The Five Elements: What Science Has to Say About This Chinese Medicine Theory

Five element theory, also referred to as Wu Xing or the five phases, has been a part of traditional Chinese medicine (TCM) for centuries.

According to a 2008 report, an early mention can be found in the ancient text Huangdi Neijing, which likely dates back to 300 B.C. Even so, this theory still has many believers today.

“The five elements are used in pretty much every different style of TCM to some extent [to] diagnose and differentiate between different illnesses, dysfunctions, and people,” says Tiffany Cruikshank, licensed acupuncturist, experienced registered yoga teacher, and founder of Yoga Medicine.

The five elements are each associated with an aspect of nature, a connection that runs deep.

“The five elements demonstrate how all aspects of human health, [like] diet, movement, and emotions, are interconnected with nature and our environment,” says Teresa Biggs, a board certified doctor of oriental medicine (DOM) with more than a decade of clinical experience.

The five element theory is used throughout Eastern medicine and culture. The five elements play a role in:

• herbs
• acupuncture
• massage
• movement therapy, like tai chi and qi gong
• meditation
• food and diet
• mental and emotional health
• organ systems
• personality expression
• sense organs
• tissues
• seasons
• the lunar calendar

You can see these relationships in the table below.

Science backs the existence of elements in nature, but their existence as a means to inform health treatment isn’t historically supported by research.

Still, more and more research is emerging using evidence-based methods.

One study from 2017 extended the concept of the five elements to a cellular level, noting that incorporating this theory could lead to a better understanding of the relationship between cells.

Another study from 2017 suggested that music therapy based on the five elements could reduce post-stroke depression when combined with acupoint needling or injection.

In 2020, researchers published work based on observational studies of Western medicine, homeopathic medicine, and TCM. They noted that “considering the Five Elements theory in the diagnosis and treatment of the patient could lead to a deeper and more effective… treatment.”

A 2020 overview of TCM and clinical pharmacology offers evidence-based research into using TCM, including the five element theory.

Researchers note several contributions TCM has made, including:

• evidenced-based empirical studies
• correlations and interactions between herbs and pharmaceuticals
• updated data on toxicity, adverse reactions, quality assurance, and herbal medicine standardization
• herbal medicines as an alternative to antimicrobial resistance in prescription drugs

Researchers recommended using TCM in conjunction with modern science as a way to prevent disease and strengthen the body with lifestyle changes.

The five element theory is a guiding principle in TCM, which Cruikshank says focuses on the person as a whole.

“This idea of using the five elements to diagnose someone isn’t just looking at the disease they have now but the roots of that,” she says.

To get to the root of the problem, TCM practitioners will often spend more time conducting a patient intake than a doctor in a conventional setting.

Cruikshank says the process can take 30 minutes or more. Biggs adds that licensed practitioners will often evaluate:

• lab work
• diagnostic imagery
• medical history
• mental and emotional health
• pulse
• tongue

“The pulse and tongue in TCM are like two internal GPS, conveying the current state of health and balance within the system,” Biggs says.

The TCM practitioner will then assess all of the collected information in attempt to determine the root cause of the issue, which Biggs says leads to a differential diagnosis.

“By treating [the] root cause of dysfunction, the symptoms are naturally resolved and health is restored,” she explains.

“The five-element theory mirrors the interdependent, dynamic, ever-changing energy present in nature,” Biggs says.

She explains that there are two cycles connecting each element, where each element has a job to do.

In the generating (or creative) cycle, each element gives way to the next.

In this cycle:

• fire generates earth
• earth generates metal
• metal generates water
• water generates wood
• wood generates fire

In the controlling (or destructive) cycle, “one element can control or be controlled by another element,” says Biggs.

In this cycle:

• water controls fire
• fire controls metal
• metal controls wood
• wood controls earth
• earth controls water

Cruikshank notes that because each element controls another and is controlled by another, it creates a balance. But dysfunction can occur when one becomes too prevalent.

“When there’s an imbalance in one element, it doesn’t usually stay in its [place],” she says.

In this case, the element may stop doing it’s job in controlling an element or promoting another.

One such example occurs when wood overpowers earth. Cruikshank says that wood affects our ability to regulate stress, and earth is linked to digestion.

“For people who have high stress levels, it’s common for them to have digestion issues,” she says. “In Chinese medicine, that’s… wood overacting on the earth and not letting it do its job of digestion.”

Re-creating harmony within the system can help provide relief.

“It’s really about moving stagnant qi in the liver,” Cruikshank says. “For someone working, they may need to manage their schedule.”

Qi is known as vital energy, your body’s innate intelligence. Some believe it guides your physical and mental-emotional processes and maintains equilibrium.

She also suggests movement — like running, yoga, and dancing — or acupuncture treatment.

“Acupuncture can move qi,” Cruikshank adds. “Anything that regulates stress can be helpful.”

If harmony is not restored, the imbalance can fester and grow.

“[Fire] can steal from water and [trigger] burnout, lower back aches, and depression,” Cruikshank says.

In this case, Cruikshank says movement can become depleting. She’d recommend more introspective practices like meditation, in addition to supplementation.

“We use a lot of herbs to support kidney deficiency,” she says. “Adaptogens and a little spice like ginger and cinnamon.”

As part of a person’s individualized treatment plan, a practitioner may make suggestions for self-care.

Because each element is associated with a season, you may experience specific imbalances during certain seasons.

“Usually, that’s when we need to cultivate and support that element the most,” Cruikshank says. “When people have imbalances with that element, it tends to become exacerbated [in that season].”

By learning about your own elemental tendencies, you can plan for seasonal effects and focus on specific methods of self-care.

For example, water is linked to winter. Cruikshank notes burnout can manifest during this season, particularly in people who are busy and don’t often have time for self-care.

“It’s a good reminder to slow down,” she says.

Cruikshank may suggest taking herbs, meditating, and doing yoga to gain introspection and support kidney deficiency.

“Our body focuses on doing, creating, and going in this external world,” she says. She suggests shifting energy to internal processes and your “body’s ability to heal, repair, digest, and create more energy.”

Biggs says people may also benefit from eating according to the seasons.

“During the colder months, the environment is adding the thermal property of cold to our system,” she says. To counteract this additional cold, “eat warm, nourishing foods that are available seasonally.”

These foods and ingredients might include:

• winter squashes
• sweet potato
• garlic
• onion
• cinnamon
• black pepper
• ginger

As the weather gets warmer, Biggs says consuming foods that cool the body can balance the excess heat.

Consider foods like:

• watermelon
• strawberries
• cucumber
• peppermint
• leafy greens
• uncooked vegetables

Year-round, you can use diet as a tool to regain harmony when you experience imbalance.

“Seaweed, being a salty food, can nourish the organs of water: kidney and urinary bladder,” Biggs says. “And if you’re craving salty foods, then this could indicate the water organ systems are out of balance.”

The elements are also part of the lunar year, with the 12 zodiac signs and animals that go along with them, though not all TCM practitioners use this system in their practice.

Each animal represents 1 year and has unique characteristics. For example, 2021 is the Year of the Ox.

Each 12-year cycle also corresponds to an element. Oxen are considered earth creatures, but the years 2020 to 2031 are considered “metal” years.

“Someone who is born during 2021 will have the influence of metal even though [oxen] are an earth creature,” says Tsao-Lin Moy, licensed acupuncturist of Integrative Healing Arts says. “You’ll see both in the person.”

What qualities, exactly, would a person born in a “metal year” possess? And how about people born in years corresponding to the other elements?

Moy provides some generalizations:

• Wood personalities may be firm and strong but also rigid or uptight.
• Metal types can be responsible and meticulous though sometimes unbending.
• Fire types may be boisterous and joyous but also quick to anger.
• Earth types may be caring and giving but can also be immovable, stubborn, or overbearing.
• Water personalities can be quiet, reserved, and introspective as well as emotive and sentimental.

Of course, these are simply caricatures of the personality types for easy understanding. When applied to actual people, they become much more complex and nuanced.

Moy clarifies that each element is connected, and we all have bits and pieces of each within us. Still, she says if an element is dominant in a person, it may influence personality traits.

Cruikshank and Biggs both stress it’s important to work with a licensed TCM practitioner to gain the most informed treatment using the five elements. There is no one-size-fits-all regimen in TCM, as the tradition focuses on the individual.

“There is a lot more complexity to it,” Cruikshank says. “If you have 5 people or 10 people who come in with headaches, they may have different diagnoses using TCM.”

Seeing a professional, rather than self-diagnosing, can help get you on the right track to regaining harmony.

Five element theory is not a replacement for medical treatment. It’s a holistic (whole-person) approach that can be integrated with your lifestyle and healthcare needs.

Biggs recommends several books to learn more about five elements.

The five elements have been a part of numerous alternative medicine traditions, including TCM, for centuries.

Some research suggests that the five element theory may help practitioners find and treat the root causes of a health condition rather than symptoms. However, more scientific research is needed.

Five elements theory should always be a part of a holistic approach to health and overall well-being. It is not a replacement for seeing a doctor.

Beth Ann Mayer is a New York-based writer. In her spare time, you can find her training for marathons and wrangling her son, Peter, and three furbabies.