A practitioner of Five Element Constitutional Acupuncture diagnoses patients by assessing which is the primary Element in distress. This diagnosis is based on various sensory signs, especially the patient’s emotional balance, facial colour, odour and voice tone. The patient’s personality is also of utmost importance. The focus is on diagnosing the balance of the Five Elements within the person rather than making a differential diagnosis of the symptoms presented by the person. As the great physician Xu Dachun described it, ‘Illnesses may be identical but the persons suffering from them are different’ (Unschuld, 1990, p. 17). This idea is also reflected in the Chinese phrase yin ren zhi yi, which translates as ‘different patients require different treatment’.

Treatment is only perceived as fully successful if patients report improvement in how they ‘feel in themselves’, as well as in their signs and symptoms. Sometimes patients are surprised to notice positive differences in how they feel even if they did not perceive anything to be ‘wrong’ with them in the first place. Five Element Constitutional Acupuncture has the ability to direct treatment to any level of the patient’s mind and spirit if that is what is required to help the patient to return to good health.

Many people already have a view, albeit indistinct, of what the word ‘spirit’ means. Others do not accept that human beings have a spirit at all. The word ‘spirit’ also has many different meanings in the English language. For these reasons this topic can be difficult to discuss.

The Oxford English Dictionary lists 34 separate meanings for ‘spirit’. The one that is closest to its meaning in Chinese medicine is ‘the animating or vital principle in man’. Cicero called it ‘the true self, not that physical figure which can be pointed out by your finger’. In the Chinese language the words shen and jing-shen most closely describe the spirit, although it also encompasses some aspects of the mind. The sinologist Claude Larre described shen like this:

People often equate ‘spirit’ with the spiritual and religious sides of the person. The word ‘spirit’, however, encompasses many other aspects of being. Religion, mysticism and spiritual awareness emanate from the human spirit, but so also does the desire to look at a radiant sunset, to listen to beautiful music or to achieve one’s potential as a human being. When people wake up and experience the joy of seeing a beautiful day dawning, it is their spirit that is touched by that experience. Love and compassion are expressions of the spirit.

People who have problems in their spirit struggle when under stress and have difficulties coping with their lives. This may manifest in areas such as their relationships, communication, posture, use of language or the look in their eyes (for more on this, see Chapter 27, this volume). Resignation, anguish, despair, depression, disappointment, sadness, anxiety and many other states are present to some extent in almost all of our patients. As Thoreau said in Walden, ‘the mass of men lead lives of quiet desperation’.

The mind is the cognitive faculty and gives people the ability to think. This includes being able to concentrate, remember, plan and make decisions. The phrase ‘mentally ill’ is legitimately used in Western medicine to describe problems in sense perception, personality, emotions or behaviour. This use of the word goes far beyond the core meaning of the word ‘mental’. Many people in psychiatric hospitals have extremely astute and able minds. It is their spirits that are in distress.