International Journal of Clinical Case Reports 2025, Vol.15 http://medscipublisher.com/index.php/ijccr © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved.
International Journal of Clinical Case Reports 2025, Vol.15 http://medscipublisher.com/index.php/ijccr © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved. MedSci Publisher is an international Open Access publisher specializing in clinical case, clinical medicine, new variations in disease processesregistered at the publishing platform that is operated by Sophia Publishing Group (SPG), founded in British Columbia of Canada. Publisher MedSci Publisher Editedby Editorial Team of International Journal of Clinical Case Reports Email: edit@ijccr.medscipublisher.com Website: http://medscipublisher.com/index.php/ijccr Address: 11388 Stevenston Hwy, PO Box 96016, Richmond, V7A 5J5, British Columbia Canada International Journal of Clinical Case Reports (ISSN 1927-579X) is an open access, peer reviewed journal published online by MedSci Publisher. The journal is considering all the latest and outstanding research articles, letters and reviews in all aspects of clinical case, containing clinical medicine which advance general medical knowledge; the event in the course of observing or treating a patient; new variations in disease processes; as well as the expands the field of clinical relating to case reports. All the articles published in International Journal of Clinical Case Reports are Open Access, and are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. MedSci Publisher uses CrossCheck service to identify academic plagiarism through the world’s leading plagiarism prevention tool, iParadigms, and to protect the original authors’ copyrights.
International Journal of Clinical Case Reports (online), 2025, Vol. 15, No.1 ISSN 1927-579X http://medscipublisher.com/index.php/ijccr © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved. Latest Content Study on the Relationship Between Dietary Adjustments Based on Traditional Chinese Medicine’s ‘Five Elements Theory’ and Metabolic Health Weiping Cai, Jing Zhang, Liye Huang International Journal of Clinical Case Reports, 2025, Vol. 15, No. 1, 1-11 Classic Case Analysis of Comprehensive Nursing Interventions in Dementia Patients Biyong Zheng International Journal of Clinical Case Reports, 2025, Vol. 15, No. 1, 12-23 The New Technology of Extracting Essential Oil from Hangbai Chrysanthemum and Its Application in Medicine Research Kaihua Lu, Jiangen Pan International Journal of Clinical Case Reports, 2025, Vol. 15, No. 1, 24-33 The Current Status of Diagnosis and Treatment and Reconstruction Strategies for Pelvic Floor Dysfunction After Gynecological Malignancy Surgery FengxiaXu International Journal of Clinical Case Reports, 2025, Vol. 15, No. 1, 34-43 Research on the Chronic Disease Management Model for the Elderly Based on a Community Health Assessment System Weiping Cai, Ziming Huang, Qianxi Han, Yeli Huang International Journal of Clinical Case Reports, 2025, Vol. 15, No. 1, 44-51
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 1 Research Insights Open Access Study on the Relationship Between Dietary Adjustments Based on Traditional Chinese Medicine’s ‘Five Elements Theory’ and Metabolic Health Weiping Cai 1, Jing Zhang2, Liye Huang3 1 Department of Geriatric Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, Beijing, China 2 Department of Traditional Chinese Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, Beijing, China 3 Department of Nursing, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, Beijing, China Corresponding author: huangyeli88@163.com International Journal of Clinical Case Reports 2025, Vol.15, No.1 doi: 10.5376/ijccr.2025.15.0001 Received: 04 Nov., 2024 Accepted: 20 Dec., 2024 Published: 05 Jan., 2025 Copyright © 2025 Cai et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preferred citation for this article: Cai W.P., Zhang J., and Huang L.Y., 2025, Study on the relationship between dietary adjustments based on traditional chinese medicine’s 'five elements theory' and metabolic health, International Journal of Clinical Case Reports, 15(1): 1-11 (doi: 10.5376/ijccr.2025.15.0001) Abstract This study explores the impact of dietary adjustments based on the Five Elements Theory of Traditional Chinese Medicine (TCM) on metabolic health, analyzing the potential benefits of Five Elements dietary practices in improving chronic metabolic diseases such as diabetes, hypertension, and obesity. The Five Elements Theory associates foods with the five elements (Wood, Fire, Earth, Metal, and Water) and adjusts the diet to balance the flow of Qi within the body, thereby promoting organ function and overall health. This study also examines the regulatory effects of sour, bitter, sweet, salty, and pungent foods on the liver, heart, spleen, lungs, and kidneys, respectively, highlighting how the Five Elements diet can aid in the prevention and management of metabolic diseases by regulating glucose metabolism, lipid metabolism, and weight management. Furthermore, the study discusses the potential integration of the Five Elements dietary approach with modern nutrition science and its application prospects in chronic disease management, emphasizing the necessity of further research to address the challenges of personalized dietary adjustments. Keywords TCM constitution identification; Personalized dietary therapy; Precision health management; Nutrition science; Interdisciplinary integration 1 Introduction Traditional Chinese Medicine (TCM) is a holistic medical system that has been practiced for thousands of years in China and other Asian countries. One of the foundational theories in TCM is the Five Elements Theory, which posits that the universe and the human body are composed of five fundamental elements: Wood, Fire, Earth, Metal, and Water. These elements are believed to interact with each other in a dynamic balance, influencing various physiological and pathological processes within the body. The Five Elements Theory is used to understand the relationships between different organs, tissues, and functions, and it guides the diagnosis and treatment of diseases in TCM (Zhao et al., 2020; Jiang et al., 2022). In TCM, dietary adjustments are considered a crucial aspect of maintaining health and treating diseases. The concept of "Yao-Shan," or medicated diet, integrates food and medicine, emphasizing the use of specific foods to achieve balance and harmony within the body. TCM nutrition is based on the principles of syndrome differentiation and the idea that the spleen and stomach are central to postnatal health. Dietary recommendations are tailored to an individual's constitution and specific health conditions, aiming to enhance the body's natural healing processes and prevent disease (Zhao et al., 2020; Yang et al., 2023). For instance, certain foods are believed to nourish specific elements and organs, thereby correcting imbalances and promoting overall well-being (Xu et al., 2018; Yang et al., 2023). Modern society faces a growing epidemic of metabolic health issues, including obesity, diabetes, cardiovascular diseases, and metabolic syndrome. These conditions are often linked to lifestyle factors such as poor diet, lack of physical activity, and chronic stress. Metabolic diseases not only reduce the quality of life but also impose a significant burden on healthcare systems worldwide (Wu et al., 2020; Chen et al., 2023; Chen and Yu, 2024). Traditional Chinese Medicine offers a unique perspective on managing these conditions through its holistic
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 2 approach, which includes dietary adjustments based on the Five Elements Theory. By addressing the root causes of metabolic imbalances, TCM dietary interventions have the potential to improve metabolic health and prevent the progression of related diseases (Nie et al., 2018; Wu et al., 2019; Chen et al., 2023). This study will explore the relationship between dietary adjustments based on the Five Elements Theory of Traditional Chinese Medicine (TCM) and metabolic health, aiming to understand how TCM dietary practices influence metabolic processes and contribute to the management and prevention of metabolic diseases. The study will emphasize the potential benefits and mechanisms of TCM dietary interventions in improving metabolic health. Additionally, it will analyze various TCM dietary strategies, their underlying theories, and their effects on conditions such as obesity, diabetes, and cardiovascular diseases. 2 Fundamental Principles of the Five Elements Theory 2.1 Definition and interrelationship of the five elements: wood, fire, earth, metal, and water The Five Elements Theory, known as Wu Xing in Traditional Chinese Medicine (TCM), refers to the five fundamental elements: Wood, Fire, Earth, Metal, and Water. These elements are seen as the basic constituents of the universe and are interconnected through two major cycles-generation (Sheng) and restriction (Ke). The generating cycle depicts how one element supports the formation of the next, such as Wood generating Fire, while the restricting cycle describes how elements maintain balance by counteracting each other, for example, Water controlling Fire (Zhou, 2009). The theory emphasizes that these elements are not isolated; instead, they interact dynamically. Wood provides fuel for Fire, Fire creates ash that becomes Earth, Earth contains Metal, Metal holds Water, and Water nurtures Wood. This interconnectedness is central to understanding how balance is maintained both in nature and within the human body. Imbalances or disruptions in this cycle are often seen as the root of disease in TCM (Fong, 2022). 2.2 The connection between the five elements and human organs, emotions, and constitutions In TCM, the five elements are linked to the five major organs, each governing specific bodily functions: Wood is associated with the Liver, Fire with the Heart, Earth with the Spleen, Metal with the Lungs, and Water with the Kidneys. These organ systems are seen as interdependent, much like the elements themselves, and their health is maintained through the balance of the elements. For example, if the Liver (Wood) is overly active, it may overstimulate the Heart (Fire), leading to symptoms such as anxiety or palpitations (Kastner, 2004). Emotions are also tied to these elements: Wood corresponds with anger, Fire with joy, Earth with worry, Metal with grief, and Water with fear. Emotional imbalances can affect the corresponding organ. For instance, excessive anger can damage the Liver (Wood), causing stress and physical symptoms such as high blood pressure or headaches. Additionally, the five elements influence human constitutions, where people may have a dominant element, which affects their susceptibility to certain conditions (Wen et al., 2007). 2.3 Application principles of the five elements theory in dietary adjustments The Five Elements Theory also plays a critical role in dietary adjustments within TCM, where foods are categorized according to their elemental properties and flavors. For instance, Wood foods are generally sour and benefit the Liver, while Fire foods are bitter and support the Heart. Practitioners of TCM adjust diets based on the balance needed to regulate organ function. For example, sour foods like vinegar can stimulate the Liver (Wood), while bitter foods like dark leafy greens can cool and nourish the Heart (Fire) (Tao et al., 2015). Dietary adjustments also change according to seasonal influences. For example, during the spring (Wood season), it is recommended to consume fresh, lightly cooked, and sour foods to align with the season's energy and nourish the Liver. In contrast, during the summer (Fire season), cooling foods like watermelon and cucumbers help balance the heat and support Heart health. This seasonal approach is integral to maintaining internal harmony and preventing diseases (Liang et al., 2013). The application of this theory extends to the treatment of chronic conditions, where specific dietary modifications can support the healing of imbalances. For example, individuals with a Kidney (Water) deficiency might benefit from salty foods like seaweed to replenish Water and strengthen the Kidney system (Zhan, 2011).
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 3 3 The Correspondence Between the Five Elements and Nutrients 3.1 Wood: the relationship between sour foods and liver function In Traditional Chinese Medicine (TCM), the Liver is associated with the Wood element, and sour foods are believed to benefit Liver function. Sour foods, such as lemons, vinegar, and pickles, are thought to have a contracting and astringent effect, which can help regulate the flow of qi (energy) and prevent stagnation within the Liver. This is particularly important in TCM, where a free-flowing qi is seen as essential for preventing diseases related to stress, irritability, and tension, all of which are commonly linked to Liver dysfunction (Kastner, 2004). Moreover, the regular consumption of sour foods is considered helpful in detoxifying the body by supporting the Liver's role in metabolizing fats and toxins. In modern nutrition, this idea can be related to the high vitamin C content in many sour foods, which acts as an antioxidant and supports liver function by helping to neutralize free radicals and reduce inflammation. The Liver’s role in storing blood, crucial in maintaining body balance, is also said to be supported by sour foods (Zhang et al., 2022). 3.2 Fire: the regulatory effects of bitter foods on heart metabolism The Heart is linked to the Fire element, and bitter foods are traditionally used to regulate Heart function in TCM. Bitter foods like dark leafy greens, bitter melon, and coffee are said to have a cooling and drying effect, which helps clear heat from the Heart and reduce excessive yang energy, a condition often manifested in symptoms such as anxiety, insomnia, or palpitations (Liu et al., 2017). Bitter foods are believed to stimulate digestion and promote the secretion of digestive juices, which helps maintain proper metabolic function. In modern terms, the alkaloids and flavonoids found in bitter foods may contribute to improved cardiovascular health by reducing blood pressure and lowering cholesterol levels. This aligns with the TCM concept of clearing Heart Fire, as heart-related conditions such as hypertension can be aggravated by excess heat in the body (Figure 1) (Zhang and Fang, 2023). 3.3 Earth: the impact of sweet foods on spleen and stomach health The Earth element in TCM is connected to the Spleen and Stomach, and sweet foods are believed to nourish and strengthen these organs. Sweet foods, particularly those that are naturally sweet such as rice, carrots, and dates, are said to have a harmonizing and tonifying effect on the Spleen and Stomach, which are responsible for transforming food into qi and blood to nourish the body (Yang and Jia, 2013). However, TCM distinguishes between the beneficial effects of naturally sweet foods and the harmful effects of excessive refined sugar, which can weaken the Spleen and cause "dampness" in the body. This is analogous to modern nutritional advice, where overconsumption of processed sugars is linked to metabolic disorders such as obesity and type 2 diabetes. Moderation is key, as over-reliance on sweet foods can lead to digestive issues like bloating and lethargy, which are symptoms of a weakened Spleen in TCM (Cheng, 2007). 4 Application of the Five Elements Theory in Dietary Adjustments 4.1 Dietary adjustments based on constitution differentiation according to the five elements theory In Traditional Chinese Medicine (TCM), the differentiation of individual constitutions is key to personalizing dietary recommendations based on the Five Elements Theory. Each person is thought to have a predominant element-Wood, Fire, Earth, Metal, or Water-associated with specific physiological traits and tendencies toward certain health conditions. Dietary adjustments are made to balance these elements, for instance, individuals with a Wood constitution (associated with the Liver) may be advised to consume more sour foods to promote liver function and avoid excessive consumption of greasy foods that may lead to stagnation (Wang, 2013). These constitution-based dietary recommendations help to maintain balance in the body by addressing the unique needs of each person’s elemental profile. For example, a person with a Metal constitution, associated with the Lungs, may benefit from spicy foods to strengthen Lung qi, while avoiding foods that are excessively cold, which could weaken their respiratory health (Kastner, 2004). This individualization of diet is central to promoting overall well-being and preventing diseases according to TCM practices.
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 4 Figure 1 The five elements theory and the zang-xiang theory in traditional Chinese medicine (Adopted from Zhang and Fang, 2023) Image caption: The five elements include wood, fire, soil, metal, and water. The mutual generation orders of the five elements are wood, fire, soil, metal, and water, while the mutual restraint orders of the five elements are wood, soil, water, fire, and metal. The five elements theory refers to that all things in the world are generated by the movement and changes of the five basic elements. The zang-xiang theory investigates the physiological functions, pathological changes, and interrelationships of various organs in the human body by the observation of physiological and pathological phenomena. The zang-xiang theory is based on the zang organs and the fu organs, which include the five zang organs (including the liver, heart, spleen, lung, and the kidney), the six fu organs (including the gallbladder, small intestine, stomach, large intestine, urinary bladder, and the sanjiao), and the extraordinary fu organs (a collective term for the brain, marrow, bone, vessels, gallbladder, and the nü-zi-bao [usually indicating the uterus], these organs are not shown in this figure). The liver, heart, spleen, lung, and the kidney belong to wood, fire, soil, metal, and water, respectively. The mutual generation or restraint orders of the five elements are the same in their corresponding five zang organs. The five zang organs belong to the interior, while their corresponding six fu organs (the gallbladder, small intestine, stomach, large intestine, and the urinary bladder) belong to the exterior. The opening of the five zang organs is as follows: the liver opens into the eyes; the heart opens into the tongue; the spleen opens into the mouth; the lung opens into the nose; and the kidney opens into the ears. The eyes, tongue, mouth, nose, and the ears are collectively termed as the five sense organs (Adopted from Zhang and Fang, 2023) 4.2 The relationship between seasons and the five elements, and its influence on dietary adjustments The Five Elements Theory also emphasizes the importance of seasonal changes in dietary adjustments. Each season is associated with a specific element: Spring corresponds to Wood, Summer to Fire, Late Summer to Earth, Autumn to Metal, and Winter to Water. As the seasons shift, the body’s needs change, and dietary recommendations are adapted accordingly. For instance, during Spring (Wood), the focus is on nourishing the Liver with fresh, green, and lightly sour foods that promote the free flow of qi, such as leafy greens and sprouted grains (Shen, 2014). In contrast, during Winter (Water), foods that nourish the Kidneys, such as salty and warming foods like seaweed and bone broth, are recommended to conserve energy and strengthen the body’s core vitality. This seasonal dietary adaptation aligns the body’s internal environment with external conditions, ensuring that energy is distributed efficiently and health is maintained throughout the year (Cao, 2008). 4.3 The five elements properties of food ingredients and the selection of functional foods In TCM, each food is categorized according to its elemental properties (Wood, Fire, Earth, Metal, Water) and is used to correct imbalances in the body’s internal environment. For example, foods with Wood properties, like sour fruits, are used to nourish the Liver, while Fire-associated foods, such as bitter greens, are beneficial for cooling excess Heart Fire. This classification helps in selecting functional foods that can target specific organs and health conditions. For instance, bitter foods like kale and dandelion greens are often recommended to support heart health and reduce excessive heat (Zhang et al., 2022).
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 5 Moreover, foods associated with the Earth element, such as root vegetables and grains, are used to strengthen the Spleen and Stomach, enhancing digestion and nutrient absorption. This systematic approach to categorizing food allows practitioners to tailor dietary recommendations based on both the patient’s condition and the desired therapeutic effect, promoting metabolic health and overall well-being (Min, 2019). 5 The Impact of Five Elements Dietary Adjustments on Metabolic Health 5.1 The regulatory effects of the five elements diet on glucose metabolism The Five Elements diet, which emphasizes the balance of different food properties (sour, sweet, bitter, salty, pungent), has been shown to regulate glucose metabolism effectively. Dietary adjustments based on the Five Elements help modulate blood sugar levels by promoting the consumption of foods that regulate insulin sensitivity and enhance liver function. For example, bitter foods (associated with Fire) can help clear excess heat and support heart and liver functions, which are critical for balancing glucose levels (Sato et al., 2007). Furthermore, diets with reduced glycemic load, which align with the Five Elements principles, have been shown to decrease postprandial glucose levels and improve insulin sensitivity in both healthy individuals and those with metabolic disorders. Studies also suggest that low-carbohydrate diets, which are aligned with the dietary principles of the Water element, improve glucose metabolism by reducing insulin resistance and lowering fasting blood glucose levels. This dietary approach may be more effective than exercise alone in regulating blood sugar and improving insulin sensitivity in obese individuals (Cai et al., 2021). 5.2 Improvements in lipid metabolism through the five elements diet The Five Elements diet also shows potential for improving lipid metabolism, particularly through the regulation of fat metabolism in the liver and blood. Foods associated with the Earth element, which are considered nourishing for the spleen and stomach, can improve digestion and fat metabolism. Research has demonstrated that moderate weight loss through diet can significantly reduce intrahepatic lipid (IHL) content and improve lipid profiles, leading to lower levels of triglycerides and low-density lipoprotein (LDL) cholesterol in individuals with obesity (Sato et al., 2007). Further, diets rich in unsaturated fats and lower in carbohydrates, akin to the dietary principles of Metal and Water elements, have shown to improve lipid metabolism by enhancing the liver’s ability to process lipids, which reduces hepatic fat accumulation and improves insulin sensitivity (Figure 2) (Volek et al., 2008). These improvements in lipid metabolism can also help prevent cardiovascular diseases, a common risk in individuals with metabolic syndrome. 5.3 Potential benefits of the five elements diet for obesity and weight management One of the key benefits of the Five Elements diet is its potential for effective weight management, particularly in the context of obesity. The diet encourages the consumption of foods that balance the body’s energy, promote digestion, and prevent fat accumulation. By reducing the intake of high-sugar and high-fat foods, which are discouraged in the Five Elements framework, individuals can reduce overall body weight and improve body composition. Studies have shown that combining energy-restricted diets with Five Elements principles can lead to significant weight loss, a reduction in visceral fat, and improvements in insulin resistance (Janssen et al., 2002). Moreover, the alternating diet approach, which aligns with the cyclical nature of the Five Elements, has been found to reduce fat mass and improve metabolic markers in individuals with diet-induced obesity. This approach helps to mitigate the negative effects of high-fat diets by incorporating phases of lower caloric intake, resulting in better weight management and reduced risk of metabolic diseases (Ma et al., 2016). 6 The Relationship Between the Five Elements Diet and Chronic Metabolic Diseases 6.1 Five elements dietary adjustments for diabetes management The Five Elements Theory provides a unique approach to managing diabetes by tailoring dietary adjustments to balance the body’s qi and improve metabolic function. Foods associated with the Earth element, which nourish the
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 6 spleen and stomach, play a key role in regulating glucose metabolism. In TCM, the spleen is responsible for transforming food into energy (qi), and its deficiency is linked to diabetes. Incorporating foods like whole grains and sweet vegetables helps to strengthen the spleen and improve insulin sensitivity. Additionally, consuming bitter foods (Fire element) helps to clear excess heat and reduce blood sugar levels, making them particularly useful in managing diabetes (Rennert and Charney, 2003). Research supports the idea that lifestyle modifications, including specific dietary interventions, can reduce the risk of cardiovascular complications in diabetic patients. For instance, diets based on the Five Elements principles, such as low-glycemic and Mediterranean diets, have been shown to lower glucose levels and improve cardiovascular outcomes in diabetes patients. These dietary strategies align with TCM principles by addressing the underlying causes of metabolic imbalance through balanced nutrition (Mazzone, 2005). Figure 2 Schematic of hepatic metabolic regulation induced by a low-carbohydrate diet (Adopted from Volek et al., 2008) Restriction in dietary carbohydrate, even in the presence of high saturated fatty acids, decreases availability of ligands (glucose, fructose, and insulin) that activate lipogenic and inhibit fatty acid oxidative pathways. The relative importance of each transcri ptional pathway is unclear, but the end result-increased fat oxidation, decreased lipogenesis, and decreased secretion of very low-density lipoprotein-is a highly reliable outcome of low carbohydrate diets (PPAR, peroxisome proliferator-activated receptor) (Adopted from Volek et al., 2008) 6.2 Mechanisms of five elements dietary intervention in hypertension Hypertension, another chronic metabolic disorder, can be managed through the Five Elements diet by addressing the root causes of excess pressure in the cardiovascular system. In TCM, hypertension is often associated with an imbalance of the Fire element (Heart) and the Water element (Kidneys). Salty foods, associated with the Water element, can nourish the kidneys, while bitter foods, linked to the Fire element, help clear heat and reduce inflammation, both of which are common in hypertensive patients. This approach not only manages blood pressure but also targets underlying imbalances that exacerbate hypertension (Oettgen, 2009). Clinical evidence suggests that combining dietary modifications with other lifestyle interventions, such as exercise, can significantly lower blood pressure. Dietary approaches to managing hypertension, such as the DASH diet (Dietary Approaches to Stop Hypertension), have parallels with the Five Elements Theory, particularly in their emphasis on reducing sodium intake and increasing consumption of fruits, vegetables, and whole grains. These foods help to balance the elements and maintain healthy blood pressure levels (Zarich, 2003). 6.3 Preventive strategies for hyperlipidemia and cardiovascular diseases using the five elements diet Hyperlipidemia, characterized by high levels of lipids in the blood, is closely linked to Cardiovascular Disease (CVD). The Five Elements diet can help manage hyperlipidemia by focusing on foods that support liver function (Wood element) and balance digestion (Earth element). For example, sour foods, such as citrus fruits and vinegar, help stimulate liver function and improve lipid metabolism, while sweet and bitter foods assist in reducing
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 7 cholesterol levels and clearing arterial blockages. By targeting the organs responsible for lipid processing, the diet aims to prevent the buildup of harmful fats in the bloodstream (Solano and Goldberg, 2006). Evidence from both TCM and modern medical research supports the effectiveness of dietary modifications in preventing and managing cardiovascular diseases. Studies have shown that diets rich in unsaturated fats, fiber, and antioxidant-rich foods, such as those recommended in TCM, can lower cholesterol and reduce the risk of heart disease. Additionally, these dietary patterns align with contemporary recommendations for reducing cardiovascular risk through healthy eating habits (Herrera et al., 2017). 7 Modern Scientific Validation of the Five Elements Dietary Adjustments 7.1 Cross-disciplinary studies between modern nutrition and the five elements diet Recent advancements in nutritional science have begun to validate the principles of the Five Elements Theory through cross-disciplinary approaches. The integration of modern nutrition and TCM dietary practices offers a unique opportunity to explore how balancing the elements-Wood, Fire, Earth, Metal, and Water-can regulate various metabolic processes. Research has demonstrated that foods associated with these elements, such as sour foods for Wood and bitter foods for Fire, contribute to regulating liver function and improving cardiovascular health. Studies on functional foods, which emphasize nutrient bioavailability and physiological impacts, provide a scientific framework for understanding how the Five Elements Theory can be applied to modern dietary practices (Poitevin, 2012). Moreover, dynamic modeling of nutritional metabonomics has further reinforced these ideas by showing how dietary interventions influence metabolic markers such as triglycerides, cholesterol, and glucose levels. This combined approach helps bridge the gap between TCM dietary adjustments and modern clinical nutrition, offering a robust mechanism for evaluating the health impacts of Five Elements dietary practices (Lundstedt et al., 2010). 7.2 Latest progress in clinical trials and population studies Clinical trials focusing on the Five Elements diet have gained traction, especially in chronic disease management. These trials aim to assess the effectiveness of personalized dietary interventions based on an individual's dominant element. For example, dietary interventions aimed at individuals with a strong Wood constitution have shown promising results in improving liver function and glucose metabolism. Randomized clinical trials, similar to those used in functional food research, are being adapted to evaluate TCM principles, providing evidence for their efficacy in improving metabolic health markers (Brown et al., 2018). Population studies have also highlighted the benefits of integrating the Five Elements diet with modern dietary guidelines. For example, studies involving Mediterranean and low-glycemic diets-both of which align with Five Elements principles-have demonstrated improvements in lipid profiles and cardiovascular health. Such dietary patterns have been linked to reductions in chronic disease incidence, further validating TCM-based dietary interventions (Assmann et al., 2014). 7.3 Exploration of functional components in five elements foods through laboratory research Laboratory research has made significant progress in identifying the bioactive components of foods associated with the Five Elements, providing a scientific basis for their health benefits. For example, bitter foods linked to the Fire element, such as certain leafy greens, have been shown to contain antioxidants and anti-inflammatory compounds that contribute to cardiovascular and metabolic health. These functional components, such as flavonoids and polyphenols, have been studied extensively in laboratory settings, revealing their potential to reduce oxidative stress and improve metabolic function (Crowe and Francis, 2013). Further exploration of the prebiotic effects of foods associated with the Earth element has demonstrated their role in modulating gut microbiota, which is essential for maintaining metabolic balance. Foods rich in fiber, such as whole grains and root vegetables, support the growth of beneficial bacteria in the gut, thereby enhancing digestion and nutrient absorption. These findings provide a scientific basis for the digestive and metabolic health benefits long attributed to Earth-related foods in TCM (Roberfroid, 2009).
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 8 8 Application and Challenges of the Five Elements Dietary Adjustment Plans 8.1 Challenges in personalized dietary adjustments and five elements constitution identification One of the most significant challenges in applying the Five Elements Theory in modern dietary adjustments is the accurate identification of an individual's elemental constitution. In Traditional Chinese Medicine (TCM), each person is classified based on their dominant element (Wood, Fire, Earth, Metal, or Water), which influences their physical and emotional health. However, determining a person's elemental type is subjective and requires the skill of experienced practitioners. This lack of standardized diagnostic methods makes it difficult to create personalized dietary plans based on the Five Elements Theory, limiting its integration with modern nutritional approaches (Gao, 2017). Additionally, modern healthcare systems rely heavily on evidence-based practices, while the Five Elements Theory is rooted in holistic and often qualitative assessments. This disparity presents another obstacle, as TCM diagnostic techniques such as pulse reading or facial diagnosis are difficult to quantify and validate using conventional scientific methods (Yang and Kim, 2006). Therefore, bridging this gap requires developing standardized diagnostic tools that can integrate traditional practices with contemporary nutritional science. 8.2 Dietary cultural diversity and the adaptability of five elements adjustments Cultural diversity also poses a significant challenge in implementing the Five Elements diet, especially in multicultural societies where dietary habits and preferences vary widely. For instance, foods recommended in the Five Elements Theory, such as specific herbs or medicinal plants, may not be readily available or culturally accepted in certain regions. The Five Elements Theory is deeply rooted in East Asian culinary and medical traditions, making it difficult to adapt to Western or other non-Asian food systems without significant modification (Chesla et al., 2009). Moreover, dietary recommendations in TCM often emphasize balance and moderation, concepts that may conflict with Western dietary guidelines, which prioritize calorie counting and macronutrient distribution. While some research has shown that integrating traditional dietary practices with modern nutrition can yield positive outcomes for chronic diseases, the adaptability of the Five Elements diet to diverse food cultures requires further exploration (Mora and Golden, 2017). 8.3 Strategies for integrating and promoting the five elements diet in modern medicine To successfully integrate the Five Elements dietary approach into modern medical practices, a collaborative framework between TCM practitioners and nutritionists is essential. This framework would involve combining the holistic, constitution-based approach of TCM with the evidence-based focus of modern nutritional science. Recent studies suggest that employing a “fusion” model-where dietary plans based on the Five Elements Theory are developed in tandem with modern nutritional advice-may offer a practical solution for patients with chronic metabolic conditions such as diabetes or hypertension (Fallows, 2023; Pu and Cai, 2024). Public health initiatives can also play a role in promoting the Five Elements diet by emphasizing its preventive and therapeutic potential. Such initiatives could focus on educating healthcare providers and patients about the benefits of integrating TCM dietary practices with Western medical care. Additionally, fostering a greater understanding of how the Five Elements Theory aligns with principles of functional medicine and personalized nutrition can facilitate its acceptance in mainstream healthcare systems (Tao et al., 2016). 9 Concluding Remarks The Five Elements Theory offers a holistic framework for dietary adjustments that can positively influence metabolic health by promoting the balance of bodily functions through tailored food choices. By aligning diet with an individual's elemental constitution, this approach addresses the root causes of metabolic imbalances, such as dysregulated glucose and lipid metabolism, and offers promising interventions for chronic conditions like diabetes, obesity, and cardiovascular disease. The flexibility of the Five Elements Theory allows for personalized nutrition, making it a valuable tool in managing and preventing metabolic disorders.
International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 9 Despite the potential benefits, current research on the Five Elements dietary adjustments is limited by the lack of large-scale, high-quality clinical trials and standardized methods for determining elemental constitutions. Most existing studies are observational or based on small sample sizes, which restricts the generalizability of their findings. Future research should focus on conducting rigorous clinical trials to validate the efficacy of the Five Elements dietary interventions and developing standardized diagnostic tools for assessing elemental constitutions. Additionally, exploring the molecular mechanisms behind the Five Elements foods and their bioactive compounds would further strengthen the scientific foundation of this dietary approach. In the context of public health, the integration of Five Elements dietary principles into mainstream healthcare has significant potential. By promoting a balanced and holistic approach to diet, which aligns with both modern nutritional science and traditional practices, the Five Elements Theory could play a key role in preventing and managing widespread metabolic diseases. Public health strategies could incorporate educational campaigns and collaborative programs between TCM practitioners and nutritionists to promote the benefits of personalized dietary adjustments. This fusion of traditional and modern medicine could offer a culturally adaptable and accessible approach to improving metabolic health on a global scale. Acknowledgments Thank you to the anonymous peer review for providing targeted revision suggestions for the manuscript. Conflict of Interest Disclosure The authors affirm that this research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. References Assmann G., Buono P., Daniele A., Della Valle E., Farinaro E., Ferns G., Krogh V., Kromhout D., Masana L., Merino J., Misciagna G., Panico S., Riccardi G., Rivellese A.A., Rozza F., Salvatore F., Salvatore V., Stranges S., Trevisan M., Trimarco B., and Vetrani C., 2014, Functional foods and cardiometabolic diseases, international task force for prevention of cardiometabolic diseases, Nutrition, Metabolism and Cardiovascular Diseases, 24(12): 1272-1300. https://doi.org/10.1016/J.NUMECD.2014.10.010 Bin C., 2007, The discuss on Chinese medical science theory about correlation of five viscera, Journal of Hubei Institute for Nationalities, 10: 223. Brown L., Caligiuri S., Brown D., and Pierce G., 2018, Clinical trials using functional foods provide unique challenges, Journal of Functional Foods, 45: 233-238. https://doi.org/10.1016/J.JFF.2018.01.024 Cai L., Yin J., Ma X, Mo Y., Li C., Lu W., Bao Y., Zhou J., and Jia W., 2021, Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: a randomized clinical trial, Frontiers of Medicine, 15: 460-471. https://doi.org/10.1007/s11684-021-0861-6 Chen M.Y., and Yu S.Y., 2024, The classification study and categorization of medicinal properties in traditional Chinese medicine, International Journal of Clinical Case Reports, 14(1): 14-22. https://doi.org/ijccr.2024.14.0002 Chen Y., Liu T., Teia F., and Xie M., 2023, Exploring the underlying mechanisms of obesity and diabetes and the potential of Traditional Chinese Medicine: an overview of the literature, Frontiers in Endocrinology, 14: 1218880. https://doi.org/10.3389/fendo.2023.1218880 Chen L., Chen X.B., Wang J.K., Zhou K., Gong W.B., Su Q., Zhang Y., Gu Y.J., Tang K.W., and Wang H., 2013, WANG Hui's exploration on various stages of physiology and pathology of five elements constitutions, Chinese Archives of Traditional Chinese Medicine, 31(10): 2153-2155. https://doi.org/10.13193/j.issn.1673-7717.2013.10.032 Chesla C., Chun K., and Kwan C., 2009, Cultural and family challenges to managing type 2 diabetes in immigrant Chinese Americans, Diabetes Care, 32: 1812-1816. https://doi.org/10.2U337/dc09-0278. Crowe K., and Francis C., 2013, Position of the academy of nutrition and dietetics: functional foods, Journal of the Academy of Nutrition and Dietetics, 113(8): 1096-103. https://doi.org/10.1016/j.jand.2013.06.002 Fallows E., 2023, Lifestyle medicine: a cultural shift in medicine that can drive integration of care, Future Healthcare Journal, 10: 226-231. https://doi.org/10.7861/fhj.2023-0094 Fong S., 2022, Modified Traditional Chinese Medicine formula: is it still effective?, Borneo Journal of Medical Sciences, 16(3): 1-2. https://doi.org/10.51200/bjms.v16i3.3887 Gao Y., 2017, Traditional Chinese medical nutrition and western nutrition, Journal of Analytical & Pharmaceutical Research, 4(2): 45-47. https://doi.org/10.15406/JAPLR.2017.04.00098.
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