Forming a Classical Five Element Acupuncture Diagnosis

TCM Theory

Forming a Classical Five Element Acupuncture Diagnosis

Diagnosis, which entails determing the causative factor, is primarily done through the observation of a persons colour, sound, odour and emotions or CSOE.






Colors red yellow white blue/black green
Sounds Laughing Singing Crying Groaning Shouting
Odor scorched fragrant rotten putrid rancid
Emotions Joy Worry/Pensiveness Grief/Sadness Fear 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.


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.


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 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 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.

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