spirit Storehouse.  Kidney 25 is used when the person's spiritually depleted, who use their stores up as soon as they get them. It is for patients who see no joy in being alive.  Another example; Liver 14 - Gate of Hope.  This point is for a Wood C.F. who is feeling like things are hopeless.  When they are ready to give up, you open the Gate of Hope to help them move on.  With a few exceptions these points are always chosen from the patients C.F. Meridians.  When tonifying a point it is thought to be important to hold the Spirit of the Point in mind and summon that energy from the point. That is Intent.

The last part of a 5 Element treatment is the command points.  It is important to ground the treatment with points from the patients Causative Factor meridians. The Command Points are such points as the Source, Junction or Accumulation Points.   These points are used to address the patients’ constitutional weakness.

Our patient is a 45-year-old woman called Mary.  She has presented because she has heard this type of acupuncture can make her “feel better”.  

As mentioned earlier an Earth C.F. carries a deep sense of emptiness.  The emotion of Earth is sympathy, which is best explained as understanding.  This they either completely take on or reject.  They want someone to hear them and what a struggle life is for them.  The skill in the T.D. is in your behavior to present the patient with a little of each of the Five Elements and see which one they most relate to.

I have chosen Mary as my example because most of her signs indicate an Earth type patient.  She is a fairly rounded body type. The quality of her flesh is poor.  The colour on her face is a gray/yellow.  Her voice sings quite profoundly.

She has not worked full time for many years as she fells she has some type of Chronic Fatigue Syndrome, this is not a typical Earth type symptom as is can manifest on any element.

She reports fairly regular stomach upsets.  What are they like?  “When I feel “down” I usually have a sense of nausea.”  Do you often feel full?  “Yes I go through stages of only eating because I have not eaten all day” and “I quite often binge on food, mostly when I am feeling upset”.  This emotional connection to the stomach can point toward an Earth C.F.

The 7am to 9am period was her low point of the day, feels best after 11am.  She worries constantly.  “I even worry when I have nothing to worry about.”  No real intake of alcohol or recreational drugs.  The bowels are OK sometimes veering toward constipation. No real problem with perspiration. Feels the cold especially on the extremities.  Has one period on anti depressants about five years ago, for three months.

Mary reported that she often feels quite empty.  She has had a lot of trouble with relationships.  She continually seems to find men who “use” her.  Even thought they treat her badly she would rather stay with them than be by herself.  She feels very good that she has not been in an abusive relationship for about 18 months now.  Eventually she mentioned that she has a “little problem with promiscuity”.   She worries about her weight.  When she is lonely she will tend to comfort eat; only once has this lead to a period of self induced vomiting, many years ago.  Her mother relied on her a lot when she was young. She felt that she was supposed to be her mothers friend and she would often have to listen to her mum complain about her father.  Her father was angry but distant.  She felt her mother needed her on one hand and was impossible to please on the other.  When she was 10 months old her mother had to go to hospital for 6 months and left Mary with a friend to look after.

She really felt like she wanted to be heard.  Her life had been a struggle and she wanted me to know about it.  If I went into the assertion of Wood with a little of shout in my voice she would quieten.  She would come up to the laughter of fire for a while but tired of that.  Any time I was giving her sympathy or understanding she seemed to be relaxed and present.

A.E. Drain
Spleen -Heart Meridian Block (Sp21 and Heart 1) Tonify
Source Points; Stomach and Spleen (St41, Sp3) Tonify

A.E. Drain is a test where you check a new patient for Aggressive Energy.  You do this by sitting needles superficially in the 6 Yin Back Shu or Associated Affect Points for ten minutes.  If A.E. is present you will find a deep crimson red around the needle. A light red may only indicate heat.

A pushy pair of Earth pulses and a nearly missing Heart/Small Intestine pulse indicated the Sp.-Ht Block.  After this was cleared the twelve pulses evened and dropped in volume.

The Source Points were chosen as a safe way of introducing the C.F. energy into her system.

The patient reported that she a lot more relaxed after the treatment, felt better in her self for a day or so, then back to much the same as before.  With no real adverse affects from the first treatment I felt I could pick up the energy and add a Conception Vessel point safely.  I chose CV (Ren) 12 as it has a direct correlation to the stomach and I wanted to start to get some energy into the Middle Jiao, as this is where this feeling of emptiness resides. . The Sp-Ht block was back. I choose the Junction Points as their spirit is quite filling.  St40 Abundant Splendor and Sp4 Princes Grandson.

Spleen -Heart Meridian Block (Sp21 and Heart 1) Tonify
CV12, 5 x Moxa and Tonify
Junction Points on Stomach and Spleen (St 40, Sp4) 3 x Moxa and Tonify

Mary reported a bit of anger coming up during the week.  This is to be expected as the patient starts to feel more embodied thought the Earth treatments.  Earth people are often quite ungrounded and can live in their head.  Earth is a lot to do with lack of mothering some patients will start to feel some old repressed anger coming to the surface. The patient needed to be reassured around this, as she was not used to having this feeling so clearly and was “scared of becoming an angry person”

As the main spirit point I used CV (Ren) 8 “ Spirit Deficiency. This is a very powerful way of helping the person feel safe and full.  It is described as the feeling a baby has when it has a stomach full of mothers’ milk - everything is all right.  Useful for when a patient has been worn down over a long period of time.

As command points I chose St36 (Leg Three Miles) and Sp8 (Earth Motivator) as they both have the spirit of helping the person feel supported in and encouraged to move forward- whether spiritually, physically or mentally.


Spleen -Heart Meridian Block (Sp21 and Heart 1) Tonify
Kidney- Heart Protector Block (Kd23 and Heart Protector 2) Tonify
CV 8, 9 x Moxa on salt
Spleen 8 and Stomach 36, 5 x Moxa and Tonify

The patient reported feeling much better. When asked how she said she was not worrying as much and was not feeling as angry with her family members anymore.  When asked what other feeling were present she said that she was feeling quite lonely and wondered if that was to do with the treatment.  By doing CV8 for its spirit you sometimes expect a “Law of Cure” result.  Some of the old feelings around feeling satisfied will surface and clear.

I chose the Associated Affect Points (Back Shu) on her C.F. meridians as the A.E.P.s will touch the Body, Mind and Spirit in one point. The Yang quality of these points will usually help the person feel a sense of their own strength. I added GV12 (Body Pillar) as the spirit is of strengthen the feel of the backbone and help them feel that they “can stand up for them self”.

Kidney-Heart Protector Block (Kd22. and Heart Protector 2.) Tonify
Associated Affect Points; Stomach and Spleen, 7 x Moxa and Tonify
GV12; 3 x Moxa and Tonify
Source Points; Stomach and Spleen (St42, Sp3), 3 x Moxa and Tonify

Quite angry again this week, reported that she felt more like her old self and did not want people to treat her the same way anymore.  She had always felt it was important to be ‘nice” and now wanted to be more than this.   Earth C.F.s quite often have issues around boundaries.  The infant quite often experiences some type of enmeshing or smothering from the mother.  As the patient comes back into health you may hear stories around this issue.

As Spirit Points I choose St20 (Receive Fullness) and Sp16 (Abdomen Sorrow).  Again concentrating on the Middle Jiao with spirit points and moxa will help her to feel supported and more full or satisfied in herself.   St20 helps the person feel they can process and receive energy from outside, whether that is love or simply attention.  It supports them in braking the cycle of having to give to others constantly  - hoping to get.  Abdomen Sorrow has the spirit of letting the person get in touch with the sadness around his or her own emptiness.  When they have felt that sadness, they then are more able to let it go and move on.

Spleen -Heart Meridian Block (Sp21. and Heart 1.) Tonify
St20 and Sp16 Moxa x 5 and Tonify
St36 Moxa x 7 and Tonify

Mary continued to see me fortnightly for the next few months.  Other points such as St9 (People Welcome)-(Window), St11 (Storehouse), St12 (Broken Bowl) were featured.  She reported that she continued to feel stronger and less dependant on other things.  She was not worrying as much and felt it was probably time to try some part time work again. She continued to go through bouts of loneliness and anger thought she reported that these felt better and thought she was “probably releasing a lot of old stuff that she could never feel before”.  Eventually Mary went to see a counselor and through our work and other support is now maintaining a relationship.

Through observing Colour, Sound Odour and Emotion it is possible to ascertain which of the Five Element is most damaged in a particular patient.  Through concentrating treatment on this element it is possible to reach the core of a person.  By touching this core you are helping them to grow and change, to become more of who they can be.  Tempting as it is to fix a sore shoulder or bad back, can we have the courage to acknowledge the persons pain below such symptoms?  In this modern age where we are well fed and housed and external causes of disease are rare can we look beyond damp and heat and touch the person inside?

Each of the elemental types has different needs and Spirit of Points to match.  As we grow and learn about our own process and personal pain it is easier to let other people go through what they need to do to grow.  5 Element Acupuncture can support the persons spirit, help the person feel stronger to make the moves necessary to develop and have more of what they want from life.

Acupuncture - The Five Elements; Nora Franglen Global Books 2001
Traditional Chinese Acupuncture Volume 1 - The Meridians and Points; Prof. J. R. Worsley
Element Books 1993
Traditional Acupuncture Volume 2 - Traditional Diagnosis; Prof J.R. Worsley. Published by The College of Traditional Acupuncture U.K. 1990
Spirits and Functions; Complied by Lois Venn.   Published by The College of Traditional Acupuncture U.K.