Chinese Medicine : five Elements Theory

The Five Elements Theory

The Five Elements theory posits wood, fire, earth, metal, and water as the basic elements of the material world. These elements are in constant movement and change. Moreover, the complex connections between material objects are explained through the relationship of interdependence and mutual restraint that governs the five elements. In traditional Chinese medicine Five Elements theory is used to interpret the relationship between the physiology and pathology of the human body and the natural environment.

1. The Basic Content of the Five Elements Theory

The Categorization of Things
The ancient physicians used the Five Elements theory to study extensively the connections between the physiology and pathology of the zang-fu organs and tissues and the natural environment. By adopting the methodology of "comparing similarity to expose phenomenon," the ancient Chinese attributed different phenomena to the categories of the five elements. On the basis of the phenomena's different characteristics, functions, and forms, the complex links between physiology and pathology as well as the correlation between the human body and the natural environment were explained.

Five Elements theory assigns each of the five elements a series of abstract generalizations and then applies them to the classification of all phenomena. Wood, for example, involved the aspects of germination, extension, softness, and harmony. It is then inferred that anything with those characteristics should be included in the category of the wood element. As for the rest of the five elements: fire involves the aspects of heat and flaring; earth involves the aspects of growing, nourishing, and changing; metal is associated with cleaning up, killing, strength, and firmness; and water is associated with cold, moisture, and downward flowing. As in the case of wood, the aspects of the other five elements are used to categorize all material objects in terms of one of the particular five elements. Table 1 shows the five categories of objects and phenomena according to five elements classification.

Table 1

Categorization of Objects and Phenomena
According to the Five Elements

Table 1

Categorization of Objects and Phenomena
According to the Five Elements



Objects & Phenomena     Elements        
        Wood    Fire    Earth   Metal   Water
Nature                                  
Tones   Jiao    Zheng   Gong    Shang   Yu
Flavors Sour    Bitter  Sweet   Pungent Salty
Color   Green   Red     Yellow  White   Black
Changes Germinate Grow  Transform Reap  Store
Climate Wind    Summer  Dampness Dryness Coldness
        Humid                           
Directions East South   Center  West    North
Seasons Spring  Summer  Late    Autumn  Winter
                Summer                  
Human Body                                      
Zang Fu Liver   Heart   Spleen  Lung    Kidney
        Gall S. Intestine Stomach L. Intestine Urinary
        Bladder                         
Senses  Eye     Tongue  Mouth   Nose    Ear
Tissue  Tendon  Vessel  Muscle  Skin&Hair Bone
Emotions        Anger   Joy Thinking Melancholy Fear
Sound   Shout   Laugh   Sing    Cry     Mourn

Mutual generation means multiplication and promotion, while mutual subjugation means mutual restriction and restraint. The order of mutual generation among the five elements is that wood generates fire, fire generates earth, earth generates metal, metal generates water, and water generates wood. In this way generation is circular and endless. In the mutual generating relation of the five elements, each of the elements has the property of "being generate" and "generating." The one which generates is the "mother," the one which is generated is the "son." This is known as the "mother-son relationship." Each of the five elements has this type of mutual generating relationship with the other.

According to the order of mutual subjugation, however, wood subjugates earth, metal subjugates wood, etc. Each of the five elements also shares this subjugation relationship with the other. This relationship has the properties of "being subjugated" and of "subjugating." The former means that my ability is inferior to the object, while the later denotes my superiority to the object. Therefore, the mutual subjugating relationship among the five elements is also known as the relationship of "being superior to" and "being inferior to" another element.

Mutual generation and mutual subjugation are two aspects which cannot be separated. If there is no generation, then there is no birth and growth. If there is no subjugation, then there is no change and development for maintaining normal harmonious relations. As the Leijing tuyi says, "If there is no generation, then there is no growth and development. If there is no restriction, then endless growth and development will become harmful." Thus the movement and change of all things exists through their mutual generating and subjugating relationships. These relationships are the basis of the never ending circulation of natural elements.

Extreme subjugation and counter subjugation are the pathological conditions of the normal mutual generation and subjugation relationships. Extreme subjugation denotes that the subjugation of one of the five elements to another surpasses the normal level. For example, if there is hyperactivity of the wood element, it will subjugate the earth element. The latter elements is made weak and insufficient.

Counter subjugation means that one of the five elements subjugates the other opposite to the normal mutual subjugation order. For example, when metal is weak and insufficient, it leads to the hyperactivity of wood. The latter will then counter subjugate the former. In the Suwen it says:

When the qi of one of the five elements is excessive, it will subjugate its subjugated element (such as wood subjugating earth) and counter subjugate the subjugating element (such as wood counter subjugating metal).

Moreover, the Five Elements theory recognizes a correlation between those things which are related to a particular element. As the Suwen points out, "The East generates wind, wind generates wood, wood generates sour, sour generates liver, liver generates tendons...."0 According to Five Elements theory, each element has its own repertory of relationships among the objects that compose the physical world. The theory of Five Elements is therefore the theoretical basis of the unique bond between man and nature. (See Fig.2)

2. Application of the Five Elements Theory to traditional Chinese Medicine The Five Elements theory is applied to the physiology and pathology of the human body by using the relationships of generation and subjugation to guide clinical diagnosis and treatment.

The Physiological Functions and Interrelationships of the Five Zang Organs

Physiologically the Five Elements theory explains the unity of the mutual relationships between the zang-fu organs and body tissues as well as between the human body and nature. The physiological activities of the five zang organs can be classified according to the different characteristics of the five elements. For example, the liver is said to preside over the vigorous flow of qi and also has the function of ensuring free qi circulation. Since these characteristics are similar to the properties of wood, the liver is categorized as wood in the scheme of the five elements. Heart yang has a warming action so it belongs to the category of the fire element. The spleen is the source of transformation of essential substances and is associated with the earth element's characteristics of growth and transformation. The lung has clearing and descending properties and is associated with the metal element's characteristics of clearing and astringency. The kidney has the function of controlling water metabolism and storing essence and is associated with the water element's characteristics of moistening and flowing downward.

The Five Elements theory is also used to describe the correlations of physiological functions between zang-fu organs and body tissues. There are both generating and subjugating relationships among the five zang organs. The generating relationships are: the essence of kidney (represented by the water element) nourishes the liver; the liver (represented by the wood element) stores the blood in order to support the heart; the heat of the heart (represented by the fore element) warms the spleen; the spleen (represented by the earth element) transforms and transports the essential nutrients to replenish the lung; and the clearing and descending functions of the lung (represented by the metal element) assist the flowing of kidney water.

The subjugating relationships among the same organs are as follows: the clearing and descending functions of the lung (metal element) can restrict the hyperactivity of liver yang; the unobstructed flowing of liver (wood element) qi is capable of removing the stagnation of the spleen (earth element); the transportation and transformation of spleen is able to subdue the overflowing of kidney water; and the nourishing and moistening function of kidney (water element) can prevent the strong flaring up of heart fire. The yang heat of the heart (fire element) can control the hyperactivity of the lung's clearing and descending functions.

Furthermore, the Five Elements theory is employed to express the mutual relationships between the human body with the seasons, climates, and flavors. For example, while the wood element is associated with East, spring, wind, sour, etc., it is also connected with the liver, tendons, and eyes of the human body. In this way the Five Elements theory gives expression to a holistic view of the relationship between the human body and its natural environment.

Five Elements Theory and Pathological Influences on the Zang-Fu Organs

Five Elements theory is not only used to correlate the functions of the sang-fu organs, but also to demonstrate their mutual pathological influence. To denote the mutual influence of the sang-fu organs in pathological changes the concepts of extreme subjugation and counter subjugation are used. For example, liver disease may affect the spleen because wood over-subjugates earth, while spleen illness may affect the liver as earth counter subjugates wood. Diseases of the liver and spleen interact with each other. Liver disease may also influence the heart, this is a "mother affecting son" illness. If the liver disease is transmitted to the lung, this is categorized as wood counter subjugating metal. If it is transmitted to the kidney, then it is considered a "son affecting mother" illness. The other zang organs follow suit. Thus the application of the Five Elements theory in explaining the complicated interaction between the zang organs can be summed up by these four relationships: extreme subjugation, counter subjugation, mother affecting son illness, and son affecting mother illness.

Use of the Five Elements Theory in the Diagnosis and Treatment of Disease
Abnormal changes of the internal organ's functions and interrelationships can be detected by external appearances. Thus changes in a a patient's complexion, voice, sense of taste, pulse, etc. can be used to diagnose disease. According to the Five Elements theory the five zang organs have certain connections with the "five colors," "five tones," and "five tastes" as well as changes in the pulse.1 Therefore, in the clinical diagnosis of a disease, the data collected by the four diagnostic methods (inspection, auscultation and olfaction, inquiring, and palpation) should be analyzed according to the properties and changing laws of mutual generation and subjugation, extreme subjugation, and counter subjugation of the Five Elements theory. For example, a blue complexion accompanied with a preference for food of a sour taste and a wiry pulse, suggests liver disease. A flushed face accompanied by a bitter taste in the mouth and a forceful pulse suggests heart disease with the symptom-complex of hear-fire flaring up. A patient with insufficient spleen qi may have a blue complexion implying wood's (i.e., liver) extreme subjugation of earth (i.e., spleen). If a patient is suffering from heart trouble and has a dark complexion, it may be explained as water (i.e., kidney) subjugating fire.

The occurrence and development of a disease is sometimes related to the abnormality of the mutual generation and subjugation relationships. Therefore, clinical treatment should not only concentrate on the diseased zang organ, but also be concerned with readjusting the relationships between the particular zang or fu organs in accordance with Five Elements theory. For example, the Nanjing says, "When the liver is diseased, the liver will transmit to the spleen, and so one should replenish the qi of the spleen."2 This reflects the clinical application of five element's extreme subjugation theory. The laws of mutual generation and subjugation and extreme subjugation and counter subjugation have been applied by subsequent generations of traditional Chinese medicine practitioners to create more methods of treatment such as "cultivating the earth in order to generate metal," "nourishing the water to conserve wood," "supporting the earth to restrict wood," etc.

The yin-yang and Five Elements theories represent the world outlook and methodology of the ancient Chinese for their understanding and explanation of nature. The application of these two theories to Chinese medicine consists of viewing the phenomena and laws of nature and applying them to the study of the physiological activities and pathological changes of the human body and its interrelationships. The theory of Yin-Yang explains the dynamics of physical objects through a consideration of their contrary, mutual depending, consuming-increasing and transforming relationships. Normal human physiological activities are understood as the relative balance and harmonization between yin and yang. When yin and yang lose their relative balance and coordination, disease occurs. The theories of Yin-Yang and the Five Elements are used together as a guide to clinical diagnosis and treatment.