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Five Phase Treatments


Five phase treatments are aptly named for both their relations to the five phases (elements) which they treat, but also that the treatment itself consists of five steps. Each step is very precise in its choosing of points to use and time in which to administer treatment. As with much of Japanese styles of acupuncture, five phase treatments are very subtle in their workings. How far the needle goes in, the direction of the needle placement, and the manipulation of the needle are very important. If you are unfamiliar with japanese needles check out the Needle Comparison Chart.

Step 1
Pulse: Feel the pulse and determine which pulse position, and in turn phase, is the weakest. Then see if the mother or son is also deficient. This is your pair. Focus on the son here, regardless which of the two is weaker, and that is the pattern under which you will treat. Let us take the kidneys as our example throughout the page. We felt the pulse and have determined that both the kidney and the lung are the weakest. We call this a kidney primary pattern. For all the pulse patterns click here.
Needling: In Step 1 we will be treating two points in a specific order. Using the command or five shu chart, we have the points laid out in the Nan Jing associated with the phases. On each meridian there is a point corresponding to each of the phases. The first point to treat will be on the primary pattern meridian (kidney here) and it will be the mother phase point (lung point here) on that meridian. The second point to treat will be on the mother meridian of the primary pattern (lung meridian here). The point to treat is the horary point on the mother meridian (lung point here). The horary point on any meridian is the point associated with the same phase as the meridian itself.

Yin Wood Fire Earth Metal Water
Lung LU 11 LU 10 LU 9 LU 8 LU 5
Kidney KD 1 KD 2 KD 3 KD 7 KD 10

If you look at the chart, feast your eyes on the column under the Metal phase (lung). These are your two points; Kidney 7 and Lung 8. Order is important here. First needle Kidney 7 since it is on the primary pattern meridian, then needle Lung 8. These are both being tonified so use a small needle, shallow insertion of 1-2mm, following the flow of the meridian. The side needled can be determined one of two ways. The first is the opposite side of pain or disease. So if someone has right shoulder pain, treat the side that is healthy, the left. If there is no pain or if the pain is bilateral then use the second method decided by gender. For men use the left; women use the right.
Time: 10 minutes (start counting after the second needle is placed).
Exceptions: The Pericardium/San Jiao pulse position is basically ignored in 5 phase since they both belong to the fire phase as does the Heart. Additionally, the Heart primary pattern is considered taboo in Japan and is not treated. They save it for extremely serious conditions of physical and mental illness.
Note: In our case of the kidney primary, the lung point Lung 5 may also be used as our second point. This was found through empirical work and does not necessarily come from the theory here.

Primary PatternPoints
LiverLv 8, Kd 10
LungLu 9, Sp 3
KidneyKd 7, Lu 8/5
SpleenSp 3, Pc 7
HeartPc 8, Sp 2 *
* The heart is explained at the end of this section.

Step 2
Pulse: With every primary pattern, there is a secondary pattern that is also treated. The possible meridians that constitute the secondary pattern are either the one that controls the primary pattern meridian, or is controlled by the primary pattern meridian (in the controlling cycle). With our example of the kidney, this means the possible secondary patterns are Spleen and Heart. However, as noted above, the heart is generally avoided under most circumstances for treatment, thus we choose the Spleen. In a case where two meridians are an option (like in treating a Spleen primary where you have either Kidney or Liver to choose from) you go by whichever secondary option stands out to you in the pulse, either by being more deficient or excess. So here we feel the Spleen pulse and we determine if it is excess or deficient (the Spleen is rarely in excess so for example purposes let's say it is deficient). If none of the above pulses seem deficient or excess you can also just do the same points as step 1 on the opposite side.
Needling: Step 2 involves one point being needled on the opposite side of the primary points. That point is the source point of the secondary pattern meridian. How it is needled is determined by the pulse and if it was deficient or excess. In our example, the Spleen is our secondary pattern, and thus our point is Spleen 3. Here we are dealing with a Spleen secondary deficiency so we are going to tonify that point by inserting a small size needle shallowly, 1-2mm, following the flow of the meridian.
Time: Remainder of 10 minutes from Step 1.
Exceptions: The Kidney is never thought of as being in excess, thus if you come up with a Spleen primary you can have either Liver secondary excess or deficiency, or kidney secondary deficiency.
Needle Removal: After the ten minutes has passed, remove the needles in the reverse order in which you put them in. So in this case, first remove Sp 3, then Lu 8/5, and finally Kd 7.

Primary PatternPoints
LiverLu 9 or Sp 3
LungLv 3
KidneySp 3
SpleenKd 3 or Lv 3
HeartLu 9 or Kd 3*
* The heart is explained at the end of this section.

Step 3
Pulse: Remove all the needles in steps 1 and 2, remembering to remove in the reverse order. Now check the pulse again, this time concentrating on the Yang organs. First find the most deficient and tonify that meridian. Then find the most excess and reduce that meridian. Only feel for the excess yang pulse after you have needled the deficient one.
Needling: When the deficient yang organ is found, tonify the point on that meridian (below are the list of points which have been empirically deduced). Use the side of the body which corresponds to the pulse position that is weak. For example, if the Large Intestine is deficient, since the LI pulse is found on the right side, treat only right LI 11. After that has been done for the appropriate time, disperse the luo point on the meridian of the excess organ. Again, only treating the side of the body corresponding the pulse position. Keep in mind that you will be using a thicker needle and you will be needling against the flow of the meridian when dispersing.
Time: Tonify the deficient yang organ for 1-2 minutes. Disperse the excess organ for 30 seconds.
Exceptions: If all the yang organs seem deficient, use either TW 4 or St 36 bilaterally.

Yang DeficientPoints
Gall BladderGB 37 (l)
Large IntestineLI 11 (r)
BladderBl 58 (l)
StomachSt 36 (r)
Small IntestineSI 7 (l)
Triple WarmerTW 4 (r)
Yang ExcessPoints (Luo)
Gall BladderGB 37 (l)
Large IntestineLI 6 (r)
BladderBl 58 (l)
StomachSt 40 (r)
Small IntestineSI 7 (l)
Triple WarmerTW 5 (r)

Note: The second part of this step, dispersing the excess organ, is not a mandatory step. Often in tonifying the deficient yang organ, the excess one will disperse on its own. Make sure to look for the excess yang pulse after needling the deficient organ / meridian.

Step 4
Needling: This step is rather simple with no pulse taking necessary. Turn the patient over and tonify the the corresponding shu points to the primary diagnosis mother and son. For example, to continue with our Kidney primary pattern, you would tonify the shu points of the Kidney and the Lung (Bl 23 & Bl 13).
Time: 30 seconds from the end of the last needle inserted.

Primary PatternPoints
LiverBl 18 & 23
LungBl 13 & 20
KidneyBl 23 & 13
SpleenBl 20 & 15 or 14
HeartBl 15 & 20

Step 5
(under construction)

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