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 very precise in its choosing of points to use and time in which to administer treatment. As with much of Japanese styles of acupuncture, five phase treatments are very subtle in their workings. How far the needle goes in, the direction of the needle placement, and the manipulation of the needle are very important. Step 1 Pulse: Feel the pulse and determine which pulse position, and in turn phase, is the 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 the pattern under which you will treat. Let us take the kidneys as our example throughout the page. We felt the pulse and have determined that both the kidney 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. Using the 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 to treat 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 of the primary pattern (lung meridian here). The point to treat is the horary point on the mother meridian (lung point here). The horary point on any meridian is the point associated with the same phase as the meridian itself. Yin Lung Kidney Wood Jing-Well LU 11 KD 1 Fire Earth Ying-Spring Shu-Stream LU 10 LU 9 KD 2 KD 3 Metal Jing-River LU 8 KD 7 Water He-Sea LU 5 KD 10

If you look at the chart, feast your eyes on the column under the Metal phase (lung). These are your two points; Kidney 7 and Lung 8. Order is important here. First needle Kidney 7 since it is on the primary pattern meridian, then needle Lung 8. These are both being tonified so use a small needle, shallow insertion of 1-2mm, following the flow of the meridian. The side needled can be determined one of two ways. The first is the opposite side of pain or disease. So if someone has right shoulder pain, treat the side that is healthy, the left. If there is no pain or if the 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 they both 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 of physical and mental illness.
Note: In our case of the kidney primary, the lung point Lung 5 may also be used as our second point. This was found through empirical work and does not necessarily come from the theory here.

Options:

Primary Pattern Liver Lung Kidney Spleen Heart * The heart is explained at

Points Lv 8, Kd 10 Lu 9, Sp 3 Kd 7, Lu 8/5 Sp 3, Pc 7 Pc 8, Sp 2 * the end of this section.

Step 2 Pulse: With every primary pattern, there is a secondary pattern that is also treated. The possible meridians that constitute the secondary pattern are either the one that controls the primary pattern meridian, or is controlled by the primary pattern meridian (in the controlling cycle). With our example of the kidney, this means the possible secondary patterns are Spleen and Heart. However, as noted above, the heart is generally avoided under most circumstances for treatment, thus we choose the Spleen. In a case where two meridians are an option (like in treating a Spleen primary where you have either Kidney or Liver to choose from) you go by whichever secondary option stands out to you in the pulse, either by being more deficient or excess. So here we feel the Spleen pulse and we determine if it is excess or deficient (the Spleen is rarely in excess so for example purposes let's say it is deficient). If none of the above pulses seem deficient or excess you can also just do the same 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 determined by the pulse and if it was deficient or excess. In our example, the Spleen is our secondary pattern, and thus our point is Spleen 3. Here we are dealing with a Spleen secondary deficiency so we are going to tonify that point by inserting a small size needle shallowly, 1-2mm, following the 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 a Spleen primary you can have either Liver secondary excess or deficiency, or kidney secondary deficiency. Needle Removal: After the ten minutes has passed, remove the needles in the reverse order in which you put them in. So in this case, first remove Sp 3, then Lu 8/5, and finally Kd 7. Options: Primary Pattern Points Lu 9 or Sp 3 Liver Lv 3 Lung Sp 3 Kidney Kd 3 or Lv 3 Spleen Lu 9 or Kd 3* Heart

Step 3 Pulse: 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 most deficient and tonify that meridian. Then find the most excess and reduce that meridian. Only feel 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 are the list of points which have been empirically deduced). Use the side of the body which corresponds 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 for the appropriate time, disperse the luo point on the meridian of the excess organ. Again, only treating the side of the body corresponding the pulse position. Keep in mind that you will be using 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 30 seconds. Exceptions: If all the yang organs seem deficient, use either TW 4 or St 36 bilaterally. Options: Yang Deficient Gall Bladder Large Intestine Bladder Stomach Small Intestine Triple Warmer Points GB 37 (l) LI 11 (r) Bl 58 (l) St 36 (r) SI 7 (l) TW 4 (r) Yang Excess Points (Luo) GB 37 (l) Gall Bladder LI 6 (r) Large Intestine Bl 58 (l) Bladder St 40 (r) Stomach SI 7 (l) Small Intestine Triple Warmer TW 5 (r)

Note: The second part of this step, dispersing the excess organ, is not a mandatory step. Often in tonifying the deficient yang organ, the excess one will disperse on its own. Make sure to look for the excess yang pulse after needling the deficient organ / meridian. Step 4 Needling: This step is rather simple with no pulse taking necessary. Turn the patient over and tonify 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 and the Lung (Bl 23 & Bl 13). Time: 30 seconds from the end of the last needle inserted. Options: Primary Pattern Points Bl 18 & 23 Liver Bl 13 & 20 Lung Bl 23 & 13 Kidney Bl 20 & 15 or 14 Spleen Bl 15 & 20 Heart

Five Phase Pulse Patterns

Key

Normal Pulse

Deficient Pulse

Excess Pulse Lung Primary - Liver Secondary Excess

Lung Primary - Liver Secondary Deficiency

Spleen Primary - Kidney Secondary

Heart Primary - Lung Secondary

Liver Primary - Spleen Secondary Deficiency

Liver Primary - Spleen Secondary Excess

Kidney Primary - Heart Secondary Deficiency

Kidney Primary - Heart Secondary Excess

Forming a Classical Five Element Acupuncture Diagnosis FIRE Colors Sounds Odor Emotions red Laughing scorched Joy EARTH yellow Singing fragrant Worry/Pensiveness METAL white Crying rotten Grief/Sadness WATER blue/black Groaning putrid Fear WOOD green Shouting rancid Anger

The initial consultation with a patient is usually a one to two hour meeting where a thorough history 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 a part 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 feel most at home in or do they respond to as you portray. Everything is information, it is an opportunity to get a feel for the person as a whole. The patients emotional and physical well being are also equally important when attempting to determine 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 is their 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 a Water 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 can produce a Wood child. A child who experiences life as an attack, whose childhood has a lot to do with 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 is also important to watch the way they interact with you in general. Do they react to the sympathy of Earth, the respect of Metal? Even though it may not be your own home element does 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 joy or have an excess. Their colour can range between ashen gray to quite red. The colour will manifest 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 when discussing 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 CF will 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 to understand 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

colour. This colour will manifest in the flesh. They will have an odour that is sweet, of blossoms that 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 going to 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 at your expense. Water Water is the element of Fear. These people will either be frozen like ice or raging like an over flowing 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 and Bladder. 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 maybe monotonous feel to it. Wood Wood is the element of determination, assertion, of anger. Their main emotion will range between a sense of frustration to hopelessness. They want to know that you are in control so they can relax. They may feel pushy and want you to push back. Their voice will have shout or a sense 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 to address 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 of these 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 five element acupuncture. Before a persons CF is directly targeted, there are a few major blocks which - if present - need to 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 will not be treated for that imbalance. In some cases, none of these blocks are present and the first treatment 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 use the 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 180 clockwise and then retaining or removing immediately and sealing the point. Sedation is the contrary, you insert against the flow of the meridian, rotate 180 counterclockwise and then retain or remove immediately not sealing the point.

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 causes of 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 over aspects 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 uncomfortable around 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 connected with themselves - these may indicate this particular block. This may show up, but not necessarily so, in patients with histories of drug and/or alcohol abuse, 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 trauma prior to experiencing these symptoms. Treatment Points External Dragons GV 20 UB 11 UB 23 UB 61 Treatment Protocol: You usually begin with the ID treatment unless it is not called for. All needles should be interested 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 noticeable change 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, you should 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 usually performed 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 or redness around the needle insertions. Internal Dragons 1/4" below CV 15 ST 25 ST 32 ST 41

Treatment Points: Treatment Points UB 13 UB 14 UB 15 UB 18 UB 20 UB 23 plus test points at each level inside or outside of the bladder meridian 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 the points listed above bilaterally from right to left and top to bottom into all of the points except for UB 15 which is inserted after having tested for aggressive energy on all of the other points first (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 be retained 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 Wei level of the body's energy, the superficial flow of energy commencing at the Lung and proceeding through the 12 main meridians to the Liver. This flow and the associated entry exit points (in red) are illustrated in the graphic below: Correspondence Lung Shu Pericardium Shu Heart Shu Liver Shu Spleen Shu Kidney Shu redness should be darker at associated shu point than at test needles for confirmation

The Classical Five Element Acupuncturist looks carefully for blocks along this flow. They are most often seen between meridians which connect, as opposed to yin/yang pairs such as LV/GB or 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 is a 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 thequalities which are used more 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 as such: 1. Heart 2. Small Intestine 3. Urinary Bladder 4. Kidney 5. Pericardium 6. Triple Heater 7. Gall Bladder 8. Liver 9. Lung 10.Large Intestine 11.Stomach 12.Spleen

A Spleen & Heart Entry/Exit (12/1-XII/I) block can be seen in the example below: Left Arm Yang SI/HT GB/LV KD/UB -1.5 -1 -1 Yin -1.5 -1 -1 Yin -1 +.5 -1 Right Arm Yang -1 +.5 -1 LU/LI SP/ST PC/TH

The Entry/Exit blocks are best explained as a dam between the flow of connected meridians. In a 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 the Entry/Exit points clears these blocks. In the case of an Sp/Ht Block you would first tonify the Exit Point of the Spleen, which is SP 21 Encircling Glory. Next you would tonify the Entry Point on the Heart meridian, which is HT 1 Utmost 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 LU LI PC TH HT SI SP ST LV GB KD UB LU 1 LI 4 *(LI 1) PC 1 TH 1 HT 1 SI 1 SP 1 ST 1 LV 1 GB 1 KD 1 UB 1 Exit LU 7 *(LU 11) LI 20 PC 8 *(PC 9) TH 22 *(TH 23) HT 9 SI 19 SP 21 ST 42 *(ST 45) LV 14 GB 41 *(GB 44) KD 22 *(KD 27) UB 67

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 25 is termed "Spirit Storehouse." KD 25 is used when the person is spiritually depleted, who use their stores up as soon as they get them. It is for patients who see no joy in being alive. Another example is LV 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 open the Gate of Hope to help them move on. With a few exceptions these points are always chosen from the patients CF Meridians. When tonifying a point it is thought to be important to hold the Spirit 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 Points on the Chest Bladder Points on the Outer line Spirit Points on the patients CF CV a/or GV Kidney Points on the Chest

Point

Spirit/Usage "Through the Valley" full of fear, feeling trapped, feelings of negativity, someone facing death, suicide a/or loneliness "Dark Gate" everything appears as "dark" or negative "Walking on the Verandah" lacking a sense of protection or safety in the world, cannot walk freely "Spirit Seal" lack of connection with ones own spirit or identity/self, low spirit "Spirit Burial Ground" depleted spirit, depression, deep loss of sense of self "Spirit Storehouse" spirit requires nourishment "Amidst Elegance" lack of sense of beauty or grace, self respect "Storehouse" depleted spirit, helps to tonify the spirit of a person

KD 20

KD 21

KD 22

KD 23

KD 24

KD 25

KD 26

KD 27