Five phase theory and its use in medicine

Philip A.M. Rogers MRCVS  
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1982, updated 1993, 1995
Postgraduate Course in Veterinary AP, Dublin, 1996

 
 

SUMMARY

 

Nature and the body are unities, in which mutual control and harmony are maintained by creation (anabolism) and destruction (catabolism). Five Phase Theory extends Yin-Yang Theory, in which all things in nature are classified into five basic types or Correspondences: Fire, Earth, Metal, Water, Wood. The Phases and their Correspondences interact in predictable ways. As Yin and Yang have anabolic and catabolic aspects, so also have the Five Phases. Thus, the Five Phases have a Sheng (Mother-Son, anabolic, creative, nourishing = ->) and a Ko (Grandmother-Grandson, catabolic, controlling, destructive, = X) Cycle.
 

The Sheng Cycle is: Fire -> Earth -> Metal -> Water -> Wood -> Fire. In the Sheng Cycle, Fire is the Mother of (feeds or strengthens) Earth and Metal is the Son of (is nourished by) Earth.

 

The Ko Cycle is : Fire X Metal X Wood X Earth X Water X Fire. In the Ko Cycle, Fire is the Grandmother of (dominates or controls) Earth and Metal is the Grandson of (is brought under control by) Earth.

 

Each Phase (or ELEMENT) relates to a specific Yin/Yang pair of the Channel-Organ System (COS) and to a wide list of Correspondences (function, emotion, excretion, body tissue, season, food etc). Thus, Fire relates to the COSs Heart and Small Intestine (HT and SI) and their Correspondences (sweat, tongue, speech, face, circulation, excitability, psyche, bitter taste, red, summer, south etc).

 

Disease involves imbalance (Excess, Deficiency or Stagnation) of Qi in one or more COSs. Therapy involves restoration of the balance of Qi. Each Channel has 5 special Points, corresponding to each of the Five Phases and a Luo (Passage) Point. These Points are used to transfer Qi between COSs when there is one or more with Qi Excess and an equal number with Qi Deficiency. This restores the balance and harmony of Qi. One usually stimulates the Deficient COS, to draw Qi from its Yin/Yang mate (via the Luo Point) or from another COS (via the Sheng or Ko Cycle). Any Deficiency thus created in the donor COS is filled from an Excess elsewhere. However, if only one COS is involved, it may be Tonified by needling its Mother Point, or Sedated by needling its Son Point.

 

Five Phase Theory has many implications in medicine. However, the theory is incomplete and it has its limitations. It is a useful guide to aetiology, diagnosis, prognosis and therapy but it is not absolutely necessary for therapeutic success. Knowledge is an ongoing process. While AP can produce good clinical results without a knowledge of the use of Five Phase Theory, the theory enhances the probability of optimal results, especially in complex disease syndromes.

 


INTRODUCTION

 

The Traditional Chinese Medical (TCM) law of Yin-Yang is the UNIVERSAL LAW of mutual control by mutual antagonism and dependence of all things. (See the papers on Holistic concepts of health and disease and on Traditional versus modern AP). The interplay of Yin-Yang is an endless cycle of action and interaction.
 

The concept of cycles is fundamental to TCM. Nothing is static. Nothing is absolute. Everything is dependent on (relative to) everything else. All things must CHANGE. The Five Phase Cycle is another fundamental concept of TCM. In essence, everything and every concept in creation is a manifestation of Qi (energy). Qi has attributes or characteristics of one or more of five basic types, and can transform from one Phase to another. The types or Phases are called: Fire, Earth, Metal, Water, Wood. For instance, suppose you are sitting in your armchair, looking into a fire and meditating on the nature (or type) of Fire. You might see it as primarily heat and light (energy-giving). However, the same fire once was (and still contains an element (Phase) of) living organic material (Wood, peat, coal, methane). As it burns, it produces (and contains an element of) ash (Earth) and mineral residue (Metal) and the hydrogen in most burning fuels is oxidised to Water. Thus Fire also contains aspects (elements, Phases) of the other Phases (Wood, Earth, Metal and Water). In turn, earth and minerals, when fed by Water can produce a new tree (Wood). Thus, all the basic components Fire, Earth, Metal, Water and Wood are needed for (inherent in) every other Phase.

 

Each Phase has typical characteristics or Correspondences. Each has also its Yang and Yin aspects. The Phases create (engender, nourish, help) one another and destroy (control, restrain, dominate) one another in a ceaseless, dynamic cycle, the dance and rhythm of life and death.

 

In TCM, the Two Phase (Yin-Yang) and Five Phase Cycles are universal Laws. They are the source and manifestation of evolving creation and destruction in all its aspects. They apply to every aspect of life and politics, art, music, science, philosophy, sociology and medicine. They are primitive (yet ultra-sophisticated) concepts of the balance and inter-dependence of all things. If one Phase becomes imbalanced (too strong or too weak), the whole cycle is upset and disharmony can arise in other Phases and their Correspondences. Restoration of balance depends on recognition of which Phases are upset and the redistribution of Qi between them so as to restore harmony, if this is possible.

 

The Five Phase Cycle has two major components, the Sheng Cycle (Mother nourishing Son) and the Ko Cycle (Grandmother restraining Grandson). The Sheng is anabolic, creative, nourishing, feeding. The Ko is catabolic, destructive, weakening, controlling.

 

Sheng Cycle: Things of a Fire nature promote (create or nourish) things of an Earth nature, which promote or create things of a Metal nature etc. The Cycle is Fire -> Earth -> Metal -> Water -> Wood -> Fire.

 

Sheng mnemonic: To remember the Sheng Cycle, visualise a gardener Watering a seed. The seed grows into a tree. The tree is cut down for fireWood. The Fire produces ashes which could be further refined to produce Metal. The sequence is Water -> Wood -> Fire -> Earth -> Metal -> Water. Because a cycle has no beginning and no end, it is not important which Phase is put at the top of the diagram, but it is usual to put Fire on top because (as will be seen later) four COSs are associated with Fire and the top position is the most aesthetic, as will be seen when the COSs are added to the diagram.

 

In this Cycle, things of Fire are Mothers of things of Earth (which are Sons of Fire). In turn, things of Earth are Mothers of things of Metal (which are Sons of Earth).

 

Another Mother and Son concept was discussed elsewhere in relation to the Diurnal Qi Cycle (daily Qi tide) from: LU -> LI -> ST -> SP -> HT -> SI -> BL -> KI -> PC -> TH -> GB -> LV -> LU. In the Qi Cycle, LU is the Qi Mother of LI and BL is the Qi Son of SI etc.

 

The following diagram shows the relationships between the Phases in the Sheng Cycle. The Sheng Cycle is represented by a clockwise circle. It is continuous, having no beginning and no end. Although Fire creates Earth, Earth is necessary for Fire: (without Earth the succeeding Phases (Metal, Water and Wood) would not be, and Fire itself would die!).

 

 

The Sheng Cycle is the concept of Interpromotion among Phases: the Mother is necessary for the creation/nourishment of the Son. Thus, the Sheng Cycle is a GROWTH AND PROMOTION (anabolic) Cycle.

 

Ko Cycle: All growth (Sheng) must be controlled or restrained, otherwise abnormalities like cancer, overpopulation, starvation and crime etc arise. The Ko Cycle is the important controlling or restraining force between the Five Phases. It is a cycle of mutual control-inhibition-restraint. In this cycle things of a Fire nature restrain-control-inhibit things of a Metal nature. Metal restrains Wood etc. The following diagram shows the relationships of the Ko (restraint) Cycle.

  

The Ko Cycle is: Fire X Metal X Wood X Earth X Water X Fire. It is represented by a clockwise pentagram or star. It is continuous, having no beginning and no end. Although Fire restrains Metal, Metal has some control on Fire also, because without Metal, Water and Wood could not be (in the Sheng Cycle), therefore Fire could not be. Thus the Ko Cycle is a cycle of mutual CONTROL and RESTRAINT (the Grandmother disciplines, brings order to, restrains, the Grandson):

 

 


COMBINATION OF SHENG AND KO CYCLES BALANCES THE FIVE PHASES

 

Without Sheng (nourishment) there can be no growth and development. Without Ko (restraint), excessive development would be harmful.
 

Thus, both the Sheng and Ko Cycles are necessary for balance. They represent a state of continuous dynamic anabolism and catabolism respectively. All things in nature must change. In biology, as in nature, nothing is static (i.e.) the system is in continuous movement, one Phase becoming another. During this movement (rhythm) there are active (Yang) and passive (Yin) phases. The combination of Sheng and Ko is represented in the following diagram: ===> represents Sheng Cycle (nourishing, promoting anabolic); ---> represents Ko Cycle (restraining, controlling, catabolic); +++> represents Counteracting (a Reverse Ko) Cycle: Fire X Water X Earth X Wood X Metal X Fire. Earth restrains (controls) Water (in the Ko Cycle) but Water may Counteract on Earth (in the Reverse Ko Cycle):

 

 

The balance of growth (Sheng) and restraint (Ko) is necessary for harmony in the system. Thus, by a process of mutual synergism and antagonism, harmony is maintained.

 

 

DISHARMONY, DISORDER

 

If there is an Excess, Deficiency or Stagnation (Blockage) in one Phase, abnormal phenomena may appear in other Phases because the primary imbalance may Overact or Counteract on other Phases.
 

Overacting means attacking a Deficient Phase via the Ko route. A Phase with normal Qi, but especially one with an Excess of Qi may attack a Deficient Phase via the Ko Cycle (the Grandmother annoys (or weakens further) the Weak Grandson). A normal (or, especially hyperactive) Grandmother harms the Deficient Grandson Phase. For example, if Wood is Deficient (weak), Metal could Overact on it, thereby exaggerating the problem. If Wood is in Excess, it can Overact on Earth (weaken it). Counteracting is another type of attack by one Phase on another, via the reverse Ko route (the Grandson annoys the Grandmother). If Wood is in Excess it can Overact on Earth and simultaneously can Counteract on Metal. If Wood is Deficient it can be Overacted upon by Metal and be Counteracted upon by Earth at the same time.

 

The Sheng, Ko, Overacting and Counteracting forces are the basis of all interactions between diseased organs. We will see later that each Phase has a set of Correspondences, including a solid Yin Organ and hollow Yang Bowel. For now, it is sufficient to know that Fire, Earth, Metal, Water and Wood are associated with the Yin COSs HT, SP, LU, KI, LV respectively. Disease in any one of these COSs can have secondary effects on any other member of the group. For instance, Lung disease could be primary. However, it could be secondary to disease in Spleen (Mother (Earth) affecting the Son (Metal) in the Sheng Cycle); to disease in the Kidney (Son (Water) affecting the Mother (Metal) in the Sheng Cycle); to disease in the Liver (Liver (Wood) Counteracting on Liver (Metal)) or to disease in the Heart (Heart (Fire) Overacting on Lung (Metal)).

 

In summary (so far), Five Phase Theory is a UNIVERSAL THEORY relating types of things in a harmonious, balanced system (the Sheng and Ko Cycles). If one of the Phases becomes too weak or too strong, the entire system can become unbalanced. By Overacting and Counteracting forces, one imbalanced Phase may affect others. Any one Phase may be imbalanced by imbalance in any other Phase. Correction of the balance depends on recognition of the Excess and Deficient parts of the system and in redistributing the Qi to the correct parts of the system to restore harmony. This concept is the first documented concept of Holistic medicine: any one organ is related to, and can influence the functions of, any other organ.

 


CORRESPONDENCES OF THE FIVE PHASES (see the following tables)

 

Each Phase has a whole series of characteristics associated with it. The following tables show some of these Correspondences. Students who wish to study the Five Phase Theory in depth are referred to standard textbooks (Wu 1973; Connolly 1979; Hsu 1982; Kaptchuk 1983; Porkert 1983; Wiseman et al 1985; Anon 1993).
 

The Correspondences of the Five Phases may help in diagnosis of health problems by indicating which Phases are imbalanced. For instance, if a human patient has a history of lacrimation, blurred vision and defects in the nails, one might suspect imbalance in the Wood Phase (see tables of Correspondences). If he/she has an angry temperament, shouted a lot and had a history of muscle aches and tendon pain, this would be further evidence of Wood imbalance. Further examination would help to distinguish between LV and GB. For instance, palpation of the bladder Shu (reflex) Points, front Mu (Alarm) Points, Yuan (Source) and TEST Points (see paper on the study techniques) would be very helpful to distinguish between LV and GB. Pulse diagnosis might also suggest that another Phase, for instance Earth, was also imbalanced. For instance, in a liverish patient, a frequent picture might include indigestion, weakness, nausea and Watery eyes. The Qi diagnosis may be LV Excess with ST Deficiency. In Five Phase Theory, the treatment of such a case is very simple. One needle at the Grandmother/Wood Point of ST (ST43) would suffice. By stimulating this point on the Deficient ST COS, Excess Qi is drained from LV (Wood, Yin) to fill the Deficiency in ST (Earth, Yang) via the Ko Cycle. (In Ko Cycle, Wood controls (is the Grandmother of) Earth and therapeutic Qi passes from Yin to Yang (or Yang to Yin) in the Ko Cycle). (Don't worry if you do not understand this example. It will become clearer when you have studied the entire paper).

 

In the Five Phase Cycle, the following relationships apply to the Channels, their Organ/Bowels, Functions and Correspondences. The Yang COSs appear outside the circle in the diagram. They are: SI=Small intestine; TH=Triple Heater; ST=Stomach; LI=Large Intestine (Colon); BL=Bladder; GB=Gall Bladder. The Yin COSs appear inside the circle. They are: HT=HearT; PC=Pericardium, Circulation-Sex, Heart Constrictor); SP=Spleen-Pancreas; LU=Lung; KI=Kidney; LV=Liver.

 

 

Note that the linked COSs form a Yin-Yang Pair within each Phase: Fire HT-SI and PC-TH; Earth SP-ST; Metal LU-LI; Water KI-BL and Wood LV-GB. Qi can be transferred from HT to SI (or SI to HT, as required) by the use of the correct Luo (passage) Point, always stimulating the Luo of the Deficient COS to draw Qi from its linked COS. Also, in therapy, the points can help SI problems and vice-versa.

 

In the Sheng Cycle, HT nourishes SP and SI nourishes ST etc, (i.e.) the Qi in the Sheng Cycle passes from Yin to Yin or from Yang to Yang only. The Qi transfer in the Sheng Cycles is as follows (-> = creates or nourishes):

 

 

Sheng Cycle Fire -> Earth -> Metal -> Water -> Wood -> Fire
Yang to Yang transfer SI -> ST -> LI -> BL -> GB -> SI
Yin to Yin transfer HT -> SP -> LU -> KI -> LV -> HT

 


CORRESPONDENCES OF THE FIVE PHASES

 

Correspondence Fire Earth Metal Water Wood
Yin Organ COS HT,PC SP LU KI LV
Yang Bowel COS SI,TH ST LI BL GB
Body fluid,Secretion Sweat Phlegm, saliva Mucus Saliva, urine Tears
Orifice & sense organ controlled Tongue, speech, words Mouth, taste Nose, smell Ears, genitals, anus, urethra, hearing Eyes, vision, foresight
Manifests externally or expands into Face, complexion Lips, mouth, throat, flesh Skin & body Hair on the head Nails
Nourishes or Governs Blood vessels, arteries, blood cir- culation Fatty tissue, muscles Skin & body hair; mucous membranes Bones, teeth; bone marrow; brain Tendons, ligaments, muscles
Main Temperament, emotions Joy, happiness excitability manic depressive extrovert Obsession, worry meditation sympathy, depression greedy Anguish, grief, melancholy negativity, sympathy Fright, fear, timidity, phobias, introversion Anger,irr-itability, depression unstable
Verbalisation emotional sound Laughter, grieving, stuttering excessive speech Singing, sing-song voice Weeping, Sobbing, lamenting Groaning, moaning, humming, yawning, snoring Shouting, crying out, bossiness
Stores or controls the non-material energies of Conscious-ness; spirit, the will to live, psychic energy Thoughts, ideas, inspirationsopinions, physical energy Life energy (Qi) Animal spirit, vital energy Willpower, ambition Soul, spirit, Spiritual faculties "First cure the spiritthen cure the body",blood, energy
Body flavour, likes or dislikes Bitter Sweet Hot, spicy, pungent Salty Acid, sour as in vinegar
Creates (->) (via Sheng Cycle) Earth HT -> SP SI -> ST Metal SP -> LU ST -> LI Water LU -> KI LI -> BL Wood KI -> LV BL -> GB Fire LV -> HT GB -> SI
Destroys (X) (via Ko Cycle) Metal HT X LI SI X LU Water SP X BL ST X KI Wood LU X GB LI X LV Fire KI X SI BL X HT Earth LV X ST GB X SP
Governs (via reverse Ko Cycle) Water KI, BL Wood LV, GB Fire HT, SI Earth SP, ST Metal LU, LI
Exertion (which weakens) Too much walking Too much sitting Too much lying down Too much standing Too much use of eyes
Body Time 1100-1500h 1900-2300h 0700-1100h 0300-0700h 1500-1900h 2300-0300h
Face Colour Red Yellow White Blue-Black Green
Climate (Good/bad) Heat Damp, Humidity,Late Summer Dryness Cold Wind
Season Summer Late Summer Autumn Winter Spring
Growth/development Growth Transformation Reaping Storing Germination
Direction South Centre West North East
Dreams Fires,blazes, looking for fire; fear & laughter hills; mountains towns, streets Hunger,no food/drink, buildings walls and houses, playing music; chanting; ruined buildings; body heavy; can't rise; hills; marshes; storms White objects, cruel; killing of people crying; flying in the air; strange metal objects; fields; country-side; landscape, frightful dreams Water, drowning, ships; fright; fears; back & waist feeling open & split apart, ravines walking & excursions Being trapped, mushrooms; lying under tree ; afraidto get up; trees in mountain forest; battles & fight; cutting open one's body
Meat Mutton, lamb dog Beef Horse Pork, fish Fowl,chicken
Vegetable Coarse greens scallions onions leeks mallows
Fruit Plum apricot chestnut dates peaches
Grain Millet millet,rye rice beans, peas, wheat  
Note Chih Kung Shang Yu Chio
Number 7 3 9 6 8

 

In the Ko Cycle, there are two types of Qi transfer (a) Therapeutic Qi transfer and (b) Pathological Qi transfer.

 

a. In the Ko Cycle, transfer of Therapeutic Qi is always from Yin to Yang or Yang to Yin only. This will be discussed later.

 

b. In the Ko Cycle, transfer of Pathological Qi is always Yin to Yin or Yang to Yang, as follows (X = weakens or damages or controls), i.e. Kidney disease can damage the Heart and Heart disease can damage the Lung; Gallbladder disease can damage the Stomach:

 

Ko Cycle Fire X Metal X Wood X Earth X Water X Fire
Yang to Yang transfer SI X LI X GB X ST X HT X SI
Yin to Yin transfer HT X LU X LV X SP X KI X HT

 

The distinction between pathological transfer of Qi (Yin -> Yin; Yang -> Yang) and the therapeutic transfer (Yin -> Yang; Yang -> Yin) is most important in diagnosis and therapy.

 

In the Five Phase Cycle the term Heart, HT etc refers not only to the heart organ but to all attributes of HEART (i.e.) Function, COS and Correspondences. This principle is applied to all COSs. Thus, when a master acupuncturist diagnoses a Deficiency in HT or Excess in LI, it does not necessarily mean physical weakness of the heart organ or hyperactivity of the colon organ. Rather, it means that the functions of HT are Deficient or that the functions of LI are Excessive. (There may be physical changes in the respective organs also). If the condition is not treated, physical changes will almost certainly occur in due course.


 

MEDICAL IMPLICATIONS OF THE FIVE PHASE CYCLE

 

Five Phase Theory has many implications in medicine: aetiological, diagnostic, prognostic and therapeutic.

 

a. Interaction: All the major organs, functions and Correspondences interact with each other and are interdependent in maintaining health. If one organ is irreparably damaged, life is threatened or secondary disorders can arise in other organs. Unnecessary surgery, especially removal of organs, may be dangerous.

  

b. Correspondences: Imbalance (Deficiency or Excess) in one COS or its Correspondence may influence other COSs, their functions and Correspondences. For example, Excess Qi in HT COS may weaken LU COS (via Ko Cycle); Deficient Qi in the KI COS may allow Excess Qi in the HT COS, also via the Ko Cycle. Similarly a Deficient LV COS may render the HT COS Deficient also, via the Sheng Cycle.

 

Bone pain (rheumatism) is more likely in cold, wet weather (winter-kidney (Water) controls bone). Too much excitement may cause heart attack (excitement injuries Fire). Septic inflammation of the throat often arises with kidney pains (KI (Water) controls kidney and throat). These (and many other) examples illustrate the great diversity of concepts which are intrinsic to Five Phase Theory.

 

The TCM view of the interdependence of the COSs and the psyche and external environment is truly a holistic view of health and is the early ancestor of modern Psycho-Somatic medicine and of dynamic self-controlling systems.

 

c. Balancing the COSs: Five Phase relationships are used in classic human acupuncture (AP) to guide the choice of the best points for AP therapy. The principle of balancing the COSs assumes that one or more COSs are in Excess and an equal number are Deficient. If so, the Deficient COSs are filled by draining Qi from the Excess in another COS. If this can not be done directly, Qi is drained from a normal COS, which is then filled by draining from the COS which is in Excess. (Examples will be given later).

 

IF there is no Excess, do not create a Deficiency in another COS! This would merely change the location and nature of the disease! Thus, attempts at Five Phase balancing are contraindicated unless there is an Excess to fill each Deficiency.

 

 

THE USE OF FIVE PHASE POINTS

 

Each Channel begins or ends at the fingers or toes. As Qi flows in the Arm Channels (LU -> LI; HT -> SI; PC -> TH) and in the Leg Channels (ST -> SP; BL -> KI; GB -> LV), a change Qi polarity occurs at the digits. As the Qi flows in the Arms, the polarity change is Yin to Yang (e.g. LU -> LI). In the Legs it is Yang to Yin (e.g. ST -> SP). (Note: at the chest and face, no polarity change occurs. In the face, the changes are Yang to Yang: (LI -> ST; SI -> BL; TH -> GB). In the chest, the changes are Yin to Yin: (SP -> HT; KI -> PC; LV -> LU).

 

The easiest place to influence the COS Qi by AP is at the extremities, where the Qi polarity is changing naturally. Therefore, the most important points influencing Qi transfer in AP therapy occur at the extremities: between elbow and digit in the thoracic limb and between knee (stifle) and digit in the pelvic limb.

 

a. Each of the 12 main COSs has a point for each Phase (i.e.) a Fire, Earth, Metal, Water and Wood Point. The location of each of the 12 x 5 ( = 60) Phase Points is given elsewhere (in the paper "The Study of AP: Sources and Study Techniques"). These points are used according to the Five Phase Cycle to redistribute Qi in the COS circuits, if imbalances are detected between the Phases.

  

If the imbalance is within a Phase (for instance between LU and LI, both in Metal), the Luo (passage) Point of the Deficient COS is used to balance Qi by draining the Excess from the linked COS. Thus, Qi can be transferred from any one COS to any other COS by using the Five Phase Points according to the Sheng and/or Ko Cycle and/or the Luo Points, as the case requires.

 

b. In the Sheng Cycle, Qi travels fromYang to Yang (SI -> ST -> LI -> BL -> GB -> SI) or Yin to Yin (HT -> SP -> LU -> KI -> LV -> HT) only. By use of Five Phase Points it is not possible to transfer Qi from SI (Yang) to SP (Yin) directly (although Earth is the Son of Fire). If the SP is Deficient and SI is in Excess, Qi is taken from HT by needling the Fire Point of SP. (Yin to Yin transfer). HT is then filled by draining the Excess from SI by needling the Luo Point of HT (Qi transfer from Yang to Yin within the same Phase via the Luo Point of the (now) Deficient COS). Similarly, if ST is Deficient and HT in Excess, it is not possible to transfer Qi directly from HT (Yin) to ST (Yang) although Earth is the Son of Fire. In this case, a needle in the Deficient ST COS at its Fire Point would fill ST (via Sheng Cycle), emptying SI in the process. SI would then be filled by needling its Luo Point, thereby draining the Excess from its linked COS, HT.

  

c. In the Ko Cycle, therapeutic Qi travels from Yang to Yin or Yin to Yang only (e.g.) from: HT -> LI -> LV -> ST -> KI -> SI -> LU -> GB -> SP -> BL -> HT. Some authors (for example, Are Thoresen (Norway)) do not agree on this point but the majority take this view. In the classic view, it is not possible to transfer Qi from HT (Yin) directly to LU (Yin), although LU is controlled by HT in the Ko Cycle. In a case where LU was Deficient and HT was in Excess, the approach would be: first needle the Fire Point LU. This would drain Qi from SI into LU, creating a Deficiency in SI. The Deficiency in SI would then be filled by needling the Luo Point of SI, thereby emptying the Excess from HT. Similarly, it is not possible to transfer Qi directly from SI (Yang) to LI (Yang) via the Ko Cycle. In a case where LI was Deficient and SI was in Excess the approach would be: first fill the Deficiency in LI by needling the Fire Point of LI, thereby draining Qi from HT (Yin to Yang transfer by Ko Cycle). Then fill HT by needling the Luo Point of HT, thus draining the Excess from SI.

 

d. Whether using the Sheng or Ko Cycle to transfer Qi, always fill the Deficient COS first, draining Qi from some other COS. Any Deficiency which is thus created is filled by draining from a COS which is in Excess. If there is no Excess, do not create a Deficiency elsewhere.

 


RULES OF USE OF FIVE PHASE POINTS

 

The use of the Phase Points, together with the Luo (passage) Points is easy to understand in principle, if one grasps the following rules:

  1. Therapeutic Qi can be transferred along the Sheng Cycle from Yin to Yin or Yang to Yang only.
  2. Therapeutic Qi can be transferred along the Ko Cycle from Yin to Yang or Yang to Yin only.
  3. Therapeutic Qi can be transferred via the Luo (passage) Points from Yin to Yang or Yang to Yin only, and only between linked COSs: LU <-> LI; ST <-> SP; HT <-> SI; BL <-> KI; PC <-> TH; GB <-> LV. These linked COSs are always within the same Phase, i.e. LU, LI = Metal; ST, SP = Earth etc.

 

When solving a problem of Qi transfer to balance imbalances in the COSs, many solutions are possible. The ideal solution uses the shortest possible route (i.e.) the fewest possible number of needles. A solution may involve either or both of the Sheng and Ko Cycles and/or 1 or 2 Luo Points. Most solutions require no more than 3 points and many can be solved with 1 or 2 points only.

 

ALWAYS BEGIN BY STRENGTHENING A DEFICIENT COS. Some examples follow. See diagram below:

  

a. HT Deficient with SI Excess. This is very simple. The imbalance is within the same Phase (Fire). A needle in the Luo Point of HT (Yin) will drain the Excess from its linked COS, SI (Yang) and replenish the HT Qi at the same time. 

   

b. HT Excess with SI Deficient. Similar to (a) but the Deficiency is in the Yang member of the linked pair. Needle the Luo Point of SI (Yang).

 

In both of the above cases, the imbalance was within one Phase, with no other imbalances. Therefore, only the Luo Point is used and there is no reason to use the Phase Points.

  

c. HT (Fire) Deficient with LV (Wood) Excess. This one is easy as Wood supplies from Yin to Yin. One needle in the Wood Point of HT drains the Excess from LV and fills the Deficiency in HT at the same time.

  

 

d. SI (Fire) Deficient and GB (Wood) in Excess. Similar to (c) but the Yang COSs are involved. Solution: needle the Wood Point of SI. This drains GB and fills SI via the Sheng Cycle.

 

e. SI (Fire) Deficient with LV (Wood) in Excess. Though the Sheng Cycle can move the Excess from Wood to Fire, it requires 2 points. First needle the Wood Point of SI. This fills SI but drain GB via the Sheng Cycle (Qi goes Yang to Yang). Then needle the Luo Points of GB to fill GB and drain the Excess from LV at the same time.

 

f. HT (Fire) Deficient and GB (Wood) in Excess. Similar to (e). First needle the Wood Point of HT, filling HT and draining LV via the Sheng Cycle (Yin to Yin). Then needle the Luo Point of LV. This fills LV by draining the Excess from GB (its linked COS).

 

g. HT (Fire) in Excess and LV (Wood) Deficient. One solution is to needle the Metal Point of LV, filling LV and draining LV by the Ko Cycle (Qi goes from Yang to Yin). Then needle the Fire Point of LV, filling LV and draining the Excess from HT via the Ko Cycle (Yin to Yang transfer) at the same time.

 

h. SI (Fire) in Excess with LV (Wood) Deficient. Solution 1: Needle the Metal Point of LV, filling LV and draining LI by the Ko Cycle, as in (g). Then needle the Luo Point of LI, filling LI and draining LU. Then needle the Fire Point of LU, filling LU and draining SI (via Ko Cycle) at the same time. Solution 2: Needle Metal Point of LV; then Fire Point of LI (fills LI by draining HT, via Ko Cycle); then Luo Point of HT (fills HT and drains SI at the same time). Solution 2, although possible, is not as good as solution 1, as it drains HT before refilling it. In general DO NOT DRAIN HT UNLESS HT IS IN Excess (danger of fainting or heart failure).

 

i. LI (Metal) in Excess with HT (Fire) Deficient. Two solutions, both equally good, are possible: HT03 plus BL40 (solution 1) or HT09 plus LI04 (solution 2). Other solutions are possible, but less efficient. Solution 1: Fill HT from BL, suing Water Point of HT (via Ko Cycle). Then fill BL from LI, using the Metal Point of BL (via Sheng Cycle). Solution 2: Fill HT from LV (via Sheng Cycle) by Wood Point of HT. Then fill LV from LI (via Ko Cycle), using the Metal Point of LV.


EXERCISES ON FIVE PHASE THEORY

 

If you wish to master the use of the Five Phase Points, you must practice with many different problems, until you are fully familiar with Sheng, Ko and Luo uses. As a test of your grasp of the therapy, please study the entire paper (up to this point) again. Then attempt the following questions. Use the Five Phase diagram to help you.

 

 

 

QUESTIONS: Which points would be used in Five Phase and Luo Theory to solve the following problems? (My answers are on the next page).

 

Q01 ----- HT in Excess and LI Deficient Q02 ----- SP in Excess and KI Deficient Q03 ----- LV in Excess and LI Deficient Q04 ----- ST in Excess and BL Deficient Q05 ----- SP in Excess and ST Deficient Q06 ----- GB in Excess and KI Deficient Q07 ----- BL in Excess and KI Deficient Q08 ----- LI in Excess and ST in Excess Q09 ----- SP Deficient and ST Deficient Q10 ----- BL in Excess Q11 ----- LU Deficient Q12 ----- BL and KI Deficient with SP and ST in Excess Q13 ----- BL Deficient and ST in Excess Q14 ----- GB in Excess and LI Deficient

 

ANSWERS: The following are my answers. Other solutions are possible but these are the most efficient solutions (in my opinion!). You MUST begin with the Deficient COS. In the Sheng Cycle, Qi is transmitted only from Yang to Yang or from Yin to Yin. In the Ko Cycle, Qi is transmitted only from Yang to Yin or from Yin to Yang. 

 

 

 

 

Q1

Fire Point of LI (fills LI from HT, via Ko Cycle). 

 

 

Q2

Earth Point of KI (fills KI from ST, via Ko Cycle). Then Luo Point of ST (fills ST by emptying SP). Alternative 2: Metal Point of KI (fills KI from LU, via Sheng Cycle). Then Earth Point of LU (fills LU from SP). Alternative 3: Luo Point of KI (fills KI from BL). Then Earth Point of BL (fills BL from SP, via Ko Cycle). 

 

 

Q3

Earth Point of LI (fills LI, empties ST, via Sheng Cycle). Then Wood Point of ST (fills ST and drains LV, via Ko Cycle). Alternative 2: Fire Point of LI (fills LI by draining HT in Ko Cycle). Then Wood Point of HT (fills HT from LV in the Sheng Cycle). This is a bad solution because of the effect on the HT COS.

 

 

Q4

Metal Point of BL (fills BL from LI via Sheng Cycle). Then Earth Point of LI (fills LI from ST, via Sheng Cycle). Alternative 2: Luo Point of BL (fills BL, empties KI). Then Earth Point of KI (fills KI, draining ST, via Ko Cycle). Both solutions are equally good.

 

 

Q5

Luo Point of ST

 

 

Q6

Earth Point of KI (fills KI, empties ST via Ko Cycle). Then Wood Point of ST (fills ST, empties LV, via Ko Cycle). Then Luo Point of LV (fills KI, empties ST, via Ko Cycle). Then Luo Point of ST (fills ST, empties SP). Then Wood Point of SP (fills SP, empties GB, via Ko Cycle). Both are equally good solutions.

 

 

Q7

Luo of KI

 

Q8 to 11 were trick questions. The Sheng/Ko/Luo methods do NOT apply in such cases: there is no way to balance these cases by internal adjustment of Qi by AP. Some external help is needed here, according to classical concepts. However, modern texts on AP do not always obey classical concepts. This will be discussed in the next section.

 

 

Q8

Trick question! Balance by classic AP needling is not possible here. Use vomition, purgation, fasting, enemas etc to empty the ST and LI.

 

 

Q9

Trick question! In this case SP (which follows ST in the Diurnal Qi Cycle) is probably empty because the ST is empty. Eat something, especially sugar!

 

 

Q10

Trick question! There is no imbalance within or between the Phases here! Empty the bladder (urinate!)

 

 

Q11

Trick question! There is no imbalance. LU Deficient (sleepiness, drowsiness, poor energy) often occurs in seminar rooms with poor ventilation and tobacco smoke. Open the windows and get some fresh air! Deep breathing exercises!

 

 

 

 

Q12

Earth Point of BL (fills BL, drains SP, via Ko Cycles) and Earth Point of KI (fills KI, drains ST, via Ko Cycle).

 

 

Q13

Earth Point of BL (fills BL, empties SP, via Ko Cycle). Then Luo Point of SP (fills SP, drains ST). Alternative 2 (equally good): Metal Point of BL, then Earth Point of LI (fills BL from LI and fills LI from ST via Sheng Cycle).

 

 

Q14

Earth Point of LI (fills LI, empties ST, via Sheng Cycle). Then Fire Point of ST (fills ST, empties SI, via Sheng Cycle). Then Wood Point of SI (fills SI, drains GB, via Sheng Cycle). Alternative 2: Luo Point of LI (fills LI, empties LU). Then Fire Point of LU (fills LU, empties SI, via Ko Cycle). Then Wood Point of SI. Alternative 3: Luo Point of LI (fills LI, empties LU). Then Earth Point of LU (fills LU, empties SP, via Sheng Cycle). Then Wood Point of SP (fills SP, drains GB, via Ko Cycle). Other alternatives are possible but avoid draining the HT in this case.

 

If you have answered Q1 to Q14 correctly, you have excellent knowledge of the classic system of point selection by the Five Phases and Luo principles. All that remains for you to learn is the location of the Phase Points and Luo Points! (see the paper "The Study of AP: Sources and Study Techniques").

 

If you have done badly in these questions, please study this paper again and repeat the test. If, despite repeated attempts, you fail to grasp the concept, please do not despair! Leave if for a few weeks and try again later. You will succeed if you want to.

 


TONIFICATION-SEDATION TECHNIQUE: ANOTHER USE OF PHASE POINTS

 

The classical balancing method of using the Five Phase Points has been described above. Another method (which disagree with some of the principles in the first method) has been described in some textbooks, including a recent from text from Beijing (Anon 1993. It is used especially where one Phase or one COS is in an Excess or Deficient (hyper- or hypo-) state, without the opposite state existing in another COS.

 

Tonification and Sedation Points for each COS are given in the following table:

 

Affected COS LU LI ST SP HT SI BL KI PC TH GB LV
Mother Point (Bu needle to tonify, strengthen) 09 11 41 02 09 03 67 07 09 03 43 08
Son Point (Xie needle to sedate, weaken) 05 02 45 05 07 08 65 01 07 10 38 02

 

The type of needle manipulation differs between diseases of Deficiency (Xu) and Excess (Shi). The Tonification (Bu) technique is used in Deficiency (Xu) diseases, when a COS is weak. The Sedation (Xie) technique is used in Excess (Shi) diseases, when a COS is in Excess. The needling techniques are described in another paper (Techniques of stimulation of the AP Points) (q.v.). For further discussion of Xu and Shi diseases, see the paper on Holistic concepts of health and disease.

 

Using the points and Bu or Xie needling techniques respectively, as above), the Tonification-Sedation Law states: if a COS is Deficient, supply Qi to it by draining from its Mother COS, using the Mother Point of the affected COS; if a COS is in Excess, drain the Excess Qi into its Son COS, using the Son Point of the affected COS. For example, if a clinical syndrome was associated with Deficiency of LI (with no other COS showing abnormality), the classical balancing system can not be used, but the Tonification-Sedation technique can be used. The solution to LI Deficiency by this method is to tonify (Bu needle) LI (Metal) at its Mother (Earth) Point (LI11). The solution to LI Excess by this method is to sedate (Xie needle) LI (Metal) at its Son (Water) Point (LI02).

 

These Tonification-Sedation techniques use the Sheng Cycle only. The Ko Cycle and the Luo Points are not involved. The Tonification-Sedation Law is summarised as follows: to Tonify a COS use its Mother Point. To Sedate a COS, use its Son Point.

 

Other examples:

a. Deficient SP. SP is Earth. Fire is the Mother of Earth. Tonify SP by Bu needling SP at its Mother (Fire) Point (SP02). This supplies Qi (via Sheng Cycle) from HT (the Mother of SP).  b. Excess BL. BL is Water. Wood is the Son of Water. Sedate BL, by Xie needling BL at its Son (Wood) Point (BL65). This drains Excess Qi from BL into GB (the Son of BL). 

 

 

Other examples are:

 

PC (Fire ) Deficient: use Wood Point of PC (Wood is Mother of Fire). PC (Fire ) Excess : use Earth Point of PC (Earth is Son of Fire). ST (Earth) Deficient: use Fire Point of ST (Fire is Mother of Earth). ST (Earth) in Excess: use Metal Point of ST (Metal is Son of Earth)


CONCLUSION

 

Five Phase Theory has a beautiful simplicity and symmetry. It has an aesthetic appeal to the poetic, artistic and intuitive in those who study it in depth. It also has a considerable basis in scientific relationships within the body.

 

The interdependence of the Five Phases (together with COSs and Correspondences) proves that the ancient Chinese Masters regarded all functions and parts of the body as one unit. Each could influence the other, directly or indirectly in health and disease. For instance, too much anger injures the liver; too much salt injures the kidney (vasopressin) and may cause secondary effects on the heart (hypertension). Furthermore, the concepts prove that the Ancients were aware of cosmic, seasonal and other external influence on health. They were also aware that health was a relative state of adaptation to environment (external and internal).

 

In treating disease, the aim was to restore balance and harmony between the various organs and functions, including the spirit (Fire), the will (Metal), the appetites and desires (Earth), the skeletal and muscular system (Water and Wood). In this respect, the Chinese were among the first of the ancient physicians to practice psychosomatic and holistic medicine and to teach the theory of adaptation to environment.

 

Despite the aesthetic appeal of Five Phase Theory, some of its interactions and Correspondences are not valid from a viewpoint of western medicine. However, the system has worked very well as a general guideline for hundreds of western acupuncturists in recent years. It is used to help diagnosis and also to indicate effective dietary, psychosomatic or AP therapy etc. Its greatest value is to indicate which points can be used to transfer Qi most efficiently from Excessive to Deficient COSs. Using the Sheng, Ko and Luo concept, points can be chosen to transfer Qi from any one COS to any other one. Tonification-Sedation techniques can be used when classical Five Phase balancing can not be applied.

 

Because of the difficulty in locating some of the Phase Points in animals (especially horses) and because very few vets have taken long residential courses in AP, the system has received little attention in veterinary medicine outside of France. The majority of practical acupuncturists (in both the human and veterinary areas) ignore these principles. They work on a system of symptomatic (Cookbook) AP, using modern concepts of segmental and intersegmental reflex and autonomic effects. Their clinical results, are, nevertheless, very good, despite their omission of the classic concepts. Also, many recent AP textbooks from China, Taiwan and Japan give little or no discussion on these classical concepts.

 

I find it very difficult to assess whether or not classical (Five Phase Theory) AP is significantly superior to modern Cookbook AP (as outlined in the paper on Selection of Points for Therapy). Intuition and experiences since 1991 tell me that in certain difficult cases, the classic concepts may be more helpful than the Cookbook alone. Therefore, I think it is worth the effort to try to understand these principles.


REFERENCES

 

  • Anon (1993) Essentials of Chinese Acupuncture (College of Traditional Chinese Medicine Peking, Shanghai, Nanking, with Academy of Trad. Chinese Medicine) Foreign Languages Press, Beijing, 432pp.
  • Austin, Mary (1974) Acupuncture therapy: Turnstone Books, London, 290pp.
  • Connolly, Dianne (1979) The Law of the Five Elements. Centre for Trad. Acupuncture, American City Building, Columbia, Maryland 21044, USA, 197pp.
  • Hsu,H.Y. ed. (1982) Natural Healing with Chinese Herbs. Oriental Healing Arts Institute, LA., California, U.S.A.
  • Kaptchuk,T. (1983) The Web that has no Weaver. Congdon & Weed, New York, USA.
  • Mann, Felix (1973) Acupuncture cure of many diseases. Heinemann Medical Books, London, 123pp.
  • Porkert,M. (1983) The Essentials of Chinese Diagnostics. Acta Medicinae Sinensis, Chinese Medical Publications Ltd., Zurich, Switzerland. 292pp.
  • Van Nghi, Nguyen (1971) Pathogenic et Pathologic Energetiques en Medicine Chinoise. Imprimerie Ecole Tech. Don Bosco, 78 Rue Stanislas Torrents, 13 Marseille, France, 699pp.
  • Wiseman,N., A.Ellis, C-Y.Li & P.Zmiewski. (1985) Fundamentals of Chinese Medicine (English translations and amendments of texts by the Beijing, Nanjing and Shanghai Colleges of Chinese Medicine). Paradigm Publications, 44 Linden St., Brookline, Mass 02146, USA, 606 pp.
  • Wu,Wei-Ping (1973) Chinese Acupuncture. Health Science Press, Wellingborough, Northants, UK 181pp.

The COS codes used in these questions are:
Metal / Earth / Fire / Water / Fire / Wood
LU-LI / ST-SP / HT-SI / BL-KI / PC-TH / GB-LV

 

1. In Five Phase Theory, one of the following statements is not correct. Indicate the incorrect statement:

 

a. ST is the Son of SI and the Mother of LI
b. LV is the Son of KI and the Mother of H
c. LI is the Son of GB and the Mother of SP
d. KI is the Son of LU and the Mother of LV
e. HT is the Son of LV and the Mother of SP

 

2. In the Ko Cycle, one of the following statements is not correct. Indicate the incorrect statement:

 

a. HT controls (weakens, damages) LU
b. ST controls (weakens, damages) BL
c. SP controls (weakens, damages) KI
d. LU controls (weakens, damages) GB
e. BL controls (weakens, damages) SI

 

3. In Five Phase Theory of Water, one of the following statements is not correct. Indicate the incorrect statement:

 

a. The Yin-Yang organs are KI-BL
b. The COLOUR is Blue-Black
c. The TASTE is Salty
d. The main EMOTION is Fear
e. The SEASON is Spring

 

4. In Five Phase Theory, one of the following statements is not correct. Indicate the incorrect statement:

 

a. One needle at the Luo (Passage) Point of LI should balance a patient whose LU is in Excess and LI is Deficient
b. One needle at the Luo (Passage) Point of LV should balance a patient whose GB is in Excess and LV is Deficient
c. One needle at the Luo (Passage) Point of HT should balance a patient whose SI is in Excess and HT is Deficient
d. One needle at the Luo (Passage) Point of ST should balance a patient whose ST is in Excess and GB is Deficient
e. One needle at the Luo (Passage) Point of LU should balance a patient whose LI is in Excess and LU is Deficient

 

5. In Five Phase Theory, only one of the following statements is correct. Indicate the correct statement:

 

a. LU09, PC07, HT07, SP03, LV03, KI03 are Earth Points for their respective COSs
b. KI04, SP04, HT05, LV05, TH05, LI06, PC06, LU07, SI07 are Fire Points for their respective COSs
c. KI27, SP21, HT01, LV14, TH23, LI20, PC01, LU01, SI19 are Water Points for their respective COSs
d. LI01, TH01, SI01, ST45, GB44, BL67 are Wood Points for their respective COSs
e. LI20, TH23, SI19, ST01, GB01, BL01 are Metal Points for their respective COSs

 

6. In the Sheng (Creative) Cycle, 2 Phases are placed in the wrong position. Indicate the switch needed to give the correct sequence, i.e. switch ( ) for ( ):

 

 

(a) (b) (c) (d) (e)
Fire -> Wood -> Earth -> Metal -> Water

 

7. In the Ko (Controlling) Cycle, 2 Phases are placed in the wrong position. Indicate the switch needed to give the correct sequence, i.e. switch ( ) for ( ):

 

 

(a) (b) (c) (d) (e)
Fire -> Metal -> Wood -> Water -> Earth

 

8. In the Sheng (Creative) Cycle, one of the following statements is not correct. Indicate the incorrect statement:

 

a. LU is Mother of KI
b. LI is Mother of BL
c. ST is Mother of LI
d. SP is Mother of LU
e. HT is Mother of LV

 

9. In the Sheng (Creative) Cycle, one of the following statements is not correct. Indicate the incorrect statement:

 

a. LU is the Son of SP
b. LI is the Son of ST
c. ST is the Son of BL
d. SP is the Son of HT
e. HT is the Son of LV

 

10. In the Ko (Controlling) Cycle, one of the following statements is not correct. Indicate the incorrect statement:

 

a. LU controls LV
b. LV controls BL
c. ST controls BL
d. SP controls KI
e. HT controls LU

 

11. One of the following statements is not correct. Indicate the incorrect statement:

 

a. LU and LI diseases are more likely in autumn
b. KI and BL diseases are more likely in spring
c. HT and SI diseases are more likely in early summer
d. SP and ST diseases are more likely in late summer
e. GB and LV diseases can be triggered by Wind and AP points to treat them often contain the name Feng (=wind)

 

12. One of the following statements is not correct. Indicate the incorrect statement:

 

a. Excess LU with Deficient LI can be balanced by Tonifying LI06
b. Excess GB with Deficient LV can be balanced by Tonifying LV05
c. Excess GB with Deficient SI can be balanced by Tonifying GB38
d. Excess HT with Deficient LU can be balanced by Tonifying LU07 and then Tonifying LI05
e. Excess SP with Deficient LU can be balanced by Tonifying LU11
f. Excess SP with Deficient BL can be balanced by Tonifying BL65 

 

 

Answers

 

1 = c 2 = d 3 = e 4 = d 5 = a 6 = switch a for b 7 = switch d for e 8=e 9=c 10=b 11=b 12=c