After answering a question asked by one of my students, I realized that our discussion could possibly be of help to others as well. So I redacted and completed my answer for clarity and set out to post it on the Internet, for whom ever would find it useful.
First of all, I would like to wholeheartedly thank all my students: their questions force me to clarify my thoughts. Clarity is essential, for as the saying goes, “energy follows thought”: the clearer the mind, the more precise the use of energy!
This time, the question was on the use of the Qi Jing Ba Mai 奇經八脈 (eight extraordinary channels) and the five elements.
When learning Chinese medicine in general, and acupuncture in particular, we tend to memorize sets of symptoms, pathways, needling techniques, sometimes even formulas or lists of points. In the long run, if we fail to achieve a general vision of the way energy functions in the body, we get stuck with a variety of techniques which we struggle to coordinate into a clear and progressive treatment. The temptation is then to resort to a symptomatic approach, needling “a point for this and a point for that”. Most often, confusion arises not from the lack of knowledge, but from the lack of integration of this knowledge. Hence the need for clarity and perspective.
The specific techniques I am referring to in this article are described in Jacques Pialoux’s manual “Guide to Acupuncture and Moxibustion”: the eight extraordinary channels are treated in Chapter 8, whereas Chapters 9, 10 and 11 expose the different levels of treatment using the five elements.
Every time we are confused about a specific technique, it’s important to go back to the actual function of the channel we are working with, or to the actual movement of energy we are seeking to induce. Thus the eight extraordinary channels (Qi Jing Ba Mai) are a direct manifestation of the way energy is distributed in the body, along the main axes: left/right, front/back, up/down, inside (core)/outside (surface). So when working with the eight channels, we are actually rebalancing the 3-D distribution of energy which sustains the whole physical structure.
Any symptoms associated with the eight channels as they are described for example by Li Shi Zhen 李時珍 in the Qi Jing Ba Mai Kao 奇經八脈考 (e.g. thermoregulation, chest pain, lumbar pain, insomnia, stabbing pain, etc.) are a direct consequence of this distribution of energy along the main axes – or of the lack thereof. It is then easy to see how a symptomatic treatment with points directed at each specific ailment could be less effective then treating the general imbalance in the distribution of energy (e.g. the energy does not gather at night, yang stays superficial and stagnates on the upper part of the body leading to headaches, red and painful eyes, insomnia, restless legs, possibly also back aches, shoulder aches, pain on one side of the body, urinary issues such as cystitis, prostate problems, etc.).
The five elements operate at a totally different level. In the above, we mentioned the use of the eight extraordinary channels to balance the distribution of energy. However, to do this, the patient needs to have energy to start with: if the patient is totally depleted, or say yang deficient, there is nothing for the eight channels to distribute!
Working on the five elements will actually regulate the patient’s metabolism, enabling their body to produce the energy suitable for each different system (the cardio-vascular system needs “fire” energy, it cannot function on, say, “water”; the bones need “water” energy, a lack of which could result in osteoporosis; muscles and tendons need “wood”, etc.).
Regulating the metabolism with the five elements also helps the body to adapt to the seasons: think hay fever or seasonal depression as striking examples of a five element disorder.
At a deeper level, the five elements relate to the direction of energy and the way the body gathers and accumulates yin in the winter and expands to accumulate yang in the summer. Thus the general movement of energy is from core to surface from spring to summer, then pause in the fall, relax, revert, and surface to core in the winter, and then gushing out again in the spring. This enables the building up and balance of yin and yang.
When the patient is suffering from a recent, acute five element imbalance due to desynchronization between their metabolism and the season, the movement of energy is stuck at a superficial level, and treatment will be achieved using the wu shu points 五輸穴. But with time, or due to the strength of the factor causing this desynchronization (stress, shock, trauma, infection, medication, etc.), the patient’s Qi is depleted and they start suffering from deep yin or yang deficiencies. In such chronic cases, the Qi Ji 氣機 (dynamic of energy) is blocked at a deeper level: treatment will start using wu shu 五輸穴 points, then should be pursued using Mu 募穴 and Bei Shu 背俞穴 points, thus resetting the whole production of energy by the organs and bowels deeply inside the three burners 三焦.
If this basic dynamic and “breath” of yin and yang is functional, then the eight extraordinary channels will keep the blood and energy thus produced evenly distributed along the main axes.
Of course, when treating patients the sequence of treatment depends on the urgency: as with any therapeutic approach, we work from superficial to deep and from acute to chronic, peeling back layer after layer of blockage. The most important is to keep the general scheme in mind, so we are at least certain of guiding energy in the right direction: as my friend Dr. Li Xin 李辛would say “In case of deficiency, gather; in case of excess, open”.
As for the frequency of acupuncture sessions, we need to let the body rest and adapt between treatments: if possible, allow for 3 weeks between treatments, especially when treating the eight extraordinary channels and the five elements. Qi reacts right away to the treatment, as reflected by the immediate change of the patients’ pulses, but the body needs time to respond at the physical level. When our treatment is clear and precise, it does not need to be repeated several times in a row.
 Please see Publications section for reference or free download.  As taught for example by the Japanese masters Yanagyia Sorei 柳谷素霞 and Shohaku Honma 本間祥白 cf. Chapter 9  See Chapter 9 and 10  Chapter 11