TCM (Traditional Chinese Medicine) and Five Element Styles of Practice

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What's the difference between TCM (Traditional Chinese Medicine) and Classical or Five-Element styles of Chinese medicine?

The Family-Based Lineage System

Historically, Chinese Medicine (acupuncture, tuina and herbal medicine) was practiced largely within a family-based lineage system. The specific techniques and knowledge required to practice acupuncture or herbal medicine were transmitted from teacher to student in the context of an apprenticeship relationship.

Oftentimes this meant a father or mother teaching his/her son or daughter, who would then teach their son or daughter. Students who weren’t related biologically to the teacher they wished to learn from had to establish a similarly close relationship – become “heart-sons” or “heart-daughters”- to that teacher, before being accepted as students. 

The Cultural Revolution & Institution of TCM

This way of transmitting the art and science of Chinese Medicine resulted naturally in the emergence of many different styles of practice – each associated with a particular family lineage. At the time of the Chinese Cultural Revolution, a decision was made to standardize and secularize the practice of Chinese Medicine. This was carried out by examining the various family lineages, extracting what they seemed to have in common, and eliminating anything that the Communist Government considered to be too overtly “spiritual." The resulting collection of standardized knowledge and techniques was given the name: “Traditional Chinese Medicine” (TCM).

This was, in other words, the historical moment when there emerged an “officially-approved” version of Chinese Medicine - which subsequently would be taught largely in government-sponsored schools instead of within a family-based apprenticeship system.

Classical Chinese Medicine & the Five Element School

One advantage of this standardization was that it made more clear what were the most commonly-agreed-upon techniques, eliminating the more idiosyncratic “variations” that may have appeared within single lineages.

A major disadvantage of the standardization was that, for the most part, it divorced the medicine from its spiritual roots. Contemporary practitioners wishing to revive this spiritual rooting, and the knowledge/techniques associated with it, often name themselves as practitioners of Classical Chinese Medicine (the form of the medicine prior to the Cultural Revolution) or Five Element Practitioners (a name associated with the work of J.R. Worsley).

What’s the Difference Between a TCM and a Five Element Practitioner?

Generally speaking, a TCM practitioner will rely primarily upon the Eight Principles diagnostic framework. A Five Element practitioner, on the other hand, will rely primarily upon a Five Element diagnostic framework. A TCM practitioner is likely to pay more attention to physical symptoms, and design treatment to eliminate the symptoms. A Five Element practitioner, on the other hand, will tend to be more focused on the emotional and spiritual aspects of the imbalance, and aim their treatments at the root cause of the disharmony.

Great variety exists among practitioners, of course - and both the Eight Principles and Five Element frameworks are important aspects of the medicine’s theoretical foundation.

And what makes Chinese Medicine unique – and uniquely powerful – is the insight that the physical, emotional, mental and spiritual aspects of an individual are always interconnected, and exist within a larger web which ultimately includes the entire cosmos. This will be the working assumption of anyone being true to the essence of Chinese Medicine – whether their practice takes a TCM, Five Element or any other form!

In terms of the practicalities of receiving Chinese Medical training, in the West today: A large majority of Chinese Medical schools and licensing exams are now based upon the TCM model, making licensing, etc. a bit more of a hurdle for those who choose a Five Element school. The medicine also evolved in a distinct way in Japan – giving rise to various forms of Meridian Therapy – but this is a topic for a future essay …