Constitutional Five Element Acupuncture
An introduction for Constitutional  5 Element Acupuncture. 
First published in the Journal of the Australian Traditional Medicine Society 2007 by Gye Bennetts


This paper is an introduction to the ideas and treatment methods used in Constitutional Five Element Acupuncture (five-element).  Five-element aims to treat the person as a whole and to look deeper into a persons being, knowing that as important as the patients symptoms are they are simply signposts to an energetic imbalance in the person.  By diagnosing and treating this deeper constitutional imbalance a five-element practitioner aims to help the person grow and change and be all they can be, knowing that treating the cause of the person’s distress the presenting symptoms will dissipate. 

With an emphasis on spirit and emotional level causes five-element is very different in theory and aim to modern Traditional Chinese Medicine (TCM) styles of acupuncture and encompasses more than the commonly taught five-phase theory.  While a modern TCM acupuncturist will look for external causes of disease such as damp, heat and wind, a five-element practitioner will view these as symptoms of a person who has moved away from their own centre.  By nurturing this movement back to centre the patient experiences an allover change in their understanding of themselves and the world in which they live.

The five-element style was first brought to the West by Prof. J.R. Worsley from his teachers Ono and Hsui in the late 1950s, after which he set up the first college dedicated to Constitutional Five Element Acupuncture in Leamington Spa U.K. 1).  It has been said that this acupuncture style most closely adheres to the values and priorities expressed in the Nei Jing and other classics of Chinese medicine 2). To understand this elegant and transformational form of acupuncture there are certain ideas that are best explored first.

The Five-Elements

Though shrouded in mystery we have records and legends tracing Chinese medicine back to around 3000 BCE and the time of the Three Culture Heroes.  One of these heroes, the Emperor Fu Xi was thought to have developed the 8 tri-grams of the I-Ching along with the concepts of the five-elements and yin & yang.  This apparently happened after the emperor saw a dragon-horse rising majestically from the Yellow river in a vision one day.  The ideas of yin & yang and the five-elements developed through Daoist and Naturalist (precursor to Confucian) thinking into the Han dynasty  (500BCE to 500CE) to become some of the core principles for diagnosing and treating in Oriental Medicine 3).

These 5 elemental energies - fire, earth, metal, water and wood - are evident in nature and can be seen in the annual march of the five Chinese seasons.  They can also be observed in ourselves as they create the twelve main acupuncture meridians that make the body’s energetic system.  Each of these elements is thought to be part of our emotional, spiritual, physical and mental make up.  Let’s briefly look at these 5 elements both in nature and in ourselves.

Wood is the energy of spring.  After the quiet still time of winter, nature bursts forth with hope and optimism to create the new growth of the season.  In us, wood creates the meridians of the gall bladder and liver.  These meridians are the parts of us that move forward into the world, that see, plan and make decisions.  In other words, goes out and makes a difference.

Fire is the energy of summer.  This is the time when nature moves into activity, the time of mating and fulsome growth.  In us, it is the energy of 4 meridians; the heart, the heart protector, the small intestine and the three heater.  Fire is the part of us that governs relationships, has fun, enables us to have intimacy and connects with others through the heart.

Earth is the energy of late summer, the 4 to 6 week period at the end of summer when nature is heavy with its harvest.  In us as people, the earth energy creates the stomach and spleen meridians. These meridians are the parts of us that are like Mother Earth herself – caring for and feeding others, being concerned about others’ wellbeing, ensuring things are safe and secure.

Metal is the energy of autumn, the time when nature lets go of what it no longer needs.  Nature is cleaning house, dropping it leaves to enrich the soil for next year’s growth.  It is the energy of the lungs – the part of us that connects to the higher spiritual realms and is the source of our own self-esteem – as well as of the large intestine, the part of us that lets go on the all levels (body, mind, spirit and emotion).

Water is the energy of winter, the time when nature retreats and recovers its vital energy ready for the next cycle of seasons.  In us, it is the energy of the bladder and kidney meridians.  This is the part of us that rests, fills up or that part that is driven forward, relentless, like a stream moving from the mountains down to the sea 11).

The Sheng Cycle

These 5 elements are seen to be a closed circle where each element passes energy on to the next element; this is called the sheng or creative cycle.  The ancient Chinese saw the movement of the elements in the beauty of nature and imagined this flow as nature’s creative cycle.  They saw in nature that water creates wood, from wood nature creates fire, from the ash of fire we find earth, from inside earth metal is found and water springs from the natural veins of metal in the ground.  Each element creating the next, supporting the next, working together to make the world, the seasons and humanity itself, as a microcosm of natures perfection.

The Law of Mother - Child

One of the natural laws of Chinese medicine is the Law of Mother-Child.  This law explains that if you enter a room with a mother and a screaming child, you may feed the child but tomorrow the child may be screaming again.  But if you feed the mother, she will now be well enough to look after her child.

In Chinese medicine, this law would indicate that it is better in the long run to look for a cause of a disease than treat only the symptoms.  In the modern world where we are mostly housed and well fed Chinese TCM 5) pathologies or external causes of disease such as damp, wind or heat - from a five- element point of view - can be seen more as symptoms as opposed causes of disease 4).

The Constitutional Element

In five-element acupuncture there is thought to be one main or root cause for most of a patient’s presenting symptoms.  It is thought that through birth or early childhood a constitutional weakness develops to the point where it impedes the flow of energy around the Sheng cycle. This weakened element is known as the person’s constitutional element (C.E.)

As an example let us look at a patient whose C.E. is metal.   This means that the metal element (the mother) has been hit hardest in childhood.  This can be either through environmental or emotional causes but eventually it will affect the metal elements ability to pass on energy by the sheng cycle to the water element (the child).  The water element will now also be distressed and show symptoms as is struggles from the weakened preceding element.  In time, following the Law of Mother-Child, this lack of flow continues around the cycle until all the five-elements are struggling, the patient is in distress and arrives at the clinic with their list of symptoms.  Instead of chasing this list of symptoms coming from the distressed elements, the acupuncturist goes right for the heart of the problem - the constitutional element, in this case, metal.

The skill for a five-element acupuncturist is through thorough questioning, listening and observing to ascertain which of the presenting symptoms are primary and which are secondary.  Which symptoms are coming from the mother, which are coming from the child?  Which observations point towards signs of a constitutional imbalance and which are symptoms of this imbalance? This differentiation is primarily achieved through looking for specific signs such as depth of colour and colour of the facial skin, the elemental sound of the person’s voice, odor that they may emanate and through the key skill of emotional rapport.

Emotional Rapport

In five-element acupuncture rapport is a foundation skill in diagnosis and for making a deeper level of contact with a patient.  This is the art of matching the person energetically, seeing which one of the elements they respond to or feel most at home in.  It enables the acupuncturist to deepen their relationship with the patient and offers the patient a chance to drop down into a feeling of safety that enhances the healing experience.  For example when making contact with the person, do they react to the sympathy of earth, the respect of metal, does the patient relax when you energetically portray the water element, feel safe when you give them the structure of wood?  For the practitioner rapport is a skill and base of knowledge that continually deepens over the years.  Below is short description of each constitutional element type of person and how we gain rapport.


A fire person will want to be in relationship and be equal with you.  Their demeanor may show either a lack or excess of joy. Their colour can range between ashen gray to quite red. This colour will manifest under the skin at the level of the blood.  Their voice will have a sense of laughter even when discussing quite grave topics or a flat sadness as thought their fire has gone out. You will gain rapport with this element by either going up into laughter and having a good time or going down into the lack of joy or sadness, depending on the person. To the fire person this will feel normal, as these two states are where they live most of their lives. The person may show a shy nature or keep you at bay with their laughter.


An earth C.E. carries a sense of emptiness or neediness as though they subtly need to be the centre of attention.  The emotion of earth is sympathy and they will either be the type of person who really wants you to understand all they have been through or assumes an attitude of “I don’t need anyone”.  Their voice will have a singing aspect to it, like a mother talking to her child.  The colour on their face will range from a grey yellow to a bright banana colour, this colour will manifest under the skin, in the flesh.  They will have an odor that is sweet, that of blossoms that are slightly off.


The emotion of metal is grief.  This is a sense of loss, a mourning for what could have been - this is different to the sadness of fire.  The colour of metal is white, this will show actually on the skin and it may look like the person is wearing white powder.  Metal’s odor is named rotten, like the smell of a butchers shop or maybe of the large intestine.  Their voice may weep as thought there is a catch in
the throat as they speak each word.  The metal person will want respect, to know you can honor who they are. The content of the conversation will be deep, focused on things that matter.  Being with them, the space will have the quiet feel of respect, like the stillness of a church.  Any laughter may be at your expense.


Water is the element of fear.  These people will either be frozen like ice or raging like an over-full stream. These people are driven; they can range from slightly manic to very quiet, like a still pond.  The colour will show over the skin as a ruddy red/ blue.  Their odour is named as putrid; the smell will range between the saltiness of a sea breeze to an odour related to the bladder.  A water person lives on the edge of fear where they have a love / hate relationship with the emotion.  A water person wants reassurance, to know things are OK.  Their voice will groan, have a continuous maybe monotonous feel to it.


Wood is the element of determination and assertion.  To gain rapport with a wood person they will want to know that you can offer structure, so they can relax.  They may want to push and want you to push back.  As the gall bladder meridian opens into the eyes, they may have trouble seeing what is ahead and sometimes experience a sense of frustration or even hopelessness.  Their voice will have shout or a sense of assertion to it.  The colour green will float above the skin nearly like a glow emanating from the tendons of the face.  Their odour is named as rancid, similar to that of oil that has slightly gone off; as though the body is not digesting fats 10).

Parental style can sometimes point towards a patient’s Constitutional Element.  Parents who over parent, enmesh or abandon can contribute to an earth C.E.  Parents who control the child’s behavior with fear can contribute to a person being a water C.E.  A household where the child is not honored, their real being is not respected can point towards a metal C.E.  Parents who over control either with discipline or too much structure can produce a wood child.  A child who experiences life as an attack, whose childhood is a lot to do with hurt may show up as a fire C.E. 


Once the practitioner has discerned through colour, odor, sound and emotion what the person’s constitutional element is, they may commence treatment. 

In treatment, most acupuncture points are tonified.  That is the needle is inserted at a 15-degree angle supporting the flow of the meridian, once the qi is reached, turned 180 degrees clockwise and immediately withdrawn.  The left side point is tonified first, then the right side.  Most five-element treatments use this technique, as the C.E. is a viewed as a deficient condition.   Direct pea sized moxa cones are used on most points.  Sometimes when appropriate, a sedation needle technique is used.  There are three stages to a treatment; checking and clearing any blocks to the flow of Qi, choosing and treating spirit points and grounding the treatment with command points from the patients C.E. meridians.


There are certain blocks to acupuncture that seem to be only used in the five-element style.  These are Entry / Exit blocks, The Du / Ren block, Aggressive Energy, Akabane Imbalance, Husband - Wife Imbalance and Possession.  In this paper we will take time to examine the most common but not most serious - Entry / Exit Blocks 4).

Entry / Exit Blocks.  The first stage of a treatment is clearing the entry / exit blocks.  These blocks pertain to the wei or superficial level of qi 12).  This superficial flow of energy commences at the lung and proceeds through the 12 main meridians to the liver.  The five-element acupuncturist looks carefully on the pulses for blocks along this flow.  They are most often seen between the element pairs, e.g., between the liver and lung (wood and metal) not between the gall bladder and liver (wood and
wood).  The main 6 entry / exit blocks are between the spleen and heart, small intestine and bladder, kidney and heart protector, three-heater and gall bladder and finally liver and lung meridians.  They are found as a difference in volume of qi present on the pulse.  The classic 28 pulse qualities are not often used in five-element treatment planning.  These blocks are best explained as an energetic dam between the elements.  In a spleen / heart block, (or a block between the earth pair and fire pair of pulses) the stomach and spleen pulses will have a fairly full, percussive or pushy feel to them, with the heart and small intestine pulses feeling like they are missing or empty volume wise 9). 

Using the entry / exit points clears these blocks 6).  In the case of a spleen / heart block, you would first tonify the exit point of the spleen, which is Spleen 21 - Encircling glory.  Next, you would tonify the entry point on the heart meridian, which is Heart 1 - Utmost source.  Once the blocks are cleared you would expect all the pulses to be even and balanced with only a very strong TCM pathology still showing through at this stage.

Spirit of Points and Intent The second step in a treatment is planning of the spirit points.  In five- element acupuncture, each of the points has a spirit name that is relied upon to decide which point is appropriate for the patient on the day, e.g. Kidney 25 - Spirit storehouse.  Kidney 25 is used when the person’s spiritually depleted, when they use their stores up as soon as they get them. It is for patients who see no joy in being alive.  Another example, Liver 14 - Gate of hope, this point is for a wood C.E. who is feeling like things are hopeless.  When they are ready to give up, you open the Gate of Hope to help them move on 7).  With a few exceptions, these points are always chosen from the patients C.E. meridians.  When tonifying a point it is thought to be important to hold the spirit of the point in mind and summon that energy from the point.  This is called intent and is an important skill for the practitioner to develop.

Command Points The last part of a 5-element treatment is the command points.  It is important to ground the treatment with points from the patients’ constitutional meridians. The command points are such points as the yuan-source, element points, connecting luo -junction or cleft –xi accumulation points.   These points are used to address the patients’ constitutional weakness and are thought to leave the person in control of their own energy 8).


Through observing colour, sound, odour and emotion, it is possible to ascertain which of the five-elements has been most affected in a particular patient.  Through concentrating treatment on this element, it is possible to touch the core of a person.  This is more than fixing a sore shoulder or poor sleep.  By supporting their constitutional weakness, it is thought that you are touching them at the level of spirit, enabling the patient to grow and change, become more of who they can be.  As the flow of the sheng cycle strengthens, the patient moves back into balance with themselves, their relationships, their work and the world in which they live.

Gye Bennetts trained at the College of Traditional Acupuncture U.K. in Leamington Spa, United Kingdom.  He ran clinics in London and Brussels for over three years before retuning to Australia nine years ago where he now treats in North Sydney.  His e-mail is and has a five-element acupuncture information website at and run courses for T.C.M. trained practitioners wanting to learn the five-element style of acupuncture. He is a member of the British Acupuncture Council and the Australian Traditional Medicine Society

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2 Mole P.  J.R. Worsley – his Legacy to the Practice of Acupuncture. European Journal of Oriental Medicine Vol 4 No4, 2003
3 Eckman P. In The Footsteps of the Yellow Emperor – Tracing the History of Traditional Acupuncture, San Francisco; Cypress Book Company, 1996.
4) Worsley J.R. Traditional Acupuncture – Volume 2, Traditional Diagnosis, Leamington Spa, College of Traditional Acupuncture U.K., 1990
5 The acronym TCM is used to describe that style of Chinese medicine currently taught and practised in China.
6) Worsley J.R. Traditional Acupuncture – Volume 1, Meridians and Points, Leamington Spa, College of Traditional Acupuncture U.K., 1990
7) Venn L. Spirits and Functions, Leamington Spa, College of Traditional Acupuncture U.K., 1992
8) Franglen N. The Handbook of Five Element Practice, London; School of Five Element Acupuncture, 2004
9) Hicks A., Hicks J., Mole P. Five Element Constitutional Acupuncture, Reading, Churchill Livingstone, 2004
10) Franglen N. The Five Guardian Elements of Acupuncture – Keepers of the Soul, London; School of Five Element Acupuncture, 2004
11) Connelly D. Traditional Acupuncture - The Law of the Five Elements, Maryland, TIA Sophia Institute, 1975
12) Also know as they Law of Midday-Midnight or the 24-hour clock flow.


Though sharing much with the modern Chinese styles of acupuncture currently being taught in Australia, Constitutional Five Element Acupuncture is very different in theory and approach in that it primarily aims to touch the patient at the levels of emotion and spirit as well as the physical.

By diagnosing and treating the constitutional cause of a person’s distress a greater sense of well being can be imparted to the patient, strengthening their spirit and enabling them to grow and change.  This helps the person to move back into harmony with themselves, their environment and their life as a whole.