Basic Theory of TCM

Chapter One Introduction

1.1 The Basic Concept of TCM

TCM is originated in ancient China and developed through several thousand years. It has unique theoretical system and is used to keep people in good health, diagnose and treat diseases.

Actually Basic Theory of TCM includes four aspects:

(1) the philosophy of TCM

(2) the discussion on normal human body

(3) the discussion on diseases

(4) the principle of prevention and treatment.

According to ancient inscriptions on oracle bones and turtle carapaces, traditional Chinese medicine (TCM) has been used to treat disease for over 4,000 years. In their struggle for survival, the Chinese people have organized their disease fighting experiences into a theoretically and practically coherent system of medicine. This empirically derived system, TCM, is one of the significant unique inventions of the Chinese culture and an effective mode of healing currently used throughout the world.

1.2 A Brief History of the Development of TCM

A. "Canon of Medicine" (Nei Jing) and "Treatise on Febrile Diseases" (Shang Han Lun)

Chinese medicine originally developed in an ancient time, in a vast land which included many different types of topology, climate and living conditions. Many TCM scholars believe that the predecessor of today's acupuncture and moxibustion originated in the Huanghe (Yellow) River valley, while medicinal therapy--the use of drugs and herbs--first arose in the Changjiang (Yangtze) River valley. From separate beginnings, the use of these two ancient modes of treating disease gradually combined together to make up what is now considered TCM. Both modes of healing have been recorded in ancient written texts and have a distinct supporting literature. The "Canon of Medicine" (called "Nei Jing" or "Huangdi Nei Jing" by the Chinese) represents ancient knowledge of acupuncture and moxibustion while the "Treatise on Febrile Diseases and Miscellaneous Diseases" (called "Shang Han Za Bing Lun") represents the tradition of medicinal therapy.

Most TCM scholars agree that the "Canon of Medicine" was probably produced in the epoch of the Warring States (475-221 B.C.). Though often referred to as "Huangdi Nei Jing", or the "Nei Jing" written by Huangdi, it most likely was not written by a single person, but rather composed by several different authors. The contents are presented in two sections: "Plain Questions" ("Su Wen") and the "Miraculous Pivot" ("Ling Shu"). The text deals with basic medical science, discussing at length normal physiology and pathology of the human body. In addition, many acupuncture and moxibustion therapies for specific diseases are elaborated. During the period of the Sui and Tang dynasties (A.D. 581-907), the material contained within the "Canon of Medicine" was altered. In fact, medical scholars throughout the ages have annotated and reorganized the book, and sections have been added and deleted. The changes of the text have reflected the evolution of ideas regarding acupuncture and moxibustion.

Other ancient texts have also contributed to the recorded knowledge of acupuncture and moxibustion. One of the most influential is the "A-B Classic of Acupuncture and Moxibustion" ("Jia Yi Jing") written by Huang Fu-mi during the Jin dynasty (A.D. 256-282). It was intended as a review of the existing literature of acupuncture and moxibustion and focused on treatment, reorganizing and re-presenting the contents of the "Canon of Medicine" and other previously written medical literature.

In addition, the "Classic of Medical Problems" ("Nan Jing"), probably written during the Eastern Han dynasty (A.D. 25-221), was originally intended to explicate difficult passages of the "Canon of Medicine". However, the contents of the extant "Classic of Medical Problems" greatly differ from the contents of the "Canon of Medicine". In particular, the former text elaborates in much greater detail needle manipulation techniques of acupuncture.

It can be said that the foundations of acupuncture and moxibustion can be found in these three books, the "Canon of Medicine", the "Classic of Medical Problems", and the "A-B Classic of Acupuncture and Moxibustion". Although later generations of TCM practitioners have added greatly to the body of literature, the basic underlying theories originally presented in these classics have remained constant.

Concerning the use of medicinals (which includes drugs, herbs, and other materia medica), in the Eastern Han dynasty a physician named Zhang Zhong-jing painstakingly recorded the knowledge and experience of his progenitors from ancient texts. Through extensive research, he collected numerous prescriptions (113 in all) which were used throughout the ages, and compiled the "Treatise on Febrile Diseases and Miscellaneous Diseases" ("Shang Han Lun", A.D. 196-204). Regarded as a medical sage by the Chinese, Zhang Zhong-jing's "Treatise on Febrile Diseases and Miscellaneous Diseases" has been hailed as the forerunner of prescription texts. The principles of TCM pharmacology presented in the "Treatise on Febrile Diseases and Miscellaneous Diseases" have exerted significant influence on the development of medicinal therapy in subsequent ages. Even today, many of its prescriptions are used to treat diseases. Its method of differentiating syndromes of febrile diseases is in accordance with the theory of six channels (stages) (which was expounded in the "Canon of Medicine"). From this method of differentiating febrile diseases, methods for differentiating other diseases also were developed.

B. Developments in Acupuncture and Moxibustion after the Han Dynasty

During the Jin dynasty (A.D. 265-420) (2), acupuncture and moxibustion expanded by leaps and bounds. The famous Jin dynasty physician, Huang Fu-mi epitomized the achievements of acupuncture and moxibustion in this era. Compiling the "A-B Classic of Acupuncture and Moxibustion", he sorted out materials from the ancient texts, "Plain Questions", "Miraculous Pivot" and "Essentials of Points, Acupuncture and Moxibustion" ("Ming Tang Kong Xue Zhen Jiu Zhi Yao Dian"). As a result of these efforts, he organized the first complete systematic treatment of acupuncture and moxibustion.

Also during the Jin dynasty, collections of illustrated plates of the human body began to appear. Examples include: "Charts of Vertical and Side Views" ("Cun Zhen Tu") and "Charts of Three Views" (the original form of this book has been lost). These visual materials aided in learning and locating the position of acupoints. Later in the Tang dynasty, "Charts of Three Views" was checked for accuracy by Zhen Quan and others. Furthermore, Sun Si-miao rendered the charts in color and then included them in his classic "Prescriptions Worth a Thousand Gold for Emergencies" (with proper reference to the original "Charts of Three Views"). (3)

In "Prescriptions Worth a Thousand Gold for Emergencies" ("Qian Jin Yao Fang") and "A Supplement to the Prescriptions Worth a Thousand Gold" ("Qian Jin Yi Fang"), Sun Si-miao (A.D. 581-682) compiled extensive information on acupuncture and moxibustion. In special chapters and sections, he collected clinical experiences from previous generations and various different schools of practice.

During the Sui (A.D. 581-618) and Tang (A.D. 618-907) dynasties, medical sciences became divided into separate and independent departments, of which acupuncture and moxibustion was one. Under the Imperial Medical Bureau of the Tang dynasty, acupuncture and moxibustion was recognized as a medical specialty with specialized physicians and instructors. In addition, during this period special emphasis was placed on combining acupuncture with medicinal herbs. (4)

In the middle of the Tang Dynasty, special consideration was placed on moxibustion techniques. In light of its added importance, Wang Tao exclusively focuses on describing moxibustion methods and techniques in "The Medical Secrets of an Official" ("Wai Tai Mi Yao").

While the Jin dynasty is regarded as the first peak in the development of acupuncture and moxibustion, the second peak occurred during the Song (A.D. 960-1279) and Yuan (A.D. 1271-1368) dynasties. During this time, three events of importance took place. The first was that developments in paper-making and printing made it possible to better organize and disseminate the large body of ancient TCM literature. The second was that two life-size bronze figures were designed for the purpose of teaching acupuncture and moxibustion. Thirdly, acupuncture points began to be selected in accordance with the time.

In the Song dynasty, Wang Wei-yi wrote the "Illustrated Manual on the Points for Acupuncture and Moxibustion on a New Bronze Figure" ("Tong Ren Shu Xue Zhen Jiu Tu Jing"). Accompanying the manual, Wang cast two life-size bronze figures to aid in the learning of acupoint locations and in examination of acupuncture and moxibustion techniques.

In the Jin and Yuan dynasties, Dou Han-qing coordinated the selection of acupoints with time of treatment. According to this theory, he advocated that acupuncture therapy, particularly the selection of acupoints, should be conducted according to the traditional Chinese theory of time based on the 10 celestial stems and the 12 earthly branches (Tian Gan Di Zhi).

The Yuan dynasty marked the zenith of acupuncture and moxibustion. Many famous physicians came forth to practice, teach, and write about acupuncture and moxibustion. Many important texts were published such as the very influential "Experience on Acupuncture and Moxibustion Therapy" ("Zhen Jiu Zi Shen Jing") written by Wang Zhi-zhong. As the title suggests, the author stresses the importance of practical clinical experience. In "Exposition of the Fourteen Meridians" ("Shi Si Jing Fa Hui"), Hua Shou discusses the Ren (conception vessel) and Du (governing vessel) meridians along side the twelve regular channels. In addition, he records his textual research of the location of acupoints according to the classics. In "A Book of Bian Que's Experience" ("Bian Que Xin Shu"), Dou Cai (often regarded as the father of the practice of moxibustion) relates the medical experiences of the famous 5th century B.C. physician, Qin Yue-ren.

The Ming dynasty was the third peak in the development of acupuncture and moxibustion. During this period, important events included the increased attention paid to needle manipulation techniques of acupuncture and the reform of moxibustion. In terms of manipulation techniques, Yang Ji-zhou presents his twelve methods of acupuncture manipulation. "Compendium of Acupuncture and Moxibustion" (Zhen Jiu Da Cheng). The reform of moxibustion was marked by the invention and the popularization of moxa roll moxibustion.

From the time of the Qing dynasty until the founding of the New China in 1949, China existed as a feudal and colonial state, and no significant breakthroughs in acupuncture and moxibustion took place. In the early years of the Qing dynasty, the Ming dynasty style of practice and study were continued, and much literature was organized and annotated. From the late Qing dynasty to the founding of the Republic of China, acupuncture and moxibustion influenced by a decadent feudal culture and colonialism suffered a sharp decline. In this period acupuncture and moxibustion progressed slowly, if at all, being used only by common people for medical treatment.

Since the founding of the People's Republic of China in 1949, the government has paid much attention to the development of acupuncture and moxibustion. The clinical applications and research of the classical literature have gradually combined with modern medicine and science. Some major areas of study include the channels, acupoints, and needling sensation from different angles. In recent years, particular attention has been paid to acupuncture analgesia and other therapeutic applications, not only in China but all over the world.

C. Internationalization of Acupuncture and Moxibustion

According to written records, acupuncture and moxibustion methods from China began to spread to Korea and Japan as early as the sixth century A.D.. In the Ming dynasty, many students from Japan came to China to learn traditional Chinese medicine. Even today acupuncture and moxibustion are an important component of the traditional medicine practiced in Japan and Korea. Moreover, acupuncture and moxibustion has spread all over Southeast Asia as well as India via long established relationships and cultural exchange routes.

Acupuncture and moxibustion have been introduced to Europe as well. Missionaries traveling to China learned of these medical methods and when they returned to their home countries they carried this knowledge with them. After the founding of the New China, the former Soviet Union and other Eastern European countries also sent doctors to China to learn the techniques of acupuncture and moxibustion.

In the 1970's, acupuncture and moxibustion earned the approval of the World Health Organization (WHO). In order to popularize this mode of treatment throughout the world, every year China offers International Acupuncture Training Courses and Study Classes. In November, 1987, a conference titled "The World Association of Acupuncture and Moxibustion" convened in Beijing. The conference heralded the international acceptance and use of acupuncture and moxibustion throughout the world. Today, over 60 countries including the United States, Japan, France, Germany, and the former Soviet Union can claim organizations for the clinical use and research of acupuncture and moxibustion. From ancient and obscure beginnings, acupuncture and moxibustion has made great inroads and is quickly becoming a major component of a global medical science.

Fundamentals of TCM

The general contents of TCM and fundamental guiding principles are presented below:

1) The basis of philosophical thought: The theory of Yin-Yang, and the theory of Five Elements (Wu Xing).

2) The basis of morphology (structure) and function: The concepts of the Zang Fu organs, meridians and collaterals (Jing Luo), Qi, blood (Xue) and bodily fluids (Jin Ye).

3) The basis of pathology: The theories of the six exogenous factors (Liu Yin), seven emotions (Qi Qing), and pathogenesis (Bing Ji).

4) The basis of diagnostics: The four methods of physical examination (Si Zhen: Wang, Wen, Wen, Qie), diagnosis and treatment based on overall differentiation of symptoms and signs (Bian Zheng Lun Zhi).

5) The basis of therapeutics: The general principles of acupuncture and moxibustion (Zhen Jiu).

As stated above, TCM therapeutics consists of medicinals as well as acupuncture and moxibustion. While both systems are based on the same fundamental principles, the two modes of treatment themselves rely on different methods and a different body of knowledge. For example, when using acupuncture to treat diseases it is imperative to be able to accurately locate acupoints. Using medicinals, it is important to be knowledgeable of the specific characteristics of drugs, herbs and prescriptions. Moreover, the method of differentiating symptoms and signs is also influenced by the mode of treatment. In acupuncture and moxibustion, more attention is paid to understanding pathology in terms of the theory of meridians and collaterals. Treating with medicinals, understanding pathogenesis and making differential diagnosis combines meridian theory with other bodily systems. For instance, exogenous febrile diseases are analyzed in accordance with the six channels and four important body systems (Wei, Qi, Ying, Xue). (5)

Philosophy of TCM and Methods of Study

From ancient times, Chinese philosophy and the foundations of TCM have maintained a close relationship. If one understands, truly understands, the thought process of the ancient Chinese it will be much easier to grasp the basic concepts underlying the science of TCM. Most basic are the theories of Yin-Yang and the Five Elements. Upon these basic principles rest the other major concepts of TCM: Qi and blood, diseases caused by cold, heat, deficiency and excess, and treatment principles from the general methods of reinforcing and reducing Qi to specific selection of acupoints. Therefore, because TCM has developed hand in hand with the theories of Yin-Yang and Five Elements throughout history, understanding ancient Chinese philosophy is essential to understanding TCM.

In addition, another important concept underlying TCM is the idea of wholism. Here the organism, the patient, is viewed as an organic whole in perpetual motion. Moreover, the human body is seen as interconnected with its surrounding environment, expanding to the rest of the cosmos. The human body is viewed as microcosm of the universe. As a result, diagnosis and treatment become a matter of pattern matching of the whole. By viewing the patient as an organic whole in a specific environment, a unique understanding of disease (and health) is acquired for each individual patient. This method of thinking, which can be described as macroscopic, wide-ranged, highly inductive, and systemic is in contrast to the methods of present day modern medicine. It is hoped that the initiate of TCM always keeps in mind this important distinction as he/she learns about TCM, eventually continuing on to clinical practice.

One final emphasis that exists throughout TCM is that of practicality. The ancients said, "Pulse conditions can be learned through much diagnosis, diseases can be known by rich experience." In order to master the concepts of TCM, it is not enough just to study from books. It is necessary for the TCM student to engage in as much clinical experience as possible. In this way, a much deeper understanding of TCM will develop. The abstract basic theories of TCM can then be realized in the concrete and compelling problems of real patients.

1.3 The Essential Characteristics of TCM

TCM had its beginnings in a primitive society and became organized in its early form in a feudalistic society. Constantly evolving during the long period of China's feudal society, it also was influenced by outside cultural forces. One example of exogenous cultural influence was Buddhism. At the end of the sixteenth century, it was also to be influenced by Western culture. But despite such outside influences, TCM retained its own basic characteristics and identity, evolving into what is today an independent system of medical science.

The early formation of TCM can be traced back to the Warring States period. During this time, TCM practices were based upon a naive type of dialectics materialist. This material dialectical thought not only differs from the materialist dialectics of current western philosophy, but also stands in opposition to the metaphysical idea of idealism.

The basic principles of TCM hold that all things are a microcosm of the world they inhabit. All things are interrelated with all other things, they are in constant motion, and therefore they restrict or promote the activities of other things. This basic concept is akin to such modern day physical concepts as the Law of Relativity, cybernetics, systems theory, and information theory.

In the absence of experimental medicine, TCM applied traditional Chinese philosophical concepts to draw its theories and hypotheses. These theories and hypotheses were verified through empirical means, mainly clinical practice. In this way, philosophy and medical science began from separate traditions, but became interrelated as philosophical ideas helped to form medical development. This view is referred to as "medicine being related to philosophy" (Yi Yi Tong Yuan).

In this chapter, we will look at four of the basic fundamental principles of TCM. These include the idea of the organism as a whole, the philosophies of Yin-Yang and Five Elements, the principle of Perpetual Motion, and the patient and illness viewed as a system--Treatment Based on Differential Diagnosis. It is of vital importance to understand these basic principles in order to understand the workings of TCM. For example, the concept of "pattern matching” is widely applied in TCM. By "pattern matching", we mean "diagnosis and treatment based on overall differentiation of signs and symptoms". This process defines the course of medical action from diagnosis to implementation of treatment methods. The process itself is based on the generalization and application of several of the basic characteristics of TCM. Therefore, the general principles must first be understood and learned by rote in order that they be applied and used in clinical practice.

1.3.1 The Concept of Holism

The Outlook of the Organism as a Whole and the Adaptation of the Human Body to the Natural Environment

One of the basic tenets that serves as the foundation of TCM is the close relationship between the human body and nature. Every man is surrounded by the natural environment and thus cannot help but be influenced by it and its changes. In order to keep in harmony with the environment, man adjusts his life rhythm in accordance with the changes in nature.

Furthermore, within the human body itself, the body's component parts are all interrelated with each other in terms of their functioning. As a result, these parts are inseparable from each other in terms of structure. In the course of physiological functioning, body systems work in coordination with each other to produce life processes. When illness strikes, the pathological functioning of one part of the body affects all the other parts.

A. The Unity of the Human Body and Nature

Man lives in the vital and dynamic conditions of nature. All changes in nature have either a direct or indirect effect on the human body. As nature changes, corresponding physiological and pathological changes also occur within the human body. Presented below are the ways changes in nature influence the human body.

1) The Influence of the Five Seasons and Climate on the Human Body

The five seasons and their corresponding changes in climate exert the most direct and powerful influence on the human body. In general, the climatic conditions in the five seasons are as follows: warm in the spring, hot in the summer, mostly damp (humid) and hot in the late summer, cool and dry in the autumn, and cold in the winter. The human body then adapts itself to these climatic conditions. According to TCM principles, the body consists of five organ systems. The functioning of these organ systems correspond to seasonal changes. This being so, the relative deficiency or sufficiency of Qi of each organ system varies depending on the season.

The liver Qi is sufficient in the spring.

The heart Qi is sufficient in the summer

The spleen Qi is sufficient in the late summer.

The lung Qi is sufficient in the autumn.

The kidney Qi is sufficient in the winter.

The human body is also influenced by climatic changes in other ways as well. In the spring and summer, because the weather is warm, blood flows freely. Qi and blood flow toward the body surface. The skin is loose and sweaty. Urine is scanty in amount.

In the autumn and winter, because the weather is colder, blood circulates slowly. Qi and blood sink down into the interior of the body. The skin is hypodrotic and the pores are closed. Urine is profuse in amount.

Changes in Qi and blood lead to corresponding changes in the pulse. For example, in the spring and summer, the pulse is floating and large. While in the autumn and winter, the pulse becomes deep and thready.

Many diseases are also associated with climatic conditions. For instance, when the weather is fine, and the temperature is relatively warm, patients suffering from rheumatic arthritis, dyspnea or cough often have milder symptoms, and feel more comfortable. Conversely, in weather that is cold, cloudy, and/or wet, patients' symptoms are often more severe. Moreover, many diseases are associated with specific seasons. Endemic febrile diseases frequently occur in the spring, diarrhea is seen in the late summer, and arthralgia syndromes are often seen in the winter.

2) Diurnal Influences on the Human Body

Changes in the cycle of day and night influence the state of the human body. The bodily state changes to accordance with its surroundings. In particular, the relative balance of Yin and Yang is the same in the body as it is in the day. From the early morning until noon, Yang Qi is ascendant and becoming stronger. This Yang Qi moves outward to the periphery of the body (skin) and vitality is full. From noon through late afternoon, Yang Qi begins to decline, and with it there is a corresponding decline of the vitality of the body. During this time, Yin Qi is ascendant. In the evening and the night, Yin Qi is relatively stronger. Yang Qi hides in the interior of the body. At this time, the body is in a state of sleep.

This alternation of Yin and Yang with the different times of the day is more obvious when a patient is ill. For example, for some types of febrile diseases, the body temperature is normal or nearly normal in the early morning. This is due to increasing Yang Qi. Then, due to a decrease in Yang Qi, body temperature rises in the afternoon and reaches its peak at night. From midnight until dawn, body temperature decreases until it is almost normal again the next morning. This variation in body temperature results from the conflict of Qi and pathogenic factors. This conflict rises and falls in accordance with the daily alternation of morning, afternoon, evening, and night.

B. The Human Body as an Organic Whole

The human body is an organic unity which is made up of internal organs, extraordinary organs and other tissues. Although each body system has different physiological functions, all are related to each other and are necessary for the physiological well-being of the whole body. Moreover, in states of illness, pathology of one body system influences the functioning of other systems. These mutual relationships in physiology are centered around the five Zang organs.

The five organs are then related to each other via the meridians and collaterals. The meridians and collaterals are distributed over the entire body. Circulating Qi and blood, they connect the internal organs with the extremities. Running longitudinally and interiorly-exteriorly, they regulate all the functional aspects of the different systems of the body. In addition, they integrate all five Zang organ systems, the six Fu organ systems, the extremities, muscles, bones, the five sense organs, nine orifices; all parts of the body are integrated to operate as an organic whole. Moreover, the component systems of the body all carry out physiological functioning through the use of Qi, blood and body fluids. When all systems are functioning properly and are working in harmony with each other, the body's physiological state is healthy. If a single body system is dysfunction, and/or body systems do not work in harmony, the body is in a pathological state.

Abnormal functioning of the internal organs, because they are connected via meridians and collaterals to all parts of the body, may manifest in the tissues or organs in the superficial areas of the body (the reverse is also true). Therefore, when analyzing a disease, it is necessary to view the human being as an integrated organic whole. Because each part of the body is closely related to the whole, a local pathological change will cause pathological changes throughout the entire body. All internal organs, tissues and other organs are related to each other in physiology and in pathology, [Therefore, in diagnosis, the TCM physician observes the overall color of the face, the condition of the tongue, eyes, and palpates the pulse.] In light of this interrelationship, it is essential to think of prevention and treatment of diseases from a synthetic point of view. In clinical practice, stomatitis is treated with the method of dispelling heat of the heart and purging the small intestine of pathogenic fire. The use of this therapy stems from the TCM theory that the heart is specially connected with the tongue, having its special orifice in the tongue. In addition, an interior-exterior relationship exists between the heart and small intestine. (Heart is interior; small intestine is exterior.) Therefore via its relationship with the heart, the small intestine can also influence the tongue (and oral cavity). In another example, alopecia and deafness are treated with the method of tonifying the kidney. The use of this therapy is based on the theory that the kidney stores the essence of life. The kidney has its manifestations in the hair of the head and its special orifice is in the ears. Therefore, in TCM, it is important to view the human being as an organic whole, and remember that one part of the body is related to many other parts of the body. In TCM, this concept of the human body as organic whole runs through the rational knowledge of physiological functioning and pathological changes. As a result, diagnosis and treatment are also based on this concept.

1.3.2 Treatment Determination Based on Syndrome Differentiation

The System Outlook--Treatment Selection Based on Differential Diagnosis

Selection of treatment based on the differential diagnosis is a diagnosis and treatment principle unique to TCM. At the core of this therapeutic model is the concept of "syndrome" (zheng). In diagnosis, the TCM physician must differentiate from a number of syndromes and determine which syndrome the patient is suffering from. Once this determination is made, then an appropriate selection of treatment, along with any additional diagnostic methods must be made.

Differentiation of syndromes refers to the process in which the doctor, through his/her own direct investigation, collects a variety of information regarding the pathological state of the patient. This investigation is of a relative nature being collected by the physician using the four methods of physical examination (inspection, auscultation and olfaction, inquiring about, and pulse feeling and palpation). From analyzing and synthesizing this information, the physician determines the syndrome to be a certain nature.

The syndrome (zheng) is a special concept in the learning of TCM. In general, it is a pathological generalization of a disease at a certain stage. Incorporating ideas such as location, cause and nature of pathological change, as well as the condition of Qi and pathogenic factors, it is a concept that differs from mere signs and symptoms (signs and symptoms refer to specific manifestations of a disease such as headache, cough, vomiting and so on). It reflects the pathological "essence" of a disease as a certain stage in its development. Therefore it exists as a more profound and more accurate representation of disease. As such, it is the starting point for TCM physicians to understand disease pathology and select a treatment.

Differentiation of syndromes involves the following five steps.

A. Differentiation of Patient

Differentiation of the patient involves observing the general conditions of the patient. This includes the patient's sex, age, physique, disposition, expression of the eyes, his living and work conditions. This information is very helpful in the differentiation of syndromes. For example, patients who are overweight have a tendency of suffering from Yang deficiency and excess dampness. Underweight patients have a tendency of suffering from Yin deficiency and excess liver Yang. A patient who overthinks is susceptible to spleen impairment. A patient who frequently angers may be susceptible to liver impairment.

B. Differentiation of the Location of Pathological Change

Differentiation of the location of pathological change refers to location of the body where the pathological change began. It is mainly based on the patient's chief complaint and supplemented by necessary examinations. The patient's subjective feeling is often an important basis for differentiation.

C. Differentiation of the Cause of Illness

Generally speaking, the cause of illness can be inferred from the manifestations of a disease. But equally important is the analysis of the patient's historical data. This data includes past personal and medical history, family history, history of contact and treatment history.

D. Differentiation of Abnormal States

Differentiation of abnormal states refers to determining the pathological state of the patient from the gathered information. The abnormal state/pathology is selected from the general eight principle syndromes. By arranging and combining the eight principle syndromes, it is possible to describe the common abnormal states of disease. For example, take the general superficial syndrome. The superficial (exterior) syndrome includes deficiency syndrome of the exterior, excess syndrome of the exterior, cold syndrome of the exterior, heat syndrome of the exterior, and deficiency syndrome of both exterior and interior, excess syndrome of both exterior and interior, cold syndrome of both exterior and interior, heat syndrome of both exterior and interior, and syndrome of deficiency in exterior and excess in interior, syndrome of excess in exterior and deficiency in interior, syndrome of cold in exterior and heat in interior, syndrome of heat in exterior and cold in interior, and so on. Different types of syndromes can be made by using all the possible combinations.

E. Differentiation of Pathogenesis

Differentiation of pathogenesis refers to understanding the nature of pathogenesis of a disease. On the one hand, the conditions of the conflict between Qi and pathogenic factors, the imbalance of Yin and Yang, and the disorder of the functional activities of internal organs, meridians and blood must be considered. On the other hand, once the pathogenesis is understood, a prediction can be made regarding the tendency of the disease which can guide the treatment and prevent the transmission of the disease.

The selection of therapeutic principles is based on the determination of a syndrome. A treatment plan is then designed for these considerations to maximize efficacy.

Differentiation and treatment parts are two necessary and inseparable parts of the TCM model for addressing disease. Differentiation is the base for treatment, is its completion, and is prerequisite for designing a specific therapy. The treatment is the means by which to affect a cure (the goal of the patient originally seeking help). Because treatment is based on the differential diagnosis, the accuracy of the differential diagnosis can be ascertained from the efficacy of the prescribed treatment. In this way, theory and practice, diagnosis and treatment work hand in hand to direct the clinical work of TCM.

In differential diagnosis, special emphasis is laid upon the individual differences of the suffering patient. Each specific treatment method (including medicinal prescription and selection of acupoints) is determined not only by the selection of a diagnosis, but also by the concrete analysis of a specific patient. Generally speaking, or theoretically speaking, "similar diseases are treated using similar methods" and "different diseases are treated using different methods". In real clinical practice, however, physicians do not focus on the differentiation of diseases, but rather analyze syndromes. The difference is that a syndrome is time and patient relative, while a disease is not. A single disease entity may include several different syndromes in the course of its development. So too, a single syndrome may be seen at various times in different diseases. So, for the physician practicing TCM, the syndrome is the important operational concept.

"Treating the same disease with different method" refers to the situation where the same time of disease may manifest as many different types of syndromes. The type of syndrome presented depends on many factors, including a difference in seasons and regions, different stages of a disease, and an individual patient's reactivity to the disease entity. For example, take the common cold. When a cold occurs in late summer, it is usually accompanied by pathogenic summer heat dampness. To treat it, it is necessary to use a fragrant herbal medicine whose function is to remove summer heat dampness. Colds occurring in other seasons, however, that do not involve summer heat dampness should be treated differently. Measles is another example. In the early stages of measles, the rash vesicles do not erupt completely. At this stage, it is appropriate to dispel the superficial pathogens in order to cause the rash vesicles to erupt. In the middle stage of measles, lung heat is often present. So it is necessary to clear away the lung heat and normalize the functioning of the lung. In the late stages, heat is still a problem, often impairing lung and stomach Yin. Priority must be given to nourishing Yin and clearing away pathogenic heat.

"Treating different diseases with the same method" refers to the situation where many different types of diseases may be treated in similar ways. The reason this is possible is because the same pathogenic situation often occurs in the course of different diseases. For example, the pathogenic situation of collapse of the middle Jiao Qi is common to many diseases. These diseases include persistent diarrhea and dysentery, prolapse of the rectum, uterus, stomach and kidney. Because all of these diseases have the common pathogenic situation, they may be treated with the same method of lifting middle Jiao Qi. The treatment should be efficacious in all cases.

The process of treatment selection based on differential diagnosis is demonstrated in the following diagram.

This diagram demonstrates that the key to treatment in TCM is the correct identification of the initial syndrome. The four methods of physical examination are the means that provide the basis for differentiation of syndromes. Once the syndrome is determined, a therapeutic strategy is designed, including the medication, prescription, acupoints, and other treatment methods. Because all treatment is based on the determination of syndrome, the syndrome holds a decisive and central position for treating patients using TCM. This spirit of this system is captured by the phrase, "similar syndromes are treated using similar methods, while different syndromes are treated using different methods".

Chapter Two Yin-yang and the Five Elements Theories

The Philosophy of TCM

The theories of Yin-Yang and Five Elements are the most fundamental ideas of TCM. They were formulated by the ancient Chinese through their long-term observations of natural phenomena. Both theories hold that, as a foundation, everything originated from Qi.

These two theories help to understand the existence of the universe and all the changes in the universe. Originating in ancient China, they belong to the realm of ancient philosophy, and can be considered the beginning of dialectical materialist thought.

The theory of Yin-Yang holds that the universe consists of two opposites, Yin and Yang. The reason why everything in the natural world occurs is due to this opposition. The interaction of Yin and Yang is the inner motive force that causes everything to develop and change. According to this doctrine, change naturally occurs when things reach their extremes.

The theory of Five Elements holds that all things in the universe are made up of the five basic elements. These elements are: wood, fire, earth, metal and water. The five elements are interrelated with each other. In general, a relationship can be described as interpromotional or interactive. This mutual relationship explains how elements can affect one another and how they remain in a dynamic equilibrium.

The theories of Yin-Yang and Five Elements have permeated medical thought and are the theoretical base of TCM. Used together, the two theories can be used to understand human physiological functions and to analyze and expound the pathological changes of the body. They are the part of the guiding ideology of TCM and are indispensable to understanding the theories of TCM.

2.1 Yin-yang Theory

2.1.1 The Formation and Concepts of Yin-yang

Yin-Yang is the abstract theory describing the opposition of two antithetical elements in the natural world. Yin-Yang represents either two things in opposition, or two opposite sides of a single entity.

According to the theory of Yin-Yang, it is believed that the universe is a material whole that is made up of a unity of two opposites. These two opposites are Yin Qi and Yang Qi. Everything in the universe contains these two opposing aspects. Though Yin and Yang are abstract concepts, they are manifest in the world as concrete things and practical relationships.

Examples of Yin-Yang Opposition

Things that are mobile, external, upward, ascending, warm, hot, bright, hyperactive, or pertaining to functional activities can be classified as Yang. Those that are unmoving, internal, downward, descending, cold, dull, hypoactive, or pertaining to materials (or structures) can be classified as Yin.

Based on the different characteristics of Yin and Yang, all things in the universe can be classified as one or the other. TCM often regards Qi, which has a propelling warm function, as Yang. However, Qi also has the function of nourishing and moistening, so it can also be regarded as Yin. The physiological functional activities of the body, as well as the signs and symptoms of pathological change, can all differentiated on the basis of Yin and Yang characteristics.

Symptom Differentiation Using Yin and Yang

The Yin-Yang nature of something is not absolute, instead being a relative concept. The relativity of Yin and Yang can be seen in the mutual transformation of one into the other (which takes place under certain conditions). In other words, Yin becomes Yang, and Yang becomes Yin. In addition, the relativity of Yin and Yang can be understood by realizing that anything can be infinitely divided. For example, in the daily cycle, the day is Yang, and the night is Yin. However, if we just examine the morning, it is Yang within Yang. The afternoon is Yin within Yang. The first half of the evening (before midnight) is called Yin within Yin. The second half of the night (after midnight) is called Yang within Yin. So all things (no matter how small) can be separated into Yin and Yang aspects. Then, one may take each aspect (either Yin or Yang), and separate them again into another Yin and Yang. And so on, ad infinitum.

Thus, anything in the universe that is classified as Yin or Yang can be divided in Yin and Yang aspects. And each of those aspects have Yin and Yang aspects of their own. And so on. This relationship of opposition can be seen in anything in the natural world.

2.1.2 Major Concepts of Yin-yang Theory

Main Concepts of the Theory of Yin-Yang

2.1.2.1 Opposition of Yin-yang

The Interdependence of Yin and Yang

Yin and Yang are dependent on each other, one presupposes the other. If there were no Yin, there would be no Yang. With no Yang, there would be no Yin. This mutually dependent relationship can be seen in all things. Here are some easy examples to understand. The top belongs to Yang while the bottom belongs to Yin. Without a concept of top there would be no concept of bottom, and vice versa. In another example, heat is Yang while cold is Yin. Hot and cold are relative terms, dependent on each other. Without a concept of heat, there would be not concept of cold and vice versa. So it is with the Yin and Yang aspects of all things.

In the human body there are many ways in which the interdependence between Yin and Yang are manifest. For instance, consider the relationship between physical structure and physiological function of the Zang Fu organ systems. The tissues and structures of the organs are considered Yin while their functions are considered Yang. The relationship between structure and function is interdependent. Without structure, there could be no functioning; without functioning, it would be impossible to promote the formation of materials. Therefore it can be said that the tissues and structures of the Zang and Fu organs (Yin) are the material base of their physiological functions (Yang). Likewise, the physiological functions (Yang) are the external manifestations of the tissues and structures. The existence of just one of the sides, the theoretical condition of single-Yin or single-Yang, is an impossibility. In addition, the mutual transformation of Yin into Yang, and Yang into Yin, is based on this interdependence.

2.1.2.2 Interdependence of Yin-yang

The Opposition and Struggle of Yin and Yang

Yin and Yang are two interdependent opposites (refer to the diagram above). However, their relationship is not a static one, no is it a simple opposition. Rather, the relationship is more complex with the opposites restricting each other and struggling against each other.

Restricting each other refers to the situation that Yin or Yang has the ability and function to limit the action of the other. The result of this is that Yin and Yang exist in a state of dynamic equilibrium. Yin can restrict an excess of Yang, and vice versa. In this way, a relative excess or deficiency of Yin or Yang can be corrected, and the equilibrium between the two is maintained. Zhang Jing-yue, a famous TCM physician in the Ming dynasty, once wrote, "the patient who is hyperactive is treated by calming him, and the patient who is excessive in Yin is treated by controlling Yang." This treatment directive demonstrates the relation of mutual restriction between Yin and Yang, and the equilibrium between movement and stasis.

Struggling against each other refers to the fact that Yin and Yang are perpetually striving to restrict the other. Because of this, on occasion Yin or Yang inevitably experience temporary victories or defeats, leading to a state of disequilibrium.

In fact, the main mechanism of health and disease is the balance of Yin and Yang. Health of the human body is indicated by the dynamic equilibrium caused by the struggle between Yin and Yang. Pathological changes in the body are caused when an excess of Yin leads to a deficiency of Yang, or an excess of Yang leads to a deficiency of Yin. This temporary victory or defeat is due to the incoordination of Yin and Yang and leads to disease.

It is the constant interaction and struggle between Yin and Yang that promote the change and development of all things in nature. While the opposition and struggle between Yin and Yang are constant and absolute, the degree to which Yin and Yang exist and the state of the equilibrium are dynamic and variable.

2.1.2.3 Wax-wane of Yin-yang

The Growth and Decline of Yin and Yang

The growth and decline of Yin and Yang refers to the specific nature of the constant motion and equilibrium between Yin and Yang. This nature is such that "Yin declines while Yang grows, and Yang declines while Yin grows." The change of climate is a good example of this relationship. In the summer, the weather typically gets hotter. This situation is one of Yang Qi ascending. At the summer solstice, the heat climaxes, and Yin Qi (carrying with it coldness), which is currently at its lowest point, begins to ascend and develop. After the autumnal equinox, Yang Qi (heat) gradually declines. At this time, the weather turns cold and winter sets in. At the winter solstice, the weather is extremely cold, Yang Qi carrying the heat factor, which is at its lowest point, begins to ascend and develop. After the spring equinox, Yin Qi gradually declines and the weather gradually warms. The cycle is complete as summer comes once again. The development from summer to autumn and then to winter is associated with Yang declining and Yin growing. The process from winter to spring and then to summer is associated with Yin declining and Yang growing.

The growth-decline change of Yin-Yang when applied to seasonal variations is mainly manifest as temperature differences. Diseases of the human body are also closely related to these changes. The incidence and mortality rates for many diseases differ according to the season. In particular, at the equinoxes, Yin and Yang are even and harmonious. During these times, diseases are at a low. At the time of the solstices, Yin and Yang are at different levels. They are connected and one is being transformed into the other. During this time of relative instability, diseases are at a high.

Another way to understand the growth-decline relationship of Yin-Yang is to examine the life functions of the human body. On the one hand, in order for the body to conduct normal activities and functions (which are Yang), it is necessary to consume nutrient substances (which are Yin). On the other hand, the metabolism of various nutrient substances (Yin) will consume a certain amount of Qi (Yang). In other words, the process of conducting Yang activities is derived from the consuming Yin nutrient substances. Also, the process of procuring Yin nutrient substances requires consuming Yang Qi. This is what is meant by the growth-decline change between Yin and Yang. It is this interchange that maintains the existence and development of both nature and man.

2.1.2.4 Transformation of Yin-yang

The Transformation between Yin and Yang

The transformation between Yin and Yang refers to the possibility that Yin or Yang, when reaching a certain stage of development, may transform into its opposite. Yin may transform into Yang, and Yang may transform into Yin. While growth and decline of Yin and Yang can be seen as a process of quantitative change, the transformation between Yin and Yang is a process of qualitative change.

This transformation can only take place under certain conditions. Often, this transformation occurs only when Yin or Yang is at a peak. Extreme Yang will necessarily lead to Yin, while extreme Yin will necessarily lead to Yang. In terms of temperature, severe cold will produce heat and severe heat will produce cold. The changes of Yin and Yang transforming into its opposite can often be seen in the course of a disease. For example, for some acute febrile diseases, the healthy Qi of the human body is seriously consumed and damaged by the overabundant virulent heat evil. After a persistent high fever, some critical symptoms of Yin cold may suddenly appear. These symptoms include: a sudden drop in body temperature, pallor, cold limbs, and a very feeble and impalpable pulse. This type of change represents a Yang transformation into Yin. In another example, a person whose Yang Qi is typically in excess may be attacked by cold evil. In such a case, the Yang Qi is besieged in the interior of the body by the cold evil which penetrates the body superficially. The cold in the external part of the body forces the Yang Qi inward where it may then be transformed into internal heat. This type of change represents a Yin transformation into Yang.

Therefore, the transformation between Yin and Yang is not spontaneous or irregular. In fact, this transformation is consistent and limited to certain conditions. Only given the necessary conditions will the transformation between Yin and Yang be promoted and accelerated.

Presented above are the basic ideas of the theory of Yin-Yang. While each aspect (interdependence, opposition and struggle, growth and decline, and transformation) has been considered separately, in practice they are not isolated. In nature, the concept of Yin-Yang is a combination of all these aspects that influence and complement each other. Mastering the theory of Yin-Yang will facilitate the theoretical and practical understanding of acupuncture and moxibustion.

2.1.3 Application of Yin-yang to Medicine

Application of the Theory of Yin-Yang in TCM

As one of the cornerstones of TCM, the theory of Yin-Yang is applied in all aspects of TCM thought and permeates the theoretical system of TCM.

2.1.3.1 Yin-yang and the Body Structure

Explanation of the Tissues and Structures of the Human Body

The theory of Yin-Yang views the human body as an organic whole. All body parts, tissues and structures, are related organically. The relationship between different tissues and structures follows Yin-Yang being divided into two opposite positions

The table above shows that a Yin-Yang relationship exists on many levels of organization in the human body. For instance, on a more general level, the upper and lower parts of the body represent one Yin-Yang relationship as do the exterior and interior of the body. In addition, some organs are Yin (the Fu organs) while some are Yang (the Zang organs). More specifically, a single organ can also be separated into Yin and Yang parts. These parts, then, can be separated into Yin and Yang as well, and so on.

2.1.3.2 Yin-yang and the Physiological Function of the Body

Explanation of the Physiological Functions of the Human Body

The theory of Yin-Yang holds that normal physiological functioning of the human body is generated from the harmonious opposition of Yin and Yang. Regarding the human body, the physical material and structure of the body is Yin while the functions of the body are Yang. The physiological functions are based on the physical material of the body. Without Yin essence (bodily materials and structure), it would be impossible to produce Yang Qi (physiological functioning). As a result of physiological activities, the bodily materials and structure are continuously produced from Yang Qi. If Yin and Yang fail to support each other and become separate, life activities of the human body will end.

2.1.3.3 Yin-yang and Pathological Changes in the Body

Explanation of Pathological Changes of the Human Body

The theory of Yin-Yang views disease as a result of the predominance or decline of Yin or Yang. This state is due to the loss of balance in the dynamic equilibrium between Yin and Yang. The onset and course of a disease is related to both healthy Qi and evils. Healthy Qi refers to the structures and normal functions of the human body as an organic whole, and the body's ability to resist diseases. Evils refer to various pathogenic factors. The theory of Yin-Yang can be used to explain both the mutual action and struggle between healthy Qi and evils. Healthy Qi is comprised of Yang Qi and Yin essence. Evils can be divided into those of Yin nature and those of Yang nature. When Yang evils cause disease, Yang is overabundant and Yin is consumed, resulting in heat syndromes. When Yin evils cause disease, Yin is overabundant and Yang is consumed, resulting in cold syndromes.

Deficiency cold syndromes of Yang deficiency are a result of the failure of Yang (due to deficiency) to control Yin. This leads to the domination of Yin. The failure to control Yang because of a deficiency or impairment of Yin bodily fluids results in deficiency-heat syndromes. Although many pathological changes appear to be complicated and variable, their basic cause can always be traced back to the uncoordinated operation of Yin and Yang.

2.1.3.4 The Application of Yin-yang in Diagnosis of Diseases

In the Diagnosis of Diseases

Because the incoordination of Yin and Yang is the fundamental cause of disease onset and course, in diagnosis the physician should first understand the Yin-Yang attributes of a disease before investigating its specific nature.

Yin and Yang are the principles guiding the method of differential diagnosis in TCM. This differential diagnostic method, which is used most often in clinical practice, separates diseases into eight principle syndromes. These syndromes are separated into Yin and Yang. Superficial, heat and deficiency syndromes belong to the Yang category of pathology. Interior, cold and deficiency syndromes belong to the Yin category of pathology.

2.1.3.5 The Application of Yin-yang in Treatment of Diseases

In Guiding the Treatment of Diseases

In TCM, treatment often rests on the strategy of adjusting Yin and Yang in order to reestablish the equilibrium between the two opposites. This fundamental principle lies at the heart of treatment with Chinese herbal medications as well as with acupuncture and moxibustion. Using these treatment methods, the physician attempts to make the Yin and Yang of the body harmonious, invigorate the refined Qi of the body, equilibrate the vital Qi, and retain the spirit inside the body. In this way, the disease can be cured.

Clinically, the disease of consumption of Yin fluid caused by an overabundance of Yang heat illustrates how Yin-Yang theory informs the treatment process. For this heat syndrome, cold-natured drugs should be administered in order to reduce the excess Yang heat. Conversely, in the case of excessive Yang caused by insufficient Yin fluid to restrict Yang, the insufficient Yin should be enhanced. Likewise, in the case of excessive Yin caused by insufficient Yang to restrict Yin, the insufficient Yang should be enhanced. In these cases, Yang should be treated to cure Yin diseases, and Yin should be treated to cure Yang diseases.

Many such methods exist where the opposite is treated to cure the original problem. TCM treatments often gain effect by producing Yang from Yin, producing Yin from Yang, puncturing the left to treat the right, and puncturing the right to treat the left. All of these treatment methods follow the theory of Yin-Yang.

Producing Yang from Yin means bringing forth the evils of Yang nature from Yin. For example, an excess of the liver acupuncture meridian (Foot-Jueyin) causing a deficiency of the gallbladder meridian (Foot-Shaoyang), can be treated by reducing the excess of the liver meridian (Jueyin). This, in effect enhances the deficiency of Shaoyang. In another example, diseases of the six Fu organs (Yang) are often treated by selecting the Front-Mu points. That is, the Front-Mu points, which are points on the Yin meridians which correspond to the Yang Fu organs, can treat Yang diseases. In this way, Yang is produced from Yin. Conversely, a deficiency of liver meridian (Foot-Jueyin) can be treated by reducing the relative excess of the gallbladder meridian (Foot-Shaoyang). Also, diseases of the five Zang organs (Yin) can be treated by selecting the Back-Shu points (which are Yang meridian points that correspond to the Yin Zang organs). In this way, Yin is produced from Yang.

In acupuncture and moxibustion, two specific methods of treatment are directly guided by the theory of Yin-Yang. These are the treatment of opposite needling, and the treatment of contralateral insertion. Both treatments are based on the principle that puncturing the left and treat the right (and vice versa). This is possible since the meridians, Qi, and blood are connected throughout the body.

In guiding the treatment of diseases, Yin-Yang also are used to describe the properties, tastes and effects of herbal medicines as they are used in clinical administration.

Differentiation of the Properties, Tastes, and Effects of Herbal Medicines According to Yin-Yang Theory

In the clinical administration of herbal medicines, the treatment principle should be determined in accordance with the theory of Yin-Yang before specific herbs are selected. When selecting specific herbs for clinical administration, the idea of Yin-Yang should take priority, giving lesser weight to other medicinal properties (such as the four properties, and five tastes, ascending and descending, floating and sinking). Yin-Yang properties are the most important factor in gaining treatment efficacy.

2.2 The Theory of Five Elements

The theory of Five Elements holds that everything in the universe consists of five basic elements and their motion and change. The five basic elements are: wood, fire, earth, metal, and water. Motion and change of the material world is seen as the interpromotion and interaction relationships between the five elements. In TCM, the theory of Five Elements not only describes the physiology and pathology of the human body, but also describes the interrelationship of the human being with the outside environment. Moreover, Five Elements theory also serves as a guide in the diagnosis and treatment of disease.

2.2.1 Formation and Concepts of the Five Elements

Main Concepts of the Theory of Five Elements

a. The Classification of Things According to the Theory of Five-Elements

In ancient China, logical analysis consisted of examining natural phenomenon and determining into which of the five elements an observed phenomenon could be classified. These phenomena were classified according to their properties, functions and formation. That is, attributes of the phenomena were separated into wood, fire, earth, metal and water. From this, classifications of the phenomena themselves were made. This type of thinking is a form of the inductive method. Attributes of different phenomena are generalized to abstract terms, corresponding to characteristics of the five elements rather than to the five types of substances themselves.

The Properties and Characteristics of the Five Elements

In TCM, it is this analogical analysis of the theory of Five Elements that is used to induce, analyze, and solve the theoretical problems in medicine. All natural phenomena, including the internal organs and tissues of the human body are classified by how their attributes correspond to the five elements.

The Classification of Things According to the Theory of Five Elements

At the heart of the theory of Five Elements is the attempt to research and explain all things in the universe and unify all things in the universe. The law of interpromotion and interaction describes how the five elements exist in a correlated, coordinated and balanced state. The law of overaction and counteraction describes how this coordinated, equilibrium state mutually impacts all five elements when it breaks down.

2.2.2 Major Concepts of the Five Elements

The Law of Interpromotion and Interaction among the Five Elements

Correlative relations between the five elements is explained by the law of interpromotion and interaction. Interpromotion refers to mutual production and generation. Interaction refers to mutual restriction and restraint. Interpromotion and interaction are the normal way of movement and change in nature. It is these two natural tendencies that are responsible for maintaining the ecological balance in nature and the physiological balance in the human body.

The order of interpromotion of the five elements is as follows: wood promotes fire, fire promotes earth, earth promotes metal, metal promotes water, and water in its turn promotes wood. In this way the five elements create an endless generative cycle.

The order of interaction of the five elements is as follows: wood acts on earth, earth acts on water, water acts on fire, fire acts on metal, and metal acts on wood. In this way the five elements create an endless restrictive cycle.

Regarding the law of interpromotion and interaction, one element influences another. Therefore, each of the five elements can exist in one of four possible conditions: promoting, being promoted, acting on, or being acted upon.

The relationship of interpromotion is called the mother-child relationship. The element which promotes is called the mother. The element being promoted is called the child. Take the situation of wood for example. Water promotes wood so water is the mother of wood. In turn, wood promotes fire so fire which is generated by wood is the child of wood.

The relationship of interaction also connects two elements in a certain relationship. The element that acts on another is called the interacting element. The element being acted upon is called the interacted element. Again in the case of wood, wood acts on earth so it is the interacting element of earth. In this relationship, earth is the interacted element. In turn, wood is acted on by metal. So wood now is the interacted element while metal is the interacting element.

Interpromotion and interaction are two necessary aspects of all natural phenomena. These two processes cannot be separated. In interpromotion resides interaction, and in interaction resides interpromotion. If only the process of interpromotion existed without the process of interaction, the excess that would inevitably develop would destroy the dynamic balance and coordinated relationship among the five elements. If only the process of interaction existed without the process of interpromotion, there would be no birth, growth and development of things. Only together in coordinated action can interpromotion and interaction maintain and ensure the eternal balanced cycle of birth, growth, and death. To review, the law of interpromotion and interaction operates in the following order: wood acts on earth, earth promotes metal, metal acts on wood; fire acts on metal, metal promotes water, water acts on fire; earth acts on water, water promotes wood, wood acts on earth; metal acts on wood, wood promotes fire, fire acts on metal; and water acts on fire, fire promotes earth, earth acts on water.

The Phenomena of Overaction and Counteraction among the Five Elements

Overaction and counteraction are abnormal processes of the five elements. The relationship of overaction refers to the condition where one element subdues another element when the latter element is weak. The abnormal condition occurs when one element acts on another to the extent that it exceeds the normal limit of interaction. Basically overaction is the same process as that of interaction except to an excess. Therefore, the order of overaction is the same as that of interaction. There are two causes that bring about a overaction relationship. The first is that the interacting element is in excess. The other is that the interacted element is insufficient. Both can result in the condition of excessive interaction, which is overaction.

Counteraction refers to the condition where one element preys upon another. While overaction follows the same order of effect as interaction, counteraction occurs in the opposite direction. In this situation, the interacted element (being in excess) becomes the interacting element, while the original interacting element (being in relative state of insufficiency) becomes the interacted. There are also two causes for counteraction. The first is that the original interacted element is in relative excess. The other is that the original interacting element is relatively insufficient. Both can result in the condition of counteraction.

The two abnormal processes of overaction and counteraction have points in common as well as points of distinction. The order of effect is one place of distinction. Overaction occurs in the order of interaction while counteraction occurs in the exact opposite direction. Because of the opposite direction of effect, overaction and counteraction often occur at the same time. For instance, if an element, wood, is in excess, it may both overact and counteract at the same time. Excessive wood overacts against earth, at the same time counteracting metal as well. If metal is insufficient, it may at the simultaneously be counteracted by wood and overacted on by fire. Therefore a very close relationship exists between these two processes. And both can result in the abnormal operation of interpromotion and interaction, and alter the coordinated balance between the five elements.

2.2.3 The Five Elements in TCM

Application of the Theory of Five Elements in TCM

a. Explaining the Physiological Functions of the Five Viscera Systems and their Interrelationships

In the science of TCM, the abstract attributes of the five elements corresponds with the five viscera system (each consisting of a pair of organs (one Yang-Fu and one Yin-Zang). The attributes of the five elements are used to explain the physiological functions and characteristics of these viscera systems. For example, the liver system corresponds with the element wood. This is because the liver's abstract attributes resemble that of wood (a tree's). In TCM, it is said that the liver system has the physiological characteristic of liking to spread out freely, yet hating dullness. In addition, the liver has the function of smoothing and regulating the flow of Qi and blood. These abstract features are similar to the abstract features of a tree.

In other examples, the heart system corresponds with the element fire. This is because the heart Yang has the function of warming which is also the Yang heat characteristic of fire. The spleen system corresponds with the element earth. This is because the spleen is the source of Qi and blood. It is like the earth upon which everything grows and changes. The lung system corresponds with the element metal. This is because the lung has the function of cleaning inspired air and maintaining its downward flow. These functions are related to the clarifying and downward moving characteristics of metal. The kidney system corresponds with the element water. This is because the kidney is in charge of water and storing the essence of life (Jing). These functions are related to the moistening and running downward movement of water.

b. The Corresponding Structures of the Five Viscera Systems

Another application of the theory of Five Elements to the five viscera systems is the Law of Interpromotion and Interaction. The processes of interpromotion and interaction can be applied in order to explain the regulating and controlling relationship between the five viscera systems.

Regarding the viscera, the relationships of interpromotion are as follows: the vital essence (Jing) of the kidney (water) nourishes the liver; the liver (wood) stores blood to nourish the heart; the heat of the heart (fire) warms the spleen; the spleen (earth) transforms and distributes food essence to replenish the lungs; the lungs (metal) disperses and descends to help the kidney. In this way the cycle of the five elements is realized in the human body.

The five viscera are also related in a interaction (or restraint) relationship. The dispersing and descending function of the lungs (metal) can strain the exuberance of the liver Yang. The liver (wood) that functions well smooths and regulates the stagnation of the spleen Qi. The spleen (earth) has the functions of transporting, distributing and transforming nutrients; this may prevent the overflow of water of the kidney. The nourishing function of the kidney (water) can prevent the hyperactivity of heart fire. The Yang heat of the heart (fire) may restrain the excess of the dispersing and descending function of the lung. In this way the endless cycle of restraint is complete.

c. Explaining Pathological Processes Between Various Viscera

The theory of Five Elements not only explains the relationship between the five viscera under normal physiological functioning, but it can also be used to understand pathological states of the body, namely how pathological influences from one viscera system can affect another viscera system.

The term, pathological influences, refers to the situation where an illness in one organ may be transmitted to another. This occurrence is called "transmission". Transmission generally occurs in two different ways.

i) Transmission Along the Interpromotional Pathway

With one type of transmission, pathological change occurs along the normal pathway of interpromotion. In the normal interpromotion case, the liver (wood) promotes the heart (fire). However, if a pathological change occurs in the liver, it may follow the normal interpromotion direction and influence the heart. This type of transmission is called "illness of the mother organ involving the child organ". In this case the mother organ is the liver as it normally promotes the heart. The heart is the child organ as it is normally promoted by the liver. Of course, this transmission applies to any set of the promotional pairs.

Conversely, pathological transmission can occur in the reverse direction as well. When pathological changes occur in the heart, they may have an effect on the liver. This type of transmission is called "illness of the child organ involving the mother organ". Again, this transmission can be seen in any set of the promotional pairs.

ii) Transmission Along the Interactive Pathway

With the second type of transmission, pathological change occurs along the normal pathway of interaction. In the normal interaction case, the liver (wood) acts on the spleen (earth). However, if pathological change occurs in the liver to make the liver relatively stronger, it may follow in the direction of interaction and influence the spleen. This type of pathological condition is called "wood overacting on earth".

Conversely, pathological transmission can occur in the reverse direction as well. When pathological changes occur in the spleen to make the spleen relatively stronger, they may have an effect on the liver. Liver pathology may be caused by original problems of the spleen. This type of transmission is called "earth counteracting on wood". In addition, an extreme weakness of the spleen may also bring about the overaction of the liver. This condition is called "weakness of earth leading to overaction of wood". Finally, an extreme insufficiency of the liver may cause the counteraction of the spleen. This condition is known as "weakness of wood leading to counteraction of earth."

Generally speaking, the severity of the illness can be gauged by the type of transmission used to cause pathology. "Illness of the mother organ involving the child organ" are typically a milder condition, while "illness of the child-organ involving the mother-organ" are usually of moderate severity. In transmission occurring along the interaction pathway, illnesses caused by a overaction relationship are typically of moderate severity, while illnesses caused by a counteraction relationship are usually milder.

iii) Diagnosis and Treatment of Diseases

The functioning of the visceral organs is manifest by many outward signs. By observing these signs, the condition of the visceral organs may be understood. These outward signs include: complexion, voice, physical condition and behavior, and the condition of the pulse. Therefore, the disease and type of pathology occurring in the internal organs can be deduced from information obtained through the four diagnostic methods (inspection, auscultation and olfaction, inquiring, and pulse-taking and palpation). Using these diagnostic methods, outward signs of disease can be obtained and internal pathology can be understood. In analyzing the outward signs of disease, it is necessary to keep the five elements classification in mind as well as the laws of interpromotion and interaction, and overaction and counteraction. For example, a patient with a blue facial complexion may suffer from liver (wood) problem; a reddish complexion suggests heart (fire) trouble; a yellowish complexion may indicate a spleen (earth) problem; a pale complexion may indicate a disease of lung cold (metal); and a black complexion is most often due to kidney deficiency.

Clinically, a bluish complexion seen in a patient with deficient spleen Qi may indicate a disease characterized as "deficiency of earth leading to the overaction of wood". A black complexion seen in a patient with heart disease may indicate a disease characterized as "water overacting on earth".

Pulse is another important facet of clinical diagnosis. Moreover, pulse characteristics can also be associated with diseases of the organs. For instance, in diseases of the liver, the pulse should be of the wiry type. However, in some patients, the pulse is not wiry, but rather deep. The deep pulse corresponds to diseases of the kidney. In these patients, the liver disease results from an original kidney disorder. Recall that the kidney and liver have a relationship of interpromotion. Water (kidney) promotes wood (liver), so kidney is the mother of liver. In this case, the diagnosis is favorable as it indicates that the disease can be easily cured. However, when the pulse is not wiry, but floating, this indicates liver disease results from an original lung disorder. Therefore the pathogenesis is one of "metal subjugating wood", an unfavorable diagnosis.

Because the onset and course of disease are related to the four processes (interpromotion, interaction, overaction, and counteraction) between the five viscera, treatment and prevention must focus on regulating these relationships. Using the theory of Five Elements, the physician may predict the transmission and tendencies of a disease. By manipulating these relationships, and by treating the diseased organ in a timely manner, transmission may be controlled, and prevention and treatment may be achieved.

For example, liver disease may be a result of the condition "overacting earth and counteracting metal". Therefore, in these cases of liver disease, it is necessary to regulate the functioning of the spleen (earth) and the lung (metal) as well as treating the liver. This treatment addresses the problem in the liver as well as preventing the overaction and counteraction of the spleen and lung, respectively.

The ancient Chinese physicians applied the theory of Five Elements with its laws of interpromotion and interaction, and overaction and counteraction to design many efficacious treatment methods. Some of these treatment methods include: replenishing water to nourish wood (nourishing the kidney Yin to benefit the liver Yin), invigorating fire and enriching earth (warming life-fire to enrich the spleen Yang), reinforcing earth to generate metal (strengthening the function of the spleen to benefit the lung Qi), promoting both metal and water (tonifying the Yin essence of the lung and the kidney simultaneously), acting on wood to support earth (restricting the liver to strengthen the spleen), reinforcing earth to control water (warming and tonifying the spleen Yang to alleviate edema and to promote diuresis), treating metal to calm wood (clarifying the lung Qi to restrict hyperactivity of the liver), and clearing up fire to supplement water (clearing up the heart fire to nourish kidney Yin).

One commonly used treatment method used in acupuncture is called "reinforcing the mother organ and reducing the child organ". This treatment method is often used to treat deficiency syndromes in which mother-child relationships form part of the pathology. Based on this relationship, the mother meridian or points of the child organ should be reinforced.

For instance, in the case of deficiency syndrome of the liver, points on the mother meridian can be reinforced (eg. the He-Sea point Yingu (KI 10) of the kidney meridian or the He-Sea point Ququan (LR 8) of the liver meridian). This type of treatment follows the dictum "if hypofunction is found in the child organ, the mother organ should be reinforced". In addition, the second part of treatment is to reduce points on the child meridian, or points on the mother meridian (eg. the Ying-Spring point (fire point) Shaofu (HT 8) of the heart meridian, or Ying-Spring point Xingjian (LR 2) of the liver meridian. This type of treatment follows the dictum, "if hypofunction if found in the mother organ, the child organ should be reduced".

In summary, the theories of Yin-Yang and Five Elements are ancient philosophical thoughts of China. Their thought processes can be classified as simple materialism and spontaneous dialectics. The theory of Yin-Yang describes the universe as a whole consisting of two contradicting opposites. These two sides are constantly in opposition, yet are interdependent, waxing and waning, and transforming one into the other. Their action gives rise to change and development in the universe. The theory of Five Elements describes all phenomena in the universe as being classified into five different elements. In addition, the laws of interpromotion and interaction, and overaction and counteraction are used to explain the properties of the five elements as well as the relationships between them.

These two theories, as they cover all things in nature, also cover the human body in health and disease. Applied to medical science, the internal organs, meridians and collaterals and other body systems can all be understood in terms of Yin-Yang and Five Elements. These two theories help to explain the physiological activities and the pathological changes of the human body. Because of this, they also guide clinical diagnosis and treatment.

In clinical practice, the theories of Yin-Yang and Five Elements are not separate. The human body must be viewed in terms of both theories together, interrelated and synthesized. When speaking of Yin and Yang, the five elements will necessarily be involved. When speaking of the five elements, Yin and Yang will also be involved. When addressing the functioning of the internal organ, each organ can be classified as Yin or Yang. This relationship remains constant. However, each organ can also be understood in terms of five elements, and the laws of interpromotion and interaction, and overaction and counteraction. Viewed from Five Elements theory, different properties and functions are emphasized for the organs and their visceral organ system relationships. But even from this new viewpoint, the operation of the human body still includes the coordinated and balanced relations of Yin and Yang. Therefore, in TCM, the physiological and pathological functioning of the body can only be fully understood by combining the teaching of both theories.

Chapter Three Visceral Theory

The Theory of the States of the Internal Organs

A. Introduction

1. The Classification of Internal Organs

The Theory of the States of the Internal Organs concerns the study of the physiological function and pathological changes of the internal organs of the human body. It also examines the interrelationships between the organs. This theory was formulated through the observation of external physiological and pathological phenomena of the human body and follows the ancient dictum, "the internal organs are bound to give outward manifestations." According to the physiological characteristics and functions of the internal organs, they can be classified into three groups: the five Zang organs, the six Fu organs and the extraordinary Fu organs. The five Zang organs include: the heart, the lung, the spleen, the liver, and the kidney. The six Fu organs include: the gallbladder, the stomach, the small intestine, the large intestine, the urinary bladder, and the San Jiao (triple warmer). Extraordinary Fu organs include: the brain, the marrow, the bones, the blood vessels, the gallbladder and the uterus.

2. The Physiological Characteristics of the Internal Organs

The common physiological characteristic of the Zang organs is to produce and preserve vital substances. The characteristic function of the Fu organs is to receive, transmit, and digest water and food. The extraordinary Fu organs differ from the Fu organs in the morphology and physiological function, and do not come into direct contact with water and food. They are relatively hermetic organ and their function of preserving vital substances is similar to the Zang organs. Because of this situation, they are classified neither as Zang nor Fu, but rather as extraordinary Fu organs.

In terms of pathology, TCM views most pathology as beginning with the Fu organs. If the disease is persistent, pathology may also involve the Zang organs. Diseases of the Fu organs tend to manifest as excess syndromes while the diseases of the Zang organs tend manifest as deficiency syndromes. A patient who suffers from an excess syndrome of the Zang organs may be treated by reducing the Fu organs. A patient who suffers from a deficiency syndrome of the Fu organs may be treated by nourishing the Zang organs. This method of treatment demonstrates the basic principles of TCM clinical treatment.

3. Three Essential Factors in the Formation of the Theory of the States of the Internal Organs

The Theory of the States of the Internal Organs is mainly based on three main factors: ancient anatomical knowledge, long-term empirical observation of human physiology, and repeated clinical practice. Regarding ancient anatomical knowledge, in the chapter of Jingshui of the book Ling Shu ("Miraculous Pivot"), records of autopsy observations document human organ sizes, blood vessel lengths, blood conditions. This information laid the foundation for the morphology of the Theory of the States of the Internal Organs. The second factor consisted of long-term observation of physiological and pathological phenomena of the human body. For instance, if a patient catches a cold because of his skin being affected by cold, other symptoms will include cough, stuffy nose, nasal discharge, and so on. By this analysis, TCM realized that close relations exist between the skin, the hair, the nose and the lung. The third factor, repeated clinical observation, also analyzed the physiological functions of the body. In addition, these physiological functions have been verified by examining how initial pathological conditions have been restored to physiology through treatment effects. For example, the relationship of the liver having its orifice in the eyes was established by repeated cases of eye disease being cured by treating the liver. In another example, it was noted that the healing of fractures was accelerated by administering herbal medicine that tonified the kidney. From this observation, it was believed that the vital substances of the kidney had the function of promoting the growth of bone. This lead to the relationship of "the condition of the kidney determining the condition of the bone".

4. The Major Characteristics of the Theory of the States of the Internal Organs

The Theory of the States of the Internal Organs is based on the concept of the organism as a whole, and is centered on the five Zang organs. This outlook holds that all the internal organs together form the whole organism. In addition, the five Zang organs are connected with the body orifices.

The Zang organs are Yin and the Fu organs are Yang. One Zang and one Fu organ are connected to form an interior-exterior relationship. There are six Zang Fu organ pairs: heart and small intestine, lung and large intestine, spleen and stomach, liver and gallbladder, kidney and urinary bladder and pericardium and San Jiao [the pericardium is considered the sixth Zang organ in terms of interior-exterior relationships, but is not usually discussed as one of the five Zang organs because of the minor role it plays in physiology]. These six pairs of interior-exterior related organs are based on the Yin-Yang relationships of the meridians and collaterals (and their courses through the body). In addition, each Zang Fu pair is mutually related as together they perform certain physiological functions.

The outward manifestations of the five Zang organs are related to their respective connections with the body orifices. According to the Theory of the States of the Internal Organs, the heart has its outward manifestations in the face, or facial complexion. It controls blood circulation and has its orifice in the tongue. The lung has its outward manifestation in the fine hair (or hair of the body, as opposed to hair of the head). It moistens and strengthens the skin and has its orifice in the nose. The spleen has its outward manifestations in the lips. It nourishes the muscles and has its special body opening in the mouth. The liver has its outward manifestation in the nails. It nourishes tendons and has its orifice in the eyes. The kidney has its outward manifestations in the hair. It determines the condition of the bone and has orifices in the ears, urethra, genitalia and the anus.

5. The Relationship between Human Mental Activities and the Physiological Activities of the Five Zang Organs

As recorded in "Nei Jing" ("Canon of Medicine"), the functions of the brain include human consciousness, thought, mental and emotional activities. However, the Theory of the States of the Internal Organs holds that the functions of the brain are closely related to the physiological functions of the five Zang organs. For example, the heart is related to mind, the lung is related to corporeal soul (Po), the liver is related to mood, the spleen is related to thought and the kidney is related to will. The five Zang organs therefore affect brain functioning, and vice versa.

6. Balance and Coordination among the Physiological Functions of the Five Zang Organs

Balance and coordination of the Zang organs are important for keeping the internal environment of the body stable. At the same time, the internal environment and the external environment of the body must be balanced and coordinated as well. This state is maintained through the relationship of the Zang organs and the body orifices and brain activities.

7. The Concept of the Internal Organs in the Theory of the States of the Internal Organs

Although the Theory of the States of the Internal Organs was based on ancient anatomical knowledge, its subsequent development was mainly due to its special outlook that the internal organs were bound to give outward manifestations. This viewpoint guided TCM observation and study methods. The results of this approach were that the concept of the internal organs inevitably came to signify more than just the human anatomical organ. Instead the concept of each internal organ evolved into a unique theoretical system of physiology and pathology.

Therefore, although the names of the internal organs (i.e. heart, lung, spleen, liver, kidney) are the same as those used in contemporary Western anatomy, they signify different concepts. While anatomically, these names simply represent the physical organ, in TCM they have a different physiological and pathological meaning. The physiological function of a single organ in this theory may encompass the functions of several organs as understood by contemporary anatomy. Conversely, the physiological functioning of an organ from contemporary anatomical theory may be spread over several different organs from the Theory of the States of the Internal Organs. Therefore the internal organ in TCM is not the same as the simple organ of the same name in contemporary anatomy. More importantly, the internal organ concept is a system in which physiological and pathological considerations have been incorporated.

3.1 The Five Zang-viscera

The Five Zang Organs

The heart, the lung, the spleen, the liver and the kidney are the five Zang organs. Although each has its own physiological function, the heart plays the leading physiological role in TCM. The theories of Yin-Yang and Five Elements are the basic theories used to characterize the interrelationship between the Zang organs. In this way, the relationship between the Zang organs can be described as interdependent, inter-restraining, coordinated and balanced.

3.1.1 Kidney

The Kidney

A Brief Account of the Kidney

-Location and Shape Located in the loins, on either side of the spinal column.

Shape resembles a cowpea.

-Main Physiological Functions Stores Jing, the essence of life.

Takes charge of development and reproduction.

Regulates water metabolism.

Controls and promotes inspiration.

-Relationships Related to fear.

(according to Five Elements) Related to the body fluid, spittle.

Determines the condition of the bone and marrow.

Outward manifestation in head hair.

Interior-exterior related organ is

the urinary bladder.

Special orifices in the ears, urogenital orifice and anus.

a. The Main Physiological Functions of the Kidney

1) Storing Jing (Essence of Life), and Taking Charge of Development and Reproduction

Jing (essence of life) is the basic material of the human body. It is also the material basis of all bodily functions. The kidney stores the Jing of the human body. Jing is divided into two components, the congenital and the acquired. Congenital Jing is inherited from one's parents. Acquired Jing is derived from food essence transformed by the spleen and stomach. These two types of Jing are interdependent. Before birth, only congenital Jing exists and acts as the material basis for the absorption of acquired Jing. After birth, acquired Jing is continuously supplied to support the congenital Jing. In this way, the two complement each other.

Jing from the kidney can be transformed into Qi, which is then called kidney Qi. A sufficient supply of kidney Qi is important for human reproduction, and growth and development. During childhood, milk teeth are replaced by permanent teeth, and hair grows longer because kidney Qi is growing richer. At the age of puberty, kidney Qi is at its highest level and this leads to production of the substance, "Tiangui". Tiangui promotes the development of sperm in boys and supports regular menstrual discharge in girls. At this time, sexually functioning is gradually developed until the ability to reproduce is acquired. In old age, kidney Qi becomes gradually weaker, causing a decline and eventual termination in sexual functioning and reproductive capabilities. The body becomes old and feeble. A dysfunction of the kidney's ability to store Jing will inevitably affect growth and development, and reproductive capabilities. Deficiency of kidney Jing may manifest as sterility, loss of hair, loose teeth, slow development of children, and soft and weak bones.

Kidney Jing is transformed into kidney Qi by the distillation of kidney Yang from kidney Yin. The material basis of both kidney Yin and kidney Yang is Jing which is stored in the kidney. Therefore, kidney Qi contains the two components, kidney Yin and Yang. Kidney Yin, also known as the "original Yin" or "true Yin", is the foundation of all Yin fluid of the body. This body fluid has the function of providing nutrients and nourishment to the internal organs. Kidney Yang, also known as the "original Yang" or "true Yang", is the foundation of the Yang Qi of the human body. Yang Qi has the function of warming and transforming in the body. Kidney Yin and Yang, likened to the opposites fire and water, reside in the kidney. This belief leads the ancients to say, "The kidney is the house of water and fire." According to the properties of Yin and Yang, Jing belongs to Yin while Qi belongs to Yang. Sometimes, kidney Jing is referred to as kidney Yin and kidney Qi is referred to as kidney Yang. Kidney Yin and Yang restrain and contain each other within the human body, maintaining physiological functions in a state of dynamic balance. The loss of this equilibrium (i.e. the imbalance of kidney Yin and Yang) causes pathological changes. Yin deficiency which leads to hyperactivity of fire may manifest as feverish sensation in the five centers (the five centers include the chest, palms of hand and soles of feet), hectic fever, night sweats, nocturnal emission for males, or dreams dealing with sexual intercourse for females. Deficiency of kidney Yang causes a decline in the warming and transforming functions. They may manifest as fatigue, pain, coldness of the loins and knees, intolerance of cold, cold extremities, dysuria, frequent micturition, impotence, premature ejaculation for males, or sterility due to cold uterus in females. Kidney deficiency without noticeable signs of cold or heat, is usually referred to as "deficiency of kidney Qi" or "impairment of kidney Jing". Because both kidney Yin and Yang deficiency are by nature characterized by insufficiency of kidney Jing and/or Qi, kidney Yin and Yang deficiency are also inherently related to each other. Kidney Yin and Yang, in the course of pathological change, frequently influence each other. That is, when kidney Yin is severely deficient it also involves kidney Yang, and vice versa. Therefore, severe cases, initially beginning with deficiency of either Yin or Yang progress to include the other, and often present as deficiency syndrome of both.

2) Regulating Water Metabolism

The kidney regulates water metabolism by regulating the retention, dissemination, and discharge of water in the body. Under normal circumstances, the opening and closing of the gate of water will be properly regulated. Opening the gate allows water to be discharged after metabolism. Closing the gate helps retain water needed by the body. Normally, water and food are first received by the stomach and then transported by the spleen and disseminated by the lung via the San Jiao (triple warmer). In the process, pure substance (food essence) is separated from the turbid. The pure substance circulates to the internal organs, while the turbid is transformed into sweat and urine and excreted from the body. This process maintains the water metabolism of the body in a relative state of balance. This entire process falls under the kidney function of regulating water metabolism. If this function is abnormal, it may lead to inappropriate opening and/or closing of the gate of water, causing a breakdown in water metabolism. The result may be edema or dysuria.

3) Controlling and Promoting Inspiration

Although the lung directly performs the function of respiration, the kidney also controls and promotes inspiration by assisting in the downward inhalation of fresh air. This is the reason that TCM states, "The kidney and lung perform the function of respiration". In this capacity, the kidney is of great importance in human respiration. Only when kidney Qi is sufficient can it properly control and promote inspiration, keep the lung's respiratory tract in a clear state, and maintain even and smooth breathing. When kidney Qi is not consolidated, fresh air will not be inhaled downward toward the kidney. The result will be difficult respiration upon exertion.

b. Relations of the Kidney According to the Theory of Five Elements

1) The Kidney Being Related to Fear

Fear is the mental state that one feels when in a state of danger. Fear is similar to terror. However, terror is the mental state that one feels when danger occurs suddenly. Fear, or timidness, on the other hand, is associated with dangerous circumstances that one has been aware of for some time. In terms of physiological activities, fear is a harmful condition. While the kidney is related to fear, the heart, through its taking charge of mental activities, is also closely related. The heart is the house of the mind. When the mind is damaged, timidness develops. Timidness turns into fear and this causes the flow of Qi to be obstructed in the upper Jiao. Qi is forced downward resulting in distention of the lower Jiao and urinary incontinence. Terror may result in the course of normal physiological functioning. The organism will be disturbed for a short time, resulting in a distraction and a fluster.

2) Spittle Being the Fluid of the Kidney

Spittle is the fluid of the mouth. It is the thicker part of saliva and is produced and transformed by kidney Qi. If spittle is not spit out of the mouth, but instead swallowed, it nourishes kidney Jing and Qi. Therefore, kidney Jing and Qi are easily impaired by excessive spitting. For this reason, it is said the ancient Qi Gong (4) practitioner raised his tongue tip against the hard palate until his mouth was filled with saliva, then he swallowed the saliva to nourish kidney Jing. Spittle is also related to the spleen.

3) The Kidney Determining the Conditions of the Bone and Marrow, Having Its Manifestations in the Hair of the Head

The kidney stores Jing which can be transformed into bone marrow. Marrow is stored in the bone cavity and nourishes the bone. If kidney Jing is sufficient, the source of marrow is rich and the bone cavity will be filled with marrow. Fully nourished by the marrow, the bone will be solid and strong. If kidney Jing is insufficient, an insufficient amount of marrow will be produced. Consequently, the bone will be malnourished. Malnourished bone is soft and weak and may even have developmental abnormalities. Therefore, in babies, deficiency of congenital Jing will result in late closure of the fontanel and soft, weak bones. If the kidney is attacked by evils, kidney Jing will be deficient, the bone cavity will not be filled with marrow and the loins and knees will be weak and sore. In severe cases, flaccidity of the lower limbs and an inability to move will result. Because the kidney determines the condition of the bone and marrow, it also influences the condition of the teeth. It is said, "The teeth are the surplus of the bone." The teeth are also nourished by kidney Jing. Sufficient Jing causes the teeth to be firm and strong. A deficiency of Jing causes loose teeth or even tooth loss.

There are two parts to the marrow: the bone marrow and the spinal cord. Because the spinal cord connects with the brain it is said that marrow combines to form the brain. The brain is also called "sea of marrow".

Jing and blood are interdependent. When blood is plentiful, Jing will be sufficient. Although the nutrients for hair are contained in the blood (which is the reason for saying that hair is the surplus of blood), the life mechanism originates from the kidney. The state of kidney Jing and Qi directly affects the growth and loss, and overall condition of the hair. During youth and the prime of life, kidney Jing is sufficient, resulting in bright hair. For elderly persons, kidney Qi decreases, resulting in hair turning white and falling out.

4) The Kidney Having Its Special Orifices in the Ears and the Urogenital Orifices and Anus

The sense of hearing of the ears is determined by the nourishment from kidney Jing. Sufficient Jing maintains a keen sense of hearing. Insufficiency often brings with it tinnitus and deafness. Hypoacusis in the aged is often caused by deficiency of kidney Jing.

Although the elimination of urine is a direct function of the urinary bladder, it is also affected by the kidney regulating water metabolism. Kidney Yang failing to be warmed results in such symptoms as frequent urination, enuresis, oliguria, and urodialysis. As stated above, the kidney also dominates the human reproductive faculties. The voiding of feces is also dependent on the kidney regulating water metabolism. Clinically speaking, constipation may be a result of either impairment of kidney Yin or deficiency and weakness of kidney Yang. If kidney Qi is not consolidated, the result may be chronic loose stools or spontaneous emission.

Appendix: Vital Gate

Gate of Life--Mingmen

The term, "Mingmen" or "Gate of Life", appeared for the first time in the book "Ling Shu Gen Jie Pian" ("Miraculous Pivot"). In this book it was stated that "what the Gate of Life means is nothing but the eyes". Throughout the generation, physician has had differing opinion regarding the location and physiological function of Mingmen. There are four main theories regarding Mingmen.

1. The theory that the right kidney is the Gate of Life holds that there are two kidneys. The left one is considered the kidney while the right one is the Gate of Life. This view was expressed in the "Classic on Medical Problems".

2. The theory that both kidneys represent the Gate of Life holds that the two kidneys together are the Gate of Life. The view was expressed by Yu Bo, a Ming dynasty physician.

3. The theory that the Gate of Life lies in between the two kidneys was expressed by Zhao Xian-ke, a Ming dynasty physician.

4. The theory that a kind of dynamic Qi exists between the two kidneys also holds that the Gate of Life exists between the two kidneys. This kind of Qi exists only as a kind of starting mechanism of primary Qi, being neither fire nor water. The view was postulated by Sun Yi-kuei, a Ming dynasty physician. Although there are many different theories regarding the Gate of Life, all have believed that the physiological function of the Gate of Life is closely bound to the kidney. The kidney, storing true Yin or kidney Yin, is the foundation of the five Zang organs. True Yin nourishes the Yin of the five Zang and six Fu organs. Storing true Yang, or kidney Yang, the kidney warms the Yang of the internal organs. From TCM clinical observations, symptoms associated with deficiency of the fire of the Gate of Life are similar to those of kidney Yang deficiency. Therefore, most drugs used to reinforce the fire of the Gate of Life function by replenishing kidney Yang. One may consider kidney Yang as the fire of the Gate of Life. Likewise, kidney Yang can be considered true Yang or original Yang and kidney Yin can be considered true Yin or original Yin. Ancient physicians simply gave kidney Yin and Yang the name Gate of Life in order to emphasize their importance.

3.1.2 Spleen

3. The Spleen

A Brief Account of the Spleen

-Location and Shape Located in the middle Jiao.

Beneath the diaphragm.

No concrete description of shape in TCM literature.

-Main Physiological Functions Transporting, distributing and transforming nutrients.

Sending food essence upward.

Keeping blood circulating within the vessels.

-Relationships Related to thinking

(according to Five Elements) Related to the body fluid, saliva.

Nourishing the muscles and limbs.

Outward manifestation in the lips

Interior-exterior related organ is the stomach.

Special orifice in the mouth.

a. The Main Physiological Functions of the Spleen

1) Transforming, Distributing and Transporting Nutrients

The spleen has the physiological function of transforming food and water into food essence. In addition, the spleen also functions to transport the food essence to all parts of the body. This function can be divided into two aspects:

-Transforming, Distributing and Transporting Water and Food

When food and water is ingested, the spleen undertakes the process of digesting and absorbing it. While food and water is actually digested and absorbed in the stomach and small intestine, these processes are dependent on the spleen. Moreover, only through the functioning of the spleen can food and water be transformed into food essence and distributed to all parts of the body. When the spleen is functioning normally, all parts of the body, the internal organs, meridians, limbs, bones and other tissues, will be supplied with sufficient nutrients, thus maintaining their proper functioning. Conversely, a spleen dysfunction, known as "spleen's failure to transport and transform", will cause a feeling of fullness and distention of the epigastrium, loose stools, poor appetite, lassitude, weight loss, and even deficiency of Qi and blood. Because of this functioning, TCM states, "the spleen and stomach provide the material basis for the acquired constitution" and "the spleen and stomach are the source of producing Qi and blood".

-Promoting Water Metabolism

The spleen also has the function of absorbing, transporting and distributing water. The spleen transports excess water in food essence to the lung and kidney. Through the functioning of the lung and kidney, which dominate water metabolism, the excess water is transformed into sweat and urine and discharged from the body. Therefore, normal spleen functioning can prevent water stagnation in the body, and thus prevent pathological changes such as retention of dampness, phlegm and fluid. Conversely, a spleen dysfunction of water metabolism will result in water stagnation, leading to retention of dampness, phlegm and fluid and even edema. This leads TCM to state, "spleen deficiency gives rise to dampness", "the spleen is the source of phlegm" and "spleen deficiency leads to edema".

2) Sending Food Essence Upward

The dominant factor of the spleen's transforming, distributing and transporting function is sending food essence upward. The tendency of spleen Qi is to ascend. By this function, food essence is absorbed and sent upward to the heart and lung. The heart and lung then transform food essence into Qi and blood which nourish the whole body. TCM states, "the healthy and vigorous state of the spleen depends upon its ascending function". Ascending and descending are a pair of functional opposites within the human body. To balance the spleen's ascending function, the stomach has a descending function. The balance and coordination of these opposite processes is vital to the internal organs as it is this balance that maintains the relatively constant location of the viscera. For this reason, only when the spleen functions well in ascending can nutrients be absorbed and distributed normally. Li Dong-yuan, a famous TCM physician (1180-1251), stressed, "spleen Qi ascending keeps Yuan Qi (primary Qi) vigorous and the body full of vitality". At the same time, the ascending function of spleen Qi keeps the internal organs from dropping (prolapsing). If spleen Qi fails to ascend, food and water will not be transformed and transported. As a result, there will be no source to produce Qi and blood. The outcome will be such symptoms as fatigue, dizziness, flatulence and diarrhea. Collapse of the spleen Qi (middle Jiao Qi) will lead to permanent diarrhea, prolapse of the rectum, and even ptosis of other internal organs.

3) Keeping Blood Circulating in the Vessels

The spleen controls the blood and keeps it circulating within the vessel, not allowing it to extravasate.

The main mechanism of the spleen for keeping blood circulating within the vessels is its ability to consolidate and govern Qi. The spleen can control blood because it is the source of all nutrients. When the spleen transforms, distributes and transports nutrients well, Qi and blood will be plentiful. As a result, the spleen can perform its consolidating and governing functions and blood will remain in the vessels. However, decreased spleen functioning causes an inadequate supply of nutrients. This will lead to a deficiency of Qi and blood and a decline in the consolidating and governing action of Qi. The result will be chronic hemorrhagic diseases such as hematochezia, hematuria [blood in urine], and metrorrhagia. In TCM this is known as "the spleen failing to control blood" because spleen Qi, which normally tends to ascend, is deficient and descends.

b. Relationships of the Spleen According to the Theory of Five Elements

1) The Spleen Being Related to Thinking

Thinking is one of the mental and emotional activities of the human body. Both the spleen and the heart are related to thinking. While pondering a problem in a normal way does not have adverse effects, overthinking and/or the failure to materialize one's thoughts will affect the normal physiological activities of the body. The normal movement of Qi is affected, which leads to stagnation and accumulation of Qi. Regarding the internal organs, the spleen is most affected by thinking and overthinking. These mental states can inhibit the transforming, distributing, and transporting of nutrients. The spleen ability to send food essence upwards is affected by the accumulation of Qi in the middle Jiao. The result is loss of appetite, abdominal flatulence and dizziness.

2) Saliva as the Fluid of the Spleen

Saliva refers to the clear watery substance produced in the mouth. Its function is to protect the mucus membrane of the mouth and moisten the mouth cavity. During the process of eating, the mouth secretes saliva, which is helpful in swallowing and digesting food. Under normal conditions, saliva ascends, but doesn't overflow, to the mouth. Incoordination of the spleen and stomach tends to cause excess secretion of saliva, causing uncontrollable overflow. For this reason, saliva is considered the fluid of the spleen.

3) Nourishing the Muscles and Limbs

The spleen and stomach are the source of producing Qi and blood. For nourishment the muscles of the whole body depend on the spleen's function of transforming, distributing and transporting food essence. The proper development and strength of the muscles is related to how the spleen and stomach performs these functions. A spleen dysfunction is bound to cause muscle atrophy and flaccidity, and may lead to the limbs being too weak to function. This is the main theoretical basis for treating flaccidity syndrome using only "Yangming" [Yangming refers to the physiological system of the spleen and stomach].

The four extremities are the ends of the human body and, compared with the trunk, are called the four distal parts. The four extremities require food essence from the spleen and stomach for nourishment in order to maintain normal physiological functioning. When the spleen performs its transforming, distributing and transporting functions well, the four extremities have plenty of nutrients and therefore have plenty of strength and can move easily. If the spleen does not function well, clear Yang Q Qi (which originates from the nutrients) fails to ascend and distribution is poor. As a result, the extremities will be in need of nutrients and will be slack and/or too weak to function.

4) The Spleen Having Its Special Orifice in the Mouth, and Having Its Outward Manifestation in the Lips

When the spleen's ascending function and the stomach's descending function are balanced and operating properly, the taste of food will be normal, resulting in a good appetite. A dysfunction of the spleen in transforming, distributing and transporting nutrients leads to abnormal sensations of taste such as bitterness, tastelessness, stickiness or sweetness. This can result in poor appetite.

The color and luster of the lips also depend on the adequate supply of Qi and blood. Because the spleen is the source of production of Qi and blood, the color and luster of the lips depend on the functioning of the spleen and stomach in transforming, distributing and transporting food essence. The state of the lips reflects the condition of Qi and blood for the entire body. If the spleen and stomach are operating properly, the lips will be red, moist and bright. reflecting the condition of spleen and stomach as well as the Qi and blood of the entire body.

3.1.3 Lung

2. The Lung

A Brief Account of the Lung

-Location and Shape Located in the chest.

Soft and spongy features.

Honey-combed architecture.

-Main Physiological Functions Takes charge of Qi and respiration.

Takes charge of dispersing and descending.

Dredges and regulates water passages.

Blood flow of the whole body converges in the lung.

Responsible for the coordination of visceral activities.

-Relationships Related to melancholy.

(according to Five Elements) Related to the body fluid, nasal mucus

Associated with the skin.

Outward manifestation in body hair.

Interior-exterior related organ is the large intestine.

Special orifice in the nose.

a. The Main Physiological Functions of the Lung

1) Taking Charge of Qi and Respiration

The lung oversees the operation of the Qi of the whole body and takes charge of respiration. Regarding the formation of Qi, the lung plays a role in forming "Zong Qi" (pectoral Qi). Zong Qi is a mixture of fresh air inhaled by the lung and food essence that has been transformed and transported by the spleen and stomach. Therefore, the functioning of the lung directly affects the formation of Zong Qi and thereby the formation of Qi for the entire body. Secondly, the lung also regulates the functional activities of the whole body. The rhythmic inhaling and exhaling of the lung plays an important role in regulating the ascending and descending, entering and exiting mechanisms of the body.

The taking charge of respiration means that the lung is the organ that exchanges gases between the interior and exterior of the body. The human body takes in fresh air and expels waste gas via the lung's respiratory function. In doing so, the lung promotes the formation of Qi and regulates the ascending and descending, and entering and exiting of Qi, thus ensuring the continuous operation of normal body metabolism.

2) Taking Charge of Dispersing and Descending

The lung's "dispersing" function refers to the lung activating the flow of Qi, food essence and body fluid, and disseminating them throughout the body. The lung's "descending" function refers to the lung sending down the lung Qi and clearing the respiratory tract.

There are three aspects of the dispersing function:

The first is that the lung expels waste gas out of the body.

The second is that the lung disseminates body fluid and food essence (transported to the lung by the spleen) throughout the whole body. This function warms and moistens the skin and body hair.

The third is that the lung disperses Wei Qi. This regulates the opening and closing of the skin pores and thereby influences the discharge of sweat (which has been transformed from body fluid).

If the lung develops a dysfunction in dispersing, pathology will include dyspnea, sensation of pressure over the chest, cough, asthma, nasal obstruction, sneezing, and anhidrosis [lack of sweating].

There are three aspects of the descending function:

The first is that the lung inhales fresh air from the outside environment.

The second is that the lung sends down the fresh air, body fluid, and food essence (transported to the lung by the spleen). This is evident by the lung's position in the body, located in the upper Jiao, being the uppermost organ.

The third is that the lung cleans and clears away foreign matter in the respiratory tract.

If the lung develops an impairment of the normal functions of clarifying and sending down lung Qi, pathology will include shortness of breath, productive cough and hemoptysis.

The lung's dispersing and descending functions are opposing functions, yet also complementary and inter-restraining. They influence each other in physiology as well as pathology. Without normal dispersing, there cannot be normal descending, and vice versa. Coordinated operation of dispersing and descending keeps the respiratory tract clear, maintains smooth and even breathing, and performs normal gas exchange. A lack of coordination in dispersing and descending will result in "sluggishness of lung Qi" and "impairment of the normal clarifying and sending down of lung Qi". This will lead to symptoms of adverse rising of lung Qi which include dyspnea, cough and asthma.

3) Dredging and Regulating Water Passages

The lung's function of dredging and regulating water passages refers to the role that the lung's dispersing and descending function plays in the dissemination, movement and excretion of water in the body. Water passages are the pathways for the movement and excretion of water. In this capacity, the lung has two main functions. The first is that the lung's dispersing function disseminates water, sent up by the spleen, to all parts of the body. Some of this water is discharged through the pores. The second is that the lung's descending function sends useless water down to the kidney and urinary bladder. When it reaches the kidney, which has the function of separating the clear from the turbid, it is changed into urine and is transported to the urinary bladder, which has the function of storing and excreting urine. In this way, the lung plays a part in regulating water metabolism. TCM states: "the lung is the upper source of water circulation" and "the lung helps maintain normal water metabolism". A dysfunction in the lung's dispersing function may result in the closing of pores which will lead to anhidrosis and edema. An impairment of the normal function of clarifying and sending down lung Qi may lead to edema and dysuria. Both of these pathological changes result from the dysfunction of the lung in dredging and regulating water passages. This theory of lung function can also be applied to treat edema syndrome caused by wind evil. Edema syndrome caused by wind evil will present as fever, chills, dropsy (fluid accumulation) of the face, and dysuria. In terms of treatment, acupoints are selected to ventilate the lung and induce diuresis. These acupoints include Feishu (BL 13), Dazhu (BL 11), and Hegu (LI 4). In addition, when treating dysuria, points of the Lung Meridian of Hand-Taiyin are often selected to facilitate the flow of lung Qi, thus keeping urination smooth. In TCM this is described as "pouring out water from a kettle with its lid off".

4) The Blood Flow of the Whole Body Converging in the Lung and Being Responsible for the Coordination of Visceral Activities

The blood of the whole body converges in the lung where the lung's respiratory function exchanges waste gas for fresh air. From the lung, the blood is again disseminated to all parts of the body. All the blood and vessel of the body are dominated by the heart as blood circulation is dependent upon the propelling action of heart Qi and the ascending and descending function of the lung. Because the lung rules over the Qi of the whole body, takes charge of respiration, and regulates the ascending and descending, entering and exiting movements of the body, blood circulation relies the proper functioning of lung Qi.

The lung is responsible for the coordination of visceral activities. In terms of visceral activities, the lung has four functions:

1. Taking charge of respiration, which is rhythmical,

2. Operating and regulating the movement of Qi throughout the body. i.e. the ascending and descending, entering and exiting movement of Qi associated with the lung's breathing (inhaling and exhaling),

3. Assisting the heart to propel blood and regulate blood circulation, via the movement of Qi,

4. The two functions of dispersing and descending, which dominate and regulate the dissemination, flow and excretion of body fluid.

Therefore, the main physiological functions of the lung are responsible for, and in fact represent, the coordinated visceral activities of the whole body.

b. Relationships of the Lung According to the Theory of Five Elements

1) The Lung Being Related to Melancholy

Although TCM views melancholy and grief as slightly different kinds of emotional reactions, their influence on the physiological activities of the body are similar. Melancholy and grief, considered emotions which are bad in nature, are associated with the lung. Their effect is to continuously consume the body's Qi. Because the lung is in charge of Qi, it is easily impaired by melancholy and grief. Conversely, when lung Qi is deficient, a person is more likely to experience these two emotions because the body has a decreased ability to endure external stressors.

2) Nasal as the Fluid of the Lung

Under normal condition, nasal mucus has the function of moistening the nostrils. But it should not be so excessive as to flow out of the nose. When cold evil attacks the lung, the result is a running nose. When heat evil attacks the lung produces yellowish, thick and turbid discharge. Lung dryness syndrome is manifest as dryness of the nasal cavity.

3) The Lung Being Associated with the Skin and Having Its Outward Manifestation in Body Hair

The skin and body hair, making up part of the surface of the body, depend on Wei Qi and body fluid to warm, nourish and moisten. Together, they form a protective screen to fight against external pathogenic factors. The lung has the physiological functions of activating Wei Qi and disseminating body fluid to the skin and body hair. As a result of normal lung functioning, the skin will be compact, the soft hair on the body will be lustrous, and the ability to combat external pathogenic factors will be enhanced. Conversely, if lung Qi is deficient, the lung's activating and descending functions will decline, Wei Qi will not be consolidated and the ability to resist the invasion of exogenous evils will be lowered. This may result in hyperhidrosis, susceptibility to colds, and lusterless and withered skin and body hair.

When exogenous evils invade the skin and body hair, the pores will close and Wei Qi will stagnate. At the same time, because the lung is associated with the skin and body hair, it inevitably will also be affected. This condition may lead to sluggishness of lung Qi. In addition, the closing of the pores, and stagnation of lung Qi are also caused by exogenous evils invading the lung. In TCM, the openings of the sweat glands are known as the "valves of air". These pores are not only the site for the excretion of sweat, but also for the exchange of air inside and outside the body which is carried out by the lung's dispersing and descending functions.

4) The Lung Having Its Special Orifice in the Nose

The nose is connected to the larynx, which in turn is connected to the lung. The nose's olfactory functions and the articulation of the larynx both depend on the action of lung Qi. The free physiological movement of lung Qi on respiration manifests as a keen sense of smell and a clear voice. Also, because the lung has its special orifice in the nose and is directly connected to the larynx, most exogenous evils invade the lung by way of the nose and/or larynx. Pathological changes of the lung result in such problems as nasal obstruction, watery nasal discharge, sneezing, itchy throat, hoarse voice and dysphonia [painful speech].

3.1.4 Liver

The Liver

A Brief Account of the Liver

-Location and Shape Located inside the ribs.

Beneath the diaphragm.

-Main Physiological Functions Smoothing and regulating the flow of Qi and blood.

Storing and regulating blood.

-Relationships Related to anger.

(according to Five Elements) Related to the body fluid, tears.

Associated with tendons.

Outward manifestation in the nails.

Interior-exterior related organ is the gallbladder.

Special orifice in the eyes.

a. The Main Physiological Functions of the Liver

1) Smoothing and Regulating the Flow of Qi and Blood

There are three aspects to the liver's smoothing and regulating function:

a) Regulating the Free Movement of Qi

The activities of the internal organs, meridians and collaterals of the body depend on the free movement of Qi, i.e. the four movements of Qi, ascending and descending, and entering and exiting. The free movement of Qi depends on the liver's regulating function.

When the liver functions normally, the four movements of Qi will be coordinated and balanced. Qi and blood will also be coordinated. The meridians and collaterals will be free. And the functional activities of the internal organs and other tissues will be normal and harmonious. A dysfunction of the liver may give rise to two types of pathology. The first is obstruction of the movement of Qi. These results in sluggishness and stagnation of Qi, manifest as local distending pains in the hypochondria, breasts and lower abdomen. The second is excess liver function. This results in the adverse rise of liver Qi caused by the disorder in the flow of Qi. The free flow of Qi produces normal blood circulation. But the abnormal rise of Qi results in bleeding (hematemesis [vomiting blood], hemoptysis [coughing blood]), and even syncope [fainting].

Blood circulation and the transportation, distribution and metabolism of body fluid depend on the harmonious functioning of Qi. Stagnation of liver Qi, therefore, may impede blood circulation resulting in blood stasis, abdominal masses, and possibly abnormal menstruation, dysmenorrhea or amenorrhea in women. The stagnation of liver Qi due to a dysfunction in the liver promoting the free movement of Qi may also affect the transportation and distribution of body fluid. They may cause an accumulation of body fluid and lead to phlegm retention syndrome or other types of pathology.

b) Promoting the Functions of the Spleen and the Stomach

The spleen has the function of sending food essence and water upward while the stomach has the function of sending food contents downward. Together, they both accomplish the task of digesting and absorbing food, and transporting and distributing food essence. The liver's function of regulating the free movement of Qi is closely related to the spleen's upward movement and the stomach's downward movement. One of the important conditions for the normal ascent of the spleen and the normal descent of the stomach is the liver smoothing and regulating the flow of Qi and blood. If the liver does not carry out this function well, not only will the spleen have problems sending food essence and water upward, but the stomach will have problems sending food contents downward. The former case is known as "hyperactive liver Qi attacking the spleen". The latter is known as "hyperactive liver Qi attacking the stomach". Together, both are referred to as "hyperactivity of wood restricting earth" (following the theory of Five Elements). The condition is manifest as vomiting, distending pains over the epigastrium and abdomen, and diarrhea (signs and symptoms of spleen and stomach dysfunction). The liver smoothing and regulating the glow of Qi and blood also helps the spleen and stomach as it influences the secretion and excretion of bile. When the liver is smoothing and regulating the flow of Qi and blood, bile can be secreted and excreted normally. This assists the functioning of the spleen and stomach. Stagnation of liver Qi may affect the secretion and excretion of bile, which results in distending pains in the hypochondrium, bitter taste in the mouth, indigestion, and in severe cases, jaundice.

c) Regulating Mood

Although TCM holds that mental activities are controlled by the heart, they are closely related to the liver smoothing and regulating the flow of Qi and blood. When the liver is functioning normally, one's mood will be open clear. This is due to harmonious functional activities of Qi and the coordination between Qi and blood. Any liver dysfunction in promoting the free movements of Qi causes mood changes, with persons becoming more depressed or excited. Stagnation of liver Qi often brings about a depressed frame of mind in the patient. A trifle upset may bring about depression which is difficult to relieve. Hyperactivity of liver Qi causes Yang energy to rise, resulting in increased impetuousness. Any little stimulus may cause irascibility. The liver's effects on mood changes occur because of an unrestrained and free movement of Qi and blood. Conversely, external stimuli, especially depression and anger may affect liver functioning as well. This leads to stagnation of liver Qi or causes excessive liver functioning.

2) Storing and Regulating Blood

The liver stores blood and regulates the amount of blood in circulation. Regarding the regulation of blood, Wang Bing, a Tang dynasty physician, said, "The liver stores blood, the heart control the circulation of blood. When the human body is in a state of motion, most blood will circulate around the body within the vessels. But when the body is in a state of rest, most blood will be stored in the liver. That is why the liver is called the 'sea of blood'." By being able to store blood, the liver is able to control the amount of blood in circulation. Because of this, the liver is related to the physiological processes of the whole body. Liver diseases may cause a dysfunction of the liver storing blood. This will lead not only to blood deficiency or hemorrhage, but also pathological changes in the entire body related to a deficiency of nutrients. For example, deficiency of blood from the liver may cause malnutrition of the tendons. This may bring about spasm of the tendons, numbness of the extremities and sluggishness of joint movements. The liver's storing and regulating blood function is also closely related to women's menstruation. Deficiency of blood from the liver may cause scanty menstruation and in severe cases amenorrhea [lack of menses]. The liver's inability to properly store blood may cause profuse menstruation and in severe cases metrorrhagia.

The liver's function of regulating the amount of blood is actually a manifestation of the liver's function of smoothing and regulating the flow of Qi and blood. Proper functioning of Qi and blood requires a coordinated and balanced relationship. So, the liver must regulate blood with respect to this balance. An excess of blood or a deficiency of Qi results in different types of hemorrhage. Stagnation of liver Qi due to blood dysfunction will cause blood stasis.

In addition, the liver has the mental functions of enduring fatigue and storing the ethereal soul (Hun). In TCM, the ethereal soul is a variant of the mind and is derived from the mind. A dream-like feeling or trance state belongs to the realm of the mind. Similar to the mind, the soul has it main material base in blood. The heart houses the mind because it controls blood circulation. The liver stores the soul because it stores and regulates blood. When the liver stores blood normally, the soul will also be in a healthy state. If liver blood is deficient causing heart blood to also be deficient, the soul will be in a morbid condition, which is indicated by being frightened, excess dreaming, restlessness during sleep, somnambulism [sleep-walking], somniloquy [talking in sleep], and hallucinations.

b. Relationships of the Liver According to the Theory of Five Elements

1) The Liver Being Related to Anger

Anger is the emotional reaction that is associated with the human body being in an excited state. Generally speaking, anger is harmful to the physiological activities of the body. Anger causes Qi and blood to rise adversely, and causes Yang Qi to ascend. Because of the liver's function of smoothing and regulating the flow of Qi and blood, and this function being related to ascending Yang Qi, anger is related to the liver. Anger, or rage, inevitably causes excessive ascending of liver Yang Qi. This leads to the saying, "Anger impairs the liver." Conversely, when the Yin blood of the liver is deficient, Yang Qi of the liver will ascend. In this case, a person will be easily angered.

2) Tears as the Fluid of the Liver

The liver has its special orifice in the eyes which is where tears exist. Tears have the function of moistening and protecting the eyes. Under normal conditions, tears are secreted to moisten, but are not excessively secreted to cause overflowing. When foreign bodies are located in the eye, an extra amount of tears may be secreted to clean the eyes and remove the foreign body. In pathological conditions, one may experience an abnormal secretion of tears. For example, deficiency of liver blood may lead to dry eyes. In the case of acute conjunctivitis caused by wind-fire evil or dampness-heat evil attacking the liver meridian, an increase of tears may be observed. In addition, extreme sorrow may bring about a copious secretion of tears.

3) The Liver Being Associated with Tendons, and Having Its Outward Manifestations in the Nails

The tendons (i.e. fascia) are a kind of body tissue which attach to the bones and gather in the joints. Tendons connect the joints and muscles, whose contraction and relaxation result in the movement of the joints and extremities. The condition of the liver determines the condition of the tendons. This is because tendons mainly depend upon nutrients from liver blood. When liver blood is sufficient, the tendons are adequately nourished and the extremities will be full of strength, dexterous and quick. Malnutrition of the tendons caused by deficiency of liver blood and Qi may result in weakness of the tendons and limited movement. In addition, malnutrition of the tendons may be caused by a deficiency of Yin blood of the liver, and may result in tremors and numbness of the extremities, sluggishness of joint movement, and in severe cases, clonic convulsions.

In TCM, the nails include the fingernails and the toenails are considered a continuation of the tendons. TCM states, "The nails are the surplus of the tendons." The condition of liver blood also determines the condition of the nails. Sufficient liver blood produces hard, bright, and red colored nails. A deficiency of liver blood results in soft, thin, withered, whitish, fragile, and in severe cases deformed nails.

4) The Liver Having Its Special Orifice in the Eyes

The eye is the visual organ of the human body. The liver meridian ascends to connect with the eye system and the eye's visual sense is mainly dependent on the nutrients from liver blood. That is the reason for the saying, "The liver has its special orifice in the eyes." Moreover, because all the essence of life and Qi of the internal organs gather in the eyes, there exists an inherent relationship between the eyes and the internal organs. Following this theory, TCM physicians of later generations developed the Five-Wheel System. This system laid a foundation for the selection of treatment based on the differential diagnosis of eye diseases.

Because the liver has its special orifice in the eyes, liver functioning will be reflected in the eyes. For instance, deficiency of liver Yin blood may lead to dry eyes, blurred vision, or night blindness. Wind evil attacking the liver meridian may lead to itching, pain and red eyes. Flaring up of excessive liver fire may lead to red eyes and production of gum. Deficiency of liver Yang may lead to dizziness. Liver wind stirring inside the body may cause upward deviation of the eyeball.

3.1.5 Heart

The Heart

A Brief Account of the Heart

-Location and Shape Located in the chest, above the diaphragm.

Shape resembles an inverted peach.

-Main Physiological Functions Controls blood circulation.

Takes charge of mental activities.

-Relationships Related to joy.

(according to Five Elements) Related to the body fluid, sweat.

Associated with blood and vessels.

Outward manifestation in the face.

Interior-exterior related organ is the small intestine.

Special orifice in the tongue.

a. The Main Physiological Functions of the Heart

1) Controlling Blood Circulation

The heart controls blood circulation. This means that the heart has the function of propelling the blood which nourishes the whole body. The heart makes the blood flow and circulate within the blood vessels (which are included in the meridians system). Controlling blood circulation depends on heart Qi. Only when heart Qi is sufficient can the blood circulate endlessly through the vessels, transporting nutrient substances to the tissues, internal organs and other parts of the body. Deficiency of heart Qi will result in a number of symptoms of deficiency of vessels. These include: pale complexion, fine and weak pulse. More serious symptoms include a red-blue face and lips due to blood stasis and a small, choppy pulse. According to the Theory of the States of the Internal Organs, problems of the heart, blood and vascular system such as hemoptysis, epistaxis, chest Bi (3) syndrome and palpitations, in general, are initially treated by regulating the heart.

2) Taking Charge of Mental Activities (Shen)

Taking charge of mental activities is also known as "the heart being the residence of the spirit", or "the heart controlling mental and emotional activities". This refers to the heart having the function of controlling mentality, consciousness and thought. The meaning of the Chinese character, "Shen", can be understood in a broad or narrow sense. The broad sense has the English translation of "spirit". The narrow sense can be translated into "mind". Spirit refers to the external appearances of the life activities of the human body as a whole. This is manifest as image of the whole body, complexion, expression in the eyes, speech, ability to answer questions and posture of the limbs. Mind refers to mentality, consciousness and thought, the mental activities that the heart controls. The function of the heart in taking charge of mental activities is very important not only in terms of these activities themselves being major physiological functions of the human body, but also because these mental activities can also affect the balance and coordination of the physiological functioning of the whole body. When the heart functions normally, a person will be full of vigor and demonstrate healthy consciousness. Conversely, dysfunction of the heart may result in abnormalities in consciousness, leading to insomnia, excessive dreaming, mental restlessness and even delirium. Other clinical manifestations include slowed reaction, poor memory, exhaustion of spirit and even coma.

Finally, the two functions of the heart, controlling blood circulation and taking charge of mental activities, are interrelated and cannot be separated from one another. Blood is the material basis of mental activity. Therefore, because the heart controls blood circulation, it also has charge of mental activities. Any abnormality in the control of blood circulation will inevitably lead to mental disorders. In the TCM clinic, mental disorders are often treated by regulating the blood system.

b. Relationships of the Heart According to the Theory of Five Elements

1) The Heart Being Related to Joy

The physiological function of the heart is related to joy. In the Theory of the States of Internal Organs, each of the five Zang organs is related to one of the five emotional activities. The five emotional activities, as related to the five elements and five Zang organs, are joy, anger, anxiety, melancholy and fear. These emotions are elicited in humans by outside circumstances acting on the Zang organs. Generally speaking, joy is the emotional response evoked by an outside stimulus that is good in nature. This situation benefits the heart in controlling blood circulation. However, excessive joy may impair heart functioning.

In addition, if the heart excessively takes charge of mental activities, this will cause uncontrollable laughing. A heart deficiency in taking charge of mental activities will make a person susceptible to grief. Because the heart controls spirit and mind, excessive joy as well as other excessive emotional states can impair the heart.

2) Sweat as the Fluid of the Heart

Yang energy transforms body fluid into sweat, which is then secreted from the sweat glands. The secretion of sweat also is dependent on Wei Qi (defensive Qi). Wei Qi controls the opening and closing of the pores of the skin. Being transformed from body fluid, sweat and blood have the same source. Therefore TCM holds "sweat as the fluid of the heart". Deficiency of heart Qi may cause spontaneous perspiration. A deficiency of heart Yang may lead to profuse sweating. Clinically, abnormalities in perspiration are treated by regulating heart function.

3) The Heart Being Associated with Blood and Vessels and Having Its Outward Manifestation in the Face

The heart being associated with blood and vessels means that the blood of the entire body belongs to the heart. Because the heart has its outward manifestation in the face, it is possible to learn the physiological condition of the heart by observing changes in the color of the face. The face is rich in blood vessels. Therefore, when heart Qi is sufficient and blood is plentiful, the face will appear red and the skin moist. When heart Qi is insufficient, the face will appear pale, dark and gloomy. When the blood of the heart is deficient, the face will appear lusterless. When there is a stagnation of the blood of the heart, the face will appear cyanotic.

4) The Heart Having Its Special Orifice in the Tongue

The tongue is the outward manifestation of the heart, and is often referred to as "seedling of the heart". The functions of the tongue include taking charge of the sense of taste and producing sound. In turn, these tongue functions are dependent on the main physiological functions of the heart: controlling blood circulation and taking charge of mental activities. If heart functioning is abnormal, other pathological changes may include changes in the sense of taste, tongue rigidity and delirium.

In addition, the tongue is rich in blood vessels and is not covered by a layer of epidermis. Therefore, by observing the color of the tongue, it is possible to directly learn the condition of the circulation of Qi and blood and to determine the heart function of controlling blood circulation. Ancient physicians established the relationship of the heart having its special orifice in the tongue through long-term observation of physiological and pathological phenomena. When the heart functions well, the tongue body appears red, moist and bright. It is soft and moves freely. It is sensitive in taste and produces fluent speech. When there is a pathological condition of the heart, it will manifest in the tongue. For example, a deficiency of heart Yang will result in a corpulent tongue body with pale color. Insufficiency of heart Yin will result in a thin crimson-colored tongue. Flaring up of heart fire may cause red-colored tongue and even tongue lesions. A stagnation of blood in the heart will result in a dark purple-colored tongue and/or ecchymoses. When the heart abnormally controls mental activities, a curled tongue, stiff tongue, delirium or aphasia can result.

The relationship of the heart with the other Zang organs and with the Fu organs will be discussed in a following section, "The Relationship between the Internal Organs".

Appendix: Pericardium

The Pericardium

In TCM, the pericardium is called "Tan-zhong". It is the peripheral tissue of the heart and has the function of protecting the heart. Because the heart is housed in the pericardium, "Nei Jing" ("Canon of Medicine") refers to the pericardium as the palace city of the heart. In the theory of the Meridians and Collaterals, the meridian of Hand-Jueying belongs to the pericardium. It forms an interior-exterior relationship with the San Jiao (triple warmer) Meridian of Hand-Shaoyang. The pericardium is considered a Zang organ while the San Jiao is the Fu organ. The Theory of the States of the Internal Organs holds that the pericardium lies on the heart periphery and protects the heart. If exogenous pathogenic factors attack the heart, the pericardium will always first be involved. Therefore, following the Theory of Seasonal Febrile Diseases, symptoms such as coma and delirium caused by exogenous pathogens are described as "the attack of the pericardium by pathogenic heat" or "pathogenic heat obstructing the pericardium".

3.2 The Six Fu-viscera

The Six Fu Organs

The six Fu organs consist of the gallbladder, stomach, large intestine, small intestine, urinary bladder, and San Jiao. Their common physiological function is to digest and absorb food, and excrete waste. This is summarized by the saying, "The six Fu organs are normal in descending, function well when unobstructed, being filled but not full." A morbid state occurs when the clearing and descending function is inadequate or excessive.

3.2.1 Gallbladder

The Gallbladder

A Brief Account of the Gallbladder

-Location and Shape Connected to the short lobe of liver.

Shape resembles a long pear.

-Main Physiological Functions Storing and excreting bile.

Related to courage in decision-making.

Also regarded as an extraordinary organ because of storing bile instead of receiving water and food, or excreting waste.

The Main Physiological Functions of the Gallbladder

1) Storing and Excreting Bile

Bile is produced by the liver and stored in the gallbladder. It is excreted into the small intestine to aid the spleen and stomach in food digestion. The excretion of bile is controlled by the liver smoothing and regulating the flow of Qi and blood. When liver function is normal, bile will be excreted freely and the spleen and stomach will transform and transport food substance normally. Conversely, if this liver function is not working well, the excretion of bile will be obstructed. Digestion and absorption of food will be affected, leading to hypochondriac pain and distention, poor appetite, abdominal distention and loose stools. The adverse ascent of bile causes a bitter taste in the mouth and vomiting bitter fluid of yellow or green color. Extravasation of bile results in jaundice.

2) Being Related with Courage in Making Decisions

The liver and gallbladder form an interior-exterior related pair. While the liver plays a role in directing reason, the gallbladder is concerned with one's courage in making decisions. Only when the function of the liver and gallbladder combine and aid each other can mental and conscious activities be normal. Deficiency of gallbladder Qi may cause one to be unable to make a decision and may cause abnormal functioning of other organs.

The Chinese have a saying that one who is brave has a big gallbladder and one who is timid has a small gallbladder. This demonstrates that bravery and timidness are related to the gallbladder for the Chinese. When gallbladder Qi is sufficient and vigorous, the Qi of all the internal organs is stronger. Because evils have a greater difficulty in invading the body, the person is less likely to experience fear. If gallbladder Qi is insufficient, the Qi of the internal organs is weaker. When an outside evil invades the body, the flow of Qi and blood will be disturbed. If this condition lasts for a prolonged period, disease will surely result. Disease, therefore, is related to whether a person is brave or timid. Persons suffering from gallbladder disorders often present as very fearful.

3) Being an Extraordinary Organ Because It Stores Bile Instead of Receiving Water and Food or Excreting Waste

The gallbladder is considered one of the six Fu organs because it stores and excretes bile which aids in digesting food. However, unlike the other Fu organs, it doesn't perform the function of transporting or transforming food. In this respect, it is different from the other Fu organs and is also considered an extraordinary organ.

3.2.2 Stomach

The Stomach

A Brief Account of the Stomach

-Location and Shape Located in the upper part of the abdominal cavity.

Shape resembles a bag.

Upper opening is the cardia or "shang wan".

Lower opening is the pylorus or "xia wan".

The area between the two openings is the "zhong wan".

All three parts together are known as "wei wan".

-Main Physiological Functions Receives, digests and transforms food and water.

Takes charge of sending food contents down as stomach Qi regularly descends.

The Main Physiological Functions of the Stomach

1) Receiving, Digesting and Transforming Water and Food

Diet enters the mouth, passes through the esophagus, and reaches the stomach where it remains for some time. Because water and food remain in the stomach, the stomach is called "the reservoir of water and food". The water and food is held in the stomach where it is reduced to chyme by the fermenting and grinding action of the stomach. The chyme is then forced downward into the small intestine. The food essence of the chyme is transported to all parts of the body by the spleen. The function of the spleen and stomach is to digest water and food, absorbing food essence to nourish the whole body. They provide the material basis for the acquired constitution. The function of both spleen and stomach together is known as the "stomach Qi". In clinic, maintaining stomach Qi is an important treatment principle.

2) Taking Charge of Sending Food Contents Down, and the Regular Descent of Stomach Qi

The stomach is the "reservoir of water and food". Diet enters the stomach to be fermented and forced downward into the small intestine. In the small intestine, it is digested and absorbed even further. For this reason, it is said that the stomach takes charge of sending food contents down. The normal tendency of stomach Qi is to descend. The proper downward movement of stomach Qi is necessary for the stomach to receive and hold food. A dysfunction of the stomach in this regard will cause poor appetite, halitosis [bad breath], abdominal distention, fullness, pain, or constipation. These symptoms are all due the stomach's failure to send the turbid substances downward. If stomach Qi adversely ascends, symptoms will include eructation with foul odor, nausea, vomiting and hiccups.

3.2.3 Small Intestine

The Small Intestine

A Brief Account of the Small Intestine

-Location and Shape Located in the abdomen.

Upper end connects with stomach.

Lower end connects with large intestine.

Long canal-like organ.

-Main Physiological Functions Receiving, transforming and absorbing food contents.

Separating clarity from turbidity.

The Main Physiological Functions of the Small Intestine

The main function of the small intestine is to further digest the food contents received from the stomach. In the process of digestion, the small intestine separates the clear substance from the turbid. Clear substance is food essence and is transported and distributed to all parts of the body by the spleen. Turbid substance is waste which is sent down into the large intestine through the ileocecal region (Lan Men). Unwanted water is sent to the urinary bladder. If there is a dysfunction of the small intestine, digestion and absorption will be affected. In clinic, ancient TCM healers adopted the method of "treating diarrhea with diuretics". This treatment is based on the small intestine's function of separating the clear from the turbid.

3.2.4 Large Intestine

The Large Intestine

A Brief Account of the Large Intestine

-Location and Shape Located in the abdomen.

Upper part connected to small intestine.

Lower part connected to anus.

Long canal-like organ, thicker than the small intestine.

-Main Physiological Functions Passing and eliminating waste.

The Main Physiological Functions of the Large Intestine

The main physiological function of the large intestine is to pass and eliminate waste. The large intestine receives food waste from the small intestine. From the food waste, it absorbs excess water and forms feces which is discharged from the body through the anus. The action of the large intestine is affected by the stomach's function of sending food contents downward and also the descending function of the lung. When lung Qi descends, the large intestine will perform its transportation function well. The function of the large intestine is also related to the kidney's regulation of water metabolism. Therefore, it can be said that "the kidney controls urination and defecation". A dysfunction of the large intestine may bring about abnormal transportation of feces. This manifests in the intestine as filthiness causing dysentery or difficulty defecating. Consumption of body fluid by heat-evil or deficiency of body fluid will result in constipation.

3.2.5 Urinary Bladder

The Urinary Bladder

A Brief Account of the Urinary Bladder

-Location and Shape Located in the middle of the hypogastrium.

Shape resembles a cone.

-Main Physiological Functions Storing and excreting urine.

The Main Physiological Functions of the Urinary Bladder

In the course of water metabolism, water is dispersed to all parts of the body by the concerted action of the lung, spleen, kidney and San Jiao. After being utilized by the body, the water accumulates in the urinary bladder as urine. The urinary bladder then excretes it from the body. A dysfunction of the urinary bladder in storing and excreting urine may result in dysuria or urinary retention. If the urinary bladder has problems in storing urine, the result will be frequent micturition and/or urinary incontinence.

3.2.6 San-jiao

The San Jiao (Triple Warmer)

A Brief Account of the San Jiao (Triple Warmer)

-Location and Shape Located throughout the body cavity.

Consists of upper, middle and lower Largest Fu organ.

-Main Physiological Functions Controls the activities of the Qi of the human body.

Acts as the passage through which water, food and fluid are transported.

a. The Main Physiological Functions of the San Jiao

1) Controlling the Activities of Qi of the Human Body

The San Jiao controls the activities of Qi of the human body because it serves as the passageway of Qi. Because Qi is located in the San Jiao, it can control the four movements of Qi, ascending and descending, and entering and exiting. Yuan Qi (primary Qi), the most fundamental kind of Qi, commences from the kidney and passes through the San Jiao as it circulates throughout the body.

2) Being the Passage through which Water, Food and Fluid are Transported

The San Jiao has the functions of dredging water passages and transporting water, food and body fluid. As the passageway, it facilitates the four movements for these substances, ascending and descending, entering and exiting. The water metabolism of the organism is performed by the concerted action of the lung, spleen, stomach, intestines, kidney and urinary bladder. However in the process of metabolism, the San Jiao must operate as the passage for water's normal movement. If the water passages in the San Jiao are blocked, it will be difficult for the lung, spleen and kidney to function properly. This will lead to difficulty of urination and edema due to retention of fluid.

b. The Locations and Functions of the Upper, Middle and Lower Jiao

1) The Upper Jiao

The upper Jiao is the portion of the body cavity above the diaphragm. It houses the heart and lung, and contains the head and face. Its physiological function is characterized by its control over the ascent of Qi and the activation of Qi's flow. Of course, this does not suggest that Qi only ascends. Rather the upper Jiao only control its ascent, after which it will descend.

2) The Middle Jiao

The middle Jiao is the portion of the body cavity between the diaphragm and the umbilicus. Its physiological function is characterized as the pivot of ascent and descent, and the source of production of Qi and blood. It also encompasses the spleen and stomach's functions of transformation and transportation.

3) The Lower Jiao

The lower Jiao is the portion of the body cavity below the stomach. It houses the small intestine, large intestine, kidney and urinary bladder. Its physiological function is characterized by excreting waste and urine. The lower Jiao also contains Jing stored in the kidney, the blood of the liver, and Yuan (primary) Qi from the Mingmen (Gate of Life).

3.3 Extraordinary Fu-viscera

The Extraordinary Fu Organs

The six organs and tissues that make up the extraordinary Fu organs consist of the brain, the marrow, bone, the blood vessels, the gallbladder, and the uterus (for women). They store Yin essence and the necessary resources for the growth and movements of the human body. Because the extraordinary Fu organs, like the earth, nourished all parts of the body, ancient TCM physicians believed that they were produced along with nature. The extraordinary Fu organs resemble the Fu organs in structure, but resemble the Zang organs in terms of function. They differ from the Fu organs in that they transmit and digest water and food without storing them. Unlike the Zang organs, the general, concerted action of the extraordinary organs takes charge of mental activities. Moreover, with the exception of the gallbladder, they cannot be considered totally Zang or totally Fu, but have characteristics of both, they are known as the extraordinary Fu organs.

3.3.1 Brain

The Brain

TCM holds that marrow combines to form the brain which is contained in the cranial cavity. The brain is located between the top of the skull and the acupoint, Fengfu (DU 16). Its main physiological function is to control mental and thought activities. Li Shi-zhen, the great Ming dynasty physician, believed that the brain was the mansion of the mind. Qing dynasty physician, Wang Qing-ren, attributed the functions of memory, sight, smell, sound and speech to the brain.

Regarding the medulla of the brain, its sufficient functioning is related to the physical strength and mental functioning of the body. When the medulla is sufficient, stamina is high and one can work for long hours. If the medulla is insufficient, the result will be lassitude, and abnormalities in hearing and speaking.

Although the ancients had some knowledge of the brain's physiology and pathology, outlined in the Theory of the States of the Internal Organs, many of the brain's functions and pathologies are attributed to the five Zang organs. Today TCM also attributes many brain functions to the Zang organs. For example, as stated previously, it is believed that the heart houses the mind and insures the pleasure of the person. The lung stores the corporeal Soul (Po) and when the corporeal Soul (Po) has problems sorrow results. The spleen houses thought and plays a part in thinking. The liver stores the ethereal Soul (Hun), a disorder of which causes anger. The kidney stores will power, a disorder of which causes fright. Among the Zang organs, the heart, liver and kidney play a dominant role in controlling mental activities. The heart is the major organ in controlling mental activities. The liver plays a role in mental activities because its smoothing and regulating function of Qi and blood (thereby regulating mind and mood). The kidney influences mental activities because it stores Jing, which can be transformed into bone marrow which in turn combines to form the brain.

Such syndromes based on differential diagnosis can be classified into those of the brain, as "the heart misted by phlegm", "the heart attacked by phlegm-fire", "heat evil attacking the pericardium", "the imbalance of the normal physiological coordination between heart and kidney", "stagnation of liver Qi", "flaring up of liver fire", "internal stirring of liver wind", and "deficiency of kdiney essence", the therapies for which are as the following: "waking the patient from unconsciousness by clearing away heat from the heart", "tranquilizing the mind by nourishing the heart", "restoring the balance between the heart and kidney", "removing the stagnated liver Qi to restore the normal function of the depressed liver", "clearing away liver fire", "calming the liver to inhibit wind evil" and "replenishing Jing (essence) to promote the formation of bone marrow".

3.3.2 Uterus

The Uterus

A Brief Account of the Uterus

-Location and Shape Located in the lower abdomen.

Behind the urinary bladder.

Shape resembles an inverted pear.

-Main Physiological Functions Produces menses.

Pregnancy.

The Main Physiological Functions of the Uterus

1) Producing Menses

Around the age of fourteen, a woman's kidney Qi becomes richer and richer brings about the production of "Tiangui" [see section on the kidney for an explanation of Tiangui]. Tiangui promotes the development of human reproductive function. By the action of Tiangui, the woman begins to menstruate which marks the commencement of her reproductive ability. While the uterus is responsible for producing menses and becoming pregnant, the production and regulation of menstruation is controlled by the Chong extra meridian and the Ren meridian. Both meridians originate in the uterus. The Chong meridian is located where the blood of the twelve regular meridians converges, and is therefore known as the "sea of blood". The Ren meridian is located where the Yin meridians converge and govern the Yin fluid of the human body (i.e. Jing, blood and body fluid). After a woman develops fully, the Chong meridian flourishes to become more unobstructed and the sea of blood becomes more full. At this time, Yin blood flow down into the uterus to produce menses.

When a woman's menses becomes regular, the egg which is periodically released from her ovary can be fertilized by sperm and the woman can become pregnant. A dysfunction of the Chong or Ren meridian, or their failure to consolidate and govern Qi and blood results in irregular, excessive or lack of menstruation, or uterine bleeding.

2) Being Pregnant

Before pregnancy, the uterus produces menses. After pregnancy is initiated, the uterus is a vital organ which protects and supports the fetus. The fetus in the uterus relies mainly on the Chong and Ren meridians to provide it with nutrients. If the Chong and Ren meridians fail to adequately nourish and consolidate the fetus, the result may be xolporrhagia during pregnancy or abortion. In therapy, points may be selected to replenish and invigorate the Chong and Ren meridians. In this way, Qi and blood are augmented and support to the fetus is thereby increased.

The uterus is also related to the heart, liver and spleen in its function. Their relationship lies in the fact that normal menstruation and support of a fetus rely on blood. The heart controls the blood, the liver stores the blood, and the spleen produces blood and maintains its flow in the vessels. Therefore, abnormal function of the heart, liver and/or spleen may affect the uterus and result in irregular menstruation or sterility.

3.4 Relations among the Zang and Fu Viscera

The Relationship between the Internal Organs

3.4.1 Relations among the Five Zang-viscera

The Relationships between the Zang Organs

a. The Relationship between the Heart and Liver

The heart controls the circulation of blood and the liver stores blood. When the blood in the vessels is plentiful, both the heart and liver have sufficient material to act upon. If heart blood is deficient, it will cause liver blood to be deficient as well. If liver blood is deficient, it will cause heart blood to be deficient. Therefore, blood deficiency syndrome is often manifest by palpitations, insomnia (heart blood deficiency problems) and blurred vision, soft and withered nails (liver blood deficiency problems).

The heart takes charge of mental activities. The liver has the function of smoothing and regulating the flow of Qi and blood. Both functions are related to mental activities and mood. Pathology caused by mental factors often includes the interaction of heart and liver. For instance, in blood and Yin deficiency of heart and liver, upset temper and insomnia always occur in conjunction with mental symptoms such as impatience and irascibility.

b. The Relationship between the Heart and Spleen

The heart controls the circulation of blood and the spleen has the function of producing blood. When spleen Qi is sufficient, adequate blood production will occur. In this case, the heart has sufficient material to act upon and heart blood will be plentiful. In normal circulation, the flow of blood through the vessels depends on the driving force of heart Qi and the function of spleen Qi to keep blood flowing within the vessels. The relationship between heart and spleen, therefore, is mainly mediated by production and circulation of blood.

In pathology, the heart and spleen often influence each other. For example, a deficiency of spleen Qi may cause a dysfunction of the spleen in transforming, distributing, and transporting nutrients. The result will be an inadequate supply of nutrients for growth and development. A dysfunction of the spleen in maintaining the flow of blood within the vessels may result in an insufficiency of heart blood. Mental anxiety and impairment of heart blood may cause a dysfunction of the spleen in transforming, distributing and transporting nutrients. This may cause a syndrome called "deficiency of both heart and spleen", which is manifest mainly as palpitation, insomnia, anorexia, lassitude and pallor.

c. The Relationship between the Heart and Lung

The heart controls the circulation of blood and the lung operates the Qi of the entire body. Both organs are located in the upper Jiao. The relationship between the two organs deals mainly with the circulation of blood and Qi. The heart blood and lung Qi depend upon each other for their existence. The circulation of blood relies on the driving force of Qi while Qi relies on the circulation of blood for transportation and distribution. An important saying in TCM characterizes this relationship, "Qi is 'the commander' of blood" and "blood is 'the mother' of Qi".

In pathology, a deficiency of lung Qi and Zong Qi (pectoral Qi, a combination of food energy plus fresh air) will lead to a lack of driving force to propel blood forward. This in turn will cause stagnation of heart blood which results in a feeling of stuffiness in the chest, palpitations, shortness of breath, cyanosis of the lips and a purplish tongue. A deficiency of heart Qi or heart Yang will lead to stagnation of blood. This may affect the lung's function of dispersing and descending and result in cough, asthma, shortness of breath, a feeling of stuffiness in the chest and a sensation of suffocation.

d. The Relationship between the Heart and Kidney

The heart, which is classified as Yang and as fire according to the theory of Five Elements, lies in the upper Jiao. The kidney, which is classified as Yin and as water according to the theory of Five Elements, lies in the lower Jiao. In normal physiology, the heart fire descends to warm the kidney's fluid. At the same time, the fluid of the kidney ascends to the heart so that heart Yang will not become excessive. This relationship is referred to as "the mutual assistance between water and fire", or "the coordination between the heart and kidney".

In pathology, a breakdown of heart and kidney coordination will cause problems in both organs. For instance, when heart Yang is deficient, it is unable to descend to warm kidney Yang. This may result in an overflow of cold fluid because of deficiency of kidney Yang. This condition may involve the heart, giving rise to the syndrome, "attack of the heart by retained fluid". Signs and symptoms include palpitation, fluster and edema. When kidney fluid is insufficient, it is unable to ascend to nourish the heart Yin. When kidney Yang is insufficient, it is unable to distill kidney Yin. The result of both conditions is that heart Yang will be excessive. Signs and symptoms include palpitations (which may be severe), feeling of pressure over the chest, and insomnia. This type of pathology is referred to as the "breakdown of the normal physiological coordination between heart and kidney". When Yin is deficient and unable to check Yang, heart fire will ascend, leading to aphthae [oral ulcers], dry mouth, dysphoria and fever in the five centers (chest, palms, soles). This condition is known as "hyperactivity of fire due to Yin deficiency".

The heart controls blood circulation and the kidney stores Jing. Because Jing and blood can produce each other, a mutual causality exists between deficiency of kidney Jing and insufficiency of heart blood. Because the heart houses the mind and kidney Jing can be transformed into bone marrow, which combines to form the brain, this mutual relationship influences mental activities. Signs and symptoms include disturbances of consciousness such as insomnia, poor memory and excessive dreaming.

e. The Relationship between the Liver and Lung

The relationship between the liver and lung mainly deals with the ascending and descending movement of Qi. The liver lies in the lower Jiao and is classified as a Yang organ within Yin. The liver meridian passes through the diaphragm and ascends into the lung from its lower aspect. In the lung, the Qi of the meridian then disperses and ascends. The lung lies in the upper Jiao. It is classified as a Yin organ within Yang. Lung Qi disperses and descends. This ascending and descending movement of Yin and Yang of the liver and lung maintain the normal physiological functions of the Qi of the body. When stagnant Qi of the liver transforms into fire, the fire sends its heat upward to the lung via the liver meridian and the fluid of the lung may be burned. This result in hypochondria pain, irritability, cough with dyspnea, and hemoptysis. This condition is known as "invasion of the lung by liver fire". Conversely, if lung Qi fails to descend, this will cause dryness and heat to descend and the liver may be affected. The result may be a dysfunction in the liver function of smoothing and regulating the flow of Qi and blood. Signs and symptoms may include cough, migrating pains, distention and a feeling of fullness in the sternocostal region, dizziness, headache and red face and eyes.

f. The Relationship between the Spleen and Lung

The lung takes charge of Qi and respiration and the spleen is the source of nutrients for the growth and development of Qi and blood. The functional activities of lung depend on an adequate supply of body fluid. Body fluid, in turn, depends on the supply of the food essence acquired through the spleen's transporting and transforming function. In addition, food essence is dispersed and disseminated throughout the body by lung Qi. TCM states that "The spleen is the source of Qi, while the lung is the key organ for taking charge of Qi."

In pathology, a protracted deficiency of spleen Qi may lead to a deficiency of lung Qi. This will result in shortness of breath and low and feeble voice. In treatment, the lung is often treated by the method of tonifying (reinforcing) the spleen and stomach. In Five Elements theory, this idea is represented as "strengthening metal (lung) by way of reinforcing earth (spleen)". If the spleen does not carry out its transformation, distribution and transportation function well, stagnation of fluid may result and lead to phlegm retention. Phlegm retention, in turn, may adversely ascend to invade the lung. This will inhibit the lung's dispersing and descending functions. Signs and symptoms include cough, asthma and excessive sputum. In TCM, it is said that "the spleen is the source of sputum, while the lung is its place of storage". In clinic, retention of phlegm may lead to cough and asthma. Treatment often follows the method of strengthening the spleen and eliminating dampness for the underlying condition of the patient while clearing the lung and resolving phlegm is usually employed for symptomatic relief. If lung Qi is insufficient and fails to disseminate food essence from the spleen, the body will become malnourished. This may lead to dizziness, pale complexion and weakness of the limbs. If lung Qi fails to descend and dredge the water passages, water metabolism may be adversely affected. Fluid may accumulate in the interior and spleen Yang may stagnate, leading to edema, lassitude, distention of abdomen, and loose stool.

g. The Relationship between the Lung and Kidney

There are two main aspects of the relationship between the lung and the kidney. These two aspects are respiration and water.

Regarding respiration, the lung performs the function of respiration and the kidney controls and promotes inspiration. The kidney aids the lung in respiration. Only when kidney Jing and Qi are sufficient can inhaled air be sent downward to the kidney by the lung's descending function. It is said that the lung is the organ which performs respiration while the kidney is the foundation of respiration. Chronic deficiency of lung Qi or insufficiency of kidney Jing and Qi may cause a failure of the kidney in receiving air from the upper Jiao. This condition may lead to shortness of breath which is aggravated on exertion.

Regarding water, the lung is the upper source of the circulation of water and the kidney is the organ that regulates water metabolism. For this reason, normal water metabolism is closely related to both organs. Either a dysfunction in the lung's ability to disperse and descend the flow of Qi and body fluid, or a dysfunction of the kidney's ability to regulate water metabolism may result in abnormal water metabolism. In addition, the two organs often influence each other in abnormal water metabolism. Signs and symptoms of this condition include severe cough, asthma when going to sleep and edema.

Lung and kidney are also related because the Yin fluid of both organs nourishes each other. The Yin fluid of the kidney is the basis of Yin fluid for the whole body. A deficiency of lung Yin may damage kidney Yin. A deficiency of kidney Yin will cause Yin to fail to ascend and nourish lung Yin. This deficiency of Yin of both organs may lead to malar flush, tidal fever, nights sweats, dry cough, hoarse voice, lassitude and soreness of the loins and legs.

h. The Relationship between the Spleen and Kidney

The spleen provides the material basis for the acquired constitution and the kidney is the foundation of the congenital constitution. The spleen functions well in transforming and transporting food essence when warmed by kidney Yang. The Jing stored in the kidney, in turn, relies on the continuous supply of food essence from the spleen. In this way, the kidney and spleen, congenital and acquired, mutually support and promote each other in human physiology. Similarly, the two organs influence each other in pathology as well. For example, when kidney Yang is deficient and unable to warm spleen Yang, or when chronic deficiency of spleen Yang involves kidney Yang, the syndrome of Yang deficiency of both organs will eventually occur. Signs and symptoms of this condition include pain and cold sensation in the abdomen, watery stools with undigested food, morning diarrhea, and edema.

i. The Relationship between the Liver and Spleen

The liver has the function of storing and regulating blood, and smoothing and regulating the flow of Qi and blood. The spleen has the function of keeping blood circulating in the vessels, transforming, distributing and transporting nutrients, promoting water metabolism, and is the source of producing Qi and blood. The liver and spleen are closely related in human physiology. The spleen's function of sending food essence upward and the stomach's function of sending food contents downward depend on the liver's function of smoothing and regulating the flow of Qi and blood. If the liver is functioning normally, the spleen and stomach will be able to function normally as well. If the liver is dysfunctioning in this respect, it will affect the functioning of the spleen and liver. This condition is known as "incoordination between the liver and the stomach or spleen". It often arises after one becomes angry and is marked by a feeling of stuffiness and fullness of the chest and hypochondria, poor appetite, abdominal distention after eating, eructations and abdominal discomfort. Conversely, a disorder of the spleen may also affect the liver. A deficiency of spleen Qi, which leads to an insufficient supply of blood, or failure of the spleen to keep blood flowing in the vessels, may lead to heavy bleeding. It may also involve the liver, resulting in the syndrome of deficiency of liver blood. In another type of pathology, chronic water stagnation in the body interior may be caused by a dysfunction of the spleen in transporting and may be transformed into heat. The damp-heat impairs the liver and gallbladder function of smoothing and regulating the flow of Qi and blood, and may lead to jaundice. So in pathology, the liver and spleen may influence each other in a variety of ways.

j. The Relationship between the Liver and Kidney

The liver stores blood and the kidney stores Jing. Liver blood relies on nourishment from kidney Jing while Jing stored in the kidney is constantly replenished by essence transformed from liver blood. Because blood can develop into Jing and vice versa, TCM says, "Jing and blood have a common source" and "The liver and kidney have a common source." In pathology, disorders of kidney Jing and liver blood often affect each other. For example, a deficiency of kidney Jing may lead to a deficiency of liver blood. Conversely, a deficiency of liver blood may also cause a deficiency of kidney Jing.

Because liver and kidney have a common source, in terms of Yin and Yang, they have an interrelated and interrestraining relationship. In pathology, they often influence each other. Insufficiency of Yin fluid may lead to excess Yang. This damages Yin fluid, which causes Yin deficiency. For example, deficiency of kidney Yin may result in a deficiency of liver Yin as well. This will lead to hyperactivity of liver Yang. On the other hand, preponderance of liver fire may descend to impair kidney Yin and lead to its deficiency.

3.4.2 Relations among the Six Fu-viscera

The Relationships between the Fu Organs

The main function of the six Fu organs is to transport and transform water and food. In this regard, the Fu organs are related to each other as they act in close coordination, working together to digest and absorb food, and excrete waste.

Water and food arriving in the stomach is fermented and digested, being transformed into chyme. Chyme then passes into the small intestine. The small intestine receives the chyme and digests it further, separating the clear from the turbid. The clear substance is food essence, which is transported and distributed to all parts of the body. The turbid refers to the waste of food and water. The water waste is transported into the urinary bladder where, by the kidney's function of regulating water metabolism, it is transformed into urine and excreted from the body. The food waste passes into the large intestine. After the excess water is absorbed, the food waste, by the large intestine's function of passing and eliminating waste, forms feces and exits the body via the anus.

This process of digestion and absorption of food, and excretion of waste also depends on the function of the gallbladder and San Jiao. The gallbladder excretes bile to aid in digestion. The San Jiao distributes primary Qi and dredges water passages. This comprehensive action accomplishes the task of digesting water and food, and transporting body fluid. As the six Fu organs continuously receive, digest, transport, and excrete water and food, they alternate between states of fullness and emptiness. Therefore, it is necessary for the organs to be clear and free of obstruction. TCM states, "The six Fu organs function well when unobstructed," and "A purgative therapy is used as a tonifying method to treat Fu organ disorders."

In pathology, disorders among the Fu organs often influence each other. For instance, the consumption of body fluid cause by excess heat in the stomach may lead to constipation and difficulty in transportation in the large intestine. Dryness of the large intestine and constipation may also affect the normal descent of stomach Qi. They may result in the abnormal ascent of stomach Qi, leading to nausea and vomiting. A dominant gallbladder fire often involves the stomach and causes a dysfunction in the descent of stomach Qi. This condition is marked by hiccups and vomiting bitter-tasting fluid. If dampness and heat accumulate in the spleen and stomach, this may suffocate and steam the gallbladder, causing bile to overflow and giving rise to jaundice.

3.4.3 Relations among Zang-viscera and Fu-viscera

The Relationships between the Zang and Fu Organs

An interior-exterior relationship is formed by a pair of one Zang and one Fu organ. The Zang organs are classified as Yin, whereas the Fu organs are classified as Yang. Yang corresponds to the exterior and Yin corresponds to the interior. Each Zang-Fu pair of organs acts in coordination and the interior-exterior relationship is manifest in the connections between their respective meridians. Each interior-exterior relationship is outlined below.

a. The Relationship between the Heart and Small Intestine

The Heart Meridian of Hand-Shaoyin originates from the heart and connects with the small intestine. The Small Intestine Meridian of Hand-Taiyang enters the small intestine and connects with the heart. The interior-exterior relationship is established as heart and small intestine are connected via their meridians. This relationship is also demonstrated in pathology. When there is fire of excess type in the heart meridian, the accumulated heat may move into the small intestine, leading to excess heat in the small intestine. Signs and symptoms of this condition include oliguria, dark-colored urine and a burning sensation upon micturition. Conversely, excess heat in the small intestine may ascend via its meridian to burn the heart. Signs and symptoms include mental irritability, red tongue and ulcers on the tongue.

b. The Relationship between the Lung and Large Intestine

In a similar way, the meridians of the lung and large intestine connect the organs to form the interior-exterior relationship. While the functional activities of the lung clean inspired air and keep it flowing downward, the large intestine maintains normal transportation of feces so that it is excreted freely. An obstruction of the large intestine may affect the descent of lung Qi. If lung Qi cannot descend, the body fluid is unable to descend as well. Clinically, this may manifest as difficulty in defecation. Heat of excess type in the large intestine and the stagnation of its Qi may lead to a dysfunction of lung Qi. This may manifest as asthmatic cough and a feeling of fullness in the chest.

c. The Relationship between the Spleen and Stomach

The meridians of the spleen and stomach connect the organs to form the interior-exterior relationship. Functionally, the stomach receives food and the spleen transforms, distributes and transports nutrients. The two organs work in coordinated action to accomplish the task of digesting and absorbing food, and transforming and transporting food essence. Stomach Qi normally descends to cause food contents to descend. The tendency of the spleen is to ascend in order to send food essence upward. The stomach is a Fu organ, classified as Yang, liking moisture while disliking dryness. The spleen is a Zang organ, classified as Yin, liking dryness while disliking moisture. Only when the Yin and Yang of the two organs are in balance, ascending and descending functions balanced, and moisture and dryness balanced, can digestion and absorption of food occur properly. Because the spleen and stomach are interrelated physiologically, they also influence each other in pathology. For example, a dysfunction of the spleen in transformation, distribution and transportation may be caused by pathogenic damp factors. This may lead to an inability of the spleen to send food essence upward and affect the stomach's function of receiving food and sending it downward. Signs and symptoms of this disorder include anorexia, nausea, vomiting, a feeling of fullness and distention in the epigastric region. On the other hand, a dysfunction of the stomach in sending the turbid downward may be cause by an improper diet or overeating. This may lead to retention of food in the stomach and may also affect the spleen's function of sending food essence upward and transforming, distributing and transforming. Signs and symptoms include diarrhea, a feeling of fullness and distention of the epigastrium.

d. The Relationship between the Liver and Gallbladder

The gallbladder is physically attached to the liver. In addition, the two organs are also connected via their meridians. Bile is formed in the liver from the surplus of liver Qi. It is secreted from the liver and moves to the gallbladder for storage. The liver and gallbladder, for this reason, are closely related in physiology and pathology. Liver diseases often involve the gallbladder and vice versa. Diseases often affect both organs together. For example, liver and gallbladder may suffer from stagnation of heat or damp-heat at the same time.

e. The Relationship between the Kidney and Urinary Bladder

The meridians of the kidney and urinary bladder connect the organs to form the interior-exterior relationship. The urinary bladder stores and excretes urine. This function relies on sufficient kidney Qi which aids the urinary bladder in metabolizing body fluid and controls the opening and closing of the gate of the urinary bladder. When kidney Qi is sufficient and the urinary bladder has the power to control urine, the opening and closing of the urinary bladder gate will be properly regulated to maintain normal water metabolism. If kidney Qi is deficient, the kidney function of regulating water metabolism will be abnormal. The urinary bladder will lose the power to control the opening and closing of the gate of water and will lose control of urine. Signs and symptoms of this condition include urinary incontinence, enuresis and frequent urination. Storing and excreting urine, therefore, are closely related to both urinary bladder and kidney.

Chapter Four Meridians and Collaterals

Concept of the meridians and collaterals

w The meridians and collaterals are passages through which the qi and blood of the body circulate, and by which the viscera and the other various tissues and organs are inter-related.

w The meridians are the main trunks in the system of the meridians and collaterals while the collaterals are the branches of the meridians.

w The book Elementary Medicine states that “the meridian means ‘pathway’, while the branches separating from the meridians are called collaterals.”

w Meridians are tracks, virtual vertical trunklines that generally run for the most part through the deeper parts of the body.

w The term collaterals imply a network, running mainly through the more superficial parts of the body.

w Meridians have specific routes, while collaterals criss-cross to reach and connect every part of the body.

Composition of the system of meridians and collaterals

w The system of meridians and collaterals is described in the following figure.

Chapter 33 in Miraculous Pivot states: “internally, meridians connect with the viscera, and externally with the limbs and joints.”

1 The twelve meridians

Nomenclature

the lung meridian of hand-taiyin

the large intestine meridian of hand-yangming

the kidney meridian of foot-shaoyin

the gallbladder meridian of foot-shaoyang

The names of the twelve meridians contain three parts:

① whether the part that certain meridian runs along the four limbs is the hand or foot.

② whether a certain meridian belongs to a zang-organ or a fu-organ.

③ whether a certain meridian pertains to yin or yang.

Moreover, based on the law of revolution of yin and yang they are again divided into three yin and three yang.

1.1 Rules of courses and connections

w Chapter 38 in Miraculous Pivot states:

“the three yin meridians of the hand travel from the viscera (chest) to the hand; the three yang meridians of the hand run from the hand to the head; the three yang meridians of the foot travel from the head to the foot; and the three yin meridians of the foot go from the foot to the abdomen (chest).”

1.2 Rules of distribution

Head and face:

w The hand-yangming meridian and foot-yangming meridian run over the face and the forehead

w the hand-shaoyang meridian and foot-shaoyang meridian run along the lateral sides of the head

w the foot-taiyang meridian runs over the vertex and the nape, the hand-taiyang meridian runs over the cheeks

The arrangement of the three yang meridians of the hands and feet generally run in the following order:

w The yangming meridians run anteriorly

w The shaoyang meridians run intermediately

w The taiyang meridians run posteriorly

The four limbs:

w The three yin meridians of the hand and the three yang meridians of the hand run along the upper limbs, the three yin meridians of the foot and the three yang meridians of the foot run along the lower limbs

w The yin meridians run along the medial side of the four limbs while the yang meridians run along the lateral side of the four limbs.

w The distributing order of the yang meridians is like this: the yangming meridians are distributed over the anterior border (lateral side of the thumb), the taiyang meridians are distributed over the posterior border (the lateral side of the small finger), and the shaoyang meridians are distributed along the midline.

w The distributing order of the yin meridians is like this: the taiyin meridians are distributed over the anterior border, the shaoyin meridians are distributed over the posterior border and the jueyin meridians are distributed along the midline.

w Over the lower part of the lower limbs, the jueyin meridians are distributed over the anterior border, the taiyin meridians are distributed along the midline. The two meridians cross about eight cun above the tip of internal malleolus, then the taiyin meridian runs to the anterior border and the jueyin meridian runs to the midline.

1.3 The external and internal relationships

w The twelve meridians can be grouped into six pairs, each pair internally and externally related to each other. The meridians in external and internal relationship with each other pertain to yin and yang respectively. The yin meridian is the internal and the yang meridian is the external.

w The meridians in external and internal relationship with each other are connected with each other at the extremities of the four limbs.

w The viscera to which the meridians in external and internal relationship with each other pertain are also related to each other externally and internally. In this way the meridians and the viscera in external and internal relationship with each other respectively associate with each other.

w The yin meridian pertains to the zang-organ and connects the fu-organ with its collaterals while the yang meridian pertains to the fu-organ and connects the zang-organs with its collaterals.

w The external and internal relationships of the twelve meridians strengthen the connection of each external and internal meridian pair, coordinate the functions of the externally and internally related viscera, and affect each other pathologically.

w In treatment, the points of the two externally and internally related meridians may be used interchangeably. For example, the points of the lung meridian may be selected to treat a disease of the large intestine or its meridian.

1.4 The flowing and infusing order of the twelve meridians

w Qi and blood in the twelve meridians follow a certain order to flow and infuse. When they have flown and infused for one cycle in the twelve meridians, they return to the original meridian and start another cycle of flowing and infusing. The flowing and infusing order is demonstrated in the following figures.

2 The eight extra meridians (extraordinary vessels)

Nomenclature

The names of the eight extraordinary vessels are

du meridian(the governor vessel)

ren meridian (the conception vessel)

chong meridian (the thoroughfare vessel)

dai meridian (the belt vessel)

yinqiao meridian (the yin-heel vessel)

yangqiao meridian (the yang-heel vessel)

yinwei meridian (the yin-link vessel)

yangwei meridian (the yang-link vessel)

w The eight extra meridians are different from the twelve regular meridians. Compared with the twelve regular meridians, the eight extra meridians are characterized by no regular distribution, no direct connection with the viscera and no internal and external relationship between each other.

2.1 The running features of the eight extra meridians

w The chong meridian, the ren meridian and the du meridian all start from the lower abdomen (the uterus for women) and run downward to the perineum where they begin to run in the different directions.

w The chong meridian, the ren meridian and the du meridian are “three separate vessels that originate from the same source”.

w The ren meridian runs forward from the perineum, moves upward from the pubic region, the abdomen, the midline on the chest, the throat and the mandible to the mouth where it runs around the lips and then upward in lines to the region below the eye socket from the cheeks.

w The trunk of the chong meridian runs from the perineum to qijie (pathway of qi) where it runs parallel to the foot-shaoyin meridian upward beside the navel, dispersing in the chest, moving upward around the lips and below the region of the eye socket.

w One of the branches of the chong meridian runs downward along the medial side of the thigh to the foot.

w The other branch stems from the abdomen, is connected with the du meridian from the posterior region and runs upward in the spine.

w The dai meridian is the only one that runs transversely around the body. It starts from the hypochondria, runs obliquely downward to the lower abdomen and then transversely around the body like a belt.

w The yinqiao meridian starts from below the internal ankle and the yangqiao meridian starts from below the external ankle. They run upward along the medial side and lateral side of the lower limbs respectively to the inner canthus of the eyes where they converge with each other and combine with the hand-taiyang and the foot-taiyang meridians.

w The yinwei meridian starts from the medial side of the shank, runs upward along the medial side of the lower limbs and, across the abdomen, the chest and the throat, connects with the ren meridian; the yangwei meridian starts from below the external ankle, runs upward along the lateral side of the lower limb and, across the lateral side of the head and the nape, connects with the du meridian.

2.2 The functions of the eight extra meridians

w The du meridian, known as “the sea of the yang meridians”, governs all the yang meridians in the body.

w The ren meridian, known as “the sea of the yin meridians”, governs all the yin meridians in the body.

w The chong meridian, known as “the sea of blood” and “the sea of the twelve meridians”, is the place where all qi and blood in the body converge on the one hand and regulates qi and blood in the twelve meridians on the other.

w Since all these three vessels start from the uterus in women, they are closely related to the physiological activities of women.

w The dai meridian runs transversely around the body and controls all the other meridians.

w The yinqiao meridian and yangqiao meridian are mainly responsible for the movement of the eyes and the lower limbs.

w The yinwei meridian is connected with all the yin meridians while the yangwei meridian is connected with all the yang meridians.

3 The twelve branches of the meridians, the twelve tendons, the twelve skin divisions, the fifteen divergent collaterals, the floating collaterals and the minute collaterals

The twelve branches of the meridians

w They stem from the twelve regular meridians, also pertaining to the twelve regular meridians.

w They all stem from the twelve regular meridians on the four limbs, then entering the cavity of the body and the viscera, eventually emerging from the surface of the body, running upward to the head where the yin branches converge with the branches of the yang meridians that are in external and internal relationships with the meridians from which they stem, finally returning to the yang meridians they pertain to.

w The actions of the twelve branches of the meridians include strengthening the communication in the interior of the body between the two externally-internally related meridians in the regular meridians, and serving as supplementary passages as the reach some organs and regions where the regular meridians can not reach.

The twelve tendons

w They refer to the muscular system that are connected with the twelve meridians.

w The twelve tendons dominate and control the bones and promote the joints movements.

The twelve skin divisions

w They refer to the twelve skin areas divided according to the twelve meridians.

w It is helpful to diagnose diseases of the viscera, meridians and collaterals through observing the changes of the color and morphology of the different cutaneous regions.

w The therapies of external pasting, moxibustion, and hot medicated compressing applied to certain areas of the skin for treatment of internal visceral diseases derive from the application of the skin areas theory on diagnosis and treatment.

The fifteen divergent collaterals

w The fifteen divergent collaterals include twelve collaterals of the twelve meridians (one for each of the twelve meridians respectively), the collateral of the du meridian, the collateral of the ren meridian and the major collateral of the spleen.

w Branching out from the meridian and finally reaching the externally-internally related meridians, they have the function of strengthening the communication in the body surface between the two externally-internally related meridians.

The floating collaterals

w They refer to the superficial collaterals. The floating collaterals are located superficially in the skin and can often be visible.

The minute collaterals

w The minute collaterals are the tiny branches of the meridians.

w They refer to the smallest collaterals in the collateral system, similizing as “grandson-collateral” in TCM.

w Both floating and minute collaterals have the function of secreting qi and blood.

4 The basic functions of the meridians and collaterals

w To connect the external with the internal and upper with lower as well as to connect the viscera with other organs

w To transport qi, blood, yin and yang to nourish the body

w Reaction and conduction

w Regulation of functional balance in the body

To connect the external with the internal and upper with lower as well as to connect the viscera with other organs

w The body is an organic whole. It is the meridians and collaterals that connect the viscera, the body, the five sensory organs and the nine orifices together. The meridians internally pertain to the viscera and externally connect the limbs. Since the meridians are composed of various collaterals of different levels, they have formulated the whole body into a network.

w There are three basic ways with which the meridians to connect all parts of the body together.

w The relationships between the viscera, the body, the sensory organs and the orifices

w The relationships between zang-organs and fu-organs

w The relationships among the meridians

To transport qi, blood, yin and yang to nourish the body

w All the viscera and other parts of the body depend on qi, blood, yin and yang to nourish and maintain their physiological functions. It is the meridians that transport qi, blood, yin and yang.

w With the extensive distribution of the meridians and collaterals, qi, blood, yin and yang in the body can flow freely to maintain a holistic balance of the body.

Reaction and conduction

w The meridians possess the function to sense and respond to various internal and external stimulations, to transmit and conduct them to the relevant viscera, and make the viscera change correspondingly in physiological and pathological terms.

w The “arrival of qi” (needling sensation) and “induction of qi” in acupuncture therapy are two examples of the phenomena of reaction and conduction by the meridians.

w Conversely, the changes of visceral functions caused by some factors may also be reflected in the body surface through the transmission of the meridians.

Regulation of functional balance in the body

w Under normal conditions, the meridians can circulate qi and blood, and regulate yin and yang.

w Pathologically, for the syndrome of disharmony of qi and blood as well as an excess or deficiency of either yin or yang, we can use acupuncture and moxibustion to trigger the regulating action of the meridians to reduce the excess and reinforce the deficient, and thus create a state of balance in the body.

5 The functional characteristics of the eight extra meridians

w to strengthen the connection of the twelve meridians

w to regulate qi and blood in the twelve meridians

w to govern some of the special physiological activities of women

to strengthen the connection of the twelve meridians

w the du meridian accumulates qi and blood in all the yang meridians

w the ren meridian accumulates qi and blood in all the yin meridians

w the chong meridian accumulates qi and blood in the twelve meridians

w the yangwei meridian connects all the yang meridians together and the yinwei meridian connects all the yin meridians together

to regulate qi and blood in the twelve meridians

w When qi and blood in the twelve meridians are excessive, they then flow into the eight extraordinary vessels to store up.

w If qi and blood in the twelve meridians are insufficient, the eight extraordinary vessels will infuse some qi and blood stored in them into the twelve meridians.

to govern some of the special physiological activities of women

w Since the chong, ren and du meridians all start from the uterus, they are closely related to the menstruation, pregnancy and labor of women.

w Since the dai meridian runs transversely around the lower abdomen, it can protect fetus and controls leukorrhea.

6 The clinical application of the theory of meridians and collaterals

To explain pathogenesis

w The occurrence of exogenous disease is usually caused by invasion of pathogenic factors which first attack the surface of the body, then invade the collaterals with scanty defensive qi, and gradually get into the internal part of the body.

w The occurrence of endogenous disease is caused either by insufficiency or imbalance of qi, blood, yin and yang. If qi, blood, yin and yang are insufficient, the meridians and collaterals will become empty; if qi, blood, yin and yang have lost balance, the meridian qi will be stagnated or in disorder, leading to the occurrence of disease.

To explain pathological transmission

w Disease is usually transmitted along the meridians. The exogenous pathogenic factors are transmitted from the external to the internal, from the collaterals to the meridians, and from the meridians to the viscera.

w Thus the pathological changes of the viscera can be transmitted by the meridians.

w On the other hand, the diseases of the five zang-organs can be transmitted among them because of the multiple relationships among the meridians and collaterals.

w Besides, disease of the internal organs can be transmitted to the surface of the body, leading to pathological changes of the related constituents, organs and orifices.

To guide the diagnosis of disease

w Since the meridians run along certain routes and pertain to certain viscera, there is a special relationship between different parts of the body and the internal organs.

w Clinically the relationship between the pathological location or the disease and the meridians can be used to decide which meridian and viscus are involved in as to make an accurate diagnosis.

For example

w the liver meridian distributes over the hypochondrium, so hypochondriac pain indicates liver disease

w the lung meridian emerges from the supraclavicular fossa, pain in the supraclavicular fossa indicates lung disease.

w Take headache for another example. It usually appears in different regions. Pain in the forehead is related to the yangming meridian; pain in both sides of the head is usually related to the shaoyang meridian; and pain in the nape is often related to the taiyang meridian.

w Besides, some diseases show special reaction points on certain acupoints. If tenderness appears on these reaction points, it is very helpful for diagnosis.

w For example, intestinal abscess will lead to tenderness on Lanwei(EX-LE7), gallbladder disease will bring on tenderness on yanglingquan(GB34).

To guide the treatment of disease

w The treatment of disease by acupuncture, moxibustion and massage is usually done by needing or massaging the acupoints proximal or distal to the affected part on the meridians to regulate the functional activities of the meridian qi and blood.

w To select acupoints, one has to differentiate the syndrome first with the theory of the meridians and collaterals to decide which meridian the disease is related to, and then select acupoints in the light of the running route and coverage of the meridian. Such a way to select acupoints is called “selection of acupoints along the meridians”.

w Drug treatment also has to be done according to the theory of meridians and collaterals because the meridians and collaterals can transport the effect of the drugs to the affected part.

w In the long course of clinical practice, TCM has developed the theory of “meridian tropism of drugs” which holds that each drug can enter one or more meridians.

w With the guidance of this theory, clinically drugs are selected, based on syndrome differentiation, according to their state of “meridian tropism” to treat disease in as to improve the therapeutic effect.

Again take headache for example.

w If it is related to the taiyang meridian, Qianghou should be used;

w if it is related to the yangming meridian, Baizhi should be used;

w if it is related to the shaoyang meridian, Chaihu should be used,

because these drugs enter to these meridians respectively.

In the formulation of a prescription, one or two drugs that enter a certain meridian can be added in order to guide the other drugs, which normally do not enter that meridian, to work on that meridian. The drug that leads other drugs to work on a certain meridian or organ is called “guiding drug”.

Chapter Five Causes of Disease

w Causes of disease refer to various pathogenic factors.

w In order to further understand the nature and pathogenic character of pathogenic factors, ancient TCM practitioners classified pathogenic factors.

Huangdi’s Canon of Medicine

w All the pathogenic factors were classified into two categories for the first time, namely yin and yang.

w Chapter 62 in Plain Questions points out:

n “the pathogenic factors either originate in yin or originate in yang;

n those coming from yang are related to wind, rain, cold, and heat;

n those coming from yin are related to food and drink, living places, sexual life, and emotions such as joy and anger.”

Synopsis of Prescriptions of Golden Chamber

w Zhang Zhongjing of the Han Dynasty said that all diseases were caused by the pathogenic factors in three ways:

n “first, internal cause that is due to invasion of the viscera by pathogenic factors via meridians;

n second, external attack via the skin that is due to stagnation of blood flow in the limbs and orifices;

n third, injuries by sexual overstrain, traumatic wound, insect or animal bites.”

Prescriptions Assigned to Three Categories of Pathogenic Factors of Diseases

w Later on, Chen Wuze of the Song Dynasty expanded the theory found in Synopsis of Prescriptions of Golden Chamber that the “thousand diseases were caused only by the three sorts of factors.”

w He also put forth “the doctrine of three causes”, i.e., exogenous factors, endogenous factors and non-exogenous or endogenous factors.

“seeking (finding) the cause by syndrome differentiation”

w TCM studies the cause of a disease, by understanding objective conditions that may become pathogenic factors according to the clinical manifestations of the disease and through analysis of symptoms and signs of the disease to infer its cause.

The pathogenic factors in TCM can be divided into four categories:

① exogenous pathogenic factors

including six climatic factors and pestilent qi.

② endogenous pathogenic factors

including seven emotions, improper diet and overstrain, etc.

③ secondary pathogenic factors

including phlegm, rheum, water, dampness and blood stasis.

④ other pathogenic factors

including various traumatic injuries, injuries due to physical and chemical factors and injuries caused by insects and animals.

1 The six climatic factors

w The six climatic factors including pathogenic wind, pathogenic cold, pathogenic summer-heat, pathogenic dampness, pathogenic dryness and pathogenic heat (fire).

w Wind, cold, summer-heat, dampness, dryness and heat (fire) are six kinds of natural climatic factors known as “six qi”.

The six climatic factors are characterized by the following features in causing disease:

(1)The cause of disease by the six climatic factors is usually related to seasonal changes and living conditions.

n spring is prone to wind

n summer is prone to summer-heat (fire)

n late summer is prone to dampness

n autumn is prone to dryness

n winter is prone to cold

n long-term living in damp area is subject to attack by pathogenic dampness

n working in the area with high temperature is subject to attack by pathogenic dryness and heat

(2)The six climatic factors may singly or collectively attack people.

n pathogenic wind may combine with cold, dampness, dryness and heat to attack people and lead to wind-cold syndrome, wind-dampness syndrome, wind-dryness syndrome and wind-heat syndrome.

(3)The nature of the diseases caused by the six climatic factors may be the same as or different from that of the six climatic factors.

n invasion of pathogenic cold may deepen internally to transform into heat

n accumulation of pathogenic dampness also may transform into heat

(4)The six climatic factors usually invade the body through the body surface, the mouth and nose, or through both simultaneously.

n That is why external syndromes tend to appear at the early stage of disease caused by the six climatic factors.

1.1 Wind

w Wind is the main climatic factor in spring. That is why wind tends to cause disease in spring. But in other seasons wind also can cause disease.

w Wind is characterized by the following features:

w Wind is a pathogenic factor of yang nature, characterized by floating and dispersion because of lightness.

w Wind is characterized by constant movement and rapid change.

w Wind is characterized by sway.

w Wind is the first and foremost factor in the course of disease.

Wind is a pathogenic factor of yang nature, characterized by floating and dispersion because of lightness.

w When wind invade the body, it leads to loosen the striae of the skin and muscles, and open the pores.

w Wind is apt to attack the upper part (the head and face) and skin first when it invades the body. So the disease caused by wind mainly involves the surface of the body, the head and the face with the manifestations of headache, running nose, sweating and aversion to cold, etc.

Wind is characterized by constant movement and rapid change.

w Wind is mobile and the disease caused by it is also migration (such as migratory pain of limbs in wind-bi syndrome).

w Wind tends to change. So the disease caused by wind is often characterized by sudden onset, immediate transmission and change as well as fast healing. For example, rubella is marked by quick fluctuation of cutaneous pruritus without a fixed location.

Wind is characterized by sway.

w This means that the syndromes and signs of a disease caused by wind have the character of constant moving, including tremor, convulsion, and vertigo (such as subjective feeling of shaking or faintness or like sitting in a boat or car).

Wind is the first and foremost factor in the course of disease.

w Since it is easier for wind to attack the body, other factors in the six exogenous factors often attach themselves to wind when they invade the body, frequently leading to exogenous wind-cold syndrome, exogenous wind-heat syndrome, exogenous wind-dampness syndrome and exogenous wind-dryness syndrome.

w That is why TCM holds that “wind is the leading one among the six exogenous pathogenic factors”, “all diseases are caused by wind” and “wind is the leading cause of all diseases”.

1.2 Cold

w Cold is the dominant climatic factor in winter. So cold diseases, though also encountered in other seasons, are usually seen in winter.

w The following is a brief description of the nature of pathogenic cold and its characteristics in causing diseases.

w Cold pertains to yin and tends to impair yang.

w Cold is characterized by stagnation and obstruction.

w Cold is characterized by contraction and traction.

Cold pertains to yin and tends to impair yang.

w When cold attacks the surface of the body, it will impair yang in the superficies; when it attacks the internal of the body, it will impair the visceral yang.

n If cold impairs the superficies, the defensive qi will be stagnated, leading to aversion to cold and anhidrosis.

n If cold directly invades the spleen and the stomach, the spleen-yang will be impaired, leading to cold pain in the stomach and abdomen, vomiting and diarrhea.

Cold is characterized by stagnation and obstruction.

w Invasion of the body by cold may cause stagnation of qi and blood in the meridians, thus give rise to various kinds of pain.

Cold is characterized by contraction and traction.

w Cold pertains to yin and tends to restrain the activity of qi, leading to contracture of muscles, tendons and vessels.

n If cold attacks the superficies, the muscular interstices will be stagnated, the muscles will be contracted and the defensive qi cannot disperse, leading to aversion to cold and anhidrosis;

n if cold invades the limbs and joints, the tendons and vessels will become contracted, bringing on spasm of the limbs.

1.3 Summer-heat

w Summer-heat is transformed from heat and fire in summer. Summer-heat pertains to yang and usually appears after summer solstice and before autumn solstice.

w Summer-heat is characterized by the following features:

w Summer-heat pertains to yang and is hot in nature.

w Summer-heat tends to disperse and elevate.

w Summer-heat is often complicated by dampness.

Summer-heat pertains to yang and is hot in nature.

w So the disease caused by summer-heat is usually marked by a series of yang symptoms such as high fever, dysphoria, reddish complexion, thirst with preference for cold drink and full and large pulse, etc.

Summer-heat tends to disperse and elevate.

w Summer-heat disturbs the mind when it elevates, leading to dysphoria and dizziness or even sudden coma and unconsciousness in severe cases.

w Summer-heat induces sweating and consumes body fluid when it disperses, leading to thirst with preference for drinking water and reddish and scanty urine.

w If there is profuse sweating, qi will get lost, eventually bringing on shortness of breath and lassitude due to qi deficiency.

Summer-heat is often complicated by dampness.

w In the hot season, heat fumigates dampness. That is why dampness is exuberant in summer and often mixes up with heat to attack people.

w Thus disease caused by summer-heat-dampness is often, apart from fever and extreme thirst, characterized by lassitude of the four limbs, chest oppression, vomiting and unsmooth loose stool, etc.

1.4 Dampness

w Dampness is predominant in late summer but also can be encountered in other seasons. Sometimes drench or living in damp area also results in disease of dampness.

w The following is a brief description about the nature and characteristics of dampness in causing disease:

w Dampness pertains to yin, tends to impair yang-qi and hinder the movement of qi.

w Dampness is heavy and turbid.

w Dampness is sticky and stagnant.

w Dampness tends to move downward. When dampness attack the body, it first impairs the lower part of the body.

Dampness pertains to yin, tends to impair yang-qi and hinder the movement of qi.

w Thus prolonged blockage of qi by dampness often cause exuberance of dampness and decline of yang.

w If dampness impairs yang, it will inactivate spleen-yang and further accumulate water and dampness, leading to diarrhea, scanty urine, edema and ascites.

w Dampness tends to retain in the viscera and meridians, inhibits the flow of qi and disturbs the activity of qi, frequently leading to chest oppression and fullness, scanty and unsmooth urination and inhibited defecation.

Dampness is heavy and turbid.

w The attack by dampness will lead to such symptoms as heaviness of the body, or heaviness of the four limbs, or heaviness of the head like being bound, or heaviness and lassitude of the whole body.

w Invasion of dampness into the body often brings on the symptoms of turbid secreta and excreta, dirty complexion, excessive secretion of gum in the eyes, loose stool, mucous and bloody dysentery, turbid urine, leukorrhea and oozing eczema.

Dampness is sticky and stagnant.

w These characteristics of dampness usually affect people in two ways.

n One is that the disease caused by dampness is not brisk. For example, the secreta and excreta are too sticky to be excreted.

n The second is that the disease caused by dampness is obstinate and recurring with long duration, such as damp-bi syndrome (damp-blockage syndrome), eczema and damp-warm syndrome.

Dampness tends to move downward. When dampness attacks the body, it first impairs the lower part of the body.

w The disease caused by dampness usually involves the lower part of the body. For example, edema often mostly involves the lower limbs; stranguria, leukorrhagia and dysentery all occur in the lower part of the body.

1.5 Dryness

w Dryness is predominant in autumn. So disease caused by dryness mostly appears in autumn.

n The disease occurring at the early stage of autumn is a kind of warm-dryness because there is still some remaining summer-heat;

n the disease occurring at the late stage of autumn is a kind of cool-dryness syndrome because the weather is already cold in late autumn.

The following is a brief description of the nature and characteristics of dryness in causing disease:

w Dryness is xerotic and unsmooth.

w Dryness tends to impair the lung.

Dryness is xerotic and unsmooth.

w The attack by dryness tends to consume body fluid and lead to dryness of the mouth and nose, dry throat, dry skin or even rhagades, scanty urine and retention of dry feces.

Dryness tends to impair the lung.

w Dryness is prevailing in autumn and is associated with the lung. So dryness tends to impair the lung when it invades the body.

w If it impairs the lung, the lung-fluid will be consumed and the function of the lung to depurate and descend will be affected, leading to dry cough with scanty phlegm, or sticky sputum difficult to expectorate, blood sputum, dyspnea and chest pain.

1.6 Heat (fire)

w Heat (fire) is the predominant climatic factor in summer. So disease due to pathogenic heat (fire) usually occurs in summer. However it can also be encountered in other seasons.

w The following is a brief description of the nature and the characteristics of heat (fire) in causing disease:

w Heat (fire) pertains to yang and tends to flame up.

w Heat (fire) tends to disturb the mind.

w Heat (fire) tends to consume qi and impair body fluid.

w Heat (fire) ends to produce wind and disturb blood.

w Heat (fire) tends to cause swelling and ulceration.

Heat (fire) pertains to yang and tends to flame up.

w So the disease caused by the pathogenic heat (fire) is marked by high fever, aversion to heat, extreme thirst, sweating and full pulse.

Heat (fire) tends to disturb the mind.

w When the pathogenic heat (fire) attacks the body, it may disturb the mind, leading to dysphoria, insomnia, mania, coma and delirium, etc.

Heat (fire) tends to consume qi and impair body fluid.

w Heat (fire) pertains to yang and tends to consume yin-fluid. So the disease caused by the pathogenic heat, apart from the manifestations of heat, is often accompanied by thirst with preference for drinking water, dry throat and tongue, dark and scanty urine and retention of dry feces due to consumption and impairment of body fluid.

w Canon of Medicine says that “strong fire consumes qi”. The pathogenic heat (fire) is strong fire, so it consumes the healthy qi. Besides, profuse sweating due to exuberance of heat also impairs the healthy qi.

Heat (fire) ends to produce wind and disturb blood.

w When heat (fire) invades the body, it usually scorches the liver meridian, consumes body fluid and deprives the tendons of moisture and nourishment, leading to occurrence of liver-wind with the manifestations of high fever, epistaxis, coma, delirum, convulsion of the four limbs, staring straight upward, stiff neck and opisthotonus.

w Blood coagulates with cold and moves fast with heat. But if the heat is excessive, it will drive blood to flow very fast or scorch the vessels or even compel blood to flow out of the vessels, leading to various hemorrhage.

Heat (fire) tends to cause swelling and ulceration.

w When heat (fire) invades blood phase and accumulates in local area, it will putrefy blood and muscles, causing abscess, furuncle and ulceration.

w These kinds of problems are marked by redness, swelling, heat and pain which are the manifestations of heat (fire). Heat (fire) responsible for abscess, furuncle and ulceration is called heat (fire) toxin.

w That is why it is said in TCM that “abscess and furuncle are caused by fire-toxin”.

2 Pestilent qi

w Pestilent qi is a kind of strong infectious pathogenic factor.

w Pestilent qi may be transmitted by air or contact and often invade the body through the mouth and nose.

w The diseases caused by pestilent qi are marked by acute onset, severe pathological condition, similar symptoms, strong infection and easiness to spread.

w Historical records show that diseases caused by pestilent qi often spread the disease far and wide with high mortality.

w The commonly encountered diseases caused by pestilent qi are facial erysipelas, mumps, pestilent dysentery, diphtheria, scarlet fever, smallpox, cholera and plague.

The occurrence and epidemic of pestilence usually involve the following factors:

w Natural climatic factors

w Environment and diet

w Social factors

w Prevention of disease and immunity

3 Internal impairment due to seven emotions

w The seven emotions refer to joy, anger, anxiety, contemplation, grief, fear and terror which are different responses of the body to the environmental stimuli and are normal psychological activities.

w Normally the seven emotions will not cause disease, but sudden, violent or prolonged emotional stimuli, beyond the range of physiological activities, will cause disorder of qi activity and disharmony of visceral yin, yang, qi and blood which consequently lead to disease.

w Since the seven emotions are endogenous and directly affect visceral qi and blood, the internal disorder caused is called “internal impairment due to seven emotions”.

w In Canon of Medicine, the seven emotions are matched with the five viscera:

n the heart governs joy

n the liver governs anger

n the spleen governs contemplation

n the lung governs grief (anxiety)

n the kidney governs fear

Terror is also closely related to the activity of qi in the five zang-organs (heart).

w Since the heart controls the mind, it is the monarch of the five zang-organs and the six fu-organs. If the heart-spirit is damaged, it will involve other viscera.

The following is a brief description of the characteristics of the seven emotions in causing disease.

w Directly impairing the viscera

w Disordering the activity of visceral qi

w Emotional upset aggravating certain diseases

1) Directly impairing the viscera

w excessive joy impairs the heart

w excessive anger impairs the liver

w excessive contemplation impairs the spleen

w excessive grief impairs the lung

w excessive fear impairs the kidney

Clinically the seven emotions often impair the heart, the liver and the spleen.

2) Disordering the activity of visceral qi

w Excessive anger driving qi to move upwards

w Excessive joy relaxing the activity of qi

w Excessive grief consuming qi

w Excessive terror driving qi to move downwards

w Excessive contemplation stagnating qi

w Excessive fear disturbing qi

Excessive anger driving qi to move upwards

w Anger is controlled by the liver.

w Excessive anger drives liver-qi, together with the blood, moving adversely upwards and leading to dizziness, distending headache, reddish complexion and redness of the eyes or hematemesis, or even sudden syncope.

Excessive joy relaxing the activity of qi

w Joy is controlled by the heart.

w Normally joy can harmonize qi and blood, smooth the activity of the nutrient qi and defensive qi as well as ease the mind.

w If it becomes excessive, it may slack heart-qi, derange the mind and lead to inability to concentrate and even mania.

Excessive grief consuming qi

w Grief is dominated by the lung, so excessive grief exhausts lung-qi.

w Usually excessive grief affects the normal functions of the lung to depurate, descend, disperse and distribute, leading to failure of the nutrient qi and the defensive qi to distribute and consumption of the pectoral qi.

w So excessive grief often impairs the lung, leading to dizziness, lassitude and dispiritedness, etc.

Excessive terror driving qi to move downwards

w Terror is dominated by the kidney.

w So sudden terror drives qi to move downwards, leading to incontinence of urine and feces due to failure of kidney-qi to fixate or weakness and atrophy of the bones and seminal emission due to failure of the kidney to store essence.

Excessive contemplation stagnating qi

w Contemplation is controlled by the spleen.

w So excessive contemplation will stagnate spleen-qi and affect transportation and transformation, leading to gastric and abdominal distension and fullness, anorexia and loose stool, etc.

w Prolonged indulgence in contemplation consumes yin- blood and deprives the heart-spirit of nourishment, often bringing on palpitation, amnesia, insomnia and dreaminess, etc.

Excessive fear disturbing qi

w When frightened, the main responses are disorder of heart-qi, derangement of the mind, indecision and bewilderment.

3) Emotional upset aggravating certain diseases

w Certain diseases may become aggravated or worsened because of abnormal changes of emotions.

w For example, the heart disease can be caused and quickly worsened by sudden terror.

4 Improper diet

w Starvation and overeating

w Unhygienic food

w Food partiality

n There are two different cases in food partiality: partiality to cold or hot food and partiality to the five flavors.

Partiality to the five flavors

w The five flavors are attributed to the five zang-organs respectively:

n the sour flavor enters the liver

n the bitter flavor enters the heart

n the sweet flavor enters the spleen

n the acrid flavor enters the lung

n the salty flavor enters the kidney

w If the five flavors are not evenly contained in the food, the relationships among the five zang-organs will be broken.

n For example, partiality to the sour flavor strengthens liver-qi and weakens spleen-qi because predominant liver-qi will over restrict spleen-qi.

5 Overwork and over-rest

w Overwork covers three aspects: overstrain; overwork with the mind and excessive sexual activity.

w Over-rest means lack of enough activity.

6 Phlegm, rheum, water, dampness and blood stasis

w Phlegm, rheum, water, dampness and blood stasis are pathological substances produced during the course of disease due to certain pathogenic factors.

w They may directly or indirectly affect the viscera and the body, leading to secondary disease.

w So phlegm, rheum, water, dampness and blood stasis are both pathological substances and pathogenic factors.

w Since they have resulted from primary disease, they are called secondary pathogenic factors.

6.1 Phlegm, rheum, water and dampness

w The basic concept of phlegm, rheum, water and dampness

w The formation of phlegm, rheum, water and dampness

w The characteristics of phlegm, rheum, water and dampness in causing diseases

1) The basic concept of phlegm, rheum, water and dampness

w Phlegm, rheum, water and dampness are pathological substances caused by disturbance of body fluid.

w But they are different from each other.

n the one that spreads and appears insubstantial is dampness

n the one that is thin and clear is water

n the one that accumulates and appears substantial is rheum

n the rheum that is condensed is phlegm

That is to say that all of them result from disturbance of body fluid and can transform into each other.

w Phlegm is either substantial or insubstantial.

n Substantial phlegm is visible, palpable and audible, such as sputum, scrofula and nodules in the skin and muscles and borborygmus.

n Insubstantial phlegm is invisible, unpalpable and inaudible. But there are pathological manifestations of phlegm.

w Synopsis of Prescriptions of Golden Chamber classifies rheum into four categories according to their location, namely

n phlegmatic rheum in the abdomen

n suspending rheum in the chest and diaphragm

n sustaining rheum in the rib-sides

n overflowing rheum in the skin and muscles

2) The formation of phlegm, rheum, water and dampness

w Various pathogenic factors, including the six abnormal climatic factors, internal impairment due to seven emotions, improper diet, overwork and over-rest, can impair the viscera and affect qi-transformation, leading to disturbance of body fluid and the production of phlegm, rheum, water and dampness due to the accumulation of body fluid.

n the spleen governs the transportation and transformation of body fluid

n the lung regulates the water passage

n the kidney governs water

n the liver promotes the metabolism of body fluid

n the sanjiao serves as the water passage

w The disorder of any of these organs will lead to retention of body fluid and accumulate dampness into phlegm and rheum which then affect the viscera and impair their functions, leading to repeated production of phlegm and rheum.

3) The characteristics of phlegm, rheum, water and dampness in causing diseases

w Hindering the flow of qi and blood

w Frequently confusing the mind

w Complicated symptoms and constant change

w Having a long course and relapsing repeatedly

Hindering the flow of qi and blood

w Phlegm and rheum can flow with qi to anywhere.

w If phlegm and rheum flow in the meridians, they tend to block the meridians and hinder the flow of qi and blood, leading to numbness and inflexibility of the limbs, or even paralysis.

w If accumulating in local areas, they frequently cause scrofula, subcutaneous nodules and cold abscess.

Frequently confusing the mind

w If phlegm disturbs the upper and blends lucid yang, it will lead to dizziness.

w If phlegm confuses the mind or phlegm-fire disturbs the heart, it will cause chest oppression, palpitation, unconsciousness and delirium or mania, etc.

Complicated symptoms and constant change

w The symptoms are chest oppression, cough, asthma, expectoration, nausea, vomiting, palpitation, dizziness, mania, numbness of the limbs, arthralgia or swelling of joints, subcutaneous swelling or suppuration, edema, ascites and diarrhea, etc.

w Generally speaking, obstinate disease and disease without evident cause are all related to phlegm and rheum. That is why it was believed in ancient times that “strange diseases are mostly caused by phlegm” and “many diseases are exclusively caused by phlegm”.

Having a long course and relapsing repeatedly

w Clinically the diseases caused by phlegm and rheum usually have a long course, relapsing repeatedly, and are lingering and difficult to cure.

6.2 Blood stasis

w The basic concept of blood stasis

w The formation of blood stasis

w The characteristics of blood stasis in causing diseases

1) The basic concept of blood stasis

w Blood stasis is a kind of pathological substance caused by disturbance of blood circulation.

n retention of blood in the vessels or viscera

n overflow of blood out of the vessels

2) The formation of blood stasis

w Various pathogenic factors, including the six abnormal climatic factors, internal impairment due to seven emotions, improper diet, overwork and over-rest, can impair the viscera and affect qi-transformation, leading to blood stasis.

w The following is a brief description of the causes of blood stasis:

n Qi stagnation

n Qi deficiency

n Blood-cold

n Blood-heat

n Traumatic injury

n Hemorrhage

3) The characteristics of blood stasis in causing diseases

w Pain

w Lump

w Hemorrhage

w Cyanosis

w Tongue variations

w Pulse variations

Five endogenous pathogenic factors

w The so-called five endogenous pathogenic factors are endogenous wind, endogenous cold, endogenous dampness, endogenous dryness and endogenous heat (fire).

w Though they are called wind, cold, dampness, dryness and heat (fire), they are actually pathogenic factors due to dysfunction of the viscera.

w That is why the word “endogenous” is used to modify their names.

Endogenous wind

w Endogenous wind is produced by the liver, so it is usually called “liver-wind” and “internal disturbance of liver-wind”.

w There are four factors responsible for the occurrence of endogenous wind.

Endogenous cold

w The occurrence of endogenous cold is due to the deficiency of yang.

w The deficiency-cold of the viscera can be caused by either the deficiency of the kidney-yang or the spleen-yang or heart-yang.

w Since the kidney-yang is the source of yang-qi in the whole body, the deficiency of the kidney-yang is the predominant factor responsible for the occurrence of endogenous cold.

Endogenous dampness

w Usually failure of water to transform due to dysfunction of the spleen may produce the endogenous dampness which encumbers the spleen and affects the transporting and transforming functions of the spleen or accumulates into phlegm and retention of fluid, further resulting in other diseases.

Endogenous dryness

w Endogenous dryness results from insufficiency of body fluid and is related to yin-deficiency.

w Since body fluid and blood can transform into each other, the deficiency of blood aim causes dryness.

w The manifestations of endogenous dryness are often related to the intestines, the stomach, the lung and other orifices, such as dry nose, dry throat, dry eyes, scanty urine and retention of dry feces, etc.

Endogenous heat (fire)

The causes of endogenous heat (fire) are various, such as

w Predomination of yang transforming into fire

w Depression of pathogenic factors transforming into fire

w Extreme five emotions transforming into fire

w Deficiency of yin transforming into fire

Chapter Six Pathogenesis

1 Occurrence of disease

w TCM believes that the healthy state implies the balance of yin and yang.

w The occurrence of disease is actually concerned with pathogenic factors and healthy qi.

1.1 Insufficiency of healthy qi: the intrinsic cause of disease

w TCM pays great attention to the role of healthy qi in causing disease.

w “with sufficient healthy qi inside the body, pathogenic factors will have no way to invade the body".

w “if pathogenic factors invade the body, qi in the body must be deficient."

1.2 Invasion of pathogenic factors: an important condition for the occurrence of disease

w Apart from emphasizing the role of healthy qi in causing disease, TCM also pays great attention to the role of pathogenic factors.

w Pathogenic factors may dominate the occurrence of disease under certain conditions, such as high temperature, high-pressure electric current, chemical poison, wound caused by gun and bite by poisonous snake, etc.

w Take pestilent qi for example. It is also an important element in causing disease, usually leading to widely spreading disease.

1.3 When healthy qi defeats pathogenic factors, no disease occurs

When pathogenic factors defeat healthy qi, disease occurs

w The occurrence of disease results from the struggle between pathogenic factors and healthy qi which exists in the whole course of disease.

2 Mechanism of pathological changes

w Though complicated, pathological changes generally can be classified into such categories as predomination and decline of pathogenic factors and healthy qi, imbalance of yin and yang as well as disorder of qi, blood and body fluid.

2.1 Predomination and decline of pathogenic factors and healthy qi

w Predomination and decline of pathogenic factors and healthy qi refer to changes of pathogenic factors and healthy qi due to struggle between them.

w The result of predomination and decline of pathogenic factors and healthy qi affects the nature and transmission of disease.

2.1.1 Predomination and decline of pathogenic factors and healthy qi and the changes of deficiency and excess

w Excess syndrome

w Deficiency syndrome

w Mixture of deficiency syndrome and excess syndrome

w Mutual transformation between deficiency syndrome and excess syndrome

w Pseudo-deficiency syndrome and pseudo-excess syndrome

1) Excess syndrome

w “predomination of pathogenic factors leads to an excess syndrome”

w Excess syndrome is characterized by predomination of pathogenic factors and abundance of healthy qi.

w Violent struggle between pathogenic factors and healthy qi leads to a series of excess symptoms.

w Excess syndrome is often seen at the early and medium stages of diseases caused by six abnormal climatic factors or diseases caused by phlegm, rheum, blood stasis and retention of food in the body.

w Clinically the manifestations of excess syndrome include high fever, mania, sonorous voice, unpalpable abdominal pain, constipation, anuria and powerful pulse, etc.

2) Deficiency syndrome

w “exhaustion of essence leads to a deficient syndrome”

w Deficiency syndrome is marked by deficiency of healthy qi. Meanwhile pathogenic factors are not strong.

w So the struggle between pathogenic factors and healthy qi is mild with symptoms of deficiency of healthy qi and hypofunction of the viscera.

w Deficiency syndrome is often seen at the advanced stage of exogenous diseases, or in chronic disease.

w Clinically the manifestations of deficiency syndrome include dispiritedness, sallow complexion, palpitation and shortness of breath, spontaneous sweating, night sweating, or feverish sensation in the five centers (palms, soles and chest), or aversion to cold and cold limbs as well as weak pulse, etc.

3) Mixture of deficiency syndrome and excess syndrome

w Mixture of deficiency syndrome and excess syndrome may be caused by delayed or improper treatment of excess syndrome that leads to prolonged retention of pathogenic factors in the body and impairment of healthy qi, or by coagulation of pathological substances like dampness, water and blood stasis due to deficiency of healthy qi.

w Mixture of deficiency syndrome and excess syndrome is characterized by either deficiency complicated by excess or excess complicated by deficiency.

n The former is marked by domination of deficiency syndrome accompanied by excess of pathogenic factors, such as edema due to inactivation of spleen-yang.

n The latter is marked by domination of excess syndrome accompanied by deficiency manifestations, such as excess-heat consuming yin-fluid at the medium stage of febrile diseases.

4) Mutual transformation between deficiency syndrome and excess syndrome

w Such a mutual transformation is characterized by transformation either from excess into deficiency or from deficiency into excess.

n Delayed or improper treatment may prolong the course of duration, leading to impairment of healthy qi and the physiological functions of the viscera and resulting in transformation of excess into deficiency.

n Deficiency of healthy qi and hypofunction of the viscera may lead to abnormal flow of qi, blood and body fluid and bring on qi stagnation, blood stasis, phlegm and rheum as well as water and dampness, eventually resulting in deficiency complicated by excess.

5) Pseudo-deficiency syndrome and pseudo-excess syndrome

w In the clinic there are also cases of “excess syndromes with pseudo-deficient symptoms” and “deficient syndromes with pseudo-excessive symptoms” caused by either a failure of the circulation of qi and blood resulting from a blockage of a meridian by retention of substantial pathogenic factors, or a hypo-function of a viscera due to a deficiency of qi and blood.

2.1.2 The relationship between the prognosis of disease and the state of pathogenic factors and healthy qi

w Domination of healthy qi and decline of pathogenic factors

w Domination of pathogenic factors and decline of healthy qi

w Healthy qi and pathogenic factors are at a stalemate

1) Domination of healthy qi and decline of pathogenic factors

w Domination of healthy qi and decline of pathogenic factors are the necessary conditions for improvement and cure of disease.

w If healthy qi is sufficient, it will be powerful in resisting pathogenic factors and pathogenic factors will gradually be eliminated.

2) Domination of pathogenic factors and decline of healthy qi

w Domination of pathogenic factors and decline of healthy qi are the basic causes of aggravation of disease or death.

w Such a variation results either from frequent deficiency of healthy qi that fails to restrict the development of pathogenic factors, or from exuberance of pathogenic factors that go beyond the body resistance, or from wrong or delayed treatment that impairs healthy qi and strengthens pathogenic factors, resulting in declination of visceral functions and separation of yin and yang, and eventually leading to death.

3) Healthy qi and pathogenic factors are at a stalemate

w If healthy qi is not strong enough to eliminate pathogenic factors and pathogenic factors are not strong enough to further develop, it will bring on such a condition in which healthy qi and pathogenic factors are at a stalemate or healthy qi is deficient and pathogenic factors are still lingering.

w In this case healthy qi is difficult to restore, disease may change from an acute one into a chronic one or become obstinate, or certain sequelae may be caused.

2.2 Imbalance between yin and yang

w Relative predomination of yin and yang

w Relative decline of yin and yang

w Inter-consumption of yin and yang

w Inter-rejection of yin and yang

w Inter-transformation of yin and yang

w Loss of yin and yang

2.2.1 Relative predomination of yin and yang

w Relative predomination of yang

w Relative predomination of yin

Relative predomination of yang

w Relative predomination of yang refers to excess-heat syndrome marked by predomination of yang and non-deficiency of yin.

w It results either from attack of exogenous warm pathogenic factors, or from attack of pathogenic factors of yin nature, or from abnormal changes of emotions, or from qi stagnation, blood stasis, phlegm and retention of food that transforms into heat with yang.

w Predomination of yang leads to heat, so usual clinical manifestation is fever, accompanied by profuse sweating, reddish complexion, reddish tongue with yellowish coating, full and large or rapid pulse.

w Predomination of yang impairs yin. So predomination of yang is usually characterized by consumption of yin-fluid, leading to thirst, dry feces and scanty brownish urine, etc.

Relative predomination of yin

w Relative predomination of yin refers to excess-cold syndrome marked by relative predomination of yin, decline of body functions and retention of pathological substances in the course of disease.

w It may result either from attack of pathogenic cold and dampness, or from excessive intake of cold and uncooked food that makes yin in the body predominant.

w Predomination of yin generates cold, clinically leading to cold symptoms, such as chills, dispiritedness, pale complexion, anhidrosis, preference for hot water, cold limbs, loose stool, clear urine, whitish tongue coating, deep and slow pulse, etc.

w Predomination of yin impairs yang.

2.2.2 Relative decline of yin and yang

w Relative decline of yang

w Relative decline of yin

Relative decline of yang

w Relative decline of yang results either from excessive consumption of yang-qi, or from congenital weakness and insufficiency of fire in life-gate, or from improper postnatal care and impairment of yang-qi, or from impairment of yang-qi during the course of disease.

w Deficiency of yang-qi generates cold and clinically brings on deficiency-cold syndrome and decline or weakness of viscera functions, leading to the symptoms of aversion to cold, cold limbs, mental lassitude, poor appetite, loose stool, clear and profuse urine, and deep-slow-weak pulse, etc.

Relative decline of yin

w Relative decline of yin may result either excessive consumption of yin-essence, or from congenital weakness and insufficiency of yin-fluid, or from improper postnatal care and exhaustion of yin-fluid, or from insufficiency of yin-fluid in the course of disease.

w Deficiency of yin generates heat and clinically brings on deficiency-heat syndrome and various hyperactivities of viscera functions, leading to the symptoms of emaciation, low fever, feverish sensation in the five centers (palms, soles and chest), night sweating, dry mouth, dry feces, scanty urine, reddish tongue coating or no tongue coating, thin and rapid pulse, etc.

2.2.3 Inter-consumption of yin and yang

w Deficiency of yin affecting yang

w Deficiency of yang affecting yin

Deficiency of yin affecting yang

w Deficiency of yin affecting yang means that consumption of yin-fluid involves yang-qi and makes yang-qi insufficient in production or exhausted, leading to a morbid state marked mainly by deficiency of yin with the manifestation of deficiency of both of yin and yang.

Deficiency of yang affecting yin

w Deficiency of yang affecting yin means that consumption of yang-qi involves yin-fluid and makes yin-fluid insufficient in production, leading to a morbid state marked mainly by deficiency of yang with the manifestation of deficiency of both yin and yang.

2.2.4 Inter-rejection of yin and yang

w Predomination of yin rejecting yang

w Predomination of yang rejecting yin

Predomination of yin rejecting yang

w Predomination of yin rejecting yang refers to a pathological state in which predominant yin drives yang-qi outside, leading to a pathological change marked by true interior cold and false exterior heat.

w The nature of this syndrome is cold, but the manifestations appear febrile because yang-qi is driven outside.

w Take deficiency of yang generating interior cold for example. If it develops to a stage marked by extreme predomination of yin-cold and external floating of yang, a pathological change of predominant yin rejecting yang will be caused, the manifestations of which include cold limbs, diarrhea with undigested food and indistinct pulse due to predominance of yin-cold as well as some pseudo-febrile signs such as fever in spite of desire for quilt in the body and reddish cheeks.

Predomination of yang rejecting yin

w Predomination of yang rejecting yin refers to a pathological state in which predominant yang drives yin outside, leading to a cold-like pathological change.

w Since pathogenic heat has deepened into the body and yang-qi cannot be dispersed outside, there are pseudo-cold symptoms though the syndrome is febrile in nature.

w Take exuberant interior heat in febrile disease for example. Since heat is superabundant, yin and yang are in disharmony and yin is rejected. The manifestations include feverish sensation in the chest, dry mouth, and dry and red tongue as well as cold limbs and aversion to cold due to the fact that extreme change of yang appears like yin.

2.2.5 Inter-transformation of yin and yang

w Transformation of yang into yin

w Transformation of yin into yang

Transformation of yang into yin

w The nature of the disease originally pertains to yang. But when yang-heat develops to a certain degree, it will turn into yin.

w For example, some febrile diseases show a series of heat symptoms at the early stage, such as high fever, thirst, reddish tongue, yellowish tongue coating and rapid pulse, indicating that the syndrome is obviously of yang-heat.

w However, improper treatment or extreme exuberance of pathogenic factors may suddenly lead to such critical signs of yin-cold as low body temperature, cold limbs, cold profuse sweating and indistinct pulse.

Transformation of yin into yang

w The nature of the disease originally pertains to yin. But when yin-cold develops to a certain degree, it will turn into yang.

w For example, attack of exogenous pathogenic cold leads to a series of wind-cold symptoms at the early stage, such as serious aversion to cold and light fever, headache, body pain, thin and whitish tongue coating, and floating-tense pulse, indicating wind-cold affecting the superficies.

w Eventually it develops into a yang-heat syndrome marked by high fever, sweating, thirst, reddish tongue, yellowish tongue coating and rapid pulse.

2.2.6 Loss of yin and yang

w Loss of yang

w Loss of yin

Loss of yang

w Loss of yang is usually caused by predomination of pathogenic factors and weakness of healthy qi to control pathogenic factors, frequent deficiency of yang and over-strain, wrong application of diaphoresis and profuse sweating that result in sudden loss of yang-qi, leading to the symptoms of profuse sweating, cold sensation in the skin, feet and hands, lying with the knees drawn up, spiritual lassitude and indistinct pulse, etc.

Loss of yin

w Loss of yin is usually caused by exuberant pathogenic heat, violent vomiting, profuse sweating and diarrhea that result in loss of great quantity of body fluid with the symptoms of emaciation, curled skin, sunken ocular orbit, scanty and sticky sweating, irascibility and very weak pulse, etc.

w Though loss of yin and loss of yang may appear solitarily, the loss of one side often leads to immediate exhaustion of the other because yin and yang depend on each other to exist.

w Thus untimely treatment of loss of yin or loss of yang may lead to death because “separation of yin and yang exhausts essence” .

2.3 Disorder of qi, blood and body fluid

w Disorder of qi

n Insufficiency of qi

n Disturbance of qi

w Disorder of blood

n Insufficiency of blood

n Disturbance of blood

w Disorder of body fluid

n Insufficiency of body fluid

n Disturbance of body fluid

Insufficiency of qi

w Insufficiency of qi causes qi deficiency syndrome with the manifestations of sallow complexion, dispiritedness, lassitude and low and weak voice.

Disturbance of qi

The manifestations of qi disorder are various, such as

w qi stagnation

w adverse flow of qi

w qi sinking

w qi closure

w qi leakage

1) qi stagnation

w Qi stagnation means unsmooth flow of qi and stagnation of qi in local areas, leading to distension, fullness and pain.

w For example, stagnation of liver-qi leads to hypochondriac distension and fullness or distending pain of lower abdomen and depression.

2) adverse flow of qi

Excessive ascent of qi causes adverse flow of qi.

w adverse flow of liver-qi causes dizziness, distension of head or syncope

w adverse flow of lung-qi causes cough and asthma

w adverse flow of stomach-qi causes nausea and vomiting

3) qi sinking

Excessive descent of qi causes sinking of qi.

w Sinking of middle qi causes dizziness, diarrhea, and visceroptosis.

4) qi closure

Failure of qi to disperse causes closure of qi.

w Closure of lung-qi causes chest oppression, unsmooth breath, stuffy nose and anhidrosis.

5) qi leakage

Loss of qi fixation causes leakage of qi.

w loss of fixation of lung-qi causes spontaneous sweating

w loss of fixation of kidney-qi causes incontinence of urine

Insufficiency of blood

w Insufficiency of blood causes blood deficiency syndrome with the manifestations of pale complexion, dizziness, palpitation, insomnia, light-colored lips and nails, scanty and light-colored menses, etc.

w Blood deficiency causes malnutrition of the viscera with the manifestations of heart-blood deficiency syndrome and liver-blood deficiency syndrome.

Disturbance of blood

The manifestations of blood disturbance are blood stasis and hemorrhage.

w The former refers to unsmooth flow of blood and blockage of meridians, leading to various pathological changes, such as pain, swelling, distension and abdominal mass.

w The latter is caused by flow of blood outside the vessels due to impairment of the vessels, or by failure of the spleen to command blood, or by failure of the liver to store blood, leading to various kinds of hemorrhage.

Insufficiency of body fluid

w Insufficiency of body fluid usually causes dryness syndrome.

w Dryness syndrome is often marked by insufficiency of body fluid, insufficient moisture in the skin, the orifices and the viscera which lead to dryness of the skin, dry mouth and throat, dry eyes, scanty urine and dry feces.

Disturbance of body fluid

w Disturbance of body fluid refers to internal retention of water and dampness due to disturbance of the metabolism of body fluid, leading to phlegm, rheum and edema, etc.

w The disturbance of body fluid results from dysfunction of the spleen, the lung and the kidney which leads to failure of the spleen to transport and transform water, or failure of the lung to regulate water passage, or failure of the kidney to control water metabolism.

Disorder of qi, disorder of blood and disorder of body fluid usually affect each other

w deficiency of qi causes deficiency of blood and vice versa

w stagnation of qi causes blood stasis and vice versa

w stagnation of qi causes metabolic disturbance of body fluid

w insufficiency of body fluid causes stagnation of blood

Chapter Seven Prevention and Therapeutic Principles

1 Prevention

w TCM gives prevention the priority over treatment. Before the occurrence of a disease or at the primary stage of a disease, it is important to take measures in advance to avoid suffering or aggravation, which is helpful for protecting healthy qi and maintaining health.

w That is why Canon of Medicine says that “the best doctors are those who can prevent the occurrence of disease”. It believes that resorting to treatment when disease has already occurred is just like drilling a well when one feels thirsty and manufacturing weapons when war has already broken out.

The preventive methods

w Giving prevention the priority

n Regulating psychological state

n Proper diet

n Proper living habits

n Exercising the body

n Avoiding attack pathogenic factors

w Preventing transmission and change

n Early treatment

n Controlling the transmission and change

1) Early treatment

w At the early stage, disease is easy to treat because it is still light and healthy qi has not declined yet.

2) Controlling the transmission and change

w The transmission and change of disease follow certain rules and routes. Measures can be taken according to these rules and routes to prevent the transmission and change of disease in advance.

w The method for controlling the transmission and change of disease is to regulate and nourish the organs or areas that the disease is liable to transmit to by means of reinforcing healthy qi to prevent the transmission of the disease.

w For example, it is said in Synopsis of Prescriptions of Golden Chamber “measures must be taken to strengthen the spleen in the treatment of liver disease because liver disease tends to transmit to the spleen.”

2 Therapeutic principles

w Treatment aimed at the root of disease is a fundamental principle which means to find the root pathogenesis of a disease and focus the treatment on it because the root pathogenesis is responsible for the emergence of syndrome.

2.1 Routine treatment and contrary treatment

2.2 Treating the branch and the root

2.3 Strengthening healthy qi and eliminating pathogenic factors

2.4 Regulation of yin and yang

2.5 Abidance by individuality, locality and seasons

2.1 Routine treatment and contrary treatment

1) Routine treatment

w Routine treatment is a commonly used therapeutic method.

w It refers to treatment opposite to the nature of disease.

w It is used to treat a disease with herbs and formulas whose natures are opposite to the nature of the disease.

w This method is used for a case whose signs are consistent with its essence, i. e. a cold disease is marked by cold manifestation, a heat disease with heat manifestation, a deficient disease with deficient manifestation, and an excess disease with excessive signs.

w In treatment, one must apply the principles of heating what is cold, cooling what is hot, tonifying what is deficient, and reducing what is excessive.

2) Contrary treatment

w Contrary treatment means treating disease according to its false manifestations.

w It is a way of treating disease with herbs and formulas whose natures are consistent with the false manifestations of the disease.

w Since contrary treatment just agrees with the false manifestations, it is in fact opposite to the nature of the disease.

w The essence of contrary treatment still deals with the nature of the disease under the guidance of aiming treatment at the root.

The following are some of the commonly used contrary therapeutic methods.

w treating heat with heat

w treating cold with cold

w treating obstruction with tonics

w treating openness with purgatives

treating heat with heat

w Treating false heat syndrome with hot-natured herbs.

w This therapy can be used to treat syndrome of real cold and false heat due to exuberant internal cold that drives yang outward.

treating cold with cold

w Treating false cold syndrome with cold-natured herbs.

w This therapy can be used to treat syndrome of real heat and false cold due to exuberance of internal heat that drives yin outside.

treating obstruction with tonics

w Treating a case with obstructive symptoms with tonic herbs.

w This therapy can be used to treat syndrome of real deficiency and false excess due to hypofunction of the viscera caused by decline of qi and blood.

treating openness with purgatives

w Treating a case with opening symptoms with purgatives.

w This therapy can be used to treat syndrome of real excess and false deficiency due to internal accumulation of pathogenic factors.

2.2 Treating the branch and the root

w “Root ” and “branch” are two relatively opposite concepts with varied connotations in different cases.

w Root Branch

healthy (vital) qi pathogenic factors

pathogenesis symptoms

old disease, primary disease new disease, secondary disease

w Treating the branch in emergencies

w Treating the root in chronic conditions

w Treating the branch and root simultaneously

Treating the branch in emergencies

w When the branch aspect of the condition is very serious and becomes the principal aspect of a disease, if not treated promptly it will endanger the life of the patient or influence treatment of the root condition. The emergency measures should then treat first its branch condition.

w For example, with a patient with massive hemorrhage, (no matter what kind), emergency measure should be taken first to stop the bleeding, the branch. Then after the bleeding stops, the root condition can be treated.

Treating the root in chronic conditions

w When the state of disease is mild, the root cause of the disease should be understood and treated. It is important in guiding treatment for a chronic disease or in the convalescent stage of an acute disease.

w For example, the root of cough in the lung is due to yin deficiency of the lung and kidney and the treatment should nourish the yin of the lung and kidney to address the root.

w Another example is a headache caused by wind-cold. Wind-cold is the root and headache is the branch, and the treatment should expel wind and cold. As the wind-cold is driven away, the headache will disappear spontaneously.

Treating the branch and root simultaneously

w When both the branch and root are acute or chronic, the branch and the root should be treated at the same time.

w In a case with clinical manifestations such as fever, abdominal fullness and pain, constipation, thirst, a dry tongue with charred yellow coating, the root is retention of pathogenic heat in the interior, and the branch is an injury of yin-fluid. Both the branch and root are acute and both should be treated at the same time.

w Another example is a patient who repeatedly suffers form cold due to qi deficiency, in which the treatment should replenish the root and relieve the exterior for the branch.

2.3 Strengthening healthy qi and eliminating pathogenic factors

w Strengthening healthy qi is usually used to treat deficiency syndromes such as qi deficiency, blood deficiency, yin deficiency, body fluid deficiency and kidney-essence deficiency.

w That is why it is said in TCM that “deficiency syndrome should be treated by nourishing therapy”.

w Nourishing therapy can be further divided into different therapeutic methods, such as qi-nourishing therapy, blood-nourishing therapy, yin-nourishing therapy, yang-warming therapy, fluid-generating therapy and essence-enriching therapy, etc.

w Eliminating pathogenic factors is used to treat excess syndromes such as attack of exogenous pathogenic factors, retention of food, internal retention of water, internal blockage of blood stasis, etc.

w That is why it is said in TCM that “excess syndrome should be treated by purgation therapy.”

w Purgation therapy can be further divided into different therapeutic methods, such as diaphoresis therapy, emetic therapy, defecation-promoting therapy, water-draining therapy, blood-activating therapy, dampness-resolving therapy, stasis-breaking therapy, heat-clearing therapy and cold-dissipating therapy, etc.

Since the order and urgency of deficiency of healthy qi and excess of pathogenic factors are different, there are three methods for strengthening healthy qi and eliminating pathogenic factors, i.e.

w purgation prior to tonification

w tonification prior to purgation

w simultaneous application of purgation and tonification

Purgation prior to tonification

w eliminate pathogenic factors first and then strengthen healthy qi

w If a syndrome mixed with deficiency of healthy qi and excess of pathogenic factors is marked by predomination of pathogenic factors that must be eliminated immediately and deficiency of healthy qi that still can bear attack, the therapy for strengthening healthy qi may reinforce pathogenic factors instead of strengthening healthy qi. In this case purgation should be used first.

Tonification prior to purgation

w strengthen healthy qi first and then eliminate pathogenic factors

w This therapy can be used to treat syndrome mixed with deficiency of healthy qi and excess of pathogenic factors. Though pathogenic factors should be eliminated, healthy qi is too deficient to bear attack. Early application of purgation may impair healthy qi. In this case tonifying therapy should be used first to strengthen healthy qi.

simultaneous application of purgation and tonification

w strengthen healthy qi and eliminate pathogenic factors simultaneously

w It can be used to treat syndrome mixed with deficiency of healthy qi and excess of pathogenic factors. Because simple use of tonification may make pathogenic factors linger inside and simple use of purgation may impair healthy qi.

2.4 Regulation of yin and yang

w Since the main manifestations of imbalance between yin and yang are relative predomination of yin and yang and relative decline of yin and yang, the purpose of regulating yin and yang is to reduce the excess and supplement deficiency.

Reducing excess

w the principle for “reducing excess” is also known as “excess should be treated by purgation” in TCM.

w Relative predomination of yin causes excess-cold syndrome while relative predomination of yang causes excess-heat syndrome.

w The therapeutic principle for treating excess-cold syndrome is “to treat cold syndrome with heat therapy” while the therapeutic principle for treating excess-heat syndrome is “to treat heat syndrome with cold therapy.”

w Since yin and yang are opposite to each other, predomination of yin may damage yang and predomination of yang may impair yin.

w So in the treatment of syndromes due to predomination of yin or yang, cares should be taken to differentiate the state of the other side so as to take both sides into consideration if necessary, i.e. dispersing yin-cold in combination with strengthening yang and clearing yang-heat in combination with nourishing yin.

Supplementing insufficiency

w the principle for “supplementing insufficiency ” is also known as “insufficiency should be treated by tonification” in TCM.

w Relative decline of yin causes deficiency-heat syndrome while relative decline of yang causes deficiency-cold syndrome.

w For the treatment of deficiency-heat syndrome, yin-nourishing therapy can be used (“treating yin for a yang illness”, “strengthening water source can control predominant yang”) ; for the treatment of deficiency-cold syndrome, yang-supplementing therapy can be used (“treating yang for a yin illness”, “supplementing the source of fire can eliminate superabundance of yin”).

w Since yin and yang depend on each other, relative decline of the one will certainly involve the other, eventually leading to deficiency of both yin and yang.

w For the treatment of such a morbid condition, both yin and yang should be supplemented.

w simple yin deficiency syndrome can be treated by yin-nourishing therapy with the addition of herbs for strengthening yang, known as obtaining yin from yang

w simple yang deficiency syndrome can be treated by yang-nourishing therapy with the addition of herbs for nourishing yin, known as obtaining yang from yin

2.5 Abidance by individuality, locality and seasons

w The occurrence, development and change of disease involve a number of factors, including individual difference, geographical environment and seasonal variations which may affect the nature, duration and treatment of disease.

w So in treating disease, apart from following the principles of strengthening healthy qi and eliminating factors as well as regulating yin and yang, one has to make corresponding changes according to individual condition, local environment and seasonal variations.

Abidance by individuality

w Abidance by individuality means to decide treatment according to the age, sex, constitution and living habits of the patients.

Abidance by locality

w Abidance by locality means to decide treatment according to geographical difference.

Abidance by seasonal variation

w Abidance by seasonal variation means deciding treatment according to seasonal changes of weather.

w In Canon of Medicine such a use of herbs according to seasonal variation is summarized as “avoiding using cold-natured herbs in winter, cool-natured herbs in autumn, warm-natured herbs in spring and hot-natured herbs in summer.”