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Chinese Medicine Theory – 5 Elements, Wu Xing

19 December 2013

Like Yin Yang theory, and Six Qi theory, Five Element theory is one of the very early, and still one of the very core, concepts of traditional Chinese medicine.

On the surface it is a beautifully simple system of generation and control. Underneath, the more one studies it and practises it, the deeper and deeper it goes. Enormous volumes of classical texts were devoted to applying this theory to medicine. It can become quite complex.

The 5 elements are basically a man-made system designed to help us understand natural processes and relationships. It can be applied to sciences outside the body like astrology, climatology, biology, ecology, music, and government and military strategy.

In medicine, that is Chinese medicine, it is a valuable tool for helping to understand normal physiology. For example, it can be used to explain the process of aging, how the various tissues and organs support each other, and the chains of command and control within the body in order to maintain balance.

The theory also allows us to understand disease processes – pathology. Why do things go wrong? What likely complications can be expected from a particular issue? How do we put things back into their normal place, and in what order of priority, so that health can be restored?

What are the 5 elements?

The elements themselves are more concepts rather than physical entities, though they do include the physical entity. Often the term “Xing” is translated as phases, agents, processes, periods, virtues, or stages, to stress that they are not only physical. These various translations also seek to separate the theory from the ancient Greek “four elements” which were absolutely physical.

The five elements are:

Wood, Fire, Earth, Metal, Water

Each element has a series of correspondences that guide the practitioner in understanding which relationships are at play. The main ones relevant to the human body are:

    Wood   Fire   Earth   Metal   Water
  Season   Spring   Summer   None   Autumn   Winter
  Direction   East   South   Centre   West   North
  Climate   Wind   Heat   Dampness   Dryness   Cold
  Colour   Green   Red   Yellow   White   Black
  Flavour   Pungent   Salty   Sweet   Sour   Bitter
  Movement   Outwards   Upwards   Centre   Inwards   Downwards
  Yin organs   Liver   Heart   Spleen   Lungs   Kidneys
  Yang organs   Gall Bladder  Small Intestine   Stomach  Large Intestine  Urinary Bladder
  Tissue   Tendons   Vessels   Muscles   Skin   Bones
  Sense   Sight   Touch   Taste   Smell   Hearing
  Emotion   Anger   Joy   Pensiveness   Sadness   Fear

History of the five phases

The doctrine of the five phases is generally considered, by Chinese historians, to have been initiated by a gentleman named Zou Yan. He is thought to have lived around 350 – 270 BC. His school arranged both concrete natural phenomena and abstract concepts into not two (referring to the earlier Yin Yang theory) but five entities.

In the Han dynasty (206 BC – 220 AD), the theory reached its maturity. Having gone through a period of a few hundred years of review and criticism, often with the addition of grain as a sixth “element”, it reached its final characteristic and lasting form in the first century AD.

By the first century AD the five phases were firmly part of Confucian philosophy, which had become the social and political orthodoxy. Confucianism was to remain the dominant social doctrine for the next two thousand years, into the twentieth century.

The most influential text, the theoretical “Bible”, of Chinese medicine, the Huang Di Nei Jing (the Yellow Emperor’s Classic of Internal Medicine), completed in the Han dynasty, shows five phase theory in established use in medicine.

The Interrelationships of the Five Phases

5 elements


The first two cycles describe the normal order, how things should be. Within the body, this is normal healthy physiology.

The Generation Cycle (Sheng)

In this sequence there is the mutual generation, or birth, of the phases.

Wood generates (nurtures, produces, gives birth to, is mother of) fire, fire generates earth, earth generates metal, metal generates water, and water generates wood.

It is said that wood provides the fuel for fire; fire produces ashes, that is earth; earth brings forth metal, since metal is dug from the ground; metal brings forth water via condensation, or otherwise it is said that metal produces the minerals in water; water produces plants and trees, that is wood.

The Control Cycle (Ke)

In this sequence there is mutual control amongst the elements. This maintains balance, preventing any one element from becoming too dominant.

Fire controls metal, metal controls wood, wood controls earth, earth controls water, water controls fire.

Or it can be imagined as, fire melts metal; metal, for example in the form of an axe, cuts wood; wood in the form of tree roots, breaks up earth; earth in the form of an embankment or dam, controls water; water puts out fire.


The next three cycles explain what happens when the balance is broken. When things go wrong, there is a quantitative change in at least one of the elements relative to the others. That is, one becomes either excessive or deficient. In medicine, this is pathology.

The (pathological) Generation Cycle

When out of balance, the generation cycle is pathological. There are two possibilities:

1) The mother element makes the child element sick.

Either the mother is too excessive against the child, or the mother is too weak to nourish the child adequately.

For example, fire may be so excessive that it damages earth, or it may be too weak to create earth.

2) The child element makes the mother sick.

The child element takes too much from the mother element. For example, the fire element is excessive and consumes too much wood, or wood is excessive and consumes too much water, etc.

The Over-controlling Cycle

This is too much force exerted along the regular control cycle.

If excessive, wood may over-dominate earth, earth may over-control water, water may over-control fire, etc.

The Insulting Cycle

This is the reverse of the control cycle, where the element that is supposed to be controlled becomes the controller.

Here earth may be excessive and “insult” (damage) its controller, wood, and so on.

How are the 5 phases used in Chinese medicine?

Combined with the other core theories of Chinese medicine, particularly Yin Yang and the Six Qi (the 6 environmental influences) theories, in the clinic, the doctrine of the five phases plays an important role in not only physiology and pathology, but also diagnosis and treatment.

Below are some simple examples of how the theory might be used in diagnosis. In the examples, refer to the table above.

1) Generation cycle – mother makes the child sick

E.g. A productive cough with thick yellow phlegm.

This would be an example of Earth invading Metal. Earth is excessive and damages metal along the generation cycle.

Earth, because the phlegm is considered a form of dampness within the body, and dampness belongs to earth. Also the colour of earth is yellow. Metal, because the lungs (the organ involved with coughing) belong to metal.

2) Generation cycle – child makes the mother sick

E.g. Frost bite.

This is water invading metal. Water, because cold belongs to water; and metal, because the skin belongs to metal. Frost bite is cold damaging the skin.

3) Over-controlling cycle

E.g. A red painful sore on the skin.

This is an example of fire invading metal. Fire, because the colour red and the sense of touch, that is, pain, belong to the fire element. The sore is present on the skin which is the tissue of Metal. Sun burn also fits this diagnosis.

Fire should naturally control metal on the controlling cycle, but this is over-control to the detriment of metal.

If the red painful sore was in the intestines, as in an intestinal abscess, it would still be an example of fire invading metal because instead of being in the skin which is metal, it is in the large intestine which is also metal. The same would apply for a lung abscess.

4) Insulting cycle

E.g. A bladder infection.

This is fire invading water, which goes against the natural flow of water controlling fire.

Fire, because of the heat and pain that the infection produces (and also sometimes a reddish colour to the urine). Water, because the bladder is an organ of the water element.

Treatment in Chinese Medicine using the 5 Elements

In treatment, the doctrine of five phases uses a fairly complex set of rules (which are beyond the scope of this article), but basically, Chinese herbs and/or acupuncture points are selected to put the problematic excessive elements back in their place, and to support the weak elements so they are less vulnerable to opportunistic attack by the other elements.