Introduction to the 5 Phases/Elements

The ancient Chinese understood the universe was in a constant state of change. They saw that things germinate and begin to expand (spring).  Grow and develop (summer) and they mature and ripen (late summer). They then begin to dry and wilt (autumn). They store and conserve (winter). For the ancient Chinese these five seasons (now called the five elements or five phases) were a constant sequence that continued endlessly. Each period of rest at winter was followed by one of new growth in spring. The 5 element/phases system is a traditional Chinese way of explaining the relationships and interactions between all natural phenomena. It is not just particular to Traditional Chinese medicine it is used to understand many different aspects of ancient Chinese thought and society, areas such as politics, astrology, martial arts, and music.

Each one of the phases has its own correspondences, these may be directions, sounds, colours, and importantly for medicine emotions, organs, body parts and tendencies to states of health and illness

	FIRE	EARTH	METAL	WATER	WOOD
Yin Organs	Heart	Spleen	Lung	Kidney	Liver
Yang Organs	Small Intestine	Stomach	Colon	Bladder	Gall Badder
Sense Organs	Tongue	Mouth	Nose	Ears	Eyes
Colors	red	yellow	white	blue/black	green
Sounds	Laughing	Singing	Crying	Groaning	Shouting
Emotions	Joy	Worry or Pensiveness	Grief or Sadness	Fear	Anger
Seasons	Summer	Late Summer	Autumn	Winter	Spring
Environment	Heat	Dampness	Dryness	Cold	Wind
Tastes	Bitter	Sweet	Pungent	Salty	Sour

To understand how the elements relate to each other we use two models. The generating cycle and the control cycle, which can be used to understand and treat element imbalances.

The Generating Cycle

The strength of an element is dependent of the strength of the previous phase. This is called the mother and child relationship. In TCM if an element is weak we often treat the weakened element and its mother element for added benefit.

As TCM (traditional Chinese medicine) practitioners we remember the generating cycle this way:

§  Wood feeds Fire;

§  Fire creates Earth (ash);

§  Earth bears Metal;

§  Metal carries Water (as in a bucket or tap, or water condenses on metal);

§  Water nourishes Wood.

The Control Cycle

This cycle is preventing one of the elements from becoming too dominant.

In the clinic we might see a patient with an excess of fire. The main fire organ is the heart which dominates the spirit. This might be seen in problems such as anxiety insomnia etc. To help this we might use points and herbs that benefit the Kidneys (the water organ) to balance out the excess fire.  Similarly an element can overact on another such as when wood over acts on earth, this is one of the most common 5 element diagnoses of IBS.

§  Wood Holds  Earth (such as roots; or, Trees can prevent soil erosion);

§  Earth channels Water (or an Earth dam can control water);

§  Water quenches Fire;

§  Fire melts Metal;

§  Metal chops Wood.

Reports from the Frontiers of Acupuncture: Dr U Win Ko talks traditional Myanmar medicine

Dr U Win Ko

In January 2010 I was privileged to be part of a small team of TCM practitioners who travelled to Sagiang in Myanmar (Burma). This was part of an ongoing project that has been teaching acupuncture to doctors of

traditional Myanmar medicine (TMM). One of the main driving forces behind the success of this project is Dr U Win Ko, a teacher and practitioner of traditional Myanmar medicine with some 30 years experience.

DK: Can you tell me about the history of traditional Myanmar medicine (TMM)?

Dr UWK: I should first explain what TMM is. As defined by the World Health Organisation (WHO), TMM includes a range of diverse health practices, knowledge and beliefs. It incorporates plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, which can be applied individually or in combination.

TMM has four basic principles:

• Desana Naya

• Beithizza Naya (ayurvedic method)

• Netkhatta Naya (medical astrology)

• Vizzadhara Naya (medical alchemy and spiritual powers)

We find written evidence of TMM in votive tablets from the Bagan era (10th century). It is generally believed that basic medical knowledge spread to Myanmar from India with the propagation of Buddhism. However, Desana Naya was invented by the physician U Hmont in the 17th century and has been in use ever since.

DK: What are the main diagnostic methods? What form of treatment do you most often use?

Dr UWK: Most TMM practitioners use a four-stage diagnostic method:

• analysis of urination based on Karma Smuthana (frequent, infrequent or painful urination related to sheeta (cold)         and ushna (hot)

• inspection of abdomen based on sheeta and ushna

• Utu Smuthana (seasonal causes): symptoms are aggravated or improve in cold or hot seasons, times or situations; patient has a feeling of aversion to cold or hot

• Ahara Smuthana (food-related causes): the symptoms are aggravated or improve when cold or hot foods are eaten.

Finally, the practitioner diagnoses and treats according to the following factors:

• the organ affected

• whether the cause of the disease corresponds to hot or cold

• whether the internal Prithvi (earth) element is excessive or deficient

• whether the Apo (water) element is excessively dispersed in the external part of the body.

The form of treatment I use most often is to harmonise the excessive or deficient element first, then regulate the affected organ, and finally reduce the symptoms.

DK: What is your history and connection to TMM?

Dr UWK: Actually, my initial ambition was to be a doctor of western medicine. But I was not eligible to attend the Institute of Medicine after matriculation on account of my score, so I went to the Arts and Science University in

Mandalay. Then I took an entrance examination for the Institute of Traditional Myanmar Medicine, which had been recently opened by the Ministry of Health. This was in 1977 and I was 19 years old. It satisfied my desire to work  in medicine, as although I was not a doctor it allowed me to become a practitioner and treat illness.

After a four-year course, I received my diploma in TMM. Following that, I worked for 16 years in the Ministry of Health. I was also in charge of a township’s traditional medicine centre and was an instructor, lecturer and physician. I retired in 1997 and continued to work full time in my own clinic. When I was in government service, I could work in my clinic only in the evening. My grandfather was also a practitioner of TMM, so I was able to inherit some of his knowledge.

DK: What do you think about the future of TMM in your country?

Dr UWK: Well, to answer that I have to briefly continue the history of TMM. Before 1976 knowledge of traditional

medicine was passed on from father to son. In 1976, the government opened the Institute of Traditional Medicine for a four-year diploma course, and in 2001 the University of Traditional Medicine started a five-year degree course.

Some study with experienced practitioners, by practising and observing over a number of years,

whereas others gain their knowledge through courses at the Institute or University, or the Ministry of Health’s Department of Traditional Medicine. These practitioners provide the entire nation with comprehensive traditional medical services through the existing healthcare system, either via Ministry of Health traditional medicine hospitals and township medical centres or via private clinics.

The important thing is people’s belief in TMM. In Myanmar, people respect TMM as our traditional heritage and believe it can treat the root of the disease causing chronic illness. Because local people accept and use traditional medicine, and because the government encourages it, TMM practitioners have a brilliant future.

Acupuncture outreach in Gadaw Village

DK: When did you start learning acupuncture? 

Dr UWK: When I was in my final year at the Institute, an acupuncturist who had just come back from China came to speak to us about his experiences and acupuncture’s efficacy. I was very interested to learn more. Fortunately,in 2000, I got the chance in Wachet Jivitadana Sangha Hospital, with the encouragement of Sayadaw U Lakkhana (the abbot of the monastery that supports our hospital). I was taught by Dr Michael Zucker from Hawaii and Dr Daniel Bruce from New Mexico. This teaching programme has continued every year since, with teaching from many foreign acupuncturists.

DK: How much similarity is there between Chinese and Myanmar medicine?

Dr UWK: TCM and TMM are both Oriental medicines and as such share certain understandings of causes of diseases, but they are quite different in their concepts of the five element theory and physiological aspects of the body. For instance, what in western medicine is called hypertension usually corresponds to one of five distinct patterns in TCM: liver fire uprising, deficient yin/excess yang, obstruction of phlegm and dampness, interior liver wind, or

deficient yin and yang. However, inTMM hypertension usually corresponds to functional disorder of one of the five elements, and the concept of these elements is quite different from TCM. In TMM, the human body is believed to be composed of earth (Prithavi), fire(Tezo), wind (Vayu), water (Apo) and space (Akasa). The earth element for instance corresponds to touchable, solid things in the body, such as the skin, the lungs, the heart, whereas in TCM it is believed to correspond to the spleenand stomach. So the two traditionsare quite different in certain aspects.

DK: What are your hopes for the future of acupuncture in Myanmar?

Dr UWK: I think it will depend on four main factors:

• efficacy

• public acceptance

• state encouragement

• integration with TMM.

All four aspects look promising at the moment. For example, the Ministry of Health established a department of acupuncture in the University of Traditional Myanmar Medicine in 2001 and since then every student has a chance to learn acupuncture in their third and fourth year. In terms of integration, at presentsome TMM practitioners have already studied a basic acupuncture course, so they have some experience integrating TMM and acupuncture in their treatments. Based on my experience, integration can reduce the duration of treatment for certain conditions, especially for strokes, post-traumatic injuries and gynaecological problems.

A very big refresher course in Myanmar (Burma)

In January 2010 I was privileged to be part of a small team of TCM practitioners who travelled to Sagiang in Myanmar (Burma). This was part of an ongoing project that has been teaching acupuncture to doctors of traditional Myanmar medicine (TMM). John Hamwee one of my colleagues has given me permission to publish this article detailing our time there.

This article first appeared in the spring 2010 copy of the acupuncturist the magazine of the British Acupuncture Council

JOHN HAMWEE MBAcC

Acupuncture Practitioner: Cumbria and Oxford

About 20 years ago a young American sat in meditation for long months in the hills of Sagaing, an important centre for Burmese Buddhism, overlooking the Ayeyarwady river near Mandalay. One day he came down to the village and a woman, a perfect stranger, seeing this westerner and apparently taking pity on him, gave him a bottle of C

oca-Cola. He was deeply touched by the gesture and thought, I must give something back. He found many ways to do so, and one of those ways was to institute an annual visit of western acupuncturists to the nearby hospital. This was the tenth annual visit. There were five of us, four from the UK and one from the USA. For one of our party it was her fourth visit, for another the second. It was my

first time, though it won’t be my last. I worked harder than I have ever worked in my life, I paid all my own expenses to get there and back, and I can’t wait to go again.

The set-up was that we worked for a week in the hospital where there are two rooms given over to acupuncture, one with about twelve beds in it and the other with about ten. Then we moved to work in a village where there were no beds, strictly speaking, so we worked on raised platformsin the monks’ dormitory, or outside. I didn’t count but I suppose there were about the same number of spaces available to patients.

And we needed them. There were almost 100 people the first day, more each day afterwards and, we were told, nearly 500on the last day. That may have been an exaggeration but the patients certainly came in waves and we did have to findnew spaces to work. That last day was all abit of a blur, partly because we were sobusy and also because we were all verytired by then, but as far as I can tell I treated 26 people myself and I supervised a further 40 or so treatments.

Which brings me on to how we worked. We had with us three local acupuncturists who had been qualified for some years and about sixteen young practitioners, in their twenties, who had qualified recently. It was a big part of our remit to act as teachers to the young people, mainly in

the clinic but also with a lecture each day.

They were all pretty good, so by the time the

numbers really hit the roof we westerners were

able to spend as little as five or ten minutes with each patient. We’d agree a diagnosis and treatment plan with one of the students and then leave it to her or him to do the treatment, coming back to check the pulses at the end. In that way, the five of us managed five or six patients at once all day long. Although some of the students were delegated to crowd control, and the senior people were usually otherwise occupied, there were still about twenty of us, each treating, say, three people an hour for about seven and a half hours. So that’s how we made up the numbers. Naturally, there were translation problems.Huge numbers of patients complained about ‘numbness’ for example but were normally sensitive as far as we could tell.We never really got to the bottom of what they were trying to tell us. More generally, because we couldn’t take much of a case history, we had to work with a simple diagnosis of the state of the patient’s energy system; it was refreshing to see how much we could do with very few words.

It was a very steep learning curve for me. Normally I have one-hour appointments, and rarely see more than eight people in a day. Also, in my own practice I tend to use zero balancing rather than acupuncture for musculo-skeletal problems, of which there were many, but it wouldn’t have been any use to the students if I had done so there. So I struggled to remember bi syndromes and shoulder points and was pretty rusty for the first day or two, which the students noticed and charmingly forgave. It felt like learning acupuncture all over again. All this reaffirmed my deep respect for this system of medicine. It really did work on conditions for which I would normally use zero balancing or recommend osteopathy. It also seemed to work on conditionswhich I never see at home and which, as a result, I had to treat simply

from first principles. After nearly 20 years in practice I hadn’t realised that I hadbecome very limited in my thinking about acupuncture, assuming, in a rather lazy way, that it was good for what I used it for and a few specialisms like pediatrics and obstetrics but not much else. Wrong! Secondly, it taught me, as if I needed to learn, the value of having to explain a

treatment before doing it. At the beginning of the work the students wanted to know why I was planning to do what I was planning to do. Sometimes, in explaining, I came to understand my rationale; one which I’d never spelt out clearly to myself and which I could then apply to other patients and other conditions. Very satisfying. And sometimes, of course, when pushed to

explain myself I found that my thinking was woolly or inadequate, and it was a

pleasure and a relief to be made to think again and to come up with a better treatment than the one I first thought of. By the end I made the students write

down their proposed treatments before I would tell them what I would do, and I learned a lot from seeing two different but equally plausible sets of points. I often let the students do what they proposed, even when it didn’t seem to me ideal, and it was instructive to see the results of those treatments which, of course, I never do!

Finally, there was the whole process of working in a multi-bed setting. I loved it. I loved the noise and the bustle. I lovedglancing up at one of the students taking pulses on the opposite side and seeing inher eyes an agreement about what we were noticing. I loved people coming round to have a look at me needling Liv 14, Lu 1 (not a treatment they knew) and their

interest in the resulting pulse change. I loved calling a colleague over to assess a hip joint which moved, or rather failed tomove, in a way I’d never felt before. I liked having to talk less (it was tedious to wait for long translations) and having to senseqi more. And I liked the whole idea of seeing more people, more often, more quickly, for less money.

The whole experience has made me a much better practitioner and it will change the way I work from now on. I recommend it to those of you who feel like taking a very big refresher course.

Thanks to all at the Watchet JivitadanaSangha Hospital, especially U Win Ko and U Aung Min, and the students; to Kirsten Germann for leading us, and my colleagues Richard Graham, Dudley Kent and John Renna; and to Oxford Medical for their generous gift of supplies.

The hospital is run as a charity and receives no financial support from the Government. The programme I describe is run under the auspices of the MettaDana project which provides funds to local initiatives, including the hospital.

Contributions welcome

http://www.vipassanahawaii.org/mettadana_projects.php