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What is 5 Element Acupuncture ?

Updated: Sep 24, 2021

An introduction to the ideas and work of J.R. Worsley

J.R. Worsley acupuncture pioneer
J.R. Worsley

5 Element acupuncture as practised in the West is a style of acupuncture formalised and taught initially by Professor J.R. Worsley, who began studying acupuncture in the early 1950s in Taiwan. While, like TCM, 5 Element acupuncture is a modern development of this ancient art, it’s roots lie in the classics of Chinese medicine, particularly the Nan-Jing which is largely based in 5 Element theory.

The term Element is perhaps a mistranslation from the original Chinese, a translation made by early missionaries to China who were steeped in the classical Greek tradition. The term Element implies a static entity and a translation that better captures the meaning of the original is Phase, which implies a process of change with one phase (Element) leading to the next and health being a state in which these changes and transformations happen smoothly So what are these Elements (or phases)?

The ancient Chinese identified five phases, the unfolding of which was seen to underlie all organic processes, including those going on in human body and human life itself. These five phases were labelled Water, Wood, Fire, Earth & Metal, although these are just one set of labels as each phase has a large number of associations; for instance there’s a season associated with each of the phases: Winter, Spring, Summer, Late Summer & Autumn, there’s an organ system associated with each Element: Kidney, Liver, Heart, Spleen, Lung, there are emotions associated with each phase: Fear, Anger, Joy, Sympathy & Grief. I could go on. Perhaps what’s important to understand here is not the detail of the theory but that it’s the balance and the smooth transformations between them which is understood to underlie good health. The converse of that is that imbalance, the domination or weakness of particular Elements, or the interruption of the smooth process of transformation from one to another, underlies ill health.

The basic idea of the of these ‘phases’ doesn’t seem to be a uniquely Chinese insight into how things develop and decay. Writing in the first half of the 20th century the American poet Robinson Jeffers, in a poem entitled ‘Shine, Perishing Republic’, wrote:

I sadly smiling remember that the flower fades to make fruit, the fruit rots to make earth

Out of the mother, and through the spring exultances, ripeness and decadence and home to the mother

The second line seems to map remarkably well onto the schema of the five phases – Water is winter, the seed, the mother, spring exultances correspond to Wood, ripeness to (Late) Summer and decadence to Autumn*. What is uniquely Chinese is the attribution of this system to human health and well-being and so to medicine. As already noted this development seems first to be elaborated in the Nan Jing, written in the first or second century AD. This ‘classic’ of Chinese medicine was central to a style of acupuncture called Meridian therapy, which developed in Japan in the early 20th Century. In his book, ‘In the Footsteps of the Yellow Emperor’ Peter Eckman tries to piece together the roots of Worsely’s acupuncture by tracing the teachers with whom he studied. Several of the early proponents of Meridian Therapy are mentioned and there are a number of similarities but also significant differences.

One of the axioms of Meridian Therapy is that one should always treat the deepest imbalance, which, in Meridian Therapy, is primarily ascertained using careful palpation of the radial pulse. Worsley took this idea a step further, suggesting that each of us has a tendency toward an imbalance in one of the Elements (phases) and he labelled this primary imbalance the Causitive Factor or Constitutional Factor (often shortened to ‘CF’). For Worsley all other imbalances within the body were elaborations of this primary imbalance.

Several things flowed from this. Firstly primacy was given to diagnosing this deepest imbalance (the ‘CF’) with far less importance being given to the symptoms and syndromes that might form the basis of diagnosis in TCM for example. Secondly treatment would be concentrated on those meridians that correspond to the organ systems associated with whichever CF the patient was seen to manifest. In terms of treatment this laser like focus on a single factor which is understood to underlie a patient’s ill health means that a 5 Element treatment often uses less needles than other styles of acupuncture. Its Japanese roots mean that needling is often relatively shallow, needles are not retained and moxibustion is an important part of many treatments. I think many patients are as surprised by the gentleness of these treatments as by their efficacy.


Bruce Bell is a fully trained 5 Element Acupuncturist working in the Midsomer Norton / Radstock area, and also from a clinic on the edge of Bath.

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