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  4. Vol 7, Issue 1, 2026

Voicing the Five Notes: Reframing Five-Element Music Therapy as a Vocal-Articulatory Tradition

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DOI: 10.23977/artpl.2026.070116 | Downloads: 1 | Views: 52

Author(s)

Jianhua Zhang 1

Affiliation(s)

1 Zhejiang Conservatory of Music, Hangzhou, Zhejiang, China

Corresponding Author

Jianhua Zhang

ABSTRACT

Five-Element Music Therapy (FEMT) has built an international evidence base over the past decade documenting effects across post-stroke aphasia, cancer-related distress, and late-life depression. The subfield treats the five notes — gong, shang, jiao, zhi, yu — as listening stimuli administered through recordings, with the mode label as the operative therapeutic variable. The classical sources operate at a different register. The Mengzi, the Tongzhi: Qi Yin Lüe, and the Yizong Jinjian describe the five notes as vocal-articulatory configurations, locating each at a specific site of tongue, jaw, lip, and breath. Song Boyuan's philological critique reaches the modal reading and dissolves it; the vocal-articulatory reading is left untouched and was the older one. FEMT has been resting on the weakest available reading of its own sources. An international research program on singing as therapeutic practice — Sing Well, Melodic Intonation Therapy, the choral physiology trials of Vickhoff, Fancourt, and others — has independently developed methods the FEMT subfield could absorb but has not. Italian appoggio, the Chinese qi chen dan tian tradition, and the recent theory of embodied singing converge on a single anatomical zone of breath support, providing a cross-cultural conceptual bridge with consequences for protocol specification, outcome measurement, and clinical collaboration.

KEYWORDS

Five-element music therapy, Vocal articulation, embodied singing, Appoggio, Music therapy, Yizong Jinjian

CITE THIS PAPER

Jianhua Zhang. Voicing the Five Notes: Reframing Five-Element Music Therapy as a Vocal-Articulatory Tradition. Art and Performance Letters (2026). Vol. 7, No.1, 95-106. DOI: http://dx.doi.org/10.23977/artpl.2026.070116.

REFERENCES

[1] Yang T, Wang J, Wang R, Yang Y, Liu Y, Zhang C. Effects of Five-Element Music on Language Recovery in Patients with Poststroke Aphasia: A Systematic Review and Meta-Analysis. Journal of Alternative and Complementary Medicine. 2019; 25(10): 983-991.
[2] Yang T, et al. Effectiveness of Five-Element Music Therapy in Cancer Patients: A Systematic Review and Meta-Analysis. Complementary Therapies in Clinical Practice. 2021; 44: 101416.
[3] Du QQ, Bai L. Research Progress of Traditional Chinese Music Therapy in China. Modernization of Traditional Chinese Medicine and Materia Medica. 2020; 22(8): 2876-2881.
[4] Ma Y, Liu MM, Gao SH. Discussion of TCM Music Therapy Based on the Five-Note Theory of the Huangdi Neijing. China Journal of Traditional Chinese Medicine and Pharmacy. 2014; 29(5): 1294-1297.
[5] Hu JX,  Music and Health Medicine. Beijing: China Federation of Literary and Art Circles Publishing House; 2004.
[6] Song BY. A Critique of Five-Element Music Therapy. Chinese Musicology. 2016; (2): 40-43.
[7] Russo FA, Good AJ. Sing Well: An International Research Program on Singing-Based Interventions. Toronto Metropolitan University; launched 2021. Available from: https://singwell.ca [Accessed 15th April 2026].
[8] Schlaug G, Marchina S, Norton A. Evidence for Plasticity in White-Matter Tracts of Patients with Chronic Broca's Aphasia Undergoing Intense Intonation-Based Speech Therapy. Annals of the New York Academy of Sciences. 2009; 1169: 385-394.
[9] Vickhoff B, Malmgren H, Astrom R, Nyberg G, Ekstrom SR, Engwall M, Snygg J, Nilsson M, Jornsten R. Music Structure Determines Heart Rate Variability of Singers. Frontiers in Psychology. 2013; 4: 334.
[10] Lin FC, He NN, Huang DH. Primary Exploration on Music Therapy Based on Five Elements in Inner Canon of Huangdi. China Journal of Traditional Chinese Medicine and Pharmacy. 2015; 30(11): 4161-4162.
[11] Tai XL, Liu XY, Pei F, Cui YD, Zhang YX, Huang XJ, Zhang WJ, Liang YX. Brief Analysis of the Five Yin and Five Sheng in Huangdi Neijing. China Journal of Traditional Chinese Medicine and Pharmacy. 2023; 38(12): 5695-5698.
[12] Lin FC. Mechanism of Five-Notes Therapy Based on Meridian Theory. Beijing University of Chinese Medicine Journal. 2014; 37(7): 466-469.
[13] Zhang XF, Liao LH. Application Research of Music Therapy Based on Five-Zang Sound Correspondence in TCM Diagnosis and Treatment. China Journal of Traditional Chinese Medicine and Pharmacy. 2020; 35(7): 3726-3729.
[14] Zhang Y. An Exploration of the Thought-System of China's Traditional Five-Note Therapy. Journal of Art Communication. 2022; (2): 46-58.
[15] Cai ZX. The History and Current Status of Music Therapy for Emotional Diseases. Chinese Journal of Information on Traditional Chinese Medicine. 2014; 21(7): 124-127.
[16] Fan XX, Zhao ST, Yong LL, Zhai ZW, Li Y, Zhong YM, Wen CB. Clinical Research Progress of Insomnia Based on the Theory of Five Tones in Traditional Chinese Medicine and Analysis of Problems and Strategies. Modernization of Traditional Chinese Medicine and Materia Medica. 2022; 24(11): 4304-4309.
[17] Li XH, et al. Research Progress of Traditional Chinese Medicine External Treatment for Depression in Recent Ten Years. Chinese Journal of Integrated Traditional and Western Medicine. 2024; 44(5): 612-617.
[18] ClinicalTrials.gov. NCT00964314, Prospective Study with RCT Designed for Evaluation of TCM Five Elements Music Therapy Improving Quality of Life in Patients with Advanced Cancer; and NCT07048938, Clinical Effect and Mechanism Study of Five Elements Music Therapy on Depression Disorder. Available from: https://clinicaltrials.gov [Accessed 15th April 2026].
[19] Zhao LZ, et al. Research Progress of Traditional Chinese Medicine Five-Tone Therapy. Chinese Journal of Traditional Chinese Medicine and Pharmacy. 2016; 31(11): 4666-4669.
[20] Zheng ZW. Origin Exploration of Five-Tone Establishing Movement. Liaoning Journal of Traditional Chinese Medicine. 2024; 26(1): 1-4.
[21] Wang F. Research on Combining Modern Electronic Music Technology with TCM Five-Tone Therapy in Clinical Application. Chinese Folk Therapy. 2024; 32(15): 88-92.
[22] Yao XY, Xu C, Yang LL, Wu AL, Xiong L. An Empirical Study on the Intervention of Traditional Chinese Medicine Five-Element Music in Alleviating Anxiety and Depression Among Medical Students: Differences in Effectiveness Among Three Different Musical Instruments. Frontiers in Psychology. 2025; 16: 1625325.
[23] Kwon N, Leem J, Park S, et al. The Modernization of Oriental Music Therapy: Five-Element Music Therapy Combined with Artificial Intelligence. Healthcare. 2024; 12(3): 411.
[24] Xu JZ, Qiao XC, Shi YJ, Li YM. To Define the Chinese Ancient Standard Pitch by Resonate Viscera and Collateral Channels.  (Journal of Wuhan Conservatory of Music). 2010; (4): 145-150.
[25] Hou Y. Basic Methods and Operations of Music Therapy.  (Journal of Wuhan Conservatory of Music). 2013; (2): 167-172.
[26] Mengzi., Book of Rites: Record of Music. In: Tai XL, Liu XY, Pei F, et al. Brief Analysis of the Five Yin and Five Sheng in Huangdi Neijing. China Journal of Traditional Chinese Medicine and Pharmacy. 2023; 38(12): 5695-5698.
[27] Wang ST. Research on Traditional Chinese Music Therapy in the Context of Cultural Anthropology. Ph.D. Thesis, Nanjing University of Chinese Medicine, Nanjing; 2020.
[28] Zheng Q. Tongzhi: Seven Notes Summary (Comprehensive Treatise: Brief on the Seven Sounds). As cited and reconstructed in Hu JX,  Beijing: China Federation of Literary and Art Circles Publishing House; 2004.
[29] Jiang X, Liu Y. Analysis of Five-Tones and Treatment of Disease with Five-Tones. China Journal of Traditional Chinese Medicine and Pharmacy. 2024; 39(7): 3779-3782.
[30] Wu Q, et al. Golden Mirror of the Medical Lineage. Qing Dynasty compilation; modern edition Beijing: People's Medical Publishing House; 2006.
[31] Zhang Y. An Exploration of the Thought-System of China's Traditional Five-Note Therapy. Journal of Art Communication. 2022; (2): 46-58.
[32] Zheng ZW. Origin Exploration of Five-Tone Establishing Movement. Liaoning Journal of Traditional Chinese Medicine. 2024; 26(1): 1-4.
[33] Loutrari K, Georgiadou E. Adapted Melodic Intonation Therapy for Voice Feminization in Transgender Women: A Preliminary Investigation. Journal of Voice. 2024; advance online publication.
[34] Li K, Weng LM, Wang XQ. The State of Music Therapy Studies in the Past 20 Years: A Bibliometric Analysis. Frontiers in Psychology. 2021; 12: 697726.
[35] Sihvonen AJ, et al. Structural Neuroplasticity Effects of Singing in Chronic Aphasia. eNeuro. 2024; 11(5): ENEURO.0408-23.2024.
[36] Pitkaniemi A. Neural Correlates of Preserved Singing Ability in Broca-Type Aphasia: Evidence for Left-Hemisphere Ventral-Stream Involvement. Ph.D. Thesis, University of Helsinki, Helsinki; 2024.
[37] Porges SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: Norton; 2011.
[38] Tatschl JM, Schwerdtfeger AR. Singing at 0.1 Hz as a Resonance Frequency Intervention to Reduce Cardiovascular Stress Reactivity? Frontiers in Psychiatry. 2022; 13: 876344.
[39] Fancourt D, Williamon A, Carvalho LA, Steptoe A, Dow R, Lewis I. Singing Modulates Mood, Stress, Cortisol, Cytokine and Neuropeptide Activity in Cancer Patients and Carers. E-cancer medical science. 2016; 10: 631.
[40] Schladt C, Nguyen GC, Tiliopoulos C, et al. Choir versus Solo Singing: Effects on Mood, and Salivary Oxytocin and Cortisol Concentrations. Frontiers in Human Neuroscience. 2017; 11: 430.
[41] Grape C, Sandgren M, Hansson LO, Ericson M, Theorell T. Does Singing Promote Well-Being? An Empirical Study of Professional and Amateur Singers during a Singing Lesson. Integrative Physiological and Behavioral Science. 2003; 38(1): 65-74.
[42] Ng TKS, Lim ZH, Todd M, Sun F, Ray K, Qi X, Guo J, Ye KX, Maier AB, Mahendran R, Goh LG, Tsakok M, Kua EH, Feng L. Effects of Choral Singing on Depression and Anxiety in Older Adults: A Randomized Controlled Trial. Journal of Psychiatric Research. 2025; 188: 162-168.
[43] Miller R. The Structure of Singing: System and Art in Vocal Technique. New York: Schirmer Books; 1986.
[44] Chapman J. Singing and Teaching Singing: A Holistic Approach to Classical Voice. 3rd ed. San Diego: Plural Publishing; 2017.
[45] Wang HT, Liu H. The Practical Application of Medical Body Philosophy: A Study of the Theory of Embodied Singing. Medicine and Philosophy. 2025; 46(5): 74-75.

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