Five Elements, Twelve Officials, and the Causative Factor

By Neil R. Gumenick - June 22, 2016
Five Elements, Twelve Officials, and the Causative Factor

By Neil R. Gumenick

The Five Elements

For thousands of years, the Chinese observed Nature’s rhythms and cycles through the model of the Five Elements: wood, fire, earth, metal, and water. These elements are in everything, everyone, and observable in any process. In nature, for a plant to grow, there must be a seed capable of growth (wood), sunlight and warmth (fire), soil (earth), minerals, trace elements, and air (metal), and, of course, water. Too much or too little of any of the elements would place the plant in peril. The expression of the seasons (spring, summer, late summer, fall, and winter) is another way in which we see this unchanging cycle. Furthermore, we can analyze any process in terms of its beginning phase (wood), its fruition (fire), its harvest and decline (earth), its letting go (metal), and its resting phase (water). The Chinese understood human beings to be microcosms, meaning that within us are the same elements that are found in nature. When these elements are functioning in health and balance within us, we experience health. If the elements are imbalanced, disease must be the result.

The Twelve Officials

Each of twelve fundamental organs and functions is associated with a specific element. The heart, small Intestine, two functions known as the Heart Protector (or “pericardium”), and Three Heater (or “sanjiao”) are associated with the element fire. The stomach and spleen are associated with earth, lungs and colon with metal, urinary bladder and kidney with water, and gall bladder and liver with wood.

We call these organs and functions “Officials,” because they are more than physical entities, as understood in the Western medical model, with only physiological tasks to do, but as “beings” so to speak, with definitive physical, mental, and spiritual expressions. The early Chinese conceptualized these Officials as ministers of an imperial court, in service to the monarch and the well-being of all. It is important to remember that the kingdom is, in reality, a metaphor for the totality of the body, mind, and spirit of a human being. As in the metaphor, the well-being of the whole kingdom depends on the healthy, smooth, and harmonious working of the Officials. If an element becomes imbalanced and falls sick, the function of its associated Officials will also be imbalanced and will inevitably imbalance the functioning of every other Element and Official, as all are related, like a family.

Interdependency of the Officials and the Importance of Balance

To understand the interdependency of the Officials, let us consider a hypothetical example. Suppose a team of emergency responders must launch a rescue mission in a flood. There will be a division of assigned duties for the mission to succeed.

Someone will gather information about the objective: what is the terrain and how can it be approached? How will evacuation occur? Someone will gather sufficient personnel. Someone else will arrange transportation of personnel. Another will assign tasks. As an emergency rescue situation, with flooding on the increase, speed is of the essence. Yet another will procure the needed supplies, food, and equipment. There will be rescue teams, medical teams, trucks, drivers, pilots, helicopters, boats, medical personnel, a communications network, and a command post to coordinate it all.

It is not difficult to see that if even one of these team members were to become sick and unable to do his or her part, the entire operation would be in peril. Disharmony will soon spread to everyone, and it will not stop until the sick member, whose absence caused the problem in the first place, recovers and is back on task. Only then will all once again work together as an efficient team. The mission will proceed as smoothly as possible, and a unified, healthy team has the best chance of a successful outcome.

It is the same in us. The Officials are the team, ordained by nature to excel at certain vital tasks. The mission of the Officials is to grant a true and full experience of life and health on all levels. In fact, the Chinese asserted that it is impossible for illness to gain a foothold if these Officials are functioning in health. Simply put, the Officials give us, according to their degree of balance and vitality, our level of health.

The Significance of Symptoms

Symptoms alone do not reveal their cause, but are only distress signals coming from the body, mind, or spirit saying, in essence, “Help me. Something is going wrong.” My teacher, Professor J.R. Worsley, used the analogy of a car. If a red warning light were to illuminate on the dashboard, it is a symptom, not the problem itself. We could simply place black tape over the light and believe we had solved the problem. Obviously, the underlying problem would not be affected at all. In time, the vehicle would make another and more serious attempt to get our attention. Having ignored the first warning signal, the next one might be smoke spewing from the engine. Were we to ignore that, the car might stop completely or even catch fire and explode.

Nature gives us warning signals in the form of symptoms, which we tend to ignore, or worse, suppress by symptomatic treatment. Suppression of symptoms shuts off the body’s attempt to communicate with us that there is a problem. The result is that the underlying disease goes deeper; the patient becomes sicker; the symptom will likely reappear more seriously in time, and/or new symptoms of the original imbalance will present themselves. As we have seen, any symptom can be the result of imbalance anywhere, as all are connected. Thus, in this system, we would not treat any two patients the same, even if the symptoms were similar in both. What is causing symptoms in one patient may be very different from what is causing the same symptoms in another. Thus, we do not employ formulas or point prescriptions based upon symptoms, but rather attend to the individual needs of the patient’s body, mind, and spirit at the level of cause.

The Causative Factor

Every human being is born with, or develops early in life, an imbalance in the natural functioning of the Five Elements, with one element being the primary source of imbalance. This primary imbalanced element, called the Causative Factor (CF), is the weak member of the team and the root cause of a person’s illnesses of body, mind, and spirit. The concept is as old as Oriental medicine itself. The ancient Chinese medical text the “Ling Shu”, the second half of the “Yellow Emperor’s Classic of Internal Medicine” written some 2000 years ago, discussed (Ch. 64) the diagnostics of five main types of people, corresponding to the Five Elements, including the concept of each element having, within itself, further expressions of all five.

Throughout our lives, the CF does not change from one element to another, regardless of how symptoms change with time. The intensity of expression of the primary imbalance and the labeled symptoms may vary, according to the state of an individual’s health, but the underlying imbalance or predisposition is ours for life. Therefore, the thrust of Five-Element treatment is to help, support, and restore the balance of the CF in the exact way needed by each unique and individual patient. In this way, symptoms, which are only the expression of the underlying imbalance, resolve naturally. When we properly treat the CF, all of the symptoms in every affected system and at every level must change for the better, provided that the disease has not progressed beyond the reach of nature to reverse.

The presence of a Causative Factor imbalance means that, to some extent, we are out of balance within ourselves and with the world around us. It means that we are, as yet, imperfect, in process, with lessons still to learn and work on ourselves still to do. As we have seen, the primary imbalance creates weakness not only in the CF element and its associated Officials, but also throughout the entire system. If one is sick, eventually the rest will become sick as well.

All elements are connected via the Sheng or Generation cycle. In the same way that a mother nourishes her child, so does each element nourish its “child” element. Wood is the mother of fire, for example. If the fire is deficient, wood is the element that will feed it. If any element falls sick, it cannot properly feed and care for its child. Soon, the child element will begin to “scream” in distress and become symptomatic, as will the next element in the cycle, and the next, as the imbalance continues to spread. Thus, symptoms can manifest anywhere. Most experienced practitioners know that, by the time a patient comes for treatment, we are likely to find all twelve pulses imbalanced and symptoms coming from many of the Officials and more than one element. The question remaining is: how do we know which element is the CF–the ultimate source of the symptoms?

The Four Diagnostic Pillars

The moment an imbalance occurs in any of the elements, nature gives us four clear and distinct signs. The odor emitted by the body will take on a characteristic smell. The color in certain areas of the face will change and certain colors will predominate. The sound of the voice will change and certain sounds will be inappropriately expressed or strangely absent. The emotions will change and, like the voice, will similarly over- or under-express. Each of the elements has a corresponding odor, color, sound, and emotion with which it is associated and which can be perceived when the particular element is the Causative Factor. While it is relatively easy to memorize the associations, developing the skills to truly see, hear, feel, and smell these imbalances requires focused study, practice, and skilled guidance. Regardless of the presenting symptoms, it is only by odor, color, sound, and emotion that the CF is determined. When we perceive at least 3 of these 4 sensory indicators–the diagnostic pillars–pointing to one element, we know that that element is the Causative Factor.

Diagnosing the Elements

Understanding the expression of the elements in the context of Nature helps to understand their expressions in human beings–both in and out of balance. Excesses or lacks of sound or emotion have nothing to do with whether the state of the underlying energy is excessive or deficient, which is determined by pulses only.

Wood is the energy of spring. It gives the power of new beginnings: birth and rebirth. It gives us assertiveness, direction, confidence, and the vision to move forward. Its Officials are the gall bladder and liver. The odor is rancid–like the smell of old fats, butter, olive oil, unscented lanolin, and furry animals such as goats, sheep, and llamas. The sound is shouting. Regardless of the volume, this sound has a “telling you off” quality. It sounds like a challenge; it has a pushy, punching quality, as if the person is simultaneously pointing an accusing finger at you. The color is green. The emotion is anger. When appropriate, anger is the driving force that propels us toward our goals, regardless of the presence of obstacles. When imbalanced, the emotion becomes incessant anger and frustration, though there may be nothing about which to be frustrated. Rather, there is an ongoing sense of battle, in which everything and everyone is seen as an enemy. In the other extreme, the wood-imbalanced patient can lose vision and hope, surrendering self-assertion, self-direction, and unable to muster the emotion of anger, even when appropriate.

Fire is the energy of the summer season, providing warmth and light, granting us the ability to love and be loved. It is the power of maturity. Its Officials are the heart, small intestine, heart protector (PC), and Triple Heater (SJ). Its color is red. In the case of a fire-imbalanced patient, the color red or ashen grey (lack of red) will appear. The odor scorched (or burnt) will be present. The sound of laughing and the emotion joy will inappropriately predominate, or its opposite–lack of laughter and joy. In the case of excess, the person will laugh at things that are not remotely funny, or express joy when another emotion would be appropriate. When lacking, we may find a patient who cannot laugh, even when things are funny, or one who cannot muster the emotion of joy, even in the midst of warm and happy circumstances.

Earth is the energy of the late summer–harvest time. It gives us the ability to nurture and care for others and ourselves. It is associated with the figure of the mother–our first source of nourishment. Its Officials are the stomach and spleen. Its color is yellow. Its odor is fragrant–the sometimes sickeningly sweet smell of infant vomit, overripe fruit, a bakery, or bad perfume. Its sound is singing, a sound we make when endeavoring to soothe or comfort another, or when we are in such need ourselves. The voice often has a whining, melodic, complaining, and pleading quality. The emotion is sympathy, a natural human emotion that manifests in a given and appropriate set of circumstances. A person with an earth imbalance will either be overly needy of sympathy or may reject it entirely. The earth-imbalanced patient may want all of the sympathy for him or herself, regardless of the needs of others, or may exhaust him or herself in caring only for everyone else.

Metal is the energy of autumn. It gives us our sense of self-worth and the capacity to see the value in others, the power to be inspired, to take in the new and fresh, and the power to let go of what is waste or unnecessary. It is associated with the figure of the Father. Its Officials are the lung and large intestine. Its color is white. Its odor is rotten, the smell of excrement, rotten meat, a garbage can in which unused food has been deposited. The sound is weeping. The voice has a falling-off quality, often with a cracked, cutting, or dismissive tone. The emotion is grief–the emotion we feel appropriately in the face of separation or loss. In the metal-imbalanced patient, the emotion may manifest as excess grief, present even though there is nothing in particular over which to grieve. It is, rather, a pervasive sense of loss, remorse, and regret. In some cases, the patient may live in denial of grief and not be able to access the emotion at all. Thus, in escaping the pain of grief, the patient can not achieve catharsis, eliminate what is old and toxic, or appreciate what is new and inspiring.

Water is the energy of winter, the coldest and darkest of the seasons, preserving and storing. Life at the surface of the earth seems to have disappeared, but winter’s power is latent and potent. It gives us endurance, flexibility, and cleansing. It is a time of hibernating, of gathering our reserves and recharging ourselves. Its Officials are the bladder and kidney. Its color is blue. Its odor is putrid, like urine, stagnant water, or a fish market. The sound is groaning, the sort of sound one makes when exhausted, but needing to push onward. The emotion is fear–appropriate in circumstances when we need be cautious and wary of danger. The water-imbalanced patient will express fear, alarm, and vigilant arousal in the face of imagined present and future terrors, even though there may be nothing, in reality, to fear. In the other extreme, he or she may live in denial of fear and present a façade of daredevil fearlessness and toughness.

Reawakening our Senses

To Smell

As young children, we all had the sensory abilities to smell, see, hear, and feel. To regain these sensory gifts requires deliberate practice. These skills cannot be learned from books. One will not re-awaken the ability to smell, for example, by reading about Chinese medical diagnosis. A young baby can smell its mother the moment she enters the room. There is no need for the child to crane its neck to see who is there. It recognizes her by her smell. We all had that sensory gift once, but have lost it through lack of use, our attentions having been distracted into other pursuits.

It is well-known that when a person loses a sense entirely, other senses sharpen to compensate. In truth, we do not have to lose our sight or hearing in order to redevelop our sense of smell. The odor given off by the patient is of primary importance in diagnosis, as the olfactory sense switches on the entire sensory apparatus. Our sense of smell is our oldest sense. The olfactory area of the brain is also its primary emotional area, the site of our most primal memories–where we not only sense our environment, but become one with it.

We can begin to regain this sense by consciously smelling a dozen (or more) things every day: paper, plastic, pens, pencils, tea, coffee, etc. Wool smells different from cotton. Oranges smell different from apples. Every time we take the opportunity to engage odor, we awaken this sense more and more. This person smells different than the next one. How can we know without this vital sense? Patients emit the odor of their imbalance constantly. It is of no use if we cannot smell it.


To See

Most of us simply do not see. Often in a hurry, we generally do not bother with more than cursory glances. We do not see the beauty of nature even as we pass it by. A key to reawakening this sense is to be relaxed, in no hurry, and become as conscious as possible of the beauty and perfection of every aspect of what we are seeing. Were we to really see a flower, we would likely overflow with emotion. The utter grandeur of its color, structure, texture, its life and spirit would be almost too much to fathom. We can sense the impermanence of a flower, which only increases our gratitude for it, and opens our heart to the flower. Every flower has a spirit. When we see through the eyes of our own spirit–pure, unobstructed awareness–we see the spirit in everything. We discover that no two trees are the same, nor are two blades of grass. If we simply look, but do not take the time to see, we see “grass”, but not the unique living quality of a single blade.

It is with such spiritual eyes that we must see each other. To see the state of the spirit in our patients requires opening this sense. As glorious as it is to see flowers and trees, we will never behold a more majestic sight as the spirit of another human being. It is with such vision that we must see our patients. We must not simply look at them. Looking, we receive data, form opinions and judgments in our minds; we may identify and categorize; we may find patients we like and others we dislike; we may evaluate based on outer appearance: hair, clothing, figure, facial features, etc.–little of which is of value in perceiving who they are.

Seeing, we can perceive not only their exterior selves, but who they are at their core: the Divine within. Seeing, we can perceive their diagnostic color or colors. We can see the layers of suffering and trauma that have obscured the connection with their essential Self. Their essential Self is exactly the same as ours. The rest is process and life experience in its many forms. In many ways, we find their life process, with its joys and sorrows, to be much like our own. Thus, we cannot help but feel love and compassion for them as we help them along their way. We can know their needs. Our choice of points is simply the response to those needs. In many cases, treatment of the mental and spiritual levels involves using points for their spiritual connotations, indicated by the point names from the ancient Chinese calligraphy.


To Feel

The sense of touch, as well, must be redeveloped. We can develop this sense to a high degree in learning to palpate twelve pulses on the patient’s wrists, each pulse corresponding to an Official. We also can glean tremendous diagnostic information beyond pulses. When we take a patient’s hand, or touch the patient in any fashion at all, we are making far more than physical contact; we are touching the mind and spirit as well. A little child knows if his or her mother is happy, sad, or angry through touch. We had that gift once ourselves, but discarded it.

With our sense of touch developed, our hands act as sensory antennas, receiving the multiplicity of messages a patient sends, consciously or unconsciously. Making physical contact is analogous to “plugging in” and activating our internal radar system. How a patient takes our hand or reacts to our touch will often reveal far more truthful and reliable information than words. We communicate messages to our patients with our touch, as well–consciously or unconsciously. When we become aware of what we are both are communicating through touch–pulse-taking, palpation, a handhold, and any other means of personal, professional contact, as well as through not touching and creating distance–we have, beyond words, another, and often truer, means of diagnosis.

Becoming conscious of touch, we can begin to know what patients like, want, and need, as well as what they reject, without relying on words alone. We will feel within ourselves any inappropriate responses in the patient as they occur. We feel it as a jarring of our own internal sensors. Some patients continually need warmth communicated via touch, others need reassurance, sympathy, acknowledgement, firm direction–to name a few. Yet others will reject these offerings. In either case, their every action or reaction is significant, revealing who they are and what they truly need.

We must be conscious, as well, of what we are giving. Our messages to the patient must be congruent expressions. It is confusing to the patient if we give a mixed message, such as saying, “glad to meet you,” while unconsciously pulling away. The message says both “come closer” and “stay away.” The patient’s reaction will be unreliable, as the reaction will not be to a clear and congruent message, but a confusing one. If our communication is clear, the mix of our words, facial expressions, body language, gestures, touch, sound of our voice, underlying emotion, and look in our eyes will give one clear and congruent message. The patient’s response will be clear to us, as well.


To Hear

Perceiving a patient’s need is also a matter of listening. Most of us hear no better than we smell or see, for we are habituated to hearing words and ignoring the deeper messages. In this system of medicine, we must hear more than words: the “music” behind the words. Much of what comes out of the mouth of a patient is utterly unreliable. Patients wear “masks” and present their façade rather than their truth. As a society, we are conditioned to conceal our true feelings and, unless in an extreme emotional state, give polite but superficial answers when asked about ourselves. We, as questioners, tend to accept the superficial verbal answer at face value and move on. However, if we listen to how the words were said, we perceive the deeper truth behind the words.

In this system of medicine, we must take the time to listen. Listening to the sound of the voice, we can perceive when it is inappropriate to the context. The sound of laughter where we would expect to hear weeping, for example, will jar us with its inappropriateness. Repeated inappropriate expressions call our attention to an element’s cry of distress. Beyond identifying the sound in the voice, however, we can know the level–physical, mental, or spiritual–at which the patient is imbalanced and exactly what the trouble is. Many patients, when asked, “how do you feel?” will automatically say “fine”, yet from the sound of his or her voice, we can well determine if that patient is truly fine or not. From the sensory information, not from symptoms, we can choose the exact points to fulfill the needs of the patient. Then, whatever its label, nature itself will throw the disease out.

Every human interaction provides us with opportunities to note what is appropriate, inappropriate, and what a person’s true needs are, if our senses are awake. In or out of the treatment room, the expressions relating to the Causative Factor will be a recurrent theme detectable in nearly everything patients say or do. By truly using our senses, we can know what is happening within our patient–in some cases, better than our patients know themselves.

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Neil R. Gumenick

Professor Neil R. Gumenick is Founder and Director of the Institute of Classical Five-Element Acupuncture Inc., which offers training to acupuncturists, physicians, and students of Oriental Medicine in this profound system of body/mind/spirit medicine. He has maintained a private practice in Santa Monica, CA, since 1981 and is a professor at Yo San University. Neil holds three degrees and an advanced teaching credential from The College of Traditional Acupuncture (UK), awarded by the late Professor J.R. Worsley. Neil was recipient of the 2007 AAAOM Pioneers and Leaders in Acupuncture and Oriental Medicine Award, and is one of the world’s foremost practitioners, teachers, and writers on the subject of Classical Five-Element Acupuncture.

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