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One of the main differences between 5 element and TCM is diagnosing and treating the level of your patients’ dis-ease.

In 5e, it’s crucial for the practitioner to ascertain on which level – body, mind, or spirit – their patient’s discomfort is primarily located during every treatment.

Here’s how and why we need to diagnose level for our patients to get the best treatment outcomes.


The purpose of diagnosing level

The purpose of determining level is to: 

  • help you select the appropriate points
  • create the right intention for that patient during treatment
  • generate deep and lasting healing results for your patient

If the correct level isn’t addressed, treatment progress will stall out and frustration will mount for both you and your patient. 

When you do treat the appropriate level, you’ll see improvement in that level and most likely all other levels as well. 

If you don’t see improvement, then you know you need to address a different level. 

For example, if you’re treating someone with severe migraines and they also have a flat affect, you might assume that their affect has to do with the amount of pain they’re in. If their migraines improve but their affect doesn’t, it’s time to reassess the level you’re treating.


How to determine level

This answer is a little more complicated because most of the time, all levels are affected simultaneously when your patient’s health is imbalanced. 

Pain from a sprained ankle can result in the mental issue of obsession about getting better, or a depressed spirit if mobility is impacted for a long time. 

A disturbance on one level usually causes subsequent disturbances on others. It’s your job to find the primary level of dysfunction and treat that. 

Treating the primary level will most improve the patient’s functioning and sometimes you have to dig a little deeper than what shows up on the surface. For example, I’ve had several patients who come in with pain and they end up getting the most benefit out of spirit level treatments. 

To determine level, the practitioner has to go beyond symptoms and observe how well a person’s body, mind, or spirit is working.

Let’s take a look at each level more in depth.


The physical level

The physical level is TCM’s bread and butter and TCM practitioners are experts at spotting physical level symptoms. 

Examples of physical level symptoms are pathogenic influences, climatic factors affecting the body and its fluids, and zang fu pathology. 

The physical level can be a tricky one for TCM folks because when they see a physical level complaint it’s full stop, treat that. 

However, it’s possible to have physical complaints but the mind and spirit need to be addressed otherwise healing won’t progress. Examples are acute injury and trauma as they’re often accompanied by mental and emotional shock. 

Long term chronic illness with tons of physical symptoms can have a profound effect on the spirit because people feel overwhelmed, helpless, and frustrated by a lack of progress. 

Here’s a helpful tip: the more obvious the physical or environmental cause, the more likely it is that a symptom is a purely physical issue. 

This may include things like being out in the cold and wind for too long, food poisoning, or living in a damp area and having swollen and stiff joints as a result. 

If you only treat at a physical level and there’s no improvement, you know you need to incorporate other levels into your treatment.

The mental level

People’s ability to think is a reflection of their mental level function. 

You want to assess their mental clarity, memory, and notice their ability to solve problems. 

Folks with clear minds can solve issues by*: 

  • staying focused
  • clearly defining their goals
  • knowing what resources they need and what they have 
  • drawing on the expertise of others who’ve already solved their issue
  • balancing cost and benefit
  • assessing whether the solutions are achievable
  • considering the effect of the solutions on the rest of their life 
  • and making a good choice 

Usually you can assess the mental level while taking a case history when people talk about past or present issues. 

A common sign of a mental level problem is an unrealistic attitude of what causes events to occur, aka magical thinking. People divorce themselves from the reality of a situation in order to make it fit in their worldview. 

An example would be wanting a larger house and deciding that buying lots of lottery tickets is the way to go about it.


The spirit level

The spirit level can be the hardest to assess and you often need to be aware of your patient’s life situation so you can put your experience with them into context. 

Some people’s spirits are more susceptible to strain and struggle. And even folks with resilient spirits may have difficulty coping after an emotional shock or trauma. 

Let’s take a look at healthy and unhealthy spirit signs and symptoms**. 


Healthy Spirit

Struggling Spirit

Look in eyes/eye contact Bright, shiny, clear eyes

Good eye contact

Dull, lifeless eyes

Indirect/poor eye contact

Posture Upright, calm Slumped, esp in head, chest, abdomen, restless
Clothing/hygiene Pride in appearance and personal cleanliness Overly obsessive or unkempt
Communication Relatively clear verbal and non-verbal communication Avoidance, evasion, indirect with others
Language Clear, positive, hopeful “I can’t” “I won’t”, “it’s hopeless” “I feel helpless”, feeling powerless though mentally and physically capable
Relationships Give love to others and enjoy receiving love Difficulty giving love and knowing they’re loveable
Dealing with difficulties Attempt to work through problems and move on when it can’t be resolved Resignation easily, try to prevent change at all costs, can’t let go
Purpose and meaning Sense of life being meaningful and wanting to fulfill their potential Feel like life has no meaning or purpose
Emotional reactions Experience their emotions as they arise and work through their emotional distress More likely to be overwhelmed by their emotions or to suppress their feelings and have very little outward reaction, or reactions out of balance to the severity of the situation
Nature Joy in nature Lack of connection with natural world and its impact on us


If you know your patients’ constitution you can also assess their spirit through the lens of their element when you understand what a healthy spirit for their element looks like.



Healthy Spirit

Wood grow and develop and assert themselves appropriately
Fire love and enjoy themselves and seek out appropriate warmth
Earth appropriately care for and nourish others and allow themselves to be cared for
Metal feel grief appropriately, receive inspiration, and let go of what’s no longer needed
Water appropriately protect themselves and feel safe


Case study: Persistent whiplash after a car accident

A 53 year old woman came to me who had a whiplash injury from a car accident that hadn’t healed. Her pain level was still high almost a year later despite seeing multiple acupuncturists, receiving dry needling and PT, massage, and chiropractic work. Nothing had touched her pain and she was considering a nerve block. 

Her language was resigned and dejected, she felt like she had no purpose besides being in pain all the time, her eyes were dull, and she had a hard time making eye contact consistently with me. 

I determined that her spirit was still suffering from the trauma of the accident and the subsequent trauma of not getting any relief from her pain, so I treated her at the spirit level with 5 element techniques. When she returned she reported that her pain had come down by 75% and had stayed that way for the full 2 weeks since I’d seen her. It was the first relief she’d had in over a year.


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Most chronic conditions, which is about 90% of the caseload in the western world, have a primary dysfunction on the spirit or mind level. TCM does not address these levels of being, as this case demonstrates since this patient had been to multiple acupuncturists before seeing me. 

When my patient’s spirit was addressed, all levels of her being improved. It really can feel like magic when it happens.


How do we treat the mind and spirit levels in our patients?

There are special points to treat the spirit in 5 element acupuncture, but all points have the capability of touching someone’s spirit and mind.

However you can’t just needle a point and expect it to reach those deeper levels in your patient. Treating at the spirit and mind level requires a very different skill set than treating at the physical level. The spirit level is the most delicate of the three to reach.

There are a few key requirements that have to be met in order for you to access the mind and spirit of your patient. You have to:

  • learn how to cultivate your own spirit
  • have deep rapport and presence
  • treat with clear intention

If you don’t have these core things, the points you choose simply won’t work on a mind or spirit level. You won’t do any harm, they just won’t be effective. 

It’s like suggesting that someone change when they’re not ready to take that step yet. Your recommendation falls on deaf ears.

Learning 5 element acupuncture isn’t just about memorizing diagnostic patterns and point protocols. 

To truly practice the medicine you have to have done your own work and know how to hold space for others at a deep level that’s free of judgment and agendas. Only then can you offer your patients the gift of mind and spirit level work.

If you’d like to learn more about how to hold this space and how to treat at these deeper levels, feel free to sign up for the waitlist for my mentorship course.


*5 Element Constitutional Acupuncture by Hicks p 213, 2004

**5 Element Constitutional Acupuncture by Hicks p 214, 2004

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