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TCM vs Classical 5 Element


I'm curious to get some in depth perspectives from acpuncturists and TCM practitioners with regard to the differences between TCM and Classical 5 Element Acupuncture.

Techniques seem to be quite different between these two schools, and I'm curious as to why 5 Element does not include herbal medicine.

With no 5 Element practitioners in my region, I am unable to seek out treatment to compare the two. However as a bodyworker I'm considering to furthering myself with more education, Institute of Taoist Education & Acupuncture sounding quite intriguing but very different than the acupuncture I am more familiar with.

Insights would be most appreciated.


Yin Yang and Five Elements theory is the center thought of TCM, no matter acupunture or herbology all should inside these rules, five elements is connecting to 5 interal organs, and all herbs are connecting to the internal organs&#39 meridians, so they have very tight relationship.


It&#39s important to distinguish between classical five element (worsley style) acupuncture and simply using the five element theory. I know what you meant, but other responses like that of Feng&#39s above miss the point without the careful distinction.

We have an entire section on the site for classical five element acupuncture which you may find interesting if you haven&#39t read it already. Certainly as an acupuncture system there are many significant differences between classical five element styles and straight tcm - both, however, as Feng points out, do use the five element theory to varying degrees. Japanese acupuncture as well uses the five elements perhaps more than most straight TCM practitioners and other systems use it also. Classical five element acupuncture, is a unique entity however.

Not being a five element practitioner myself I cannot comment on much of the specifics of the system. I&#39m generally leary, however, of pigeon holing myself like that in Chinese Medicine (my admitted bias) - so I tend to be more open than exclusive...

With regards to your herbal question - there are two simple reasons. First, however, a comment - many five element practitioners do practice herbalism as well. The herbs however rely very heavily on standard tcm theory and the five element theory has very little to do with choosing appropriate herbs and combining formulas. These are based more on tcm patterns, properties, meridians influenced, actions, etc.

The other reason why many five element practitioners do not practice herbalism is because they are not trained. As the schools they attend are often lacking in extensive tcm theory they do not have the theoretical background to properly apply herbs. You can see this somewhat in the national exams (at least here in the US), which are biased towards straight TCM. Many students from five element schools have difficulty compared to their colleagues from straight TCM colleges passing the first time around. They just do not spend the time on these theories - for acupuncture, particularly if you are practicing what you were taught it is not an issue - for herbs, however, it can lead to very poor results.


As a Classical 5 Element practitioner, I hope I can clarify. When I refer to 5 element I mean Classical, as the contemporary 5 element has a different diagnostic procedure.

The 5 element theory underpins much of CM, as well as Chinese philosphy. It comes from the time(thousands of years ago) when observations of nature were applied to the human condition, i.e., seasonal changes and patterns in the environment mirror those in the body/mind/spirit. TCM is the result of more &#39modern&#39 observations of the human as an independent organism, and the patterns described are more particular to clinical conditions. Both recognise climatic conditions as causes of illness, and both are systematic and disciplined in their own format.

5 element practice emanates directly from 5 element theory with the diagnosis and treatment described in those terms. The presenting symptoms are not a major feature of the diagnosis, and treatment rarely links into them, although many symptoms can be understood as connected to the 5 element influence.

In practice you treat the patients Causative or Constitutional Factor(CF), the pivotal element that provides balance to the other 4 elements. The CF is the strength and the weakness.

My husband, who is both 5 element and TCM trained, and uses both in practice, describes it thus

5 element is like homeopathy in that it treats the constitutional type, whereas TCM analyses the symptoms using a differential daignostic method. In his experience a patient may have, for example, Liv qi Stagnation; treatment with Liv 3, 13, 14/GB 34 would improve their symptoms. However, the etiology may be frustration over a long period of time, with increasing resentment. If the CF is Wood, treating Liv would help short and long term outcomes. But if the CF is Fire, frustration and resentment comes from the vulnerablitiy of that element. By treating Fire, vulnerability would be replaced by ontological security, leading to resolution of resentment and frustration.

I only use 5 element, even where there are protocols to managing treatment (e.g. in IVF), as I treat on the CF as well as the protocol.

Classical/contemporary 5 element does not use herbs because they tend to correspond to TCM, although a good practitoner can do so. Mostly, this requires further training in patterns of disorders. Many practitioners are, like my husband, dual trained. I would say that TCM is great for addressing specific complaints and 5 element is great for embedded or chronic complaints. Both are wonderful systems of medicine. Neither is superior to the other. Both get great results.



Thanks for the great response. I haven&#39t received this sort of clarity with regard to Classical 5 Element Acupuncture.

As far as treatment plans, how does 5 Element differ from TCM then, as diagnoses is quite different. With CF, do you find a different kind of result than with TCM - I will be careful with how I phrase this, but the way it sounds, it may offer a greater sense of &#39overall&#39 wellness...? Lastly, I&#39m curious about your experience with treating different ailments. Do you find yourself treating more people in your office whose goals are related to their psychology/emotions? And have you had success with oncological, neurological, or more complicated medical issues?... or are there any conditions that perhaps 5 Elements may be superior at treating in comparison to TCM and vice-versa?

Thank you!


Thanks for the positive feedback!

Well, one of the reasons I left nursing after 30 years of it was that I couldn&#39t get on with the reductionist approach to health and treatments. So, I am reluctant to go down that route now I am an acupuncturist! However, there are one or two principles that might answer some of your questions.

5 element treatment planning is, theoretically, very simple. Treat the CF and everything else will fix itself. And, honestly, in most cases I have found that to be true. The difficulty is in diagnosing the correct CF. It may sound easy - after all, there are only 5 possible options - but, in practice it is much harder. There is also the added complication of blocks between officials, and whether they are due to the nurturing cycle, or the controlling cycle. Additionally, elements can be in &#39distress&#39, or an element &#39within&#39 the you treat those first or stick to CF work and trust it will right itself? These are clinical calls that are made from taking pulses and constantly checking the patients colour, sound, odour, and emotion.

5 element theory also states that the root of dis-ease is emotional. It might claim that ALL ailments are emotional in origin, so it makes no difference what the biomedical, or TCM, diagnosis is, it will have an emotional origin. In many cases this is a very hard concept for patients to accept, as we tend to perceive that if we &#39allow&#39 our emotions to dominate then we are somehow weak, or that it is our &#39fault&#39. Not so, although understanding the complexity of emotions is crucial to helping patients manage their constitutional type and reducing dis-ease.

I work a lot with oncology patients, as well as IVF. I tend to view my practice as helping the patient tolerate such massively invasive procedures and do not go into the &#39cause&#39 of it - it&#39s not the right time nor is the patient in any fit state during those treatments to be challenged about the origins of their complaint. Again, just treating the CF, and working within the cyclical nature of the 5 elements is usually enough to give relief of distressing symptoms or acheive reasonable success.

Sometimes, I recommend a TCM approach and refer on. Mostly it is a &#39gut&#39 feeling, although it can be where the 5 element approach is too slow for the patient - e.g., where there is a lot of damp or phlegm. In some cases, enlightened TCM practitioners refer a patient for 5 element.

There are some instances where only 5 element will do; husband/wife imbalance, and internal dragons. They are amazing treatments and effect enormous change both clinically and reported, paving the way for any other interventions to be much more successful. There is no substitute.

When all is said and done, much depends on the patient and not the practitioner. 5 element is more systemic and more gentle, but can be too subtle or soft for some. TCM may be too brutal or short-term for others. It&#39s ultimately up to the patient and practitioner to work together and decide. That&#39s why I think it&#39s very important not to take an either/or, better/worse approach. It is good practice to be au fait with other modalities, as we can then best serve our patients and feel sure of our professional integrity.


I would like to clarify some elements that have been mentionned above. First of all I do not think the 5 elements school should use the term "classical acupuncture" as an alternate name. Because the unquestionble " classical" treaty, source of acupuncture theory, (i.e : the Huang Ti Nei Jing Ling Shu"), is not at all part of the study and practice of a 5 element practionner; they logically cannot use this word as it is misleading on their knowledge and abilities.

This is in my view capital since the ling shu defines the use of all the secondary vessels on top of the use of the primary meridians. According to the Ling Shu each channel system has a direct access to certain layer of problems ( ex: sinew meridians will deal with WEI QI pb such as ENT, Neurological, and Dermatological pb... sorry I do not have time to go into detail and I am taking a short cut by refering to a western nomenclatura for convenience sake). More over the claim that the 5 elements is dealing with primarily the essential emotional issues of disease is contested by the same Classic whith a clear statement that these pertain to the Luo channels and the YING QI level. Treating emotional issues with the primary vessels (which is what the 5 element school does, is not, according to this primordial source, optimal to treat emotional problems (the 5 elements school uses only Primary meridian wich is really just a non descript from of treatment).I will not even mentionned the use of the Bie Jing or even the 8 extras which are totally unkonw to them. The 5 element school like to refer to themselves as having more depth than TCM practioners because they treat the root as opposed to the syptoms. I wonder how deep they have studied to make such claims.

The 5 elements school is based on the Nan Jing which is a classic explaining the difficult issues of the Nei Jing su wen and ling shu, (The Nan Jing is a compilation of commentaries of practiooners on the Nei Jing; it is not the source of Chinese medicine; the Nei Jing is.) .

What is sad is that in their haste to proclaim that there is nothing to study other than the 5 elements sytstem, they have negated the whole history of CM. The Nan Jing is written around 200 CE. Then Chinese medicine evolved and received invaluable contributions from so many doctors but this all but ignored by the 5 elements practitioners. (li dong yuan 3 triangles, liu wan su 8 barriers, lishi zhen 8 extras opennings...etc). They also make the claim that somehow the acuouncture system was "bastardized" by the herbal theory. It is not my understanding. i feel the knowledge of herbs is integral to the practice of CM since so much of the incredible body of theory comes from there.It has greatly enhanced my intelligence of disease and wellness (as herbs are also taken as a mean to cultivation (ex: Bai Zhu will make your body light and enhance your clarity which can be useful for a practitioner), not just linked to disease theory!)

I want to ask 5 element P : why do you choose to ignore all the tools that were given to us by such a rich history? Why do you decide what is worth treating and what is not ? ( I have regularly people calling me because a 5 element practitioner refered them to me, telling them that they do not treat shoulder pain!). I feel this not the practice of medicine.

As doctors, I believe we must commit to help people in the most numerous configurations not just psychological issues/root pb. This is much alike a western model of specialties that is not in the spirit of the oath to relieve pain and suffering at all cost. I feel that there is the root and the branch of a disease. You choose to treat primarily one or the other according to the urgency of the presentation. It is not for the practioner to choose to play doctor only on what he wants to treat, and certainly as a TCM practionner I take issue with them claiming that they treat only the root of problems and me "lowly" tcm just treat the symptoms. Funnily I have spent most of my life studying all the possible models that would help me treat each patients with the most fitting strategies. (That includes studying acu, QI GONG, diet, herbs and meditation so that i can choose to each the best approcach to reconnect with their whole self). In all of these tools i include the 5 elements which is one of my favorite practice when i am in nature....and here I am speaking about what i believel to be a misapropriation and sectarian view of chinese medicine.

In the spirit of the undying model of health given to us by an uninterrupted lign of kind teachers, do not spread falsehoods. We are all in the service of others. We must study endelssly and avoid the pitfalls of dogmatism and sectarianism.

The system is only as great as its practionner...


Thank you for such a full comment. I would like to add my understanding to your comments and perhaps gain some clarification.

Firstly, I know what I studied in my course. I also know that, like TCM, the 5 element canon has a number of variables. The LicAc I studied was based on daoist teachings, essentially the Nei Jing and all that emanates from it (3 treasures, 8 extra channels, and so on). Root and branch theory was very much at the heart of it, and we were also told again and again that while there is no &#39superior&#39 kind of acupuncture &#39superior&#39 practitioners were possible - mainly ones that understood the concept of humility.

I think I made it clear in my comments that there is no gain in being territorial, although preserving the integrity of a practice tradition is worthy. I am married to a TCM/herbal practitioner, and we learn much from each other. He is also a practising Christian, and I am aetheist; again, we learn much from each other.

Good practitioners are found in all fields of medicine, regardless of the discipline. Respectful practitioners - respectful of the patients as well as other practitioners as well as the self - tend to be good practitioners. The hall mark of a professional, however, is one who knows what they cannot do, and a good professional practitioner will also have an awareness of who would be able to &#39do it&#39.

Using Western terminology to translate and define Chinese terminology does, as you rightly point out, cause significant problems in gaining common ground and understandings. Part of this is because the conceptual frameworks are so different, and this leads to ontologies and epistemologies that are not always compatible. Clearly this impacts on training and studying, especially when an institution of education requires courses to comply with the wider teaching models, which appears to be one of the disadvantages of Chinese Medicine being taught in the West. Indeed, here in the UK there is a faction of so-called academic scientists who are hell-bent on closing courses that contain (in their words) voodoo and mumbo-jumbo, on the premise that they are not proper subjects. Students and teachers operating that that kind of environment are bound to become defensive and protective. Similarly, MDs/physiotherapists et al doing weekend courses in sticking needles in and calling it acupuncture are an outrage, yet a recent study claims that 48% of all &#39acupuncture&#39 consultations in the UK are of this sort. The net result may be that a proportion of LicAc practitioners feel they must hold on to their expertise at all costs and not embrace any other way of working.

Whatever the influences, my stance is to welcome input from experienced, knowledgeable people, so I can deepen my understanding and, hopefully, improve my service to patients. To that end, anyone who is a practitioner of Chinese Medicine is welcome in my world.


Dear Yeoman,

I am not sure you answer my questions regarding the 5 elements practitioners, as you are in a unique position to appreciate the value of TCM. However I still feel it is a wrong statement to say that somehow TCM does treat in an "allopathic mode" and cannot address complex and chronic patterns. Again this not my experience. As long as this is repeated I think a lie is propagated....Some of the most gifted healers I have seen were TCM P.

My point is that this claim is arrogant in essence as it means that somehow the school of JR Worsley would be the last bastion of true acupuncture and millions of asians are practicing a watered down version of CM. This seems to me, a claim that borders on megalomania...

It seems that because of the proximity of the JR Worsley school, there is a great number 5 elements P. where I practice. In consequence I have had first hand experience of their intolerance and condescension... very unjustified in my view since it seems that each time I engaged them in any discussion on theory, they feel compelled try to box me in the :" Oh but that is just what YOU do TCM people....". Their dismissal always feels more like a protective mecanism of somebody who is about to reveal the depth of their ignorance. Sorry if I sound arrogant, it is not my intention, only with people who combine agressivity and ignorance (I cannot not give the other cheek :). Your forum is reasonable and respectful but I have seen a lot of them out there that are anything but.

As for the daoist word used so often in association with the 5 elements, it is somewhat surprising since the Dao De jing of Lao Zi, makes no reference to the 5 elements whatsoever and that is because this thinking model is of the Naturalistic school not of the Daoist tradition.

Anyhow I recommend, if you are interested in daoist acupuncture, to check any teaching that Jeffrey Yuen has put out there, I am sure you will appreciate them....

In health,


It appears you have had some less-than-helpful interactions with individuals who have in common the local 5 element teaching. I am sorry about that, as hostility is rarely a pleasant experience. Clearly, you assume this is an identifying feature of the 5 element system of Chinese medicine. I am sorry about that, too.

J R Worsley had long left the college in the UK when I studied there and I can assure you, arrogance and entitlement were not part of the curriculum. As he has been dead for 10 years, I am confident that if those aspects are being taught now they are nothing to do with him as a person, and certainly not part of the 5 element system as I know it after 12 years practice.

Reading through all the posts following the original query, it seems that nobody has suggested TCM is akin to allopathic/modern medicine, neither has it been suggested that TCM is somehow inferior to any other system of medicine (Chinese or modern biomedicine). I can only surmise that&#39s because most of us here don&#39t believe either to be true.

I am familiar with Jeffrey Yuen&#39s work but, thank you anyway for the reference. Perhaps you might like Elisabeth Rochat de la Valle and Claude Larre for their excellent explanations of 5 element medicine.

Om Shanti Shanti SHanti

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