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1. ABSTRACT
Traditional Chinese medicine TCM is a form of alternative medicine which dates back to more than two thousand five hundred years. This ancient concept has been gaining popularity due to its effectiveness and extremely low side effects. It is now used in different countries throughout the world. TCM uses natural herbs and spices as medicine. It also applies treatment methods like acupuncture and moxibustion, which require highly skilled professionals. TCM is based on two interesting philosophies: Wu Xing and Yin and Yang. Wu Xing stands for the five elements.
Interestingly, a similar theory of five elements exists in Ayurveda, which is a form of traditional Indian medicine TIM.
In this report, the five element theory in TCM has been compared to the five element theory in Ayurveda.

2. INTRODUCTION
The five element theory is the philosophical base on which TCM has been built and evolved. The five elements are known as “W? Xíng” in Chinese. The theory of these five elements explains phenomena which involve the interaction between internal organs in our body. This paves way to getting a further understanding of how diseases work and hence, how they can be treated. The five element theory is one of the main reasons why TCM has been working beautifully to cure and resolve complicated health conditions.
3. MATERIALS AND METHODS
For this article, information has been retrieved from academic papers, blogs written by scholars in TCM and philosophy, the official website of the school of Ayurveda in California and also personal blogs of people who have used TCM and ayurveda and have shared their experience.
4. FIVE ELEMENTS: TRADITIONAL CHINESE MEDICINE
The five elements in TCM are wood, fire, earth, metal and water. In Chinese, they’re known as”mù”, “hu?”, “t?”, “j?n” and”shu?” respectively.1
The system of Wu Xing came to light during the Han dynasty, in the first century BCE 2 The theory of five elements is versatile, as it not only focuses on medicine, but also explains astrology, music and art.

The five elements are in a constant state of interaction among one and other. These are “cycles”. There are two main types of cycles. One is the generating cycle, the other is the overcoming cycle. The generating cycle is understood by basic concepts of everyday life.
“Wood feeds fire”: This statement means that wood is required to be burnt in order to generate fire.
Fire then progresses to create ash, which is mixed to and becomes a part of earth. The fourth element, metal, is found on earth.
The bridge between metal and water is formed by the fact that metal bears water. Water is required for the growth of trees. Wood gets its nourishment from water.
This way, the five elements are required for creating each other. So, it can be concluded that one element cannot exist without another. These five generating processes promote development. This generating cycle is compared to how a mother nurtures the foetus in her womb.3
The second cycle is the overcoming cycle. This cycle speaks about how one element opposes the other element.
Wood leaves the earth and causes soil to erode. This is one of the main reasons why deforestation is really bad for our planet earth. Interestingly, TCM has explained these concepts much before deforestation became a problem.
Earth absorbs water and makes it dirty and muddy. This decreases its purity.
Water extinguishes fire. This is another way in which one element prevents the growth of another element.
Fire, on the other hand, can melt metal. It can change and manipulate the shape of a metal and can make metals lose their integrity.
The end of the overcoming cycle is with the metallic axe which chops wood off. This way, metal curbs the growth of wood and trees.
Both of these cycles are important for life. The first cycle makes things move forward while the second cycle exerts brakes. An imbalance in any of the cycles can cause a problem. It is not good if things go too fast or too slow. The two cycles described in the five elements theory, stress on the fact that we should all be in the perfect pace in order to be healthy.4
Each of the five elements have a corresponding season, emotion, direction, organ and planet.

4.1 WOOD
Wood corresponds to spring, which marks a juncture of growth. This is also the reason why wood’s planet is thought to be Jupiter, the biggest planet. The direction of wood is said to be east. Wood, signifies emotions of anger. In TCM, wood’s organs are the gallbladder and the liver.5

4.2 FIRE
Fire, on the other hand, represents summer which signifies high amount of energy and lots of light. Fire expresses strong emotions such as passion, love and joy. It brings positive vibes and is said to be the “most” yang of all the five elements. The planet for this element is Mars, which also corresponds to the colour red. The direction which fire represents is south. Heart and the intestine are the organs associated with fire.5

4.3 EARTH
The third element, earth, doesn’t quite correspond to any particular season, but signifies the period of levelling of the temperatures, a gradual change of the hot summer to the cold winter, and vice versa. The direction of earth is centre. The main emotion of earth is sympathy. Earth corresponds to the stomach and the spleen.5

4.4 METAL
Autumn, the period of harvesting, is given by the element metal. Metal has a strong yin component which is the reason why its associated emotion is grief. Its direction is west and planet is Venus. The large intestines and lungs are represented by metal.5

4.5 WATER
Lastly, water indicates winter, which is cold and is a phase of retreat. The direction is north and the associated emotion is fear. Its associated planet is the one closest to the Sun, Mercury. Water is related to the kidney and the bladder. 5

5. APPLICATION OF THE FIVE ELEMENTS IN TCM
The five elements are also associated with two particular body parts: one is the yin organ and the other one is the yang organ. 4

5.1 WOOD
The yin organ that wood signifies is the liver. Liver is the organ which is responsible for the smooth flowing of Qi (the vital force of life), promoting absorption and digestion, and is also responsible for regulating emotions. It is believed that the liver is the place in the body where “hun” resides. Hun refers to one’s spiritual consciousness. The liver is said to house emotions, along with impulses, speech and intelligence. In TCM, the liver is believed to be connected to the eyes, tendons and nails via meridians. So if there is any problem in the liver, there will be changes in the eyes and nails, which will hence make it easier to diagnose. If the blood going to the liver is decreased, there will be symptoms of blurred vision and dry eyes. On the contrary, if the liver is working too much, the eyes will get bulged and swollen. Similarly, if the nail beds look deformed in an individual, it indicates that there is a problem with their liver activity. As mentioned earlier, the emotion depicted by wood is anger. This statement also establishes that the liver is the most sensitive organ to anger. If a person is very angry, his liver will shunt the incoming Qi in an upward direction, towards the eyes, which is manifested as red eyes in angry people. Conversely, liver disorders also lead to irritability. People who are have a lot of tolerance have been proved to have better liver function.7 Also, people who have a very thin pulse generally have liver problems because it indicates that the liver’s function of storing blood is impaired.8
Drinking alcohol is said to stimulate the yin factor of the liver. Gall bladder is the yang organ. Greasy, oily food acts against the yang factor of the gall bladder. 4 Medically, this relation is very true because alcohol causes liver cirrhosis and eating too much oil could lead to gall stones. 5
Qi is said to be the most active in the gall bladder and liver between 11pm and 3am at night. At this time, they get nourished too. This is why it is very important to get good sleep at that time. This is the reason why people who do not get enough sleep at night seem irritated in the mornings.7 Since wood generates fire, it is the mother of the heart.

5.2 FIRE
Fire represents the heart. In TCM, the heart is thought to be the ruler of all organs in our body. It is thought to be the birthplace of thinking and seeing. It is known to be “Shen Ming” (??), which, in Chinese means God. This means, the heart is the most dominant and important organ, giving rise to all the blood vessels, hence making all the other body parts dependent on it.9 Furthermore, the heart is also considered to be the location at which consciousness exists.10 The heart is connected to the face and tongue. Interestingly, the tongue is seen as a geographic map of all the organs in our body. Different part of the tongue can be used to diagnose illnesses of the corresponding body parts.11 The tip of the tongue is the point which corresponds to the heart. 12

Figure 1: Making a diagnosis with the appearance of the tongue 24

The pulse is also commonly used to diagnose problems related to the heart. TCM has identified eighty different pulse qualities, each with their own significance. 13
The pulse for heart related problems is seen at the distal, lateral part of the forearm. Large segment findings might indicate irregular rhythm of the heart. 14 This is very cost effective and is much less risky as compared to western medicine, which uses a number of machines and invasive procedures to diagnose diseases. Hyperthermia and increased body heat could lead to heart diseases. This way, heart is directly connected to its element, fire. Also, since the taste bitter is also related to fire, people with heart diseases tend to crave bitter food.5 The small intestine is the yang organ which fire represents.

5.3 EARTH
The Yang organ of earth is the stomach. It is known to be the feeder of Qi for all parts of the body. It is very similar to how the earth provides and nourishes everything in this planet. The stomach is strongly affected by emotions and it is viewed as an organ that not only ingests food, but also ingests emotions. The stomach is believed to be the most active between 7am and 9am. This is why, breakfast is the most important meal of the day.
The Yin organ represented by earth is the spleen. According to TCM, the spleen is the official earth of our body. The spleen not only substantiates at a physical level, but also nourishes our mind and spirits. 15 Deep lines from base of the nose to the lateral part of the lips indicate spleen and stomach infirmities. 5

5.4 METAL
The yin organ of metal is the lung. The lungs are the receivers of pure Qi from heaven. The lungs are extremely susceptible to cigarette smoke and so are the yang organs of metal-the large intestine. Cigarette smoke can not only cause lung cancer, but can also cause constipation. The large intestine is seen as an organ which chucks waste out of our body. Besides, it also is responsible for letting toxic emotions and negativity go out of our body. 16 Grief is the emotion associated with metal. That is why people who have depression also suffer from constipation. Also, grief is felt when people “let go” of us (Just the way the intestine lets go of things the body doesn’t need). Metal problems are seen as paleness in the face.
If a patient is suffering from asthma, it means that his metal component (lung) is not receiving enough support from his earth component (spleen). Asthma can also be caused by extreme sadness. This is how the earth controls metal.

5.5 WATER
Water’s yin organ is the kidney. Since kidney is a yin organ, it is involved in cooling the body. It also has a lubricating function, which reduces friction between substances. Kidney is directly related to bones, teeth and bone marrow. It is said to be the emperor of the skeletal system, controlling all two hundred and six bones in our body. Therefore, a kidney problem can present as lower back pain and knee pain.
The yang organ of water is the urinary bladder. According to the Yellow Emperor’s Classical Book of Internal Medicine, “The bladder is where the water converges and where, after being catalyzed by Qi, it is eliminated.” Hence, a dysfunction of the bladder would lead to the accumulation of Qi in our bodies, which is very dangerous. Problems with water’s organs are seen as dark eye bags as well as baldness. 17

6. COMPARISON WITH AYURVEDA
Ayurveda is a form of Indian traditional medicine. It has not been researched much as compared to TCM. Although Ayurveda and TCM are from two different countries, they do have some similarities. Yoga and Tai Chi follow the same concept of “the flow of Qi” which is known as “chakra” in Indian medicine. In the next section, the five element theory of TCM will be compared to and contrasted with that of TIM.

6.1 SIMILARITIES
Ayurveda is also based on a five element theory. The five elements in TIM are known as the Pancha Bhoota. Namely, akasha (ether), vayu (air), teja (fire), aap (water) and prithvi (earth) 18
Fire, water and earth are the elements which are present in both TCM and Ayurveda.
Fire represents summer and lots of energy and light.19
Water, just like in TCM, is linked to the urinary system in Ayurveda.

6.2 DIFFERENCE
The organs represented by the five elements are very different in both forms of medicine, each with their own logical explanation.
Fire, in Ayurveda represents the eyes. Since eye is the organ that takes in the bright light. 19 Fire is also said to play an important role in digestion.
In Ayurveda, water is believed to be the foundation of earth. An imbalance in water elimination is seen as a change in a person’s ability to experience taste. Unlike TCM, Ayurveda attributes water’s characteristics to the season spring. This roots from the fact that flowers in spring require water to bloom.21
The organ related to earth is the large intestine. This is because the earth element is strongly related tot the sense of smell. Any discomfort or disorder in the rectum, for example, constipation or diarrhoea, produce a pungent smell. Also, a person with thick hair on their skin is said to have an excess of the element earth in their body.22
There are two elements which are different from TCM. They are, air and ether. Air in Ayurveda is believed to be the motion of life. Excess motion involves symptoms of hyper-excitability and diarrhoea. Whereas lack of motion involves slower heart rate, constipation and sluggishness. Air freely flows in the body and mind, providing vibes of faith throughout. The motion changes throughout life. As one grows older, the air component is said to decrease. This forms the basis of ageing. 23
Ether means space. The organ associated with it is the mouth. People born with the loss of speaking ability are said to have a deficiency of ether. Ether is found in empty spaces in our body such as intestine and lungs. An excess of ether takes up a lot of space and reduces the space for tissues and cells. Hence, there is a loss of function. This explains diabetes. People with excess ether are said to be predisposed to diseases such as Parkinson disease and Alzheimer disease (both, which involve tissue destruction in the brain).

7. CONCLUSION
Both TCM and Ayurveda have interesting concepts. It is mind blowing how such forms originated many years ago when there was very little technology. This proves that our ancestors were really intelligent.
Although different, TCM and TIM have their own perspective of looking at medicine and the world. Perspective is very important. If everyone thinks in the same way, there will be no innovation. So, it is always good to consider things from different frames of references so that one can draw a big picture and understand medicine better. This shows how one disease can be seen in many ways. However, TCM has been established much better than Ayurveda has.
In my opinion, these forms of alternative medicine have a very bright future due to the reduced side effects and risks. They don’t involve harmful, aggressive techniques like surgery and chemotherapy, but use milder methods to combat diseases. This, however, is very time consuming. In today’s busy world, I believe time is the reason why traditional medicine is not as widely used as allopathy is. These forms of alternative medicine need to have more studies and clinics trials so that many more people trust them and make them their choice of treatment. This would not only cut down costs for costly equipments, but also turn human’s life into a healthier one.

ACKNOWLEDGEMENT
Firstly, I’d like to thank my teachers who have taught me TCM and have inspired me to choose this topic. This review paper has been possible with the support and encouragement from my parents and friends. I’m very grateful to have chosen this topic as I got to learn a lot of new things regarding TCM and the traditional medicine of my own country.