5 Elements acupuncture: The Five phases

Five Elements or Phases
Five Phase Diagram - Copyright Acupuncture Points

Key Learning Points

  • 5 Elements acupuncture, an important form of treatment, now very much back in fashion
  • Rooted in the classics
  • Hugely elaborated by Jack Worsley’s Leamington Spa school of acupuncture
  • Looks for and treats a ‘causative’ factor

Five Elements acupuncture is almost as ancient as yin-yang theory and its 8 principles or what on this site we call TCM theory.

These Five Elements of Nature were described in the root text of Chinese medicine, the Huang Di Nei Jing, written over a period of time up to 2000 years ago. This has two parts, the Su Wen (Plain Questions) and the Ling shu (Spiritual Axis).

Ling shu chapter 64 explores Five Element constitutional types, basing these mainly on a person’s character and physical shape. Later, the Nan Jing, or Classic of Difficulties, also provided source text ideas.

On the face of it, 5 Element theory consists of a group of five groupings or associations, one set for each element. When you understand how it works you can often make predictions about health and behaviour. So it is a very powerful resource.

More than that, the 5 elements of Nature (or 5 Elements of Life) are a sequence, with each having an effect on the one before and the one after, and a relationship across the circle with both the element two down the line – the grand-child, and two up the line – the grandparent. In fact, the Chinese name is wu xing meaning five movements. (More on this below.)  This can be transformative when you see it acting out in a patient.


Five Elements of Life – Cycles of Being

There are two important sequences in the Five Elements movements,

  • the Mother-Child  or Creative sequence (known as the ‘sheng’ cycle, where each element is both a child of the one before, and a mother of the one after), and
  • the Control sequence (ke or ko sequence) where it is both grandparent and grandchild.


These relationships can be important. In most modern families, the parents have a direct responsibility and the grandparents offer a different influence, often stabilising. Just so with the cycle.


Although both systems were discussed in the centuries after the Nei Jing was written, the 5 Element system was particularly admired in the period from 200BC to 200AD, a period known as the Han dynasty. But admiring references to it continue through the millennia.

In the 20th century in China it seems to have been suppressed. In 1982-3 when I studied in China, there was a doctor considered ‘mad’ by his colleagues. We eventually discovered that he favoured the 5 element system but the only way we could get him to discuss it was by taking him behind the bicycle sheds and plying him and the interpreter with cigarettes. Both feared for their jobs had they been discovered.

So you could say that probably all modern practitioners of Chinese medicine have a passing knowledge of the Five Element system, but use it very little. This is also partly because, when considered at its most profound level, it addresses the deepest level of our humanity – who we are, why we are, what we should be doing with ourselves, and what’s stopping us.

In effect our spiritual level. In modern China medicine has no time for that!  (Though I heard that a British acupuncturist was recently asked to lecture on it in China, so you never know!)

Basic Associations

There are many ways to approach the theory, and a set of associations to learn, though once you understand the theory, many of the associations become obvious.

First, I’ll introduce a way of understanding it that appeals to me. I hope it helps you understand it too. See below under ‘Understanding the Sequence’.

Next I’ll list the associations.

After that I’ll try to convey how Jack Worsley’s ‘take’ on it makes it so powerful, yet – for some – so difficult to practise.

Understanding the Sequence

Just about every project you can conceive of has a life-cycle. Events in its life proceed along a recognisable series of phases.

Shakespeare drew attention to it in his play  As You Like It (II, VII, 139-166) where he has the character Jacques give one of the most famous speeches ever written.

5 Elements acupuncture and Shakespeare
Photo by Jessica Pamp

All the world’s a stage

“All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages.

At first the infant,


boy sitting on floor

Mewling and puking in the nurse’s arms;
Then the whining school-boy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school.

And then the lover,

painting of couple

Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honour, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon’s mouth.

And then the justice,

Photo by Neenu Vimalkumar on Unsplash

In fair round belly with good capon lin’d,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part.

The sixth age shifts …

man in brown jacket wearing black framed eyeglasses
Photo by Pietro Schellino

Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side;
His youthful hose, well sav’d, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound.

Last scene of all,

man in black crew neck shirt

That ends this strange eventful history,
Is second childishness and mere oblivion;
Sans teeth, sans eyes, sans taste, sans everything.”


Wu xing – the Five Elements – its place in history

The Wu xing (Five Processes, Phases or Elements) model explaining life and disease seems to have been part of Chinese thinking for possibly centuries before Zou Yan described it, mainly as a political theory. It seems to have become popular during the Warring States period 474BC to 221BC. It appears in texts from about 239BC, much later than the yin-yang theory. Later in the Han dynasty, commencing 206BC, scholar-doctors began to use it to describe how illness arose.

Eventually it combined the seasons, the movement of the Heavens, foods, emotions, climactic factors and much else and linked them to the body, its organs, tissues and acupuncture channels in a unified theory we now know as the Five Element or Five phase model.

This model has been popular on and off over the centuries. After the Han dynasty its influence waned for some 8 centuries until the Song dynasty (961AD – 1279AD) when they used it extensively. Then from the 14th century until the 20th century it waned again.

How does this work?

We all start as a seed. For nine months we are nourished, protected as we grow, out of sight.

Then we emerge and, if properly supported, we begin to grow in body and mind.

We start as a baby, become in turn a child, teenager, young adult, then mature gradually until, withered by old age, we are ready to return to the earth.

Each stage has its associations. The teenager and young adult is quick to anger and react, to fall in love. The ‘mature’ adult is more stable but inclining to ‘wise saws’ and so on.

Diurnal cycle

Another cycle, of day and night, carries the same process.

Diurnal cycle and the Five Elements
Photo by Jordan Spalding

We wake from sleep and unconsciousness, and – if we are healthy – looking forward to the new day, with our plans and hopes. At some point, often around lunch-time, we reach the zenith where we realise something of our ambition. For some this might be meeting a friend for lunch, which can only happen if the other parts of the cycle are working – for example that our occupation provides the money and time for it.

In the afternoon our energy is slowing but with luck we can see how progress has been made. In the evening we are with family, enjoying the fruits of our labours before we head to bed and new unconsciousness.

Business cycle

A new business goes through the same process.

  • It starts with an idea, or a realisation of an opportunity (Water).
  • At some point, if we go ahead, we start by making plans and gathering resources. Then comes a hectic period (Wood), fun but hard work as the business takes shape and overcomes obstacles.
  • Eventually we realise a measure of success and public recognition (Fire).
  • Then we enter the period of consolidation, when our business brings a steady, reliable income (Earth). If we are careful to adapt the business to changes, not to over-reach ourselves, not to withdraw too much money from it, and to live within our means, this stage can last many years. During that time we fill out our family wealth with better possessions and home. Most people prefer this stage to be relatively quiet, away from the public eye, very different to our earlier efforts to attract attention to expand demand for our business product.
  • But that’s not the end of it. At some stage our business must adapt to radical new events or die. In both cases, its ashes (Metal) – in the form of financial resources or knowledge or other assets …
  • … can provide fertiliser for the next business starting again in its Water phase.

Symbolism of the Five Elements

Each of these stages is symbolised by one of the five elements.

WATER element

Water is the unconscious, the waiting, the winter, night, the in-between: sleep and mulling over events. Downward moving. It can be a period of convalescence, away from the public eye as we recover. But it can be a fruitful period as we consider our next moves. From this Water phase we look over towards its opposite, the Fire phase where our plans have matured and we enjoy their success, often with recognition and accolade. Fire happens after we work our way through the Wood phase …

(Read more about the WATER element here.)

WOOD element

Wood represents taking the opportunity; spring; morning; growth, expansion, plans and push. Exciting! Outward, expanding, upward moving.

(Read more about the WOOD element here.)

FIRE element

Fire is the zenith, summer, noon, the recognition, the fun, what we aimed for: success! Upward.

Fire - the zenith of the Five Elements
Fireworks – Photo by Riley McCullough on Unsplash

(Read more about the FIRE element here.)

EARTH Element

Earth is the fruits of our success, the late summer, afternoon, steady growth, the family, the home, the ongoing income and wealth-building. Stabilising, centripetal, neutralising.

(Read more about the EARTH element here.)

METAL Element

Metal is the refining process, the gradual letting-go, autumn, evening, possibly advising others who are younger, providing a restraining hand, eventually handing over what we made to the next turn of the cycle. Contracting, downward moving. 

This moves us forward into the Water phase, the anchoring base from which the next cycle begins.

Each element or phase should naturally lead on to the next  in this ‘sheng’ cycle.

(Read more about the METAL element here.)

Notice that each phase also has a controlling effect on its grandchild (ke cycle). Too much Water can dowse Fire; too much Wood growth and expansion disturbs Earth stability. Fire melts Metal, Earthworks dam up Water, Metal cuts Wood.

Tabulating the Five Elements

In the tables below you’ll notice each phase or element has associated colours, sounds, smells, emotions, tastes and foods.  For example, the Fire phase, often likes bright colours, notably red. The Fire phase often enjoy bitter foods in the shape of cola or coffee. They like laughing and may like getting high on drugs which can make them hyper or manic. Usually in this phase we like recognition, parties or events.

Even introverts in their Fire phase like going to concerts or public lectures! See and be seen.

Fire melts Metal. If we try to stay in the Fire phase, desirable because it’s where the parties are, with the adulation, recognition and applause, the being loved and loving, then we don’t move on and we certainly have no patience with the older, reflective phase of Metal people. If anything, we enjoy their gratitude for livening them up, warming their old bones and teaching them how to use the latest gadget.

From the grand-parents point of view, the grandchild is a source of warmth and enjoyment. It benefits both.

Grand-parent grand-child relationship in the 5 Elements
Photo by Johnny Cohen

Passing through each of the 5 phases in turn is healthy

Reaching the Fire phase is a vital part of life. We should enjoy it. Except for a few of us, it doesn’t last long but remains a happy memory as life continues. If we try to stay in it, jetting from one party to the next, remaining high on the drugs, ultimately we’ll burn out, lacking the inner fibre to keep it up. That fibre comes from the process of living through the phases: it makes us what we are.

Now we reach the interesting part!

Each of the five phases relates to an organ energy, or Zangfu. That means that if a given phase is over- or under-emphasised, we may expect health issues from its associated organs or channels.

Fire, for example, relates to the Heart and Small Intestine organ energies. Fire is the zenith, the fulfilment of the dream we had in the Water phase so it could be the perfect marriage ceremony, the public recognition, or just meeting our friend for lunch!

To stay awake we take bitter foods like coffee and to maintain the feeling of excitement we take drugs, alcohol or worse. We get dependent on recognition: ‘celebrity’ and then we easily persuade ourselves we’re wonderful!

Drugs to stay in the Fire

Many of the stronger drugs affect our heart, and this constant excitement raises our blood pressure. At the same time we explore different foods and our small intestine stops working efficiently so our Blood is more anaemic and we become hyper. So we head towards circulation problems, possibly heart problems or stroke. These would then arise from Blood and Yin deficiency, for example of Heart Blood.

Remaining stuck in a phase brings health issues, often with that element’s associated organ energies. On the other hand, if we live naturally through the phases, each element gets its stimulation before moving on to the next.

Our lives are such that we can be at different stages in the cycle all at once, but in different situations or departments of our life.

For example …

  • I may be enjoying the Earth phase at home with partner, children and comfortable house.
  • At the same time I may be planning a holiday in the sun, window-shopping holiday brochures and articles, deciding where to go and buying the clothes – this is the Wood phase for that activity.
  • But I may have realised that although my job provides me with a steady, reliable income, I want more. So I am sleeping on it, letting half-formed dreams come and go – Water phase.
  • I’m also advising a friend how to build an extension to his house, using my own experiences of doing it – a Metal phase.
  • To celebrate my daughter’s engagement, we’re having a party tonight – Fire!


Living this way, with multiple 5 phase processes simultaneously, can be wearing but keeps us very much alive. The ‘trick’ is to remain balanced throughout!

Jonathan Brand colours

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Towards the End of Life

Indeed, you can see people who withdraw from activity and participation in society, who don’t exercise properly, perhaps just watch television. They become uninterested in others’ opinions. Also, they may lack openness to new ideas: they become stuck, unchanging, unable or unwilling to learn tricks, like old dogs. (And not just in the elderly!)

When old people walk they often walk bent forwards, restricting deep breathing.

Photo by K. Mitch Hodge on Unsplash

In due course they get constipated and because they mostly sit, they don’t breathe properly, so they get respiratory problems – they are stuck in the Metal phase (Lungs and Large Intestine), which precedes the Water phase.

In their case the succeeding Water phase may mean death.

This explanation is very simplistic but the theory can go far deeper, and explain many health problems.







Yin organKidneyLiverHeartSpleenLungs
Yang organBladderGallbladderSmall intestineStomachLarge intestine
TasteSaltySourBitterSweetSpicy, Pungent
SoundGroanShoutLaughSingWeep, Cry
EmotionFearAngerJoyPensivenessWorry, sorrow, sad
TissuesBones, head hairSinewsBlood vesselsMusclesSkin, body hair
OrificeEarsEyesTongueMouth, lipsNose


Leamington Five Elements Acupuncture

One school of acupuncture has taken this 5 Element model into an almost completely different place. In the 1960s an Englishman, Jack Worsley, ‘re-discovered’ it. Undoubtedly he had a genius for it, and because its ‘deep’ level appealed to the generations of the time, his school became very successful. My first qualification came from his college in Leamington Spa. Worsley was an inspiring teacher.

The main points used are the five ‘shu’-points used as element points, and the source and luo-connecting points.

Subsequently, he or his followers established similar schools all over the world.

In recent years, graduates have even lectured on it in China, where it finds new-found interest!

Worsley’s ‘Causative Factor’

Worsley was influenced by others when developing his theories. One of his core teachings was that, for nearly everyone, one of the 5 Elements contained what he called the ‘causative factor’. Concentrating our treatment on this would eventually re-balance all our other Element organs.

This was like the homoeopathic concept of the ‘constitutional’ remedy. Samuel Hahnemann set out his ideas on homoeopathy in his ‘Organon of Medicine’ although in this he does not mention this ‘constitutional’ concept.

However, the idea of the constitutional remedy grew in influence and remains important in homoeopathic treatment. It was certainly espoused by homoeopaths that Worsley knew.

Hering’s Law of Cure

From homoeopathy came also the ‘Law of Cure’ elaborated by Constantine Hering, another homoeopathic doctor in the 19th century. (There’s a brief explanation of this on our page on Suppression.) This ‘law’ can also apply to 5 Element treatment done the Leamington acupuncture way. As we improve according to this ‘law of cure’, what are called ‘aggravations‘ may be temporary discomforts on the road to recovery.

The ‘Officials’ through the Five Elements

Another innovation was drawn from the Su Wen Chapter 8 where it talks about the organ energies as being ‘officials’ in charge. For example it suggests that the Liver is like the Chief of Defence staff or the General in charge of the armed forces. The Lung is like a Prime Minister. When these officials do their job correctly and in harmony with the other officials, health reigns.

Being treated the Leamington 5 Element way is transformative for many people. The difficulty is to identify the ‘causative’ factor. Also, this system is less relevant for acute disease.

Comparing the Leamington 5 Element system with Chinese medicine as currently practised in China reveals many differences both of emphasis, diagnosis and in treatment.

Some of those differences are tabled below.


TCM theory

Five Element Leamington style

Basic underlying theoryYin/yang theoryFive Element theory
Substances usedJing-essence, Qi, body fluids, Blood and shenQi and jing, reached via yuan-source and element points.
AetiologyTendency to emphasise external factors, (eg weather) or effect on channelsEmotional and internal factors
(Root) Ben or Biao (manifestation)Ben and biao but often more biao.Ben = Causative factor, and treating the ‘officials’ as per Su Wen chapter 8
Treatment levelSyndromes and ChannelsShen, spirit, mind
How diagnosedSigns, symptoms, and knowledge of syndromesColour, odour, sound, emotion and life patterns
How many points usedSeldom less than 4Seldom more than 6

Minimum ‘Dose’

Notice that normally Five Element (Leamington) practitioners use few needles because a small or minimum treatment is usually enough to prompt the body to start changing. This concept of the ‘minimum’ dose also comes from homoeopathy.

Also, usually the Leamington practitioner would try to ignore secondary, even acute, problems, in the expectation that putting the ‘chronic’ causative factor right would automatically lead to improvement all round. The patient would report that overall he felt better. He might also discover that ailments not previously reported began to improve.

This idea of using very few needles goes back to the greatly admired Han dynasty doctor Hua Tuo (style name Yuan Hua) who lived approx. 108AD – 203AD.  According to texts written 20 years after he died, he got exceptionally good results by using very few points. However, the text also says that he was incredibly good at obtaining deqi and propagating it along the channels. This is sometimes a feature of TCM treatment but not of Leamington 5 Element treatment.

The Basic points used in Five Element acupuncture

Bladder Point 67 Acupuncture
Bladder Point 67 – Copyright Acupuncture-points.org

Although other points are employed, the basic ones are the element points. (In the picture, Bladder point 67 is the Metal point on the Bladder channel and, since Metal is the Mother of Water and the Bladder and Kidney channels are Water channels,  Bladder 67 is the tonification point on the Bladder channel.)

Five element acupuncturists would nearly always use these element points as part of a treatment.

Hua Tuo also stressed Lifestyle

Hua Tuo believed in lifestyle factors like exercise to maintain health – he apparently invented a form of what we might now call calisthenics. Likewise, this form of advice is commonly given to patients, at least in the West.

I didn’t notice such advice being given much when I studied in Nanjing in 1982 but I did rise very early several times to see thousands of Chinese residents in the parks practising Qi Gong and Tai Chi before dawn.

Admittedly most of them were elderly, but they carried forward their culture of health, much of it derived from the ancient medical texts.

The rich historical culture of China has bequeathed to us what the ancients thought about food, and in particular what different tasting foods can do.

So, in amongst the advice you receive from your practitioner may be similar suggestions to improve your life and health through better exercise and Nutrition.

For more read up on Taste in Chinese medicine.


Other differences

Leamington 5 Element acupuncturists believe that, before commencing the main treatment, any blocks to success must be removed.

These blocks include

  • Aggressive energy, the test for which is also treatment for it. Leaving aggressive energy in place before commencing treatment endangers the body, as this energy may spread to other organs from the originating organ.
  • Husband-wife: one side of the body ceases to communicate properly with the other side. Usually diagnosed from the pulses supported by evidence from the patient.
  • Possession: destabilising forces called internal or external ‘devils’. Diagnosed from the range of confusing symptoms the patient experiences or displays. Specific groups of points are used to ‘clear’ the devils.
  • Exit-entry points: where one channel ends and the next begins. If there is a block here it prevents successful treatment.


Back to the Causative Factor

forest trees marked with question marks

Discovering the causative factor is of primary importance for Leamington style 5 Element treatment.

It is not easy. Theoretically, recognising the patient’s colour, odour, sound and emotion should provide the answer. (Well … sometimes it is easy! But often it is not.)

Especially since one is looking for a deep, ‘chronic‘ pattern that may have been present from birth or soon afterwards. The pattern is deeply ingrained but, still, not always obvious.

As regards the emotion, it is often what is not congruent that one must discover. This might be the emotion that is over-expressed, but is often its opposite, the emotion that the patient cannot display or displays inappropriately, such as laughing over sad things, or appearing to mourn happy things. To reveal this may require an interplay between patient and practitioner that some patients consider inappropriate.

But as the patient improves, he or she finds it easier to share emotions, no longer trapped in such limited ways of self-expression. The body responds more easily to events, and the patient thrives. In effect, the five phase cycle begins to work again for the patient, as energy transforms again from phase to phase.

Links to pages on each of the five elements:

Personal note

If, from my training at Leamington I am able to recognise the causative factor, I get deeper, faster, results. However, many people consult me for acute problems for which Five element acupuncture is not always so appropriate.

Other pages you may like:

Source texts for this page include:

Acupuncture and Chinese medicine: Roots of Modern Practice by Charles Buck (Singing Dragon 2015)

What is Five Element Constitutional Acupuncture? By Angela Hicks, John Hicks and Peter Mole (Journal of Chinese Medicine • Number 85 • October 2007)

What is Five Element Constitutional Acupuncture? by John Hicks (Journal of Chinese Medicine 25 September 1987)

Five Laws for Healthy Living by Angela Hicks (Thorsons 1998)

The Web that Has No Weaver by Ted Kaptchuk 2000 Contemporary Books

Foundations of Chinese Medicine by Giovanni Maciocia (Elsevier 1989 and 2005)

Five Elements and Ten Stems by Matsumoto and Birch (Paradigm publications)

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