7. Introduction to the Five Elements
Chapter contents
Introduction44
The first chapter – the Element and the resonances44
The second chapter – the functions of the Organs48
The third chapter – the behaviour typical of each Constitutional Factor48
Introduction
The Five Elements lie at the heart of a Five Element Constitutional Acupuncturist’s diagnosis. This chapter gives an overview of Chapters 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 and 23, which describe the Elements in detail. Each Element is described in three chapters:
• The first of the three chapters covers the Chinese character for the Element and the Element’s ‘resonances’. In many places we refer to the Chinese character and at the same time refer to a text where the character can be looked up. These references enable students to access some discussion of the various characters and thus broaden their understanding.
• The second of the three chapters explains the functions of the Organs associated with the Element.
• The third chapter of the three describes some aspects of the behaviour typical of the CFs of each Element.
Together, the three chapters about each Element provide the basis for diagnosing a patient’s CF.
The first chapter – the Element and the resonances
The Elements
Each chapter begins with a discussion about the Element itself. Earth, Water, Fire, Metal and Wood all evoke powerful images. Understanding the Elements allows practitioners to gain deeper insight into patients who have that Element as their constitutional weakness. The Chinese character is analysed and its connection with the life of a person is discussed. There is further comment about how the Element appears in nature and the relationship of one Element to another via the sheng and ke cycles.
The resonances
In most translations of Five Element texts the areas connected by an Element are called either ‘associations’ or ‘correspondences’. ‘Association’ suggests that the connection may be empirical or arbitrary. ‘Correspondence’, on the other hand, conveys something more about a relationship but does not suggest that the connection is energetic. Although ‘resonance’ departs from the usage of many writers, we prefer to use it because it suggests that there is an energetic link. For example, Wood, green, anger, wind and spring resonate together. Their qi has the same nature (see Chapter 2, this volume).
In the following chapters we describe two kinds of resonances:
• the ‘key’ or primary resonances
• the ‘secondary’ resonances.
Key or primary resonances
The key resonances used by a practitioner of Five Element Constitutional Acupuncture are colour, sound, emotion and odour. These are the primary resonances and provide the foundation of CF diagnosis. As Ling ShuChapter 47 states: ‘Examine the external resonances of the body to know the body’s inner viscera’ (Wu, 1993). These resonances can only be used in diagnosis if practitioners use their sensory acuity and intuition. Ideally the practitioner discerns all four of these resonances in order to make a diagnosis of a patient’s CF. Table 7.1 sets out the key resonances.
| Note that the translations from the Chinese vary slightly from one translator to another. | |||||
| Wood | Fire | Earth | Metal | Water | |
|---|---|---|---|---|---|
| Colour | green | red | yellow | white | blue/black |
| Sound | shout | laugh | sing | weep | groan |
| Emotion | anger | joy | sympathy or worry | grief | fear |
| Odour | rancid | scorched | fragrant | rotten | putrid |
Assessing the resonances
Each resonance expresses imbalance somewhat differently. Colour, for example, is present on the face. To assess the emotion, on the other hand, requires a context in which a topic is discussed and its ‘appropriateness’ assessed. The following are some comments about how the different resonances express balance and imbalance (see Chapter 26, this volume, for more on diagnosis using the key resonances).
Colour
When an Element is in balance, the face does not manifest the Elemental colour. When a colour is apparent, the associated Element is out of balance. The colour resonant with the Element appears on the face beside or under the eyes, in the laugh lines or around the mouth. Unlike the emotion or the sound in the voice, the colour is relatively constant.
The colour may change over time, for example, as the balance of an Element improves. It can also change very quickly after a shock, during an acute illness or while an emotion is intensely felt. In general, however, colour is the most constant of the four key resonances.
Sound
A person’s voice normally manifests different and appropriate tones. Different voice tones occur because a person has a variety of emotions. When the emotion is felt the qi moves and this affects the voice tone. For example, a person shouts because anger makes the qi rise and this gives added force to the voice. The practitioner is listening for the sound that stands out as inappropriate or incongruent.
As the patient and practitioner talk, the content of the conversation and the rest of the patient’s expression determine appropriateness. For example, if patients are speaking about events that gave them great pleasure the emotion they express would naturally be joy. It is therefore normal if the voice tone is laughing, the sound resonant with the Fire Element. If patients are talking about their grief about a loved one’s death, then the fitting sound would be weeping, the sound resonant with the Metal Element. A sound that is not appropriate to the context, for example, laughing when the current context is painful, is a sign of an Elemental imbalance.
The voice tone is revealed during conversations between the patient and practitioner, so the practitioner must have skill and determination to ensure that several different contexts and emotions arise in those conversations.
Odour
Ideally patients do not have a particular odour. When they do, the Element resonating with the odour is imbalanced. Odour is less constant than colour, but more constant than sound. Odours can change during a treatment by lessening or increasing. They are also more fragile than colour. A practitioner can look away from a colour and then return to it expecting it to still be there; on the other hand, practitioners easily habituate or become desensitised to an odour. Acutely ill or elderly patients tend to emit one or other of the odours strongly.
Emotion
An appropriately expressed emotion fits the context it is expressed in. During the practitioner–patient interaction the ‘context’ arises mainly from the content of the conversation. The practitioner must decide which of the five emotions is the least appropriately expressed. Like voice tone, appropriateness is measured by assessing whether the emotion is appropriate to the context in which it is used and the movement of the qi is smooth and of appropriate intensity. Emotions do not have a clear definition in modern psychology. The Rebers say ‘Historically this term has proven utterly refractory to definitional efforts; probably no other term in psychology shares its combination of nondefinability and frequency of use’ (see Reber and Reber, 1985, pp. 236–237). We would say that an emotion usually involves three things: 1, bodily sensations (to which people can become habituated and hardly feel); 2, some cognitive element, for example, interpretative perception based on memory; and 3, motivational properties in that the emotion tends to play a role in impelling activity.
The practitioner notices which emotion is the least fluent and least appropriate of the five. To use the previous example, if a patient is describing pain but has a laugh in the voice and appears to feel joyful, she or he is expressing an inappropriate emotion. By contrast, someone describing an upcoming and genuinely threatening situation would normally show some signs of fear, however mild.
Observing an emotion is somewhat different from observing a colour. From the practitioner’s point of view, emotions are perceived as patterns that can be discerned from what the patient says, the tone of voice, the facial expression, the gestures and bodily stance. The emotion is not simple, like a colour, but is more complex and changes from one moment to the next. According to Ekman and Friesen (2003, p. 7), ‘Our studies of the body, published in professional journals, have explored the differences in what the face and the body tell us. Emotions are shown particularly in the face, not in the body. The body instead shows how people are coping with emotions.’
Table 7.1 suggests that there are just five emotions. In the language of everyday life, this is not true. The concept, set out in the Nei Jing, of five key emotions posits that there are five emotional areas, each resonating with an Element. The resonance table labels the main emotion, but that emotion is really part of a continuum that has various extremes. For example, joy is a natural and normal emotion. But here its use spans both a complete absence of joy or misery on the one hand to euphoria on the other. Both are extreme and usually ‘inappropriate’ expressions.
Another issue about emotion is the language patients use to express what they feel. Practitioners cannot necessarily trust the patient’s own perception of their emotions because emotional language was not primarily designed to describe feelings. For example, many patients who are obviously anxious and fearful in temperament do not perceive themselves to be that way at all. Verbal descriptions have their use, but even novelists when attempting to convey emotions rely less on the language of emotions and more on context, thoughts and the telltale, non-verbal signs of emotions.
The first chapter on each Element discusses the emotions associated with each CF, and Chapter 26 outlines how practitioners can gain a deeper understanding of their patient’s non-verbal expression of their emotions. The practitioner’s ability to feel what the patient is feeling and build intimate rapport is essential if the practitioner is to identify the patient’s more hidden emotions. Gaining insight into these emotions enables the practitioner to understand how their patients really feel rather than listening to a description of their feelings.
The emotions associated with an Element are not simple or uniform. This is especially so when the patient moves from a more expected or appropriate emotion to the expression of emotions that are more pathological. It is the inappropriateness of an emotion that is the main factor in deciding if it is pathological. Practitioners need to ask themselves questions about their patient’s emotions, such as:
• Is the emotion too intense or too prolonged for the situation?
• Is the person inclined always to have the same emotional response to many different situations?
• Which emotions create particularly disharmonious movements of qi, resulting in changes in the voice, facial expression or body language?
It is the subjective judgement of the practitioner in answer to these kinds of questions that makes the diagnosis.
The secondary resonances
As well as the primary resonances there are also other diagnostic categories that are described as ‘secondary’ resonances in the following chapters. These resonances assist the practitioner to gain a better understanding of the Element and they can also support the primary resonances when making a CF diagnosis. When the practitioner is assessing the balance of an Element the secondary resonances can indicate dysfunction, but not whether the Element is the CF. They are considerably less reliable than the key resonances and provide supporting, as opposed to primary, evidence for the CF.
For example, Wind is the climatic resonance for the Wood Element. Wind is invisible, it comes and goes and it makes the branches of the trees shake and sway. Understanding the nature of Wind helps practitioners to understand the nature of the qi of Wood.
Wind can also affect people who have an imbalance in their Wood Element. Such people are often disturbed by wind, even when they are protected from it. They may say that it bothers them or even that they hate it and they may become irritable if exposed to wind. The frequency of this occurrence, however, is not consistent. A majority of Wood CFs do not report this symptom. On the other hand those patients who do report this phenomenon definitely have a Wood imbalance and may be Wood CFs.
Another example is speech, which comes from the tongue, the sense organ associated with the Fire Element. ‘Speech’ means many things, from the act of speaking to the desire to communicate. Most Fire CFs will have no appreciable abnormality in their speech. However, people who speak awkwardly, stutter or mix words up probably have some problem with their Fire Element and may be Fire CFs.
If the secondary resonance of an Element is present in a patient in an imbalanced form, then it points strongly to that Element being out of balance. The secondary resonances are presented in Table 7.2.
| Wood | Fire | Earth | Metal | Water | |
|---|---|---|---|---|---|
| Season | spring | summer | late summer | autumn/fall | winter |
| Stage of development or power | birth | maturity | harvest | decrease | storage |
| Climate | wind | heat | humidity, damp | dryness | cold |
| Sense organ or orifice | eyes, sight and tears | speech and tongue | mouth and taste | nose and smell | ears and hearing |
| Tissues and body parts | sinews and tendons | blood and blood vessels | muscles and flesh | skin and nose | bones, bone marrow and hair on the head |
| Generates | nails, from sinews | hair, from blood | fat, from flesh | body hair, from skin | teeth, from bone |
| Taste | sour | bitter | sweet | pungent | salty |
The difference between key and secondary resonances
From the practitioner’s point of view there is a major difference between key and secondary resonances. Colour, sound, odour and emotion are all diagnosed through the perceptions of the practitioner. The secondary resonances predominantly depend on the descriptions of the patient. It is the practitioner’s sensory perceptions that must form the basis of the diagnosis.
The second chapter – the functions of the Organs
The second chapters discuss the functions of the Organs for each Element. In Chinese medicine the Organ functions are predominantly drawn from the classical texts. Five Element Constitutional Acupuncture places particular emphasis on the descriptions given in Su WenChapter 8.
With the exception of Fire, each Element has two Organs. For example, the Wood Element includes the Liver and Gall Bladder and the Earth Element, the Stomach and Spleen. The Fire Element has two ‘true’ Organs – the Heart and Small Intestine – and two functions – the Heart-Protector (also called the Pericardium) and Triple Burner. Note that the convention of capitalising an organ has been followed when referring to the Chinese understanding. The Organs are listed in Table 7.3.
| Wood | Fire | Earth | Metal | Water | |
|---|---|---|---|---|---|
| Yin Organ | Liver | Heart and Pericardium | Spleen | Lung | Kidney |
| Yang Organ | Gall Bladder | Small Intestine and Triple Burner | Stomach | Large Intestine | Bladder |
The chapters that follow discuss the functions of the Organs in this order:
• the functions of the yin Organ
• the functions of the yang Organ
• the time of day when the Organs are most active
• a comparison of how the paired Organs relate.
Five Element Constitutional Acupuncturists discuss the functions of each Organ in relation to how it affects the patient’s body, mind and spirit. For example, one function of the Lungs is ‘receiving qi from the Heavens’. Five Element Constitutional Acupuncturists interpret this not only as a way of describing breathing but also as literally taking in qi from the spiritual domain of the Heavens. The spiritual aspect of the yin Organ (in the case of Metal, the po) is also discussed.
The functions of the yang Organs appear to be less important than the yin Organs in many classical texts. Five Element Constitutional Acupuncturists, however, regard them as equal to the yin Organs and also consider them to have an impact on the body, mind and spirit. Thus, for example, the Small Intestine’s function of separating the pure from the impure has an important effect on the mind and spirit as well as on the body. This point of view is useful in that often one of the yang Organs turns out to be crucial in treatment and the belief that the yin Organs are always more important could stop a practitioner from noticing this.
The third chapter – the behaviour typical of each Constitutional Factor
Behavioural patterns
The main substance of the third of the three chapters on each Element concerns the behavioural patterns that are typical of each CF. These are, effectively, additional modern ‘resonances’ based on practitioners’ observations of patients. These associations do not directly derive from the classical texts. They are largely descriptions of how imbalanced emotions drive people’s behaviour. In some cases they are extensions of what is set out in the descriptions of the Organs or Officials in Su WenChapter 8.
Although diagnosis based on colour, sound, odour and emotion is paramount, understanding the motivation behind certain behaviour can also be an important resource when making a diagnosis and when monitoring progress. This method is described more fully in the section ‘Golden Keys’ in Chapter 27. Understanding people’s underlying drives and needs can also enable the practitioner to gain deeper rapport with a patient. In order to describe these behaviours it is important to give some background about these areas and discuss the following questions:
• What is meant by behaviour?
• How does an imbalance in an Element manifest in behaviours that are part of a person’s personality?
• What behaviours will manifest as a result of an Elemental imbalance?
What is meant by behaviour?
In everyday life people often use the word ‘behaviour’. When trying to define this word, however, difficulties can arise. In this context, behaviour is what the practitioner can observe from the outside. For example, the practitioner may discern that a patient is timid, withdrawn and unwilling to give opinions. Another patient may be over-assertive, forthcoming and more than willing to give opinions. Behaviour in this sense is something that a patient’s own description may corroborate. A patient may say, for example, ‘Oh I don’t like to be forward’ or ‘I always say what I think’. In this sense the practitioner may be noticing both single instances of behaviour as well as behavioural patterns that are discovered partly by the patient’s own descriptions. Practitioners will watch in the treatment room for specific examples of behaviour, but will often also use their patients’ accounts of other events in order to determine whether what they observed is a typical behaviour for the patient.
In order to allow this to happen it is essential that practitioners discuss a much wider range of topics with patients than the traditional ‘ten questions’ about their physical health. Patients need to be drawn out about areas such as their family, work and childhood in order to discover how they interact with others and behave in difficult situations (see Chapter 25, this volume, for more on these areas of diagnosis). In the treatment room the practitioner needs to be acutely aware, to observe accurately and ideally hear the patient’s confirmation of a pattern.
The patient’s perception of themselves may, however, completely contradict the practitioner’s perception. This is especially common if the person is in denial of certain aspects of their behaviour or if their behaviour puts them in ‘a bad light’. Many people, for example, would not describe themselves as lacking in joy, being excessively needy for sympathy or irritable, but the practitioner may well experience them as being so.
Examples of behaviours that a practitioner might observe are the person:
• being a clown and cracking a lot of jokes
• being very organised or very disorganised
• being excessively attentive to others’ needs
• being distanced and cut off from emotional involvement
• taking part in dangerous pursuits, but with very little awareness of the danger.
A patient’s behaviour is to some extent contrasted with what goes on in their internal world. Similar behaviours can have a very different underlying cause. For example, two people may tend to withdraw in order to protect themselves, but they do it for different reasons. One may withdraw because an imbalance in the Heart or Heart-Protector makes her or him feel vulnerable. The other may withdraw because of the fragility of the Lungs and feelings of excessive sensitivity.
How does an imbalance in an Element manifest in behaviour?
When considering the link between a person’s behaviour and their CF it is important to consider why the constitutional weakness of an Element should have such an impact on a person’s behaviour. It was stated earlier in the chapter that an imbalance in the Element manifests in small but detectable differences in a person’s emotional state (as well as colour, sound and odour).
This emotional imbalance will cause people to react to situations in very different ways and will shape how they react to events during different developmental phases in their lives. For example, from birth to first schooling, children are extremely dependent on their carers. Early separation from the mother will have a different impact on a Fire CF as opposed to a Wood CF. Later when people start school they leave the almost complete dependence on their parental carers and enter the world of teachers and social groups. A Metal CF will respond to bullying differently from an Earth CF. A person’s CF and the balance of the other Elements will largely determine their response because the CF influences emotional responses, core values and beliefs. The general pattern is shown in Box 7.1, while Box 7.2 shows how this might be manifested in a Fire CF. Patterns of the sort shown in Boxes 7.1 and 7.2 are attributable to each CF and are described in the third chapter.
Box 7.1
Constitutional weakness of an Element
↓
Impairment or instability of the associated emotions
↓
A pattern of repeated emotional states
↓
Core values and beliefs develop, partly in response to these imbalanced states
Box 7.2
The Fire Element gives the capacity for receiving love and warmth with appropriate degrees of openness and closeness.
↓
An imbalance of the Fire Element leads to a predisposition to feelings of hurt, abandonment and not being loved. There is a strong tendency for Fire CFs to doubt that they are loveable. They have issues around their lovability to a degree that other CFs do not.
↓
These states become habitual. They alter perception and the need for love, warmth, happiness and closeness becomes greater.
↓
Beliefs are formed, such as ‘I must be happy to be liked’ or ‘I feel better if I don’t spend too much time alone’.
The effect of the impaired or unstable emotions attributable to a person’s CF is combined with the effect of their environment. Fire CFs with a loving family will probably turn out to be more stable and healthy than those who were unwanted and had unloving parents. In either case, the CF will shape the nature of the person’s internal world and influence many core values and fundamental beliefs. The core values and beliefs in turn help to create people’s experience of the world.
What behaviours will manifest as a result of an Elemental imbalance?
Two people both watching a woman talking loudly in public might describe her differently. They may dispute what she said or did and disagree, for example, about the words she used or whether she pounded her fist on the table. A video recording, however, could soon sort what was factually right or wrong.
This becomes more difficult, however, when describing what is important to her or her deeper motivations. The woman may be described as ‘showing off’, ‘trying to get attention’, ‘hoping to gain some recognition’ or ‘throwing her weight around’. If two people disagree with this kind of description, a video will not help and they cannot use the speaker’s inner experience as a reference point. They may be persuaded by someone else to revise their description, but there is almost always room for doubt. We have no direct vocabulary to describe these events.
The process of the weakest Element appearing in observable behaviours is supported by recent scientific research. In Chapter 1 of Eckman (2007) there is a summary of research proving the universality of facial expression in revealing emotion. Also discussed (Ekman, 2007, Chapter 4) is what are called ‘affect programmes’, the programme whereby an emotion gets expressed in behaviour. For example, when angry more blood goes to a person’s hands and the person is predisposed to move towards the object of the anger. When fearful more blood goes to the legs and the person is predisposed to move away from the threat. The concept of ‘affect programmes’ is such that some part of the programme is pre-set and part is the result of learning. So part will be universal, like the facial expression, and part will be learned.
By understanding the different Elements and their behavioural ‘resonances’ practitioners can begin to gain a deeper and more accurate understanding of the reasons for different people’s behaviours. Rather than just speculating on the person’s motivation, the behaviour can be put into context and the practitioner can begin to understand the underlying patterns from which the person’s behaviour may have resulted. This understanding is learned by the practitioner and reinforced over a period of time. Table 7.4 gives the main behavioural patterns of each CF. These are described in greater detail in the third chapters on the behaviours of each Element.
| Wood | Fire | Earth | Metal | Water | |
|---|---|---|---|---|---|
| A balanced Element gives a person the capacity to: | Be assertive and yield appropriately in order to grow and develop | Give and receive love with appropriate degrees of emotional closeness | Give and receive appropriate emotional support and nurturing | Feel loss and move on. To take in the richness of life in order to feel satisfied | Assess risks and know the appropriate degree of ‘threat’ |
| The extremes and balance of emotion when this capacity is impaired are: | Meekness – assertiveness – rage/irascibility | Misery – joy – euphoria | Rejecting caring from others – centred – needing care from others | Melancholic – satisfied – no grief/inert | Terrified – safe – fearless |
| This leads to main issues of concern about: | Boundaries Power Being correct Growth Development |
Happiness Emotional volatility Closeness and intimacy Love and warmth Clarity and confusion |
Feeling supported Getting nourished Being centred and stable Mental clarity Being understood |
Recognition Approval Feeling complete Feeling adequate in the world Finding meaning |
Needing to be safe Being reassured Trusting Drive Excitation in danger |
| The spectrum of behavioural responses to these issues may be: | Assertive/direct – passive/indirect Seekingt justice – apathetic Rigid – over-flexible Excessively organised – disorganised Frustrated and defiant – over-obedient and compliant |
Compulsively cheerful – miserable Open and overly sociable – closed and isolated Clowning – earnest Vulnerable – over-protected Volatile – flat |
Smothering/mothering – not supporting Feeling needy – repressing needs Excessive independence – dependency Uncentred and dispersed – heavy and stuck Over-dependent on the security of the home – inability to put down roots |
Fragile – unyielding Cut-off – seeking connection Resigned or inert – over-working and achieving Craving quality and purity – messy and polluted Deeply moved – nonchalant |
Risk-taking –fearing the worst/over-cautious Distrusting – trusting Intimidating – reassuring Driven – no drive Agitation –paralysis |
Table 7.4 describes how the patient’s behaviour arises from the constitutional imbalance. The imbalance of the Element leads to a person having certain emotional responses. This in turn leads to issues of great concern arising. These ‘main issues’ are the areas practitioners might discover if they ask themselves, ‘what does this person seem to be most concerned about day in and day out?’ Each CF responds to these concerns with certain behavioural responses. Although there is no one behaviour that will define every CF, the patterns of behaviour described are the natural options people are likely to take given their inner state.
These behaviours tend to exist along a continuum from one extreme to another. For example, Earth CFs, in response to their ‘issues’, tend to vary from being excessively dependent to overly independent. Water CFs tend to be either inclined to recklessness or extreme caution. People do not necessarily only behave at one end of the spectrum or the other, however. Some Earth CFs can be very dependent in some situations and independent in others. Some Water CFs are reckless in some ways and cautious in others. The practitioner observes which of these aspects are not balanced or appropriate in the person.
It is also important to remember that all people have all five Elements within them and may exhibit some characteristics of any of the Elements. Elements other than the CF Element will almost certainly be imbalanced to some degree.
Often a person’s behaviour patterns will manifest as a direct result of their CF. Sometimes, however, people’s behaviour may appear to be driven by the issues of one Element whereas it is motivated by other drives and needs. For example, a person may be cut-off and detached (a trait often associated with Metal CFs) but the behaviour is actually driven by an attempt to hide their fear (resonant with the Water Element). Noticing these behavioural responses is therefore useful but does not replace colour, sound, emotion and odour as the primary diagnostic indicators of the Constitutional Factor.
The chapters on the typical behaviour patterns of the different CFs look at the issues that arise when that particular Element is the constitutional imbalance. These issues are linked to fundamental uncertainties and questions deep within the person’s character. The responses to these issues are as varied as there are people, but the chapter outlines some of the more common ways they manifest. These descriptions are not definitive. As more practitioners gain experience with this style of treatment it is to be hoped that even more patterns of behaviour will become apparent.
