Treatment Methods in Classical Five Element Acupuncture

TCM Theory

Treatment Methods in Classical Five Element Acupuncture

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.


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

Internal Dragons

GV 20 1/4" below CV 15
UB 11 ST 25
UB 23 ST 32
UB 61 ST 41
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.


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.

Treatment Points:

Treatment Points


UB 13 Lung Shu
UB 14 Pericardium Shu
UB 15 Heart Shu
UB 18 Liver Shu
UB 20 Spleen Shu
UB 23 Kidney Shu
plus test points at each level inside or outside of the bladder meridian redness should be darker at associated shu point than at test needles for confirmation
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:

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 the qualities 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:

A Spleen & Heart Entry/Exit (12/1-XII/I) block can be seen in the example below:

Left Arm

Right Arm

Yang Yin Yin Yang
SI/HT -1.5 -1.5 -1 -1 LU/LI
GB/LV -1 -1 +.5 +.5 SP/ST
KD/UB -1 -1 -1 -1 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



LU LU 1 LU 7 *(LU 11)
LI LI 4 *(LI 1) LI 20
PC PC 1 PC 8 *(PC 9)
TH TH 1 TH 22 *(TH 23)
HT HT 1 HT 9
SI SI 1 SI 19
SP SP 1 SP 21
ST ST 1 ST 42 *(ST 45)
LV LV 1 LV 14
GB GB 1 GB 41 *(GB 44)
KD KD 1 KD 22 *(KD 27)
UB UB 1 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



KD 20 "Through the Valley" full of fear, feeling trapped, feelings of negativity, someone facing death, suicide a/or loneliness
KD 21 "Dark Gate" everything appears as "dark" or negative
KD 22 "Walking on the Verandah" lacking a sense of protection or safety in the world, cannot walk freely
KD 23 "Spirit Seal" lack of connection with ones own spirit or identity/self, low spirit
KD 24 "Spirit Burial Ground" depleted spirit, depression, deep loss of sense of self
KD 25 "Spirit Storehouse" spirit requires nourishment
KD 26 "Amidst Elegance" lack of sense of beauty or grace, self respect
KD 27 "Storehouse" depleted spirit, helps to tonify the spirit of a person

Bladder Points on the Outer line:




UB 42 (37) T3/LU Shu metal cf, issues of grief or sadness, experiences of trauma
UB 43 (38) T4/PC Shu fire cf, weakness from chronic diseases, generalized fatigue
UB 44 (39) T5/HT Shu fire cf, spirit issues, emotional/psychological trauma, anxiety, insomnia
UB 45 (40) T6/GV Shu strong experiences of grief, cannot let go of past events a/or losses
UB 46 (41) T7/Diaphragm Shu issues related to breathing, counterflow qi (hiccups)
UB 47 (42) T9/LV Shu wood cf, issues of anger a/or resentment, lack of sense of purpose in life, depression, drug a/or alcohol abuse issues
UB 48 (43) T10/GB Shu problems with making decisions
UB 49 (44) T11/SP Shu earth cf, obsessive thoughts, overthinking, eating disorders
UB 50 (45) T12/ST Shu similar to above, digestive issues
UB 52 (47) L2/KD Shu water cf, lack of willpower, sense of hopelessness, weakness from overwork

Command Points

The last step in treatment involves the treatment of a patients CF directly. The overriding idea behind classical five element acupuncture is that by treating a persons root imbalance the rest of the meridians and associated symptomology will improve. The command points are not a single group of points but involve the full breadth of points used within classical five element acupuncture. Some of the more common command point categories are listed below:

Horary Points:

Horary Points are drawn from the Transporting (Five Shu) Points Chart in accordance with the active meridian times according to the Chinese clock (indicated in the graphic above) and the associated element you are interested in treating.

For example, to tonify the Wood Element, you would tonify the Wood point (LV 1) on the Wood meridian at the Wood time (1a.m. to 3a.m.).




Metal LU 8 3-5a
LI 1 5-7a
Earth ST 36 7-9a
SP 3 9-11a
Fire HT 8 11a-1p
SI 5 1-3p
Water UB 66 3-5p
KD 10 5-7p
Fire PC 8 7-9p
TH 6 9-11p
Wood GB 41 11p-1a
LV 1 1-3a

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