five phase treatments

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Five Phase Treatments

Introduction

Five phase treatments are aptly named for both their relations to the five phases (elements)which they treat, but also that the treatment itself consists of five steps. Each step is veryprecise in its choosing of points to use and time in which to administer treatment. As with muchof Japanese styles of acupuncture, five phase treatments are very subtle in their workings. Howfar the needle goes in, the direction of the needle placement, and the manipulation of the needle

are very important.Step 1Pulse: Feel the pulse and determine which pulse position, and in turn phase, isthe weakest. Then see if the mother or son is also deficient. This is your pair.Focus on the son here, regardless which of the two is weaker, and that is thepattern under which you will treat. Let us take the kidneys as our examplethroughout the page. We felt the pulse and have determined that both thekidney and the lung are the weakest. We call this a kidney primary pattern.

Needling: In Step 1 we will be treating two points in a specific order. Usingthe command or five shu chart, we have the points laid out in the Nan Jing associated with the

phases. On each meridian there is a point corresponding to each of the phases. The first point totreat will be on the primary pattern meridian (kidney here) and it will be the mother phase point(lung point here) on that meridian. The second point to treat will be on the mother meridian ofthe primary pattern (lung meridian here). The point to treat is the horary point on the mothermeridian (lung point here). The horary point on any meridian is the point associated with thesame phase as the meridian itself.

YinWood Fire Earth Metal Water

Jing-Well Ying-Spring Shu-Stream Jing-River He-Sea

Lung LU 11 LU 10 LU 9 LU 8 LU 5

Kidney KD 1 KD 2 KD 3 KD 7 KD 10

If you look at the chart, feast your eyes on the column under the Metal phase (lung). These areyour two points; Kidney 7 and Lung 8. Order is important here. First needle Kidney 7 since it ison the primary pattern meridian, then needle Lung 8. These are both being tonified so use asmall needle, shallow insertion of 1-2mm, following the flow of the meridian. The side needledcan be determined one of two ways. The first is the opposite side of pain or disease. So ifsomeone has right shoulder pain, treat the side that is healthy, the left. If there is no pain or ifthe pain is bilateral then use the second method decided by gender. For men use the left;women use the right.Time: 10 minutes (start counting after the second needle is placed).Exceptions: The Pericardium/San Jiao pulse position is basically ignored in 5 phase since theyboth belong to the fire phase as does the Heart. Additionally, the Heart primary pattern is

considered taboo in Japan and is not treated. They save it for extremely serious conditions ofphysical and mental illness.Note: In our case of the kidney primary, the lung point Lung 5 may also be used as our second point. Thiswas found through empirical work and does not necessarily come from the theory here.Options:

Primary Pattern Points

Liver Lv 8, Kd 10

Lung Lu 9, Sp 3

Kidney Kd 7, Lu 8/5

Spleen Sp 3, Pc 7

Heart Pc 8, Sp 2 *

* The heart is explained at the end of this section.


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Step 2Pulse: With every primary pattern, there is a secondary pattern that is alsotreated. The possible meridians that constitute the secondary pattern areeither the one that controls the primary pattern meridian, or is controlled bythe primary pattern meridian (in the controlling cycle). With our example ofthe kidney, this means the possible secondary patterns are Spleen and Heart.However, as noted above, the heart is generally avoided under mostcircumstances for treatment, thus we choose the Spleen. In a case where twomeridians are an option (like in treating a Spleen primary where you haveeither Kidney or Liver to choose from) you go by whichever secondary option stands out to youin the pulse, either by being more deficient or excess. So here we feel the Spleen pulse and wedetermine if it is excess or deficient (the Spleen is rarely in excess so for example purposes let'ssay it is deficient). If none of the above pulses seem deficient or excess you can also just do thesame points as step 1 on the opposite side.Needling: Step 2 involves one point being needled on the opposite side of the primary points.That point is the source point of the secondary pattern meridian. How it is needled is determinedby the pulse and if it was deficient or excess. In our example, the Spleen is our secondarypattern, and thus our point is Spleen 3. Here we are dealing with a Spleen secondary deficiencyso we are going to tonify that point by inserting a small size needle shallowly, 1-2mm, followingthe flow of the meridian.Time: Remainder of 10 minutes from Step 1.Exceptions: The Kidney is never thought of as being in excess, thus if you come up with aSpleen primary you can have either Liver secondary excess or deficiency, or kidney secondarydeficiency.Needle Removal: After the ten minutes has passed, remove the needles in the reverse order inwhich you put them in. So in this case, first remove Sp 3, then Lu 8/5, and finally Kd 7.Options:


Liver Lu 9 or Sp 3

Lung Lv 3

Kidney Sp 3

Spleen Kd 3 or Lv 3

Heart Lu 9 or Kd 3*


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Step 3Pulse: Remove all the needles in steps 1 and 2, remembering to remove in the reverse order.Now check the pulse again, this time concentrating on the Yang organs. First find the mostdeficient and tonify that meridian. Then find the most excess and reduce that meridian. Onlyfeel for the excess yang pulse after you have needled the deficient one.Needling: When the deficient yang organ is found, tonify the point on that meridian (below arethe list of points which have been empirically deduced). Use the side of the body whichcorresponds to the pulse position that is weak. For example, if the Large Intestine is deficient,since the LI pulse is found on the right side, treat only right LI 11. After that has been done forthe appropriate time, disperse the luo point on the meridian of the excess organ. Again, onlytreating the side of the body corresponding the pulse position. Keep in mind that you will beusing a thicker needle and you will be needling against the flow of the meridian when dispersing.Time: Tonify the deficient yang organ for 1-2 minutes. Disperse the excess organ for 30seconds.Exceptions: If all the yang organs seem deficient, use either TW 4 or St 36 bilaterally.Options:

Yang Deficient Points

Gall Bladder GB 37 (l)

Large Intestine LI 11 (r)

Bladder Bl 58 (l)

Stomach St 36 (r)

Small Intestine SI 7 (l)

Triple Warmer TW 4 (r)

Yang Excess Points (Luo)

Gall Bladder GB 37 (l)

Large Intestine LI 6 (r)

Bladder Bl 58 (l)

Stomach St 40 (r)

Small Intestine SI 7 (l)

Triple Warmer TW 5 (r)

Note: The second part of this step, dispersing the excess organ, is not a mandatory step. Oftenin tonifying the deficient yang organ, the excess one will disperse on its own. Make sure to lookfor the excess yang pulse after needling the deficient organ / meridian.Step 4Needling: This step is rather simple with no pulse taking necessary. Turn the patient over andtonify the the corresponding shu points to the primary diagnosis mother and son. For example,to continue with our Kidney primary pattern, you would tonify the shu points of the Kidney andthe Lung (Bl 23 & Bl 13).Time: 30 seconds from the end of the last needle inserted.Options:


Liver Bl 18 & 23

Lung Bl 13 & 20

Kidney Bl 23 & 13

Spleen Bl 20 & 15 or 14Heart Bl 15 & 20


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Five Phase Pulse Patterns

KeyNormal

Pulse

Deficient

Pulse

Excess

Pulse

Lung Primary - Liver SecondaryDeficiency

Lung Primary - Liver SecondaryExcess

Spleen Primary - Kidney Secondary Heart Primary - Lung Secondary

Liver Primary - Spleen SecondaryDeficiency

Liver Primary - Spleen SecondaryExcess

Kidney Primary - Heart SecondaryDeficiency

Kidney Primary - Heart SecondaryExcess


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Forming a Classical Five Element Acupuncture Diagnosis

FIRE EARTH METAL WATER WOOD

Colors red yellow white blue/black green

Sounds Laughing Singing Crying Groaning Shouting

Odor scorched fragrant rotten putrid rancid

Emotions Joy Worry/Pensiveness Grief/Sadness Fear Anger

The initial consultation with a patient is usually a one to two hour meeting where a thoroughhistory of the patient is taken. Each of the elements are tested, the person questioned, listened

to and observed. Physical routines are noted; sleep, appetite, alcohol intake is all looked at as apart of an extensive list. The colour of their face, the sound of their voice, their odour is all

observed. What colour comes up on their face through which questions? What is their body

language telling you? How do they answer the questions? Which of the elements do they feelmost at home in or do they respond to as you portray. Everything is information, it is anopportunity to get a feel for the person as a whole.

The patients emotional and physical well being are also equally important when attempting todetermine a persons causative factor. How they function in the world is important. What was

their childhood like? Do they remember it? What is their ability to have relationships? How istheir work history? What are the things they like about people, what are the things they don't?

The answers to these questions all point to an elemental type.

Parental style may also point towards the CF. Parents who over parent, enmesh or abandon can

contribute to a Earth CF. Parents who control the child's behavior with fear can contribute to aWater CF. A household where the child is not honored, their real being is not respected can

indicate a Metal CF. Parents who over control either with discipline or too much structure canproduce a Wood child. A child who experiences life as an attack, whose childhood has a lot to dowith hurt may show up as a Fire CF.

The process in which a practitioner gets in touch with a patients CF involves many things,

including experience. Developing rapport, or connecting with the patient, is very important. It isalso important to watch the way they interact with you in general. Do they react to thesympathy of Earth, the respect of Metal? Even though it may not be your own home elementdoes the patient relax when you portray Water, feel safe when you give them the structure of

Wood? Below are a few of the things that you look for when searching for the CF element.

A Fire CF will want to have relationship, will want to be equal with you. They may either lack joyor have an excess. Their colour can range between ashen gray to quite red. The colour willmanifest under the skin at the level of the blood. Even the most ashen gray or joyless Fire CF

will occasionally rise like a fire into laughter. Their voice will have a sense of laughter even whendiscussing quite grave topics. You can gain rapport with this element either by going up to the

laughter and having a good time or by going down into the lack of joy or sadness. The Fire CFwill feel this to be normal as this is where they live most of their lives. Sometimes the person

may show a shy nature or you may feel they are keeping you at bay with their laughter.

Earth

An Earth CF carries a deep sense of emptiness. The emotion of earth is sympathy and they may

convey a sense of neediness. They will either be the type of person who really wants you tounderstand all they have been through or expresses that they "do not need anyone." Their voice

will have a sing to it; the colour on their face will range from a gray yellow to a bright banana


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colour. This colour will manifest in the flesh. They will have an odour that is sweet, of blossomsthat are slightly off.

Metal

The Metal person wants respect. The emotion of Metal is grief. This is a sense of loss, a feel for

what could have been. This is different than the sadness of Fire. The colour of metal is white;this will show on the skin. It may look like they have a white powder on. The odour is rotten,

like the smell of a butchers shop or of the Large Intestine. They want to know you are not goingto feel better than them. It will feel normal for you to be at a physically lower position to them

in the room. The space will have the quiet feel of respect, like a church. Any laughter will be atyour expense.

Water

Water is the element of Fear. These people will either be frozen like ice or raging like an overflowing stream. These people are driven, maybe manic or quiet like a still pond. The colour will

show on top of the skin as a ruddy red/blue. Their odour is putrid, the smell of the Kidneys andBladder. A Water person lives on the edge of fear where they have a love/hate relationship with

the emotion. A Water CF wants reassurance. Their voice will groan, have a continuous maybemonotonous feel to it.

Wood

Wood is the element of determination, assertion, of anger. Their main emotion will rangebetween a sense of frustration to hopelessness. They want to know that you are in control sothey can relax. They may feel pushy and want you to push back. Their voice will have shout or asense of assertion to it. The colour green will float above the skin nearly like a glow. Their odour

is rancid, similar to that of oil that has gone off; as though the body is not digesting fats.

Through observing the Colour, Sound, Odour, Emotion and gaining rapport with the person the

CF element will show itself. After that determination is made most of the treatment is used toaddress a deficiency in that element and therefore the person. This way it is thought, you can

help the whole person grow and change.

Intro and Major Energetic Blocks - Internal and External Dragons, Aggressive Energy

Once a persons CF is decided upon, the acupuncturist may begin treatment. Within classical five

element acupuncture there is a relatively standard protocol which practitioners follow. Some ofthese protocols will be unfamiliar to TCM or Japanese style acupuncturists. Outside of the

concept of a CF, these protocols provide the foundation of what is unique in classical fiveelement acupuncture.

Before a persons CF is directly targeted, there are a few major blocks which - if present - needto be cleared before the CF will improve with treatment. These are listed below in the order in

which they are usually used. If a person does not exhibit the signs of a particular block, they willnot be treated for that imbalance. In some cases, none of these blocks are present and the firsttreatment will involve direct work on the patient's CF.

A quick note about needling in five element acupuncture is also appropriate. Generally speaking,

needles are not retained for a significant duration during treatments as in TCM style treatments.The idea behind needling is similar to that in Japanese style treatments in that you want to usethe minimal amount of stimulation on the most potent points to create the largest effect during

a given treatment. Points are tonified by inserting with the flow of the meridian, twisting it 180clockwise and then retaining or removing immediately and sealing the point. Sedation is thecontrary, you insert against the flow of the meridian, rotate 180 counterclockwise and then

retain or remove immediately not sealing the point.


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Internal & External Dragons:

These blocks have to do with a relatively significant disruption in the connection between a

persons body, mind and spirit. The Internal Dragons (ID) have more to do with internal causesof disease, whereas, the External Dragons (ED) have to do with external causes.

Symptoms:

A patient who has internal a/or external dragons may be experiencing a lack of control overaspects of their body, mind or spirit. From a practitioners perspective, this is usually

experienced as an inability to communicate directly with the patient, even feeling uncomfortablearound the patient. If you cannot look directly into their eyes and speak with them, if you feel

you are not getting honest responses to your questions, if you feel they are not quite connectedwith themselves - these may indicate this particular block.

This may show up, but not necessarily so, in patients with histories of drug and/or alcoholabuse, in patients who indicate that they feel "out of control," or in patients where other

treatments have proven unsuccessful.

External Dragons are specifically noted when a patient has the above symptoms and has

experienced extreme weather or climates or an external trauma such as an accident or traumaprior to experiencing these symptoms.

Treatment Points

External Dragons Internal Dragons

GV 20 1/4" belowCV 15

UB 11 ST 25

UB 23 ST 32

UB 61 ST 41

Treatment Protocol:

You usually begin with the ID treatment unless it is not called for. All needles should beinterested from right to left, top to bottom with perpendicular insertions. After the insertion they

should be dispersed in the order they were inserted. What you are looking for is a noticeablechange in the patient, in their colour, sound, odour, emotion and shen. Once you see the change

you are looking for, the needles should be removed. If there is no change after 15 minutes, youshould tonify the needles from left to right and top to bottom removing them as you go and

continue the treatment with the ED points.

Aggressive Energy

The aggressive energy block is another foundational block in the sense that, if present, it is

likely that other treatments will be unsuccessful until it is cleared. This treatment is usuallyperformed after the Internal or External dragons are cleared, if they were present or suspected

in the patient.

Symptoms:

Aggressive energy is considered when a patient has experienced strong psychological a/or

emotional stressors. If suspected it will be confirmed by the appearance of an erythma orredness around the needle insertions.
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Treatment Points:

Treatment Points Correspondence

UB 13 Lung Shu

UB 14 Pericardium Shu

UB 15 Heart Shu

UB 18 Liver Shu

UB 20 Spleen Shu

UB 23 Kidney Shu

plus test points at each level inside or

outside of the bladder meridian

redness should be darker at associated shu point

than at test needles for confirmation

Treatment Protocol:

The patient should be comfortable as the duration of the treatment depends on how long the

redness takes to completely clear or "drain." The needles should be inserted at each of thepoints listed above bilaterally from right to left and top to bottom into all of the points except

forUB 15which is inserted after having tested for aggressive energy on all of the other pointsfirst (i.e. tested alone). The test needles should be inserted after the shu points have been

needled.

If aggressive energy is present you will see an erythema (redness) that appears surrounding the

needle which is different in nature than any change near the test needles. The needles should beretained until this redness clears. If you do not see any strong changes, retain the needles for a

few minutes, remove them and then move on with the next step in the treatment.

Entry Exit Blocks

After the major blocks described above are cleared, or if they were not present to begin with,

the first stage of treatment involves treating entry/exit blocks. These blocks pertain to the Weilevel of the body's energy, the superficial flow of energy commencing at the Lung andproceeding through the 12 main meridians to the Liver. This flow and the associated entry exitpoints (in red) are illustrated in the graphic below:
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The Classical Five Element Acupuncturist looks carefully for blocks along this flow. They aremost often seen between meridians which connect, as opposed to yin/yang pairs such as LV/GBor ST/SP. That is, for example, between the Liver and Lung not between the Gall Bladder and

Liver. The main 6 Entry/ Exit blocks are between the:

Spleen (SP) & Heart (HT) Small Intestine (SI) & Urinary Bladder (UB) Kidney (KD) & Pericardium (PC) Triple Heater (TH) & Gall Bladder (GB) Liver (LV) & Lung (LU)

Entry/Exit blocks are found by looking at the quantitative differences between the pulses. That isa score noted between a +3 pulse down to -3 measuring strength. The pulse strengths are

concentrated on in classical five element acupuncture as opposed to thequalitieswhich are usedmore in TCM. You may also see/hear blocks described as a IV/V or 4/5 block which is the result

of a meridian numbering system used by some practitioners. The meridians are numbered assuch:

1. Heart2. Small Intestine3. Urinary Bladder4. Kidney5. Pericardium6. Triple Heater7. Gall Bladder8. Liver9. Lung10.Large Intestine

11.Stomach12.Spleen
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A Spleen & Heart Entry/Exit (12/1-XII/I) block can be seen in the example below:

Left Arm Right Arm

Yang Yin Yin Yang

SI/HT -1.5 -1.5 -1 -1 LU/LI

GB/LV -1 -1 +.5 +.5 SP/ST

KD/UB -1 -1 -1 -1 PC/TH

The Entry/Exit blocks are best explained as a dam between the flow of connected meridians. Ina Spleen/Heart block the Spleen pulse will be a zero or slightly plus and the Heart pulse will be

weak (-). The Spleen pulse will have a fairly full, percussive or pushy feel to it. Using theEntry/Exit points clears these blocks. In the case of an Sp/Ht Block you would first tonify the

Exit Point of the Spleen, which isSP 21Encircling Glory. Next you would tonify the Entry Pointon the Heart meridian, which isHT 1Utmost Source. Once the blocks are cleared you would

expect all the pulses to be even and balanced.Treatment Points:

Entry Exit Points

Those entry exit points that are not the first or the last points on the meridian are marked with

an * and the first or last point is within parentheses

Entry Exit

LU LU 1 LU 7*(LU 11)

LI LI 4*(LI 1) LI 20

PC PC 1 PC 8*(PC 9)

TH TH 1 TH 22*(TH 23)

HT HT 1 HT 9

SI SI 1 SI 19

SP SP 1 SP 21

ST ST 1 ST 42*(ST 45)

LV LV 1 LV 14

GB GB 1 GB 41*(GB 44)

KD KD 1 KD 22*(KD 27)

UB UB 1 UB 67
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Treatment Protocol:

Once you determine the entry/exit block that you would like to treat you will tonify the exit point

of the preceding meridian and then tonify the entry point on the following meridian.

Spirit Points

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 heavily relied upon to decide which point is appropriate

for the patient. For example,KD 25is termed "Spirit Storehouse."KD 25is used when theperson is spiritually depleted, who use their stores up as soon as they get them. It is forpatients who see no joy in being alive. Another example isLV 14- Gate of Hope. This point is

for a Wood CF who is feeling like things are hopeless. When they are ready to give up, you openthe Gate of Hope to help them move on. With a few exceptions these points are always chosenfrom the patients CF Meridians. When tonifying a point it is thought to be important to hold theSpirit of the Point in mind and summon that energy from the point. That is, your intent when

needling should match the intent of the point.

Some of the more common spirit points used in classical five element acupuncture are:

Kidney Pointson the Chest Bladder Pointson the Outer line Spirit Points on the patients CF CVa/orGV

Kidney Points on the Chest

Point Spirit/Usage

KD 20

"Through the Valley"

full of fear, feeling trapped, feelings of negativity, someone facing death, suicide a/or

loneliness

KD 21"Dark Gate"

everything appears as "dark" or negative

KD 22"Walking on the Verandah"

lacking a sense of protection or safety in the world, cannot walk freely

KD 23"Spirit Seal"

lack of connection with ones own spirit or identity/self, low spirit

KD 24"Spirit Burial Ground"

depleted spirit, depression, deep loss of sense of self

KD 25"Spirit Storehouse"

spirit requires nourishment

KD 26"Amidst Elegance"

lack of sense of beauty or grace, self respect

KD 27 "Storehouse"depleted spirit, helps to tonify the spirit of a person
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