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Acupuncture Articles by Neil R. Gumenick

Neil R. Gumenick, M.Ac. (U.K.), C.T. (A), L.Ac., Dipl. Ac. (NCCAOM)
The Institute of Classical Five-Element Acupuncture

Neil R. Gumenick is the founder and Director of The Institute of Classical Five-Element Acupuncture. Neil is a Worsley certified advanced teacher of Classical Five-Element Acupuncture and a practitioner with over 27 years of private practice experience. Neil holds three degrees from the College of Traditional Acupuncture (U.K.), and he participated for 10 years in the Master Apprentice Programô, led by Profs. J.R. & J.B. Worsley. Neil has taught at the USC and UCLA Schools of Medicine, the Worsley Institute of Classical Acupuncture, the Traditional Acupuncture Foundation, California Acupuncture College, Santa Barbara College of Oriental Medicine, and Pacific College of Oriental Medicine. He has been a Professor at Emperor's College of Traditional Oriental Medicine and SAMRA University of Oriental Medicine. Neil is co-author of The Art of Practice Management for Acupuncture Health Care Practices

Symptoms: Distress Signals, and Nothing More

By Neil Gumenick, MAc (UK), LAc, Dipl. Ac

Some of the most frequently asked questions regarding Classical Five-Element Acupuncture diagnosis and treatment are, "How is it that a specific symptom can be the result of imbalance in any of the elements or organs/functions? If the organ showing the symptom is not the cause of its own distress, how can we know the cause?"

The 12 organs/functions (the "Officials") are related, as are members of a family.

As soon as there is an imbalance in any Official, within a space of time, the imbalance will and must affect the other members of the family.

Let us take the example of the Liver, the Official of Planning; consider some aspects of its role within the body/mind/spirit; and examine the vast influence it has over the working of every other Official.

The Liver's job is likened to that of an architect, who draws up the plans from which an entire structure will be assembled. The plan gives everyone involved in the job a goal and purpose. With a plan in hand, the workers know exactly what they are to do. Everything moves in a smooth and orderly fashion, directed toward the ultimate goal.

Power of the Five Elements The Chinese Medicine Path to Healthy Aging and Stress Resistance

On a personal level, if we live our lives according to an internal plan, all parts of us run smoothly and orderly, as well. Each Official knows what to do and where to go. Even in the event of an unexpected obstacle arising, a healthy Liver will have foreseen alternatives and made contingency plans. This clarity of vision allows us to be confident within ourselves, knowing that we are on purpose, yet relaxed and flexible.

If the Liver is imbalanced, whether through an inherited predisposition and/or exposure to physical, emotional, mental or spiritual trauma beyond its capacity to repel, the Official will begin to malfunction. There may be difficulties with vision and the eyes, as Wood controls our ability to see; yet we do not see with our physical eyes alone. For example, we may say, "I see what you mean." Of course, we do not physically see this, nor do we physically see the logic in a line of reason, but we do see these things with the mind's eye.

We need our inner eye to envision our future, to foresee what is ahead and what the next step will be. Lacking this vision, we may feel the frustration of not knowing which way to go, being lost, perhaps having a strong desire to move forward, but feeling blocked in every direction. We can begin to see how the emotion of anger is associated with this element and Official.

When the Liver is imbalanced, the storage of blood; protein; fats; iron; the menstrual flow; and the release of bile, all part of an organized flow, governed by this Official, can become chaotic. The tendons and ligaments, controlled by the Wood, can lose their suppleness and become rigid and tense, causing spasm, cramps and physical awkwardness. Symptoms can arise anywhere along the extensive pathway of the Liver meridian, including the genital and abdominal areas, as well as the head.

All of the body's rhythms, down to the smallest cellular exchanges, follow an internal plan. Nothing happens randomly. We eat and digest food according to a plan: The process of respiration, with its exchange of gases, happens according to a plan; hormones are released in accordance with a plan; the circulation of blood - every movement follows a plan. Every conscious and unconscious process contains a "blueprint" that arises from the work of the Liver Official.

More devastating than the myriad physical symptoms that can arise when this Official is imbalanced are the mental and spiritual manifestations. Our spirit is fueled by our hopes, dreams and ability to see a future harvest on all levels. Wood gives us the ability to make new beginnings, to grow and change. Whether we perceive it or not, there is a divine plan, a path (or Tao), a natural order of things and a unique and necessary place for us within it. When our Planner is sick, we cannot truly sense our purpose. With no sense of future, we lose hope and optimism. The anger, frustration and despair of having lost our way can be such that we feel like giving up. The anger can be turned inward as well as outward. The rigidity and inflexibility of a Liver imbalance can make us intolerant and overly judgmental, particularly if others do not share our plans, our spiritual path, or our ideas of how things should be.

It is beyond the scope of this, or any article, to fully cover the expressions of the Liver: the hypothetical starting point of our discussion of how an imbalance originating in a specific Official can and will produce symptoms anywhere. However, it should be clear thus far, by understanding something of the vast importance of the Official of Planning, that it has an enormous impact and influence on each of the other Officials.

Imagine an assembly line, smoothly fitting together parts in perfect combination, to construct a machine. Suppose the 12 Officials are workers in this line. They do their jobs according to a plan of operation. Suppose the Planner gets sick and is out of commission. Now, a problem arises on the assembly line. There is no one to turn to for a contingency plan, or a new plan. The problem grows in intensity as parts begin jamming and pieces begin falling off the assembly line onto the floor. Soon, the workers begin to argue and bicker among themselves. "Why don't you do your job?" "My job? It's your fault!" "No, it's his fault...!" Some workers frantically attempt to restore order and take over the Planner's job, a job they are not prepared to do. Some give up in resignation. Anger and frustration mount, as no one knows what to do next. There is no one with the vision to hold it all together.

Any of the other Officials (the assembly line workers), all now in a state of imbalance, can and will show symptoms (on any level) associated with their own functioning. The Fire Officials will exhibit Fire symptoms; Earth Officials will exhibit Earth symptoms, etc. It would be futile to treat these workers, as they are only reacting to the underlying problem: the Planner is sick. He may not be the one screaming the loudest; he may be quietly exhausted, but he is, nonetheless, the cause. If we tend to him and restore him to balance, he will naturally resume his proper task on the assembly line. Order will be restored, and all the other workers will level out.

Within us, the 12 Officials are similarly members of a team. Classically, the Chinese saw them as ministers of an imperial court. Whatever the metaphor, they are related and interdependent. Let us take a specific example and consider how an imbalance in the Official of Planning could cause symptoms of disease in the Spleen.

The Spleen is the Official of Transportation and Distribution. It takes the extracted nourishment, churned and mixed by the Stomach, and distributes it to every other Official, every cell and every corner of the body/mind/spirit. Its job is likened to a transport manager, overseeing a fleet of trucks, on the road 24 hours a day, seven days a week, carrying food to the people. Even if there were a good supply of food with which to start, it would be of no use if it never reached its destination. All of the other Officials would panic (and show symptoms) at the shortage.

If the transport manager had no plan or schedule, the whole delivery system would be in chaos. Trucks would depart and arrive at random, showing up at destinations where they were never intended, or never showing up at all. Trucks would break down, and there would be no contingency plans for their repair or replacement. Some recipients of goods would receive little or nothing; others would be stuffed with far more than what was needed or wanted. The problem here does not originate with the Spleen (the transport manager). It may be ready and able to do its job, but cannot without the vision and planning that the Liver provides.

Now, we will start to see a whole host of Spleen symptoms emerge. As the chi is unable to reach its destination(s), we may find coldness and numbness in the extremities; weakness; lethargy; and immobility as the muscles are deprived of their nourishment. With the lack of movement, things tend to stagnate and thicken. As the movement of fluids becomes impaired, we may develop coagulations of mucous and phlegm. There may be asthma; bronchitis; fibroids; stones; or paralysis. As the movement of blood stagnates, we may find varicose veins; hemorrhoids; tumors; and menstrual difficulties such as amenorrhea or dysmenorrhea, to name a few possibilities.

Mentally, the mind becomes stuck and immobile, unable to transmit thoughts or retrieve them from the storehouse of memory. There may be an inability to study or concentrate. Incessant worry and anxiety are expressions of stagnancy at the mental level. We lack the stability and security the Earth's harvest provides when the bounty is well distributed to every corner of body/mind/spirit.

We could continue to list each Official by name and, in similar fashion, understand how an imbalance in the Liver (on any level) could be the cause of distress and the resultant expression of symptoms in each. None can do the job that Nature ordained without a plan. Further, we could examine the job of any other Official and see how an imbalance originating within it will affect the functioning of all the rest. For example, if we reversed the foregoing relationship and determined that Spleen was the cause, we could easily see how the Liver would malfunction if it was deprived of fuel on which to operate, or was overloaded and overburdened.

Another area for consideration as to how imbalance in one Official will cause distress in all the rest is via the two cyclic processes that describe the relationship between the elements: the Sheng and K'e cycles. The Sheng cycle represents the cycle of creation wherein one element feeds and nourishes the element following, the relationship likened to mother and child. Wood is the mother of Fire, which is the mother of Earth, which is the mother of Metal, which is the mother of Water, which is the mother of Wood.

Let us suppose again that the Liver is the original imbalance. The Wood element feeds Fire - creates and sustains it. The Liver (the predominantly yin Official) is the mother of the Heart and Heart Protector (Pericardium). As in any family, if the mother is sick, the children may be screaming in distress due to lack of food and attention. In this example, the elemental children may scream (often louder than the mother) in the form of showing any number of symptoms associated with the Heart and Heart Protector. There may be palpitations; shortness of breath; chills; cold limbs; pallor; circulatory problems; sweating; arrhythmia; insomnia; dream-disturbed sleep; and joylessness - just to name a few.

To treat these screaming children would be akin to stuffing pacifiers in their mouths. We might quiet them temporarily, but they would still be suffering, and eventually, symptoms of their distress would manifest. If we were to treat the mother, who is the cause, and restore her to balance, she would naturally turn her loving attentions back to her children, feed and care for them, and their screaming and suffering would stop.

Furthermore, Fire, the child of Wood, is also the mother of Earth. If Fire is weak and in decline, it will be unable to feed and care for its child, Earth. Now, we will begin to see symptoms in the child of the Heart and Heart Protector - the Spleen, some of whose distress signals have already been described. The Spleen will be unable to care for her child, the Lung, and so on around the Sheng cycle. Any of these sick children may manifest symptoms such that we may be tempted to treat them, but palliating them will not solve the real problem, but rather will allow the real problem to fester and grow deeper with the passing of time.

Further, the relationship between the Liver and its paired Official, the Gall Bladder, is like sister and brother. They share an intimate bond, and it is essential that they share equally in the available energy, just like siblings within a family. It would cause major disharmony, envy and resentment if one child were fed while the other was deprived. If the Liver is imbalanced, it cannot share appropriately with its brother. Now, the Gall Bladder will begin to show symptoms as a result.

The Gall Bladder, the Official of Decision Making and Judgment, is mother to the Small Intestine and Three Heater (Sanjiao), so these children will become imbalanced. They, in turn, will be unable to properly mother their child, the Stomach, who will be unable to properly mother the Large Intestine, who will be unable to properly mother the Bladder, and so on. Hence, we can have symptoms showing up anywhere.

We can consider the K'e cycle in the same way. The K'e cycle represents the process of control between the elements, the means by which the elements keep each other in order, preventing unbridled growth. Wood controls Earth; Fire controls Metal; Earth controls Water; Metal controls Wood; and Water controls Fire.

Suppose the Earth element in someone is weak. There may be distress signals from the Earth itself; there may symptoms of distress showing in the mother, Fire, as well as the child, Metal. There also may be insufficient Earth to control Water. In Nature, Earth dams and contains Water, holding it in its proper boundaries. If the soil banks are too weak to contain the Water, it will overflow and run out of control.

We would expect to see symptoms of internal flooding in such a patient, such as edema, swelling and bloating. If the excess Water is retained in the system, there is a grave danger of retention of toxins, which can poison the entire system. In time, the excess Water will put out the Fire, and so on through the elements. By the time the patient shows up at our door, it is very likely for us to find that all 12 Officials are imbalanced.

This is why, in this system of acupuncture, we disregard the symptoms. They are simply cries for help from the body, mind or spirit: "Help me! Something is going wrong!" As we can see from the above, the expression of a symptom may have nothing directly to do with the organ in which it manifests. It is impossible to use symptoms to guide us to the original imbalance, the Causative Factor, or "CF," which is assessed by way of objective information provided by the body itself and can be perceived via our senses.

Each of the elements has a corresponding color, sound, emotion and odor, which will stand out from the rest and point to the Causative Factor the moment imbalance occurs. To discover the Causative Factor, we need to awaken our sensory skills of seeing, hearing, feeling and smelling. The original imbalance at the root of the problems will show in a particular color in specific areas of the face, a particular vocal sound, emotional expression and odor. Skilled guidance and much practice are required to develop these natural sensory gifts we all had as young children, but which were largely abandoned in favor of academic and material pursuits.

The elements and Officials are not separate entities, but are engaged in constant relationships with each other. We know that when we treat the correct member of the family in accord with his/her true needs, all the others will, in time, return to their natural state of balance. Instead of an inner world of conflict and turmoil, we can assist Nature to resolve not only symptoms, but the mental and spiritual suffering that accompanies them, finally bringing the family to inner peace, strength, and authentic love.


Worsley JR. Classical Five-Element Acupuncture: The Five Elements and the Officials. JR & JB Worsley, 1998.

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The Art of Practice Management for Acupuncture Health Care Practices

What you will find in this book is a specific, comprehensive approach that gets to the root cause of success in practice.
This new book presents acupuncture practice as art from the standpoint of centering, qi, and wholeness. It builds on the premise that practices succeed from bridging inner and outer aspects of the self. It is an inquiry into the self and addresses clear understandings and approaches to reputable patient care and practice qi. It brings in the five elements and work with the seasons of practice from training and start-up to growth, stability, expansion and transformation. The authors artfully bridges the essence of both patient and practitioner well-being without excluding the practicalities of financial well-being. This book very specifically and extensively shows how the different parts of practice nourish and feed one another and are interdependent on one another for the qi to flow synchronistically.
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