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One of the biggest questions I get from practitioners is if they can integrate the 5 elements and TCM into their diagnostic and treatment process.

Yes you definitely can, and it’s easier than you might think. 

But it’s understandable why it seems challenging or impossible based on how at odds the 5e and TCM communities seem to be with each other.

Let’s dive into why you can integrate them so smoothly, how you might integrate them, and the main benefits of doing so.

I know that when I started integrating these two modalities, I saw a positive impact on my patients’ wellbeing, their outlook on life, their ability to engage with their bodies, and overall health outcomes.


Why are the 5 elements and TCM so compatible?

Because not so long ago they were the same medicine. In the 1960s, Chinese medicine was reformed during the communist revolution.

The emotional and spiritual aspects that seemed outdated or superstitious to the modern western world were lopped off and Traditional Chinese Medicine, or TCM, was born.

Traditional Chinese Medicine is not exactly traditional in that it doesn’t include the full breadth of the medicine and it was formed less than 100 years ago.

Today TCM is backed by the Chinese government and is often accompanied by herbal prescriptions as TCM principles work extremely well with herbs.


5 element acupuncture is also not traditional 

Many of its main principles stem from classical Chinese teachings that are thousands of years old, but it also began its modern form in the 1960s and 1970s when it was created by JR Worsley.

He was heavily influenced by Japanese acupuncture and received his 5 element theory training there because entrance into China was impossible until 1972. 

In Japan, it was customary to receive massage alongside acupuncture in contrast to herbs like TCM, and the importance of touch in diagnosis was stressed. We see these themes play out in Worsley’s work as he placed emphasis on sensory and intuitive skills in contrast to TCM’s more analytical diagnostic approach.

Japanese practitioners also had not integrated the changes to Chinese medicine that placed more emphasis on the 8 principles and the syndromes of zang fu and tongue diagnosis that TCM had and as a result this isn’t a part of modern 5 element theory.

5 element acupuncture is a style developed by a westerner and is a part of the process of modifying Chinese medicine for the western world.* 

Both TCM and 5 element were an attempt to adapt Chinese medicine to the western world and unfortunately, they both lost something in the process.


Integrating 5e and TCM is easy because they’re two sides of the same coin

They both offer valuable and complementary ways to treat your patients and were never meant to be mutually exclusive.

Before the 1960s they were part of the same medicine which is known as Classical Chinese Medicine. Classical Chinese Medicine is still taught in some schools, but it’s in the minority like 5 element when compared to the number of TCM schools. Let’s take a look at just how complementary these medicines are.


Comparison Between TCM and 5 Element Philosophies

5 Element TCM
  • Organized around 5 element theory and the idea that the observation that nature is a major path to understanding people and illness
  • Organized around yin/yang theory with emphasis on the effect of climate and pathogenic factors that can influence the body
  • Treatment is focused on emotional and spirit-level issues
  • Treatment is focused on the physical level or with no reference to level
  • Diagnosis is mainly based on signs or objective, observable phenomena 
  • Diagnosis is mixed between signs and symptoms but relies more on symptoms, or subjective experience
  • Emphasis is placed on treating the root via constitution and officials; constitution is regarded as the most fundamental imbalance
  • Emphasis is placed on treating the branch with pathogenic factors, and treating the root with yin/yang, patterns, and syndromes
  • Treatment of chronic conditions is emphasized, especially those that result from constitutional imbalance and emotions
  • Treatment of both chronic and acute conditions is emphasized, mainly at the channel level or substance level (qi, blood, jing, etc.)
  • Internal or emotional causes are emphasized
  • External, climatic causes and miscellaneous lifestyle causes are emphasized


By integrating the 5 elements and TCM, you can provide your patients with holistic and personalized care that’s more effective than practicing one medicine on its own. Calm symptoms and help them to achieve a deeper internal balance so they can thrive in their lives. 


How do you integrate 5e and TCM?

Now that you know they’re compatible, let’s get down to the brass tacks of what diagnosing and treating with both 5e and TCM in your practice looks like.



You can diagnose with both systems at the same time. 


TCM Diagnosis

TCM diagnosis is focused on finding syndrome patterns, judging the balance of yin and yang, and assessing climatic and external factors that may influence health. With TCM, you’ll be looking for:

  • signs and symptoms that correlate to syndromes 
  • external pathogenic factors
  • pulse qualities
  • tongue appearance


5 Element Diagnosis

In 5 element acupuncture, there are 3 separate components a practitioner needs to assess in order to diagnose and treat. These components focus on internal causes of dis-ease and where the root imbalance is located.


#1 Diagnosing Constitution

An imbalance or dysfunction in our main elements, or our constitution, is regarded as the most fundamental imbalance a person can have. Therefore it’s crucial to diagnose constitution and treat it.  You diagnose constitution through:

  • color, sound, odor, and emotion (CSOE)
  • psychological and behavioral patterns
  • hand, face, and body characteristics
  • the energetics of being in the room with that person 


#2 Diagnosing Blocks

A 5 element block is a pattern that has emerged in someone that dampens their vitality and spirit and prevents them from recovering their health. It’s crucial to discern if any 5 element blocks are present because these will hold up treatment indefinitely if they’re not cleared. You find these through:

  • psychological, behavioral, and physical signs
  • pulse patterns


#3 Determining Level

A key part of 5 element diagnosis is determining the level of someone’s being – body, mind, or spirit – that houses the root cause of their issue. A practitioner needs to assess and treat at the correct level for health to improve. Otherwise symptom patterns won’t resolve. The overwhelming majority of health complaints in the western world are chronic mind or spirit-based issues, which makes 5 element acupuncture an extremely effective and needed tool as western medicine and TCM overlook these aspects of health.

Even though this sounds like a lot to assess between TCM and 5 element, experienced practitioners are able to do both in a few minutes

The real trick is knowing how to prioritize all of the information that you’ve collected into a coherent treatment.

We always want to address the root cause for our patients otherwise folks won’t experience lasting healing. 

You can use this table to help you determine which category represents the root issue(s) for your patient. 

Please note that the categories are hierarchical, meaning that treating category 1 can affect categories 1-4 and treating category 4 can only affect category 4.


Integrated Diagnosis and Treatment Hierarchy

Category 1 (mind/spirit) 5 constitutional patterns affecting core beliefs/values which affects the spirit/mind/emotions and leads to syndromes 5e
Category 2 (mind/spirit + bodily function) Basic syndromes like deficiencies + stagnations of organs, affects organ fxn in terms of qi, bld, yin, yang, e.g., spleen qi xu, liver qi stagnation Likely 5e
Category 3 (bodily function) Secondary syndromes involving pathogenic factors wind, cold, damp, heat, phlegm, dryness, bld stagnation, e.g., damp heat invading the LI, usually acute TCM
Category 4 (Body/channels) Channel issues where there is a blockage at a superficial level but isn’t affecting the organ itself, e.g., musculoskeletal problems TCM


Category 1 is all about disharmony from an internal cause, mainly the emotions or spirit. An imbalance here can easily filter down into the rest of the categories and affect someone’s whole picture of health.

Imbalance in categories 2-4 can be caused by external factors like sleep, stress, diet, acute illness, and more, or by internal factors. 

You may notice that in category 2 it’s possible to have significant overlap between 5e and TCM. We’ve got TCM diagnoses like spleen qi deficiency and liver qi stagnation but the cause of those syndromes can relate directly to an imbalance in constitution.

The imbalance could be within the constitutional organs themselves or the relationship between that organ and the constitutional organs. 


This is where you really have to start parsing out your diagnostic impulses 

If you diagnose heart blood deficiency and there’s not a pathogenic factor you observe that would put that diagnosis in category 3, realize that you need to use 5e treatment techniques first as the cause is likely internal.

If you’ve got patients who repeatedly show up with the same TCM diagnoses, it’s very possible that adding 5 element treatment will resolve those chronic diagnoses.

The take home message here is that imbalances in organs that appear to be TCM pathology can originate from a constitutional level. By addressing constitution (category 1), imbalances on all other levels can potentially be rectified.



Creating treatments using both TCM and 5 element is very simple. Here are some of the main differences between the two medicines during treatment:


5 element
Multiple sets of needles are used Usually one set of needles is placed
Pulses are taken after each set of needles to assess changes and receive feedback about your point selection Pulses are taken once at the beginning of treatment
More time in the room with the patient for counseling and layering needles Significantly less time spent with the patient


Since 5e practitioners usually use multiple sets of needles to address blocks and imbalances, it’s easy to layer in any TCM points that you think would also support your patient.

Most of the time you can overlap 5e and TCM points. For example, you can balance constitution or clear a block while also addressing acute qi and blood stagnation in the gallbladder channel.

I don’t overlap points in a few circumstances, like when I’m treating certain blocks that change the pulses quickly and I need to assess if that specific protocol created the change in the pulses I was looking for.


Are you worried about overwhelming the patient?

Even if you’re treating with both 5e and TCM, your point selection can be very focused.

I’m only concerned if someone has told me that they’re sensitive or trepidatious about needles. Then I’ll stay in close communication with them and encourage them to let me know if they feel overwhelmed or anxious.


With 5e and TCM together you can address both internal and external causes of dis-ease

Combining 5e and TCM is so effective because together they leave no stone unturned.

Only using one or the other can leave a whole pile of issues unaddressed, creating treatment plateaus and frustration for both you and your patients. 

Learning how to prioritize 5 element and TCM diagnosis and treatment is an art and requires practice. I teach it in depth in my mentorship course.


When you combine both 5e and TCM, you’re saving your patients time and money

The purpose of integrated treatments is to help your patients to overcome their health obstacles with the least intervention possible. 

Yes that means choosing your points wisely, but it also means that by using both systems simultaneously you’ll be able to provide your patients with faster and deeper results for all levels of their being than if they went to an acupuncturist who only used one type of acupuncture. 

By addressing symptoms and the root cause, your patients will be able to feel better in the short term and long term and they’ll likely maintain the benefits of your treatments for a greater length of time.

Integrating 5 element and TCM can also help you to build your business 

Using both medicines together:

  • sets you apart from other practitioners as few folks know about the 5 elements in depth enough to use them in treatments
  • increases patient retention since you’ll be better equipped to deal with mental, emotional, and spirit-based issues that are extremely common in the western world
  • improves the patient-practitioner relationship by helping you create more rapport and genuine connection through empathy and appreciating your patients’ unique elemental challenges
  • helps you get new clarity around your ideal patients based on the strengths and challenges of your own elements and the elements of your patients

Using both 5 element and TCM helps you practice Chinese medicine as it was meant to be: an integrated, complete system that serves and nourishes your patients at a physical, emotional, and spirit-based level.

References: *5 Element Constitutional Acupuncture by Angela and John Hicks, 2004, p x

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