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When the theory of the five elements is applied in traditional Chinese medicine, the classification of phenomena according to the properties of the five elements and their interpromoting, interacting, overacting and counteracting relationships are used to explain both physiological and pathological phenomena, and to guide clinical diagnosis and treatment.

The five elements and the interrelationship between the zang-fu organs

Based on the theory of the five elements, each of the internal organs pertains to one of the five elements. The properties of the five elements serve as an analogy to explain some of the physiological functions of the five zang. In addition, the interpromoting and interacting relationships are used to explain some of the interconnections between the zang-fu organs. The liver may serve as an example, it is promoted by the kidney, promotes the heart, is acted on by the lung, and acts on the spleen. The roles of the other organs can also be explained in the same way, and thus an integral relationship between the internal organs is generalised.

The meridians have a close relationship with the zang-fu organs. They are the passages by which the zang-fu organs connect with one another according to the interpromoting and interacting relationships of the five elements. In general, the zang-fu organs connect with each other directly through the meridians, according to the cycles of the five elements. The relationships between the liver, heart, spleen, lung and kidney can serve as an example. In the meridian system, the Liver Meridian of Foot-Jueyin and the Gallbladder Meridian of Foot-Shaoyang run through the heart; the Liver Meridian of Foot Jueyin runs on both sides of the stomach which is externally-internally related with the spleen; the Kidney Meridian of Foot-Shaoyin ascends and runs through the liver; the Liver Meridian of Foot-Jueyin ascends to the lung; the Kidney Meridian of Foot-Shaoyin ascends through the liver and lung, etc.

By means of the interconnecting system of the meridians, the five elements maintain a relative balance and coordination. The theory of the five elements is not without limitations. The laws of interpromoting and interacting can not reflect all the interrelationships between the zang-fu organs and their related tissues. Clinical practice, however, has shown that these laws do reflect certain objective relationships among the five zang organs and can be used to determine diagnosis and treatment.

The five elements and pathological relationships among the zang-fu organs

The occurrence of disease is the pathological manifestation of the dysfunction of the zang-fu organs and their related tissues, which may be due to a number of factors. The human body is an organic whole, and both interpromoting and interacting relationships exist among the viscera. Thus when one internal organ is afflicted, other organs and tissues may become involved. This is called "transmission." According to the theory of the five elements, intertransmission may follow either the interpromoting or the interacting cycles.

Transmission following the interpromoting cycle involves disorders of "the mother affecting the son" and "the son affecting the mother"'. For example, when liver disease is transmitted to the heart, it is called a disorder of "the mother affecting the son," and when liver disease is transmitted to the kidney, it is called a disorder of "the son affecting the mother."

Transmission following the interacting cycle involves "overacting" and "counteracting." When a liver disease is transmitted to the spleen, it is called "wood overacting on earth," and when a liver disease is transmitted to the lung, it is called "wood counteracting on metal."

It must be pointed out that mutual pathological influences among the viscera exist objectively. Some of them can be explained by disorders of "the mother affecting the son," "the son affecting the mother," "overacting" and "counteracting." Therefore the theory may serve to explain those pathological transmissions which are observed in clinical practice.

The five elements and clinical diagnosis and treatment

The theory of the five elements is applied to synthesize clinical data obtained through the four diagnostic methods and determine pathological conditions according to the natures and laws of the five elements. For instance, a patient with redness and pain of the eye and irritability suggests a liver problem; a red complexion accompanied by a bitter taste in the mouth suggests hyperactivity of heartfire.

In treatment, the five Shu-Points correspond to the five elements. The Jin-Well, Ying-Spring, Shu-Stream, Jing-River and He-Sea points of the yin meridians correspond to wood, fire, earth, metal and water respectively, whilst those of the yang meridians correspond to metal, water, wood, fire and earth respectively. Clinically they are selected for treatment according to the principle of "reinforcing the mother" and "reducing the son". In addition, it is common clinical practice to determine the principle of treatment and selection of points according to pathological influences among the zang-fu organs which follow the cycle of the five elements. For instance, in case of a disharmony between the liver and stomach, "wood overacting on earth", the principle of treatment should be to promote earth and restrain wood. Points such as Zhongwan (Ren 12), Zusanli (S 36) and Taichong (Liv 3) will be selected.

In general, the theories of yin and yang and the five elements both encompass rudimentary concepts of materialism and dialectics, and to some extent reflect the objective laws of nature. They are of prime importance in explaining physiological activities and pathological changes, serving to guide clinical practice. In their clinical application, the two principles are usually related. They supplement each other and cannot be entirely separated. In other words, when applying yin-yang theory, the five elements will be involved; when using the theory of the five elements, yin-yang will be involved.

When considering the theories of yin-yang and the five elements, it must be understood that they originated in clinical practice, have played a progressive role in the development of traditional Chinese medicine, and are still guiding clinical practice to a large extent up to the present day. At the same time, owing to the limitations inherent in the historical development of ancient Chinese society, the theories are incomplete and need to be improved through continuous research and summation in clinical practice.

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