Each set of command points also contains points which have a specific association with the five elements, creating a subsidiary circle of the elements. These points lie along the arm and leg in the order of the five element circle. One of the points will be a Metal point, another a Wood point, and so on. On yin officials the order of the elements on the arms and legs starts at the nail or first point with the first command points being Wood points and the final command points being Water points, whilst on yang officials the order starts with Metal points at the nail or first point, and finishes with Earth at the elbow or knee. The element points add the quality of their particular element to the official they form part of. A Fire point on the Gall Bladder will therefore add some Fire quality to the Wood of the Gall Bladder.
The element point of a patient's guardian element (Earth points on Stomach and Spleen for an Earth patient, for example) are the most frequently used of these elements points, because they are selected according to a specific time of day or season. Treatment for the time of day is called horary treatment (from the Latin word for "hour"), and is based on the 24-hour Chinese clock. Treatment chosen for a particular season is called seasonal treatment.
An element's element point has a particular resonance, as it emphasizes that element's qualities. A Metal point on Lung or Large Intestine therefore increases the power of the Metal element. This is particularly so when the element points of that person's guardian element are selected for horary or seasonal treatment in Metal's horary time or Metal's season, autumn, and doubly so if these points can be needled at the same time both in Metal horary time and in the right season.
For horary treatment, the twinned horary points of the yin and yang officials are needled to time exactly to correspond to that particular official's horary time according to the 24-hour clock by the sun. It will therefore be impractical to choose horary points for some of the officials whose horary times are at unsocial hours during the night, such as those for Wood and Metal patients. It is much easier to arrange for Earth, Fire and Water patients whose horary times are during practice hours. For these patients, the time of treatment has to be during both officials' horary times. For an Earth patient, with Stomach's horary time from 7- 9 am, and Spleen's from 9 - 11 am, XI (St) 36 must be needled before 9 am by the sun (in other words around 8.45), and then there will be a slight wait until XII (Sp) 3 can be needled after 9 am.
There is much discussion and some disagreement among five element practitioners as to whether we should consider giving horary/seasonal treatments to people whose element has no particular relationship to that time of day or season. In other words, should we give a Fire person a Wood seasonal treatment in spring. I have not myself included this as part of my treatment protocol over the many years of my practice, but I know many other practitioners who do. I think my decision was based on one example of a Fire patient who I gave a Water seasonal treatment to in winter and who told me that she had felt a bit odd after the treatment, but this might have had nothing to do with the Water points but instead related to what was going on in her life. Perhaps practitioners should do their own research on this to discover how far giving seasonal treatments for any season which is not that of their patient's guardian element appears to support their patients. The problem here is that I believe that the positive effect of treatment is based on the cumulative effect of a number of treatments on their element, rather than on the effect of a single treatment.
Apart from horary and seasonal treatments, we enter a complex area of five element treatment when we consider whether we should select other element points, such as a Metal point on a Water patient, or an Earth point on a Fire point. Leaving aside the fact that some element points are chosen as part of tonification or sedation treatment, I think it is not advisable to think that it might be useful to add some Metal to Water points for the Water patient, or more Earth to Fire for the Fire patient. This requires great insight to pinpoint whether the Water patient would indeed benefit from more Metal, or the Fire patient would benefit from more Earth, because this is a very subtle area of diagnosis. During our training we were strongly advised just to use the element points for tonification or sedation and for seasonal or horary treatment, and for no other reason. This is the advice I am therefore passing on here as it is what I have always done.
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