Thanks for the positive feedback!
Well, one of the reasons I left nursing after 30 years of it was that I couldn't 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 'distress', or an element 'within' the CF...do 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 'allow' our emotions to dominate then we are somehow weak, or that it is our 'fault'. 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 'cause' of it - it's 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 'gut' 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's ultimately up to the patient and practitioner to work together and decide. That's why I think it's 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.