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 from Yang 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:
SI TH
HT PC
Fire
GB LV Wood Earth SP ST
BL KI Water Metal LU LI
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.
SI TH
HT PC
Fire
GB LV Wood Earth SP ST
BL KI Water Metal LU LI
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.
Fire
SI TH
HT PC
Wood GB ST Earth
LV SP
KI LU
Water BL LI Metal
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.
Fire
SI TH
HT PC
Wood GB ST Earth
LV SP
KI LU
Water BL LI Metal
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!
Fire
SI TH
HT PC
Wood GB ST Earth
LV SP
KI LU
Water BL LI Metal
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).
Fire
SI TH
HT PC
Wood GB ST Earth
LV SP
KI LU
Water BL LI Metal
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