Pip waller Blog

Five Element Medicine

by | Jan 12, 2022

The Five Elements – Classical Chinese Medicine

This can be found in my book ‘Holistic Anatomy’ as Appendix A at the back of the book.


The Five Element system is a complete system of medicine. Classical Chinese five element medicine was brought to England in the 1970s by J.R. Worsley who had travelled widely in China. Its foundations were laid down over 2000 years ago in ancient China. One of its great differences from other systems is that symptoms are treated by the practitioner with benign indifference – a diagnosis cannot be made by reference to symptoms at all!

Of course as patients we don’t treat our symptoms with benign indifference; but the five element view is that, as part of nature, we are capable of being in complete balance and health, and when things go awry there are signs which a skilled practitioner can read – changes in the sound of our voice, our colour, our body odour and the emotional tone of our lives. The diagnosis of our particular imbalance is made on these parameters and not on any symptoms of illness. This is in complete contrast to modern Western medicine, which is all about symptoms.

Like all other systems with their roots in ancient times, the Five Element system is derived from a close study of nature. At heart, it understands that Spirit is at the root of health; that most imbalance causing disease originates at the level of Spirit. In this chapter I am attempting the merest introduction to the Five Element system, which is an amazingly complex and elegant paradigm. In my descriptions of elemental imbalance here I am mainly emphasizing the way they manifest in the emotional and spiritual sphere. If you are drawn to further study there are excellent books on the subject, as well as courses to learn how to become a five-element practitioner.

The elements themselves
The Chinese word which has been translated as “element” really means something more like ‘phase’ or ‘movement’. The elements are great cosmic forces which shape everything in the universe.You can think of the elements as being like the seasons. As I write this midwinter approaches; outside it is icy cold and beginning to get dark already, though it is only 3pm. The trees are bare, the landscape bleak. The energy of the earth has gone deep below. Nothing is happening on the surface. Even though the Christmas mayhem is approaching, there is a pull to go quiet, to go within, to do little, to sleep more.

This is not a time for action, for doing, but for being. This is the time of Water; rain washes the land clean, snow and ice freeze us into immobility. The colour is black or dark blue, the black of night. Water is Life, more than any other element – any desert dweller knows this. The absence of Water brings certain death – therefore the emotion of water is fear; fear having the function of keeping us alive. Water is always changing and moving, from rain to ice to snow, even from the stagnant pond it is moving as it evaporates into the air to come down as rain on a far off mountain. There is a mystery to water – where does it come from? Life comes, just as the spring emerges from the earth, out of some great mystery, the original Source.

After this phase of darkness and quiet, of conserving and resting, comes the next – the spring, the time of growth. Everything will erupt with green; a magnificent orchestrated medley of growth. This is the Wood element – like a tree, it contains all the others within it; water is drawn up by the tree, which is made of wood. It takes the heat of the sun to make energy and it grows with its roots in the earth, from which it takes the precious minerals or metals. More than any other element, Wood is the element of healing; of the growth of regeneration as well as development. Wood is upward-moving, surging, vibrant. Wood is determined to grow to its full potential and will push through obstacles which impede on its progress. Thus the emotion of Wood is anger; the emotion which arises in us when our growth is thwarted, the emotion which we can use to assert our boundaries. The colour is green.

When the prolific growth of the spring, of adolescence, is over, we reach a period of maturity with the energy of summer. Everything is at its peak. Plants are in flower, attractively drawing insects and bees to them. As days lengthen and grow warmer, we come outside and are drawn to each other, to play and laugh and party. This is the energy of Fire – expansive and connecting, the warmth of joy and love, fun and laughter. The red energy of the Heart.

Towards the end of summer, the grass is yellowing and the flowers have turned to fruit. The Indian summer or harvest time of berries and fruits and nuts shows the bounty of the Earth element, which is all about nourishment and sweetness. Our Mother Earth gives us all that we need for survival; she nourishes us at her sweet breast throughout our lives. The Chinese gave the Earth element the colour yellow because of the rich yellow earth of their fertile places.

Then comes a time when the weather changes; a fresh cold sharpness is felt in the air, and we breathe deeply, feeling its purity and quality. Autumn is here, the time of winds and falling leaves, a time when all will be stripped away but the bare essentials. This is the time of Metal, with its energy of worth and quality; the precious metals and minerals which plants drew up from the earth will be returned as vegetation dies down and rots away. Metal is the element of purity – and so has the colour white.

And so the wheel will turn as the water of winter comes again to wash the land clean.

These Five Elements exist within us all, each having spheres of influence and controlling functions in our body, mind and spirit. The elements manifest within us as personalities – known as ‘officials’ – who are in charge of various areas. For example, the Water Officials are the Kidney and the Bladder, in charge of the control and storage of fluids. But do not make the mistake of thinking that the officials are just another name for the organs you now know something about; they are this, but they are much, much more. It’s best to literally imagine them as people, a great gang of highly skilled and honourable wise ones who are running the show – a kind of spiritual Numbskulls! (British people of a certain age may remember a comic book that had a story about the Numbskulls – funny little men who live in your head and run the various operations of your body).

Whilst we all have all the elements within us, we also are all born with one particular mix of elements which is uniquely us, and which shows where our greatest strengths lie, what is the calling of our soul. One element will predominate – though there is an element within an element, and an element within this and so on, so the complete picture has depth and complexity. Our main element will be revealed by the way we most relate to the world, and because of this, because it is the one we are most ‘out there’ with, it is also the one most vulnerable to hurt. When we get hurt the wound happens first in our main element, causing an imbalance. For most of us, this happens at a very young age – even pre-birth, due to the gross imbalances within our society. This ‘original wound’ is known as the ‘causative factor’; from it all of our problems originate and can be traced back to.

Because we are part of nature, nature shows our need in natural ways, which become more and more obvious to the trained eye. Each elemental disturbance shows itself in the sound of our voice, a colour that comes to certain areas of our face, a type of odour, and a particular flavour of emotional imbalance.

Elemental Emotions
Emotions are central to our existence. The Five Element system has it that a human being is an emotional being, that we are always experiencing the world through our emotions. If we are in balance and harmony (which few of us are), we feel appropriate emotions according to the situation.

The general emotional tone for a balanced person is a deep contentment or joy, a feeling of connection to all things and rightness with the world and our existence in it. Interestingly, this is what Candace Pert, neuroscientist, also suggests – that our natural state is happiness.(Candace Pert, Molecules of Emotion).

Although our natural state is happiness, there are five emotions which will rise and fall within us on top of this basic happiness depending on what is happening. If something happens to impede our growth, then anger naturally arises – giving us the impetus to remove the obstacle and continue our growth. Of course for British people there is a general cultural  imbalance here, as we are in a society which really frowns on anger. The joke is, in New York, if someone steps on your foot, you say, “get off my foot”; in London, if someone steps on your foot, you say, “sorry”!

When your desires are fulfilled, you feel joy – not the same as the deep joy which underlies it all, but a more frothy happiness to do with satisfaction of some want. When someone is in need, the natural emotion to feel is sympathy – the emotion of the mother tending to her hurt child. ‘There there, poor you, tell me all about it’ – actually in Britain we don’t encourage sympathy much either – the famous stiff upper lip! There is a feeling of respect in the presence of that which we value, and when we lose something we value, the natural feeling is grief. Finally there is the emotion which is very much connected to feeling alive – fear. Fear is what helps to keep us alive, since it warns us to react to danger.

You can think of the emotions as being like doors – one must always be open, and when one is open the other four are closed. We feel one at a time, and when we are in balance we are able to move with ease from one to another. When imbalance is present, something goes awry with this mechanism. For some people, it’s as if one door is stuck permanently open, and there is only one emotion they feel no matter what the circumstances. For others, one door is locked closed and they simply cannot go there no matter what. For most of us, it is as if there is only one emotion that we most come alive in, though we can go in and out of the others a little.

Diagnosis of the causative factor
We are all moving more in and out of balance throughout our lives. Here follows a very brief introduction to how we uncover a person’s causative factor, or ‘CF’. As a general rule, the more imbalanced a person is the more extreme the signs described below. This is not to say however that a balanced person is like a bland empty page – when in balance each element has its particular beauty and strengths; the particular gifts we bring to the world are expressed through the power of our elemental makeup.

People with what is known as a ‘Wood CF’ look green, smell ‘rancid’, have a voice which shouts or has emphasis, or else lacks all shout, and may be stuck in anger, or unable to express appropriate anger at all. You have probably come across someone like this, who sounds furious even when they are asking you the time, or conversely someone who tells you about the most terrible outrage against them but is unable to feel the slightest hint of anger (o yes, the doctor took off my good leg by mistake, but never mind he did a great job…).

Fire people are red or often ‘lack of red’ – pale, or grey. The odour is scorched; the sound is that of laughing or a lack of laughing, the emotion joy, or a lack of joy. One extreme example is a person who tells you with hilarity about how last week they lost their job, got evicted from their house and were diagnosed with terminal cancer. The opposite extreme is the person who talks with absolute flatness about the wonderful holiday they just had.

For Earth people, the colour is yellow, the smell is fragrant, the voice has a singing quality to it and sympathy is the emotion that will be pronounced or absent. An imbalanced Earth person might be always looking after others, stuck in permanent sympathy. On the other hand, they might be completely unable to understand the suffering of another.

For Metals, the colour is white, the smell is rotten, and emotions focus around weeping and issues to do with loss or grief, or with a sense of value. Some people are stuck in grief, unable to move on from loss. Others are impoverished,by being unable to value anything enough to feel any grief at losing it.

Water people are blue or black, smell putrid, have a groaning voice and may be stuck in fear, or unable to feel fear at all and go after extreme situations in order to feel something.

The smells are interesting. It is not a person’s armpits or feet or whatever we are talking about – it is a general overall odour that characterizes us. The smells have a quality, a feeling. When I smell the Wood smell for example, it’s like a punch – I feel an upward movement in my head. Sometimes it really does smell like old oil. Sometimes it would be better described as ‘green’. The Fire smell can be quite spicy, sometimes smells like freshly ironed linen sheets, or can be like anything scorched – even quite unpleasant like burnt rubber. I feel it in my head also, but it moves in all directions, not just upwards. The Earth smell I feel down in my tummy, a warmth. Sometimes a person smells so fragrant it’s like they have perfume or aftershave on when they haven’t. The fragrant smell, like all of them, can be anything from lovely to revolting, sickly and cloying. The Metal smell, rotten, can be like old rubbish or even like poo. But it can also be like gentle rotted down compost or leaves in a wood. I feel it like a heavy or low sensation in my throat and the front of my body. The putrid smell of Water is sharp and acrid, almost chemical in nature, like ammonia. It can smell like brackish water or like sweet urine.

Don’t assume, however, that we can all be easily categorized; it’s safe to say there are probably about a billion different types of each causative factor. You can’t stereotype people, and knowing a person’s CF does not mean you know anything else about them. What it reveals is what a person most needs at the deepest level to restore them to health.

As I have said, symptoms are not at all useful in making a Five Element diagnosis. This is because each element feeds the next, and is in relationship with the others. Thus if the winter is too mild and the spring too dry, the summer and harvest time will suffer. ‘Anything can come from anything’ and is the Five Element motto when it comes to symptoms. A Fire person might have all of their symptoms in the Earth element and no apparent problems in Fire. The diagnosis can only ever be made on sound, colour, odour and emotion. The elements are expressed in the body via the officials. These officials are a team, working together to make the whole body, mind and spirit function well. Each one has unique areas of responsibility, and each is the only one who can provide that service to all the others. So if one is very sick, all can suffer in different ways. Each element manifests as two officials, but the element of Fire has four. These come in two pairs and take care of the functions of Fire in quite different ways.

The Twelve Officials
The Water Officials are the Bladder and the Kidney. The Bladder is ‘the official in charge of the reservoirs and reserves of fluids.’ Fluids must be stored to be on hand when we need them, otherwise they are not of benefit. The Bladder Official is in charge of this – is in fact the only official who is even remotely capable of storing fluids of any kind. This applies to all fluids in the body, not just urine and water but blood, lymph, tissue fluid, tears, sweat, synovial fluid, cerebrospinal fluid, sexual fluids – even including hormones which are found always in the blood and body fluids. (The bladder in the body is not in charge of all fluids physiologically speaking. Do not try and correlate this all physiologically; this is a completely different system). Qi (the energy of life) itself is a fluid – in the sense that it flows through the body, mind and spirit. We always need it, and must always have reserves from the unpredictability of life. It is the Bladder Official who maintains these reserves, thus giving us adaptability – the ability to move with the flow of events. If we don’t have reserves, we naturally feel afraid: how will we survive in a crisis? We can be literally paralysed with fear.

The biggest way to deplete our reserves is by overwork, making this a chronic imbalance of the whole of modern society, in which overwork is the norm. The modern world relies on caffeine to fuel unrealistic and unsustainable workloads. Caffeine exhausts the Water Officials – by allowing us to work more than we have energy for. A good way to relate to caffeine is to realize that in using it, you are borrowing time from tomorrow. Eventually, it must be paid back. Overwork is often motivated by fear, so in fact it is a vicious circle, fear leading to overwork leading to depletion of reserves, leading to fear. The Kidney is called ‘an official who excels through ambition and cleverness’ and has a lot to do with our intellect and mental clarity. The Kidney is like a spring emerging from the earth – it harbours our Ancestral Qi, which is kind of like the sand in our hourglass – at the moment of conception, we get ancestral Qi from our mum and our dad. We will use up this Qi throughout our life, and when it is gone we die. We can never get any more of it, but we can use it up at faster or slower rates, depending on how we live. Throughout our life we also get Qi from the Earth Mother, through eating, and the Heavenly Father, through breathing.

The Kidney, as controller of fluids, is in charge of cleansing in our body, mind and spirit. The emotion of Water is fear, and one aspect of this is awe – the fear we feel when we come face to face with something huge and mysterious. The aspect of the Kidneys and the Water element of bringing forth life is awesome – mysterious, impenetrable, cannot be made sense of. The Kidney Official is the only official capable in any way of controlling fluids.

The Wood Officials are in charge of growth processes; the Liver is the architect, who makes all the plans for everything in the body, mind and spirit. The Gall Bladder is like the building contractor, who makes the day to day decisions to do with carrying out the plans of the architect.

Nothing can happen without a plan. Someone must have the vision, the foresight to figure out what to do in any eventuality. This is the job of the Liver Official, who holds the vision and the blueprint for our lives on the grand scale as well as the everyday. Think of the incredible energy of growth seen in our bodies during childhood. The Liver controls it all.
Then, when physical growth is over, growth must continue at the same powerful rate in the mind and the spirit throughout our lives. The Liver in good shape is capable of making plans with strength and flexibility. The Liver is also the detoxifier, and as such is overloaded by drugs and alcohol. If our Liver Official is in poor shape, we may be stuck and unable to see any way out of an intolerable situation, unable to plan – or we may be rigid and bound to over-planning everything, trying to control every aspect of our lives and the lives of others. The Liver Official makes all of the plans for the body mind and spirit – it is the only official capable of making any kind of plan.

The Gall Bladder Official is like an air traffic controller, sitting in isolation and thinking carefully to make the decisions necessary to orchestrate and execute successfully the plans of the Liver. To do this, it needs a certain purity. It is known as ‘the upright official of decisions and judgment’. It coordinates all the other officials and pairs of opposites – the right and left, upper and lower, front and back. It is related to order and orderliness. If impaired, we might find it difficult to decide things, or have poor judgment. Or we may be rigid and judgmental, with an obsessive over-concern for purity, unable to tolerate disorder. On the one hand, feeble decision makers, on the other obsessive over-planners. Habitual lateness can be a Gall Bladder thing; to do with difficulty organising and coordinating enough to be on time, or it can even be a kind of covert aggression – anger being the emotion of the Wood Officials. As
you’ve probably guessed, the Gall Bladder is the only official even remotely capable of making any kind of a decision…

The Fire Officials are different in that there are two pairs of them – one pair is the Heart and Small Intestine, one the Heart Protector and the Triple Heater.

The Heart is the Emperor, the Supreme Controller, in ultimate charge of guiding us to fulfil our Divine purpose or destiny. Remember that the names of the officials originate in ancient China; then it was seen that the role of the Emperor was the representative of the pDivine on earth. He stayed in his palace, protected from everyday affairs, meditating and focusing on God in order to be able to receive Divine guidance regarding the destiny of China. So our Heart Official is kept in splendid isolation, protected from occupation with
everyday affairs, to allow her or him to remain in contemplative connection with the Divine and guide us wisely on our journey through life.
The Heart is helped out particularly by tw officials – its twin the Small Intestine is the official food taster – ‘the Official in Charge of Separating the Pure from the Impure’. Nothing passes the Emperor’s lips that hasn’t first been tasted by the Small Intestine, to ensure no poison gets to the Heart. Remember that the officials are operating on the level of the mind and spirit as well as the body – so all ideas and all energy which come our way are received by the Small Intestine, who then decides whether to let them in or not – whether they are pure or impure. Consider the huge amount of information we modern humans are subjected to: junk mail, newspapers, the internet, the television. All of this information must be sifted through by the Small Intestine to decide if it is of value for us to take in and digest or not. You can see how this official can so easily be overwhelmed these days – like an overworked clerk, sometimes it is made ill and even simply gives up because of the terrible burden of work put upon it. This can be a very serious situation because without a well-functioning Small Intestine Official, a person becomes completely unable to discern, to tell the difference between right and wrong. One way this shows up might be a person who keeps having terrible relationships, choosing the wrong people to be with – because they are literally unable to tell what would be good or bad for them. On the physical level, if the small intestine Official is not well, you might have a person who, although they eat a very good healthy diet, is poisoned and toxic because the Official absorbs everything that should be excreted; or is malnourished because the Official is unable to absorb anything at all.

Extremely, you even have ‘sociopaths’ and people such as paedophiles who are so confused that they try to get adult love from children. In the Five Element view, they are not monsters to be punished, but people in such a terrible state of imbalance that they cannot tell what is good or bad – people who are in great need of healing. The Five Element system says that people are and behave only as the condition of their Officials allows them. The small intestine official is the only one that can distinguish right from wrong, pure from impure.

The other pair of Fire Officials is the Heart Protector, known as the ‘Official in Charge of the Pleasures of the People’, and the Triple Heater. These are two officials who do not really have equivalents in terms of organs, although the Heart Protector is sometimes called the Pericardium, and sometimes Circulation/Sex – its two areas of physical functioning.

The Heart Protector is the second official with the express job of protecting the Heart Official. The best way of doing this is to have an open loving heart and have a lot of fun! The Heart Protector loves a party, and loves to connect in a loving way with others. It is this function of warmth and joy which is able to afford our Heart the best protection (remember the research we discussed about laughter being good for your heart?).

Most of what we think of as heart disease is in fact a problem with the Heart Protector failing to do its job. It’s ironic that when we get hurt, we can have the tendency to shut down, to avoid getting close again in case we get hurt some more, when this is the very worst thing we can do in terms of looking after our Heart. When a person’s Heart Protector is not working well, we can feel the most terrible vulnerability, feeling the slightest casual unkindness like a blow to the heart.

The Triple Heater is like the heating engineer – it keeps the warmth (and Qi) circulating evenly around the body mind and spirit, keeping everywhere at the right temperature for all the officials to function well. You can feel it directly on the body by feeling the ‘Three Jaios’ – place a hand on the belly below the umbilicus, above it, and over the heart, comparing the temperature in each area. They should be pretty much the same, neither too hot nor too cold.

The Triple Three Heater is known as ‘the Official of Balance and Harmony’. It is responsible for the principle of ‘warming up’ – not just physically, but mentally and emotionally.

Think of an orchestra warming up to get in tune with each other, or a party which warms up to be a whole, rather than separate individuals – this is the province of the triple heater. On a mental and spiritual level, when the triple heater is not working you might see a person who blows hot and cold, incredibly enthusiastic one minute and cold and un-caring the next. Someone may be unable to maintain relationships, or indeed any project, for lack of continued enthusiasm.

Since the Earth element is about the bounty of our Mother Earth and about nourishment, naturally the Earth Officials are those in charge of receiving nourishment – the Stomach – and of transporting this sweetness throughout the being – the Spleen/Pancreas. So if our Earth Officials are in good shape, we are well nourished and have a deep sense of security. If not, we may be voraciously hungry, unable to get what we need, deeply insecure, angry and vicious at our lack, or smothering and over-nurturing to compensate for our lack.

The Stomach Official is the ‘official in charge of rotting and ripening’ – just as the physical stomach receives food and digests it ready for the small intestine to absorb, the Stomach of the mind and spirit receives ideas, experiences and energy and digests them, make sense of them, so we can fully absorb them. In this way the Stomach is about understanding – chewing over our life experiences and making sense of them. Without a balanced Stomach,
we might worry endlessly; chew over the same thoughts again and again without satisfactory conclusion. We may be unable to properly understand our experiences; and in extreme cases even be cut off from reality.

The Spleen Official can be simplified as having a fleet of little yellow lorries (trucks) which transport everything around the body, mind and spirit; nourishment, blood, nerve impulses, energy, everything. When the Spleen Official is not working, we see signs of stuckness on the one hand, and over-activity on the other. Memory may be poor, as it is the moving function of the Spleen which is responsible for bringing the memories from their storage place to the forefront of the mind. Nothing can move without the Spleen Official.

Finally the Metal Officials – the Lung and the Colon. These are responsible for maintaining purity in the body: the Lung brings in the pure, rarefied energy of Heaven, the energy of quality and respect and all that is worthwhile in life; the Colon removes the waste and the dross, and in this way maintains purity and sparkle in every cell of our body and our being.

A person with a problem with the Colon Official gets polluted, negative, literally ‘full of shit’. Sometimes a person might be filthy in their body, their home, their language.

Sometimes the opposite is seen, an obsessive cleanliness. Some people become champion grudge-bearers – a kind of mental or spiritual constipation. Others may show the imbalance with an obsession with status and worth, a need to impress.

The Lung Official is about worth and quality, and is what allows us to take in essence and quality. So an imbalance may be seen as an inability to receive a complement and expression of appreciation of one’s worth. In Chinese medicine the skin is known as the ‘third lung’ – so problems with the lungs may be seen in the skin quality.

Five Element treatment protocol
Actual treatment within the Five Element protocol involves much more than strengthening the causative factor, important though this is. There are, for example, blocks to treatment which must first be addressed. There is something called ‘aggressive energy’ which is a serious and unnatural condition which untreated will eventually result in death. This condition can be detected by subtle changes in the pulse. There is also something called ‘husband-wife imbalance’ which can cause terrible symptoms in the body mind and spirit – and is also detected from the pulses. Then there is ‘possession’ – an invasion of the mind and spirit by some foreign entity. Risk factors for this condition include underlying poor health, terrible emotional or physical shocks, drug and alcohol abuse, amongst others. You can see that it could well be fairly common in today’s world! If possession is suspected, a practitioner treats this first before doing anything else, as it will completely block all healing otherwise.

The above is, as I have said, just the briefest introduction to the Five Elements. To study them completely is a lifetime’s work. I’m repeating this to make it absolutely clear that there are many, many important things missing from this essay;  that it is not pretending to do anything more than skim the surface. If you want to learn more, there are excellent books and courses on the subject. You can get Five Element constitutional treatment as acupuncture
or as Eliot Cowan-style Plant Spirit Medicine. I definitely advise trying it for yourself: it will transform your life in ways you can’t even begin to imagine.

Further reading on the five elements:
Professor J.R. Worsley Classical Five Element Acupuncture Volume III – The Five Elements and the Officials.
Nora Franglin Keepers of the Soul – The Five Guardian Elements of Acupuncture.Angela & John Hicks Five Element Constitutional Acupuncture.