According to the definition by American Music Therapy Association (AMTA), music therapy employs interventions to accomplish individual goals within a therapeutic relationship by a professional who has completed an approved music therapy program [1] . For centuries, music therapy has served as an alternative and complementary approach for various neurological disorders, including stroke, aphasia, visual neglect, Parkinson’s disease, dementia, autism, and pain syndrome [2] [3] . Besides, its effectiveness has been validated by clinic practitioners and researchers worldwide [4] . Music therapy triggers neuroplasticity, repairs brain damage and regulates the cognitive, emotional and social disorders [5] . Music therapy is usually considered as a subdivision of psychotherapy, esp. art pyschotherapy, which can be solely or jointly applied to intervene mental disorders [6] . In Chinese Medicine (CM), psychology and physiology are regarded as an inseparable unity, which means in the etiology, pathogenesis and treatment, psychological and physiological changes are mutually affected [7] . Over 2000 years, CM has been employing many non-physiological approaches in its therapeutic spectrum, e.g. music therapy, linguistic therapy, kinesitherapy, etc. [8] [9] . Additionally, music theories have been widely used in CM not only to analyze and explain an illness condition but also to treat mind-body disorders [10] .

Five Phases Music Therapy (FPMT), also called Chinese Medicine Music Therapy (CMMT) employs the theory of five phases and five music scales to analyze and treat mind-body illness. The five music scales i.e. Gong (do), Shang (re), Jue (mi), Zhi (so), Yu (la) were firstly defined in Yue Ji (translated as Chapter of Music), which is the 19^th chapter in Li Ji or The Book of Rites (collected by Dai Sheng from 51 B.C. to 21 B.C.) and the first systemic theoretic records on music [11] . In this chapter, the medical effects of music have already been involved.

The model of five phases i.e. metal, wood, water, fire and earth is one of the most basic philosophic foundations in CM. In Yellow Emperor’s Inner Classic, a connection of the five phases, five Zang-organs, and human sound with the five scales has been established (Figure 1). It is also explained that Jue, Zhi, Gong, Shang, and Yu are derived from the very primary sound in the beginning of the universe. As recorded in the classic, each organ has its corresponding sound in nature. This relationship is based on the unique holistic understanding in CM that human being and the nature are unified. Music is the bridge of human body and the universe. There are five scales and six temperaments in nature and there are five Zang-organs and six Fu-organs in the human body correspondingly. Pathologically, harmful sound of Gong, Shang, Jue, Zhi and Yu tends to cause spleen, lung, liver, heart, and kidney disorders respectively.

In CM, the model of five music scales is used to interpret the personality and constitution characteristic of individuals [12] . There are five main types (Wood Type, Fire Type, Earth Type, Metal Type, and Water Type) and each type is further divided into five sub-types (Gong Type, Shang Type, Jue Type, Zhi Type, and Yu Type). Altogether, the 25 types of personality and constitution are defined [13] . In Yun-Qi theory which includes five Yun (wood, fire, earth, metal,

water) and six Qi (wind, cold, summer, damp, dryness, fire) to analyze the climatic changes and their relationship to illness on human body. Briefly, Yun-Qi theory can be used to analyze the etiology and predict the onset of a disease [14] . The five music scales are applied to interpret a climatic feature. For instance, Gong is the sound of Yang-earth and Yin-earth. The Yang Earth corresponds to Tai Gong (greater Gong) and the Yin Earth to Shao Gong (lesser Gong). Tai Gong generates Yin-metal. Thus, the fives sounds are systemically applied to analyze the temporal and spatial variation of the nature and human illnesses [15] .

Music is regarded as a universal feature of human societies, owing to its ability to trigger strong emotions and affect moods [16] . Music therapy has been widely used in coping mental disorders, such as depression, anxiety, insomnia, schizophrenia, phobia, burnout, etc. The mental disorders belong to the emotion and will diseases [8] [17] . Music with the parameters of pitch, frequency, timbre, and volume affects the emotion, regulates the dynamics of Qi movement including ascending, descending, exiting and entering.

In CM, emotions are closely related to organs. Specifically, thinking corresponds to the spleen (Gong), sorrow/worry to the lungs (Shang), anger to the liver (Jue), joy to the heart (Zhi) and fear/fright to the kidneys (Yu) respectively [18] . The five scales and human emotions are regarded as manifestations of Qi movements and changes. Emotion-will plays a basic role in the onset, progress and prognosis of almost all diseases, not only the psychological and psychiatric disorders. The emotion-will overcoming therapy (EWOT) derived from the philosophical foundation of Chinese medicine, i.e. Yin and Yang, and Five Elements, is believed to be the most effective modality in dealing with mental illness [19] .

Shen (spirit) is the reflection of vitality of the human body [20] . Shen governs all psychological and physiological activities. Therefore, priority must be given to heal Shen in all therapeutic approaches in Chinese Medicine, esp. in acupuncture treatment [21] . Music is regarded as the best connection with Shen in all cultures [22] [23] [24] . In CM, the psychological and physiological processes can be translated into Qi, blood, emotion and cognition. Thus, a model is established, showed in figure 2.

Therefore, music is called remedy by Zhu Danxi (1281-1358 A.D.), the founder of School of Minister Fire. Interestingly, the two Chinese characters of music and herbal medicine in Chinese language looks very similar (Figure 3) [18] . For example, music could significantly treat the burnout symptoms [19] .

Music therapy has been reported as an effective modality in the treatment of neurological, psychological and psychiatric disorders, which are regarded as Shen disorders in CM. Music therapy is found to have positive effects on decreasing national anxiety score [30] . There is evidence of music-supported therapy’s positive effects, supporting its use for the treatment of stroke-induced motor dysfunction [31] [32] . It is recorded that listening to music in daily life improves perceived control over pain in female FMS patients. There are also abundant reports on the clinical application of FPMT. The FPMT has been widely used in the treatment of depression, anxiety, PMS, chronic and pain etc., solely or in combination with other therapies [19] . Researchers have pointed out that FPMT could alleviate the anxiety and depression symptoms and improve quality of life in lung cancer patient after chemotherapy [10] [33] - [35] . FPMT could alleviate the symptoms of seasonal affective disorder in the elderly [36] . It is usually applied in combination with acupuncture. For instance, Li et al. [25] holds that the combination of FPMT plus electro-acupuncture could reduce the

neonatal acidosis and suffocation during normal childbirth. FPMT together with acupuncture, Tuina, Tai Chi, and Qigong have represented adjunctive benefits for the symptoms of cancer patients from the meta-review of 67 RCTs (Tao et al., 2016). FPMT is also known to improve the condition of chronic fatigue syndrome (CFS). Wu et al. found that FPMT could regulate the emotion of CFS patients, relieve depression and anxiety, improve the fatigue symptoms [26] . Researchers have tried to explore the neurological mechanism of FEMP on animals. Li et al. [37] reported FPMT tended to increase the value of OE%, as well as the crossing and rearing movement times on SD rats. Qi et al. [38] found that the combination of FEMP or electronic acupuncture could lower the 5-HT level in hypothalamus of anxiety rat.

Music therapy has served as complementary and alternative medicine for various psychological and pathological disorders. FEMP is a unique method from the combination of Chinese music and CM. It has a self-contained theory and practice. Abundant clinical trials have showed its benefits as primary or complementary approach. More systemic, controlled, randomized, clinic trails must be performed to validate and optimize its routines and biological and neurological mechanism must be further conducted. It may be a new therapy besides the conventional or western music therapy. As CM is getting more and more popular worldwide, introducing FEMP to the world may attract more attention as an effective music therapy.

This study is sponsored by Sichuan Chinese Medicine Culture Cooperation and Development Grant (ZYYWH1619) and Fund of Chengdu University of TCM (ZRQN1541).

The author declares no conflict of interests.

Zhang, H. and Lai, H. (2017) Five Phases Music Therapy (FPMT) in Chinese Medicine: Fundamentals and Application. Open Access Library Journal, 4: e4190. https://doi.org/10.4236/oalib.1104190

AMTA American Music Therapy Association

CM Chinese Medicine

CMMT Chinese Medicine Music Therapy