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Hu Dongpei (Ed.

)
Traditional Chinese Medicine
Traditional
Chinese Medicine


Theory and Principles

Edited by
Hu Dongpei
This work is co-published by Tsinghua University Press and Walter de Gruyter GmbH.

Contributors Committee
Editor-in-Chief: Hu Dongpei
Chinese Chief Reviewer: Li Qizhong
English Chief Reviewer: Portia Barnblatt
Assiociate Chief Editors: Zhang Ting, Xie Ning
Editors (in alphabetical order of surnames):
Cheng Liguo (Medical College of Ji’Nan University)
Hu Dongpei (Shanghai University of Traditional Chinese Medicine)
Ji Lijin (Fujian University of Traditional Chinese Medicine)
Li Jing (Anhui College of Traditional Chinese Medicine)
Li Qizhong (Shanghai University of Traditional Chinese Medicine)
Li Xiaoqian (Shanghai University of Traditional Chinese Medicine)
Liang He (Henan College of Traditional Chinese Medicine)
Liu Xiaoyan (Changchun University of Traditional Chinese Medicine)
Lü Zhiping (Southern Medical University)
Ma Shuran (Beijing University of Traditional Chinese Medicine)
Meng Jingyan (Tianjin University of Traditional Chinese Medicine)
Ni Xianghui (Guiyang College of Traditional Chinese Medicine)
Portia Barnblatt (America College of Traditional Chinese Medicine)
Shi Jianmei (Shanxi College of Traditional Chinese Medicine)
Wang Yingxiao (Shanghai University of Traditional Chinese Medicine)
Xie Ning (Heilongjiang University of Traditional Chinese Medicine)
Yu Ling (Shanghai University of Traditional Chinese Medicine)
Zhang Qingxiang (Shandong University of Traditional Chinese Medicine)
Zhang Ting (Shanghai University of Traditional Chinese Medicine)
Zhu Manjia (Chengdu University of Traditional Chinese Medicine)

ISBN 978-3-11-041729-6
e-ISBN 978-3-11-041766-1
e-ISBN (EPUB) 978-3-11-041780-7

Library of Congress Cataloging-in-Publication data


A CIP catalog record for this book has been applied for at the Library of Congress.

Bibliographic information published by the Deutsche Nationalbibliothek


The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed
bibliographic data are available in the Internet at http://dnb.dnb.de.

© 2016 Walter de Gruyter GmbH, Berlin/Boston and Tsinghua University Press, Beijing
Cover image: Yi Lu/iStock/Thinkstock
Typesetting: Lumina Datamatics
Printing and binding: CPI books GmbH, Leck
♾ Printed on acid-free paper
Printed in Germany

www.degruyter.com
Preface
Management of teaching materials is one of the basic requirements for high quality
education in traditional Chinese medicine (TCM). This requirement applies to training
of TCM practitioners as well. Since the establishment of the universities of traditional
Chinese medicine, teaching materials have been developed by the state-unified TCM
colleges and universities. They have played an important role in the application of
TCM, systematically improving teaching quality as well as cultivating talents in the
TCM field. With the rapid development of the TCM field and the need for globally
expanding TCM education, comprehensive teaching material, incorporating digital
features of the English language, has become important. With the help of such high
quality teaching material, Chinese culture and knowledge of TCM may be spread
worldwide without loss of its essence.
The basic theory of TCM is an important part of the curriculum of TCM. The
theory is not only a basic course for the Chinese-medicine profession but also a com-
pulsory content for the license examination of domestic and international Chinese-
medicine practitioners. It is the foundation for continual education in the field of
TCM diagnosis, Chinese herbal medicine, Chinese herbal formula, TCM classics, and
TCM clinical education. It includes the study of basic TCM philosophy, TCM visceral
manifestation, TCM etiology and pathology, and the TCM treatment principle. This
book is most suitable for TCM universities and western-medicine practitioners. It is
also an important reference book for TCM clinical practice and research.
As on date, there are about 50 kinds of teaching materials for topics in basic
theory of TCM and TCM foundation. But none of those include the digital features in
the English language. The existing materials are written in the traditional and classi-
cal form, without effectively using modern scientific means and methods to repre-
sent knowledge with regard to the simplicity of the ancient Chinese language, its
profound concept, and the difficulties commonly encountered in the teaching of
TCM theory. Current scholars in the TCM field concur that materials on TCM theory
require significant improvement to enhance readability and understanding.
This book is intended to break the inherent model and establish a culture that
promotes independent learning ability. The basic theory of TCM supports multi-
media digital teaching and changes the merely simple text mode effectively. The
content is rich while the text is concise and focused. Using videos, pictures, and ani-
mation, the book creates a vivid, innovative, and lively learning mindset. It departs
from the old and dull teaching models of the previous educational system, cultivat-
ing interest in the student to explore and learn TCM. The bilingual form of this mate-
rial mitigates the language barrier often faced by international exchange students; it
stimulates students’ interests in learning as well as activates a classroom atmo-
sphere. By using the digital production for the entire material will lead the reform in
the teaching textbooks.
VI  Preface

The content of this book is based on China’s TCM undergraduate educational


syllabus. It covers all the materials for TCM licensing exams domestically and inter-
nationally as well as fully embodies the basic theory, knowledge, and skills related
to TCM. It integrates every aspect of the basic TCM theory in accordance with the
nature of the subject and the scope of the study. The book reflects the disease spec-
trum of today’s society and provides guidance to the modern clinical practice of
TCM. The features of modern international education have been integrated into this
book, which gives full consideration to beginners and foreign students, particularly
focusing on the way they think and learn and the difficulties they face in learning
TCM. To enhance readability and practicality for foreign students, this book reorga-
nizes every concept concisely in a simple, correct, and orderly digital way in both
Chinese and English. This book summarizes the essence of Chinese medicine and
records the results of modern research; learn from the experience of textbook writ-
ings of the entire country in China, maintain and carry forward the characteristics of
traditional Chinese medicine. This book is written under the guidance of the high
starting point, high standard and high concept, as well as endowed with an innova-
tive mode of thinking and the positive learning attitude. I believe this book will play
a positive role in improving the quality of teaching of the basic theory of TCM, pro-
specting the Chinese medicine and spreading the TCM culture.
I thank the office of academic affairs from the university and members of the
department of fundamental medicine college, who gave me huge encouragement
and support during the writing of this book.
There might be flaws in this book despite my efforts to eliminate them. I welcome
advice from experts in this field to make the book better.

Hu Dongpei
March 2013
Contents

1 Introduction  1
1.1 The discipline, nature, and properties of traditional Chinese
medicine  1
1.1.1 TCM is characterized by its natural science nature  1
1.1.2 TCM has the characteristics of social science  1
1.1.3 The mutual influences of TCM and ancient Chinese philosophy  2
1.1.4 TCM is a product of multidisciplinary interactions  2
1.2 The main characteristics of TCM theory  3
1.2.1 Concept of holism  3
1.2.2 Differential diagnosis and treatment  5

2 The Philosophical Basis of Traditional Chinese Medicine  7


2.1 Theory of yin-yang  7
2.1.1 The basic concept of yin-yang  7
2.1.2 The basic contents of yin-yang theory  8
2.1.3 The applicable examples in traditional Chinese medicine of the yin-
yang theory  10
2.2 Five elements theory  14
2.2.1 Fundamental concepts and characters of the five elements  14
2.2.2 The classification of the five elements  16
2.2.3 The cycle of generation, restriction, over-restriction, and counter-
restriction in five elements  18
2.2.4 The application of five elements theory in TCM  19

3 Visceral Manifestation  24
3.1 Summarization of visceral manifestations  24
3.2 Five zang-organs  25
3.2.1 Heart  25
3.2.2 Lung  27
3.2.3 Spleen  30
3.2.4 Liver  34
3.2.5 Kidney  38
3.3 Six fu-organs  43
3.3.1 Gallbladder  43
3.3.2 Stomach  44
3.3.3 Small intestine  45
3.3.4 Large intestine  45
3.3.5 Urinary bladder  46
3.3.6 Triple-jiao  47
VIII  Contents

3.4 Extraordinary fu-organs  48


3.4.1 Brain  48
3.4.2 Uterus  49
3.5 The relationships among the zang-organs and fu-organs  50
3.5.1 The relationships among the six fu-organs  56
3.5.2 The relationship between the five zang-organs and six fu-
organs  57

4 The Theory of Qi, Blood, and Body Fluids  59


4.1 Qi  59
4.1.1 Concept of qi  59
4.1.2 Production of qi  59
4.1.3 Movement of qi  60
4.1.4 Functions of qi  61
4.1.5 Classification of qi  62
4.2 Blood  65
4.2.1 Concept of blood  65
4.2.2 Production of blood  65
4.2.3 Functions of blood  66
4.2.4 Blood circulation  66
4.3 Body fluids  67
4.3.1 Concept of body fluids  67
4.3.2 Metabolism of body fluids  68
4.3.3 Function of body fluids  69
4.4 The relationships among qi, blood, and body fluids  69
4.4.1 The relationship between qi and blood  70
4.4.2 The relationship between qi and body fluids  71
4.4.3 The relationship between blood and body fluids  72

5 Theory of Meridians and Collaterals  73


5.1 Overview of the theory of the meridians and collaterals  73
5.1.1 The concept of the meridians and collaterals  73
5.1.2 Composition of the meridian  73
5.2 Twelve meridians  75
5.2.1 Nomination of 12 meridians  76
5.2.2 Route and connection of the 12 meridians  76
5.2.3 Distribution of the 12 meridians  77
5.2.4 Exterior–interior relationship  78
5.2.5 Circulating sequence of the 12 meridians  78
5.2.6 Travelling routes of the 12 meridians  79
5.3 Eight extra meridians  90
5.3.1 Concept and functions of eight extra meridians  91
Contents  IX

5.3.2 Distribution and physiological functions of the eight extra


meridians  91
5.4 Physiological functions and applications of the meridians  99
5.4.1 Physiological functions of the meridian  99
5.4.2 Application of the theory of the meridian  100

6 Constitutional Theory  101


6.1 Concept of constitutional theory  101
6.1.1 Basic concept of constitution  101
6.1.2 Signs and characteristics of constitution  102
6.2 Factors affecting constitution  102
6.2.1 Relationship of the constitution to viscera, meridians, essence, qi,
blood, and body fluids  103
6.2.2 Factors which affect the constitution  103
6.3 Classification of constitution  106
6.3.1 Balance constitution  107
6.3.2 Yang-inclined constitution  107
6.3.3 Yin-inclined constitution  107
6.4 Application of the constitution theory  108
6.4.1 Explanation of the susceptibility of individual to certain
pathogens  108
6.4.2 Illustrating the etiology  109
6.4.3 Explaining the pathological changes  109
6.4.4 Guiding syndrome differentiation  110
6.4.5 Guiding treatment  110
6.4.6 Guiding the health maintenance  111

7 Onset of Disease  112


7.1 Concepts of pathogenesis  112
7.2 Cardinal principle of disease onset  112
7.2.1 Deficiency of vital qi is the intrinsic factor for the
pathogenesis  113
7.2.2 Pathogenic qi is an important factor to cause the disease  114
7.2.3 Struggle between pathogenic and vital qi determines the progress and
prognosis of disease  115

8 Etiology  117
8.1 Exogenous pathogens  117
8.1.1 Six evils  117
8.1.2 Pestilential pathogens  125
8.2 Endogenous pathogens  127
8.2.1 Internal injury due to mental disorders  127
X  Contents

8.2.2 Injury due to improper diet  129


8.2.3 Injury due to overstrain and over-idleness  131
8.3 Pathogens from pathological products  132
8.3.1 Water-dampness, phlegm, and retained fluid  133
8.3.2 Blood stasis  135
8.3.3 Calculus  137
8.4 Other pathogens  139
8.4.1 Medicine abuse  139
8.4.2 Iatrogenic pathogen  141

9 Pathogenesis  143
9.1 Exuberance and debilitation between vital and pathogen  143
9.1.1 Concept of pathogen, vital, exuberance, and debilitation  143
9.1.2 Changes of deficiency or excess  145
9.1.3 The relationships among pathogen, vital qi, excess, and deficiency as
well as the outcome of disease  147
9.2 Imbalance of yin and yang  150
9.2.1 Concept of imbalance of yin and yang  150
9.2.2 Types of imbalance of yin and yang  150
9.3 Disorders of qi, blood, and body fluids  155
9.3.1 Disorders of qi  156
9.3.2 Disorder of blood  158
9.3.3 Disharmony between qi and blood  160
9.3.4 Metabolic disorders of body fluids  161
9.3.5 Disharmony among qi, blood, and body fluids  163

10 Principles of Prevention and Treatment of Diseases  165


10.1 Principles of disease prevention  165
10.1.1 Disease prevention prior to its outbreak  165
10.1.2 Controlling the development of an existing disease  165
10.2 Principles of treatment  166
10.2.1 Treating the root of a disease  166
10.2.2 Strengthening the vital and dispelling the pathogen  170
10.2.3 Regulating yin and yang  173
10.2.4 Regulating qi and blood  175
10.2.5 Regulating the viscera  175
10.2.6 Three optimal treatment administrations  175

References  179
1 Introduction

1.1 The discipline, nature, and properties of traditional


Chinese medicine

Key points
– TCM belongs to the category of natural science.
– TCM has the characteristics of social science.
– TCM is profoundly influenced by ancient Chinese philosophy.
– TCM is the product of multidisciplinary interactions.

Traditional Chinese medicine (TCM) is a life science that originated from ancient
China, focusing on researching human health, illness, and disease prevention. It has
a close relationship with the geographic culture in China and belongs to the tradi-
tional-science category of the Orient. TCM is an important part of the world’s knowl-
edge of medical science; its characteristics and properties are discussed in the
following sections.

1.1.1 TCM is characterized by its natural science nature

Natural science is a subject which studies the law or nature of material movement
and change and development in nature. Medical science is a scientific system
which studies the process of life and its fight against disease. It belongs to the cate-
gory of natural science. The study of TCM is focused on human beings, especially
on the basic law of birth, growth, aging, and death. TCM also emphasizes the
mechanism of physiology, pathology, and disease prevention. It has the character-
istics of medical science. Therefore, TCM belongs to the category of natural
science.

1.1.2 TCM has the characteristics of social science

Social science is a subject which studies the change of human society and its devel-
opment. Human beings are not only the highest product of natural evolution but
also have social attributes. TCM focuses on studying different physiological func-
tions from different angles of the social background. It also studies the social roots
and the personal relationship and how they affect the physical as well as the mental
health of human beings. These features reflect distinctively the social and scientific
characteristics of TCM.
2  1 Introduction

1.1.3 The mutual influences of TCM and ancient Chinese philosophy

Philosophy is a science which studies the general rules of the common movement in
nature, society, and thoughts. The development of any object is related to philoso-
phy. The interactive relationship between TCM and philosophy is reflected in two
aspects.
Firstly, TCM was constantly receiving the development of philosophical research
during its process of formation and development. Since its initiation, TCM has unceas-
ingly absorbed research progress from ancient Chinese philosophy; a series of TCM
phenomena may be explained through important philosophical concepts. For example,
yin-yang, a philosophical concept in Huangdi Nei Jing, is used to explain the relative
attributes and their relationships of the two opposite aspects of correlative things or
two opposite aspects within one thing. Combining with the other terms, it formulates
the special TCM terms which are used to explain the physiological functions and
pathological changes of the human body. Therefore, yin-yang is a methodology which
is used to direct the development of TCM theory and is also applied repeatedly in
TCM research. The same concept is applied to the theories of yuan-qi and the five
elements.
Secondly, TCM enriched and developed ancient Chinese philosophy. For
example, the relationships between yin and yang and the laws of promotion,
restriction, counter-restriction, and over-restriction among the five elements were
first put forward and fully discussed in the TCM literature. Many philosophers
also used the TCM theory to do philosophical research. Therefore, TCM not only
enriched ancient Chinese philosophy but also promoted the development of the
ancient philosophy.

1.1.4 TCM is a product of multidisciplinary interactions

To a certain extent, the development of TCM is also the medical application


history of multidisciplinary knowledge. Besides ancient Chinese philosophy,
our ancient astronomy, geography, meteorology, phenology, agronomy, biology,
botany, mineralogy, specialties, mathematics, and metallurgy played an impor-
tant role in the initiation and development of TCM. For example, meteorological
knowledge is an important factor in the development of the initial theory of
the six climatic pathogens. By comparing the four seasons, TCM recognized the
differences in pulse according to the changes of the four seasons. With knowl-
edge of geography, ancient TCM scholars developed the theory of treatment
according to environmental changes. Therefore, TCM is a product of multidis-
ciplinary interactions. Multidisciplinary knowledge promotes the development
of TCM.
1.2 The main characteristics of TCM theory  3

1.2 The main characteristics of TCM theory

The theoretical system of TCM is influenced by ancient philosophical thought and


developed over long-term clinical practice. TCM theory consists of two aspects:
holism and differential diagnosis and treatment.

Key points
– The main characteristics of the theoretical system of TCM:
– Concept of holism
– Differential diagnosis and treatment

1.2.1 Concept of holism

Key points
– The concept of holism includes the following:
– The human body as an organic whole
– The unity between human and environment

Wholeness signifies the unity and integrity of an object. TCM holds that the human
body is an organic whole in which all constituent parts are structurally insepar-
able, functionally coordinative and interactive as well as pathologically inter-
influencing. The human body is closely related to the natural and social environ-
ments. Through the process of adaptation, it maintains its balanced activities. The
concepts of unity between the internal and external environment, the connection,
the integrity of the body itself as well as the balance represent the wholeness of
TCM theory. The wholeness concept is an important thinking method permeating
in various areas such as physiology, pathology, diagnosis, health care and
treatment.
1. The human body as an organic whole
The human body is composed of different viscera and tissues. Each of them has
different functions which are the constituent part of the whole activity. A
human’s normal physiological activity is affected by the whole activity. On the
other hand, it also influences the functions of other viscera and tissues. This kind
of function is the whole activity. From the viewpoint of TCM, integral unity is
established by connecting the five zang-viscera, six fu-viscera, the five body con-
stituents, the sensory organs, the nine orifices, the four limbs, and the bones
through the meridian systems: The liver, gallbladder, tendon, and eye constitute
the liver system; the heart, small intestine, vessel, and tongue constitute the
heart system; the spleen, stomach, muscle, and mouth constitute the spleen
system; the lung, large intestine, skin, and nose constitute the lung system; and
4  1 Introduction

the kidney, urinary bladder, bone, ear, and anus constitute the kidney system.
These constituents form the whole unity and accomplish its functional activities.
Any local areas belong to the parts of the whole unity. Local illness, diag-
nosis, and treatment must be based on the concept of wholeness. Otherwise,
whole pathological changes will affect local disorder.
2. The unity between human being and external environment
Human being is a by-product of natural evolution. From the TCM point of view,
a human being is materially connected with the external environment. Human
beings live in nature. Therefore, the external environment will directly or indir-
ectly affect the functional activities of the human body. The body’s beneficial
adaptations to environmental changes belong to the category of physiologically
adaptive adjustments. Otherwise, they are called pathological reactions and will
result in diseases. This idea is referred to as the unity between the human being
and the external environment.
A. The unity between human being and nature
Human beings live in nature. Natural factors, for example, seasonal and cli-
matic changes, day and night as well as the geographical differences, can
directly or indirectly affect the body’s physiological functions and patholo-
gical changes.
In general, it is warm in spring, hot in summer, damp in late summer, dry
in autumn, and cold in winter. Under the influence of these climatic changes,
there are many adaptation changes for living things: germination in spring,
growth in summer, change in late summer, reap in autumn, and storage in
winter. Just as any other living thing, human beings must also adapt them-
selves to climatic changes. For example, in spring and summer, yang-qi rises
upward and flourishes whereas qi-blood of the body trends to circulate superfi-
cially, which often results in loose skin, profuse sweating, and less urination.
During autumn and winter, yang-qi goes inward and becomes astringent
whereas qi-blood of the body trends to go internally, which often results in
tight skin, less sweating, and more urination. These adaptations indicate that
seasonal climatic changes can influence the body’s physiological functions.
Although daily temperature changes are not as obvious or regular as
seasonal changes, long-term regular changes will result in the same rhyth-
mic change as the day and night to adapt to the changes in the environment.
Geographical differences in living environment are also an important
factor, which can directly influence the physiological function of the human
body. Regional climate and different cultures and customs are all geographi-
cal differences. They can affect the body’s physiological function and mental
activities to a certain degree. For instance, the southern region of China is
usually damp and hot, and the striae of the human body tends to be loose
and body shape thin; the northern part of China is dry and cold, and the
striae of the human body tends to be tight and the body shape is stronger.
1.2 The main characteristics of TCM theory  5

B. The close relation between human beings and society


Human beings live in society. Different social environments also result in
different physical and mental functions.
The change of social status definitely brings differences to the indivi-
dual’s spiritual life. Social development enriches humans, widens living
room, elevates levels of health care and promotes human living conditions
and lengthens life span. On the other hand, with a turbulent society or war
occurring frequently, an individual’s physical and mental functions will be
affected more. The progress that society makes will undoubtedly bring
many benefits to human health.
Due to the relationships of unity and opposition between the human
being and the external environment, the principles of treatment according
to time, different locations and each individual have become the important
rules in the TCM treatment. Therefore, more attention should be paid to the
organic relationships between the external environment and the overall
functional activity during the treatment process.

1.2.2 Differential diagnosis and treatment

Key points
– Syndrome
– A syndrome is a pathological summary during a stage of disease onset. It includes etiology,
the location of the disease, the pathology as well as the relationship between right and evil
pathogen.
– Differential diagnosis
– Differential diagnosis refers to the analysis, differentiation, recognition, and summarizing of
the syndrome of a disease by the collection of medical history, symptoms and signs through
the four traditional methods of inspection, olfaction, inquiry, and palpation.
– Treatment determination
– Treatment determination refers to the choice and formulation of the corresponding therapeutic
principle as well as the method according to the result of the differential diagnosis.
– Same disease but different treatment
– This method refers to the different treatment principles due to different disease onsets, differ-
ent disease locations, different body reactions or different stages of the disease originating
from the same kind of a disease. In other words, treatments are based on the different syn-
dromes.
– Different diseases but same treatment
– This method refers to the same treatment principle based on diseases with similar etiology,
and pathology.

There are fundamental differences among the syndromes, symptoms, and diseases.
Symptoms refer to the complaints by a patient, such as headache and abdominal
pain. The same symptom may have different reasons. And its pathological mechanism
6  1 Introduction

can also be completely different. Disease refers to a complete morbid process, includ-
ing the specific etiology, disease onset, typical clinical presentation, prognosis, and
outcome. For example, common cold, stroke, and dysentery are all diseases. There-
fore, compared to symptom and disease, syndrome reflects much profound pathologi-
cal change than the disease itself and symptom. Differential diagnosis refers to the
analysis, differentiation, recognition, and summarizing of the syndrome of a disease
by the collection of medical history, symptoms, and signs through the four traditional
methods of inspection, olfaction, inquiry, and palpation.
Treatment determination refers to the choice and formulation of the correspond-
ing therapeutic principle as well as the method according to the results of differential
diagnosis.
Differential diagnosis is the prerequisite and basis for treatment determination,
whereas treatment determination is the means and method for treating disease
based on the result of differential diagnosis as well as its execution. On the other
hand, treatment result can test the precision of differential diagnosis and treatment
determination. During clinical treatment, two different therapeutic methods – different
treatments for the same disease and the same treatment for different diseases – can
be applied separately according to the results of differential diagnosis.
Same disease but different treatment refers to different treatment principles
employed due to different disease onsets, different disease locations, different body
reactions or different stages of the disease originating from the same kind of a
disease. In other words, different treatments are based on different syndromes.
Different diseases but same treatment refers to the use of the same treatment
principle based on the different diseases with similar etiology and pathology. In
other words, the syndromes are the same.
On the whole, TCM treatment is based on the syndrome instead of different dis-
eases. Because the same syndrome represents the same patho-mechanism, the same
or similar treatment can be given; and different syndromes represent different
patho-mechanisms, therefore, the treatment must be given differently. This reflects
the true essence of differential diagnosis and treatment.
Yin-yang and the five elements belong to ancient Chinese philosophy. It is the
methodology by which our ancestors recognized and explained nature. The five ele-
ments permeate TCM and become an inseparable part of TCM. The yin-yang and five
elements theory is applied in TCM and has become the theoretical tool and metho-
dology of TCM. It determines the thinking mode of TCM and directs its clinical
practice.
2 The Philosophical Basis of Traditional
Chinese Medicine

2.1 Theory of yin-yang

2.1.1 The basic concept of yin-yang

Key points
– Yin and yang
– Yin and yang are the summarization of the attributes of two opposite aspects of correlative
subjects or phenomena in universe.

Relativity: The original meaning of yin and yang was very simple and was from
hieroglyphs. It mainly referred to the directions facing toward the sun and away
from the sun. Facing toward the sun belongs to yang, while facing away from the
sun belongs to yin. Based on the yin-yang theory, the ancient scholars made
further inferences and extensions. Anything with the characteristics of facing
toward the sun was classified as yang, while anything facing away from the sun
was classified as yin. Generally speaking, the things that bear the properties of
being active, external, ascending, warm, and bright pertain to yang, while the
things that bear the properties of being static, internal, descending, cold, and dark
pertain to yin.
Separability: The ancient scholars realized that all kinds of things and phenom-
ena had two opposite sides. The mutual actions of the two opposite sides promote
the formation, development, and change of things. Therefore, yin-yang was used to
explain all kinds of natural things that were inter-opposite and mutually wane or
wax. The interactions between yin and yang exist intrinsically within all kinds of
things. Thus, yin-yang is refined to a specific philosophical concept. It is the sum-
marization of the attributes of the two opposite aspects of correlative things or phe-
nomena in universe.
Correlation: Yin-yang refers to the attributes of two opposite aspects of correla-
tive things or phenomena. It can be used to distinguish all kinds of phenomena
under the condition that yin-yang stands for two correlative things or two opposite
aspects within one thing.
The ancients realized that all things can be divided without limitation. Any cor-
relative things or phenomena in the universe can be summarized as yin or yang.
Any aspect of yin or yang within one thing can be further classified into yin or yang.
This classification is called the infinite divisibility of yin-yang.
Everything is in constant motion. Therefore, the attributes of things in yin-yang can
change as well, which means that one side of yin-yang under a certain condition can
8  2 The Philosophical Basis of Traditional Chinese Medicine

transform itself into the other, that is, yin may change into yang and yang may change
into yin. Obviously, the yin-yang attribute is in relative motion and changes constantly.

2.1.2 The basic contents of yin-yang theory

The basic contents of yin-yang theory are mutual opposition and restriction, mutual
rooting and dependence, waxing and waning, and balance as well as mutual
conversion.

Key points
– The basic contents of yin-yang theory
– Mutual opposition and restriction of yin and yang
– Mutual rooting and dependence of yin and yang
– Waxing – waning and balance of yin and yang
– Mutual conversion of yin and yang

1. Mutual opposition and restriction of yin and yang


The opposition and restriction of yin and yang include two aspects. One
aspect refers to the opposition of yin and yang, while their properties are
opposite in the universe, such as heaven and earth, day and night, cold and
heat, active and static, internal and external, ascending and descending,
and entering and exiting. The other aspect refers to the complicated rela-
tionships of mutual restriction and opposition between yin and yang, such
as the four seasonal changes. It is warm and hot in spring and summer
because ascending yang qi restricts the cold-cool qi, while it is cool and
cold in autumn and winter because ascending yin qi restricts the warm-hot
qi. These are results of mutual restriction between yang qi and yin qi in
nature.
2. Mutual rooting and dependence of yin and yang
Yin and yang are rooted in each other. One cannot exist without the other. For
example, upper belongs to yang and lower to yin, and without the lower there
would be no upper, and vice versa. Left belongs to yang and right to yin, and
without left there would be no right, and vice versa. Thus, it is obvious that yin
and yang rely on each other. Interdependence of yin and yang refers to the
mutual generation and promotion among certain categories of yin-yang rela-
tionships. Take, for example, heaven and earth and cloud and rain. The water
on the earth can be carried up to the heaven to form cloud and mist by the
ascending of earthly qi, while the cloud and mist in the sky can fall onto the
surface of the earth in the form of rain by the descending of heavenly qi. This
reciprocal process of cloud and rain and heavenly qi and earthly qi is called the
interdependence of yin and yang.
2.1 Theory of yin-yang  9

3. The waxing – waning and balance of yin and yang


The waxing and waning of yin-yang refers to the movement of yin and yang.
The two opposite and interdependent forms are not in a state of stillness but
constantly change. This change includes the following two types.
In the first type, yin wanes while yang waxes or yang wanes while yin
waxes. The mutual restriction of yin and yang leads to such a consequence. For
example, considering the four seasonal changes, from winter to spring and
summer, the weather becomes warmer gradually, which is called yin wanes and
yang waxes, while from summer to fall and winter, the weather becomes colder
gradually, which is called yang wanes and yin waxes.
In the second type, yin wanes the yang also wanes or yin waxes the yang also
waxes. Under the condition of reciprocity of yin and yang, any side of yin-yang
becoming too deficient to promote its counterpart will make it weak, while any side
of yin-yang becoming abundant will promote its counterpart, so yin-yang also gets
abundant. For example, in qi and blood, qi belongs to yang and blood belongs to
yin. Qi promotes blood production and its deficiency may further cause blood defi-
ciency, resulting in manifestation of deficiency of both qi and blood. Tonifying qi
can promote the generation of blood. Thus, qi and blood are both sufficient. The
former is called waning of yin-yang and the latter is called waxing of yin-yang.
The waxing and waning movement of yin-yang is absolute and endless.
When waxing and waning of yin-yang can be kept within a certain range,
degree, and period, it will not be recognized and things will be in a relatively
stable state. On the contrary, when waxing and waning of yin-yang are not kept
within a certain range, degree, and period, things will be in an abnormal state.
4. Mutual conversion of yin and yang
Mutual conversion of yin and yang refers to yin-yang conversation among them-
selves under certain circumstances. It is the change of the attribute of yin-yang.
Anything has two aspects of yin-yang and is in the state of waxing and waning
motion. When the motion is out of a certain range, one side of yin-yang can
transform itself into the other. This change often occurs in the extreme phase
during the changing cycle. The waxing and waning of yin-yang is a process of
the quantitative change, while the transformation of yin-yang is a process of the
qualitative change based on the quantitative change.
The transformation of yin-yang can be a gradual process such as the alter-
nation of cold and warm during the four seasons. It can also appear to be a
sudden process such as the sudden shock or fainting as well as the cold extre-
mities during the acute febrile disease symptoms change suddenly from yang to
yin. No matter which kind of form it converses, it will always experience a
process from quantitative change to qualitative change.
Therefore, the mutual rooting and interdependence of yin-yang is the foun-
dation for the transformation of yin-yang. And the waxing and waning of yin-
yang is an important prerequisite for the transformation of yin-yang.
10  2 The Philosophical Basis of Traditional Chinese Medicine

2.1.3 The applicable examples in traditional Chinese medicine of the


yin-yang theory

1. To interpret the structure of human body


All the tissues and organs in the body are not only organically related to each
other but are also categorized into two parts of yin and yang. Generally speaking,
the upper part of the body pertains to yang, while the lower part to yin. The exter-
ior of body belongs to yang, while the interior of the body to yin. The back pertains
to yang, while the abdomen to yin. The lateral side of the four limbs pertain to
yang, while the medial side to yin. When considering the functions of the viscera,
the five zang-viscera pertain to yin because they store the essence but do not trans-
port and transform food. The six fu-viscera pertain to yang because they transport
and transform food but do not store essence. Among the five zang-viscera, the
heart and lung are located in the upper (thorax), so they pertain to yang, while the
liver, spleen, and kidney are located in the lower (abdomen), so they pertain to
yin. Each viscera itself can be further divided into yin and yang aspects, such as
heart-yin and heart-yang, kidney-yin, and kidney-yang.
Overall speaking, every part of the human body, superior – inferior, inter-
nal – external, interior – exterior, and anterior – posterior as well as the inner
organs may all be applied by yin-yang theory.
2. To explain physiological functions
The coordination and balance of yin-yang result in normal human life activity.
In terms of substances and functional activities, their relationship embodies the
unity of the opposite aspects of yin-yang. The physiological function of the
human body is based on the substances of the body. Without the movement of
the substances, there would be no physiological function. On the one hand, the
physiological activities consume energy and substances, but on the other hand,
they constantly promote metabolism as well as receive and store the energy.
Once the physiological activities are blocked to function normally, it will affect
the normal metabolism. Therefore, the relationship between the physiological
activities and substances is the process of mutual restriction, production as well
as waxing and waning of yin-yang. From the point of view of qi and blood, qi
belongs to yang while blood belongs to yin, and qi can generate, move, and
control blood. Therefore, the normal function of qi helps the blood to have the
normal production and circulation. Blood can generate and hold qi. Therefore,
the abundance of blood can promote qi’s normal function. The correlation
between qi and blood reveals the mutual rooting and interdependence of
yin-yang.
3. To explain pathological changes
The harmony and balance between yin and yang in Chinese medicine is consid-
ered as healthy symbol, whereas the imbalance of yin-yang is regarded as the
basic reason of the occurrence, development, and change of the disease.
2.1 Theory of yin-yang  11

The mutual rooting and restriction of yin-yang exist in the state of constant
waxing and waning. The imbalance of yin-yang will result in the excess or defi-
ciency that causes the diseases; which is called the disharmony of yin-yang. On
further analysis, the occurrence and development of disease mainly involve the
two aspects: vital qi and pathogenic qi. The vital qi is classified into yang qi and
yin fluid, while the pathogenic qi is classified into yin and yang pathogens. For
example in the six climatic pathogens, cold and damp belong to the yin patho-
gen, while wind, summer heat, and fire (heat) belong to yang pathogen. The
process of the occurrence, development, and change of the disease is a process
of conflict between the vital qi and the pathogenic qi. The conditions reflected
by the interaction and mutual conflict between the vital qi and the pathogenic
qi can all be explained by excess or deficiency of yin-yang, namely the imbal-
ance as well as the waxing and waning of yin and yang.
A. Excess of yin or yang
Excess of yin or yang refers to the pathological change due to the excessive
yin or yang. Generally speaking, the predominant part belongs to the
pathogenic qi, while the deficient part belongs to the vital qi that includes
yin fluid or yang qi. The pathological changes generally have the following
categories.
(a) Excess of yang: Excess of yang leads to heat and results in yin disease.
It refers to the pathogen going beyond the physiological limit and
reaching the absolute exuberance degree, all of which belongs to the
excess of yang. Due to the nature and pathogenic character of yang
pathogen, that is excessive heat, excessive yang results in heat. Predo-
minance of yang often consumes yin-fluid within the body and leads
to the pathological deficiency of yin-fluid. Therefore, there is a saying
“predominance of yang makes yin suffer.”
(b) Excess of yin: Excessive yin leads to cold and results in yang disease.
It refers to the pathogen going beyond the physiological limit and
reaching the absolute exuberance degree, all which belongs to excess
of yin. Due to nature and pathogenic character of yin pathogen, that is
excessive cold, the predominance of yin often damages yang-qi within
the body and leads to the pathological deficiency of yang-qi. Therefore,
there is a saying “predominance of yin makes yang suffer.”
B. Deficiency of yin or yang
Deficiency of yin or yang refers to the pathological change of either yin or
yang going beyond the normal level. Generally speaking, deficiency refers
to yang qi or yin fluid that is the same as the vital qi. The pathological
changes generally have the following categories.
(a) Deficiency of yang: Yang deficiency leads to cold. It refers to yang-qi
deficiency and is characterized by its decreasing ability to move and
warm the system. On the other hand, yang-qi deficiency causes the
12  2 The Philosophical Basis of Traditional Chinese Medicine

body to be easily attacked by cold pathogen. Therefore, there is a


saying “yang deficiency leads to cold.”
(b) Deficiency of yin: Yin deficiency leads to heat. It refers to the fluid defi-
ciency and is characterized by its decreasing ability to nourish and
moisten the system. On the other hand, yin deficiency cannot restrict
yang-qi and resists yang pathogen. Therefore, there is a saying “yin
deficiency leads to heat.”
C. Mutual damage of yin and yang
It is the pathological manifestation of both damage of yin and yang. Yin
and yang are mutually connected and rooted with each other. If one side is
damaged, the other side will be affected. When yang-qi or yin fluid gets
damaged, it will result in the deficiency of either side and cause a patholo-
gical change of the system.
When yang deficiency reaches to a certain degree, it cannot transform
or generate yin fluid, which results in symptoms of yin deficiency, which is
called damage of yang affects yin. Vice versa, when yin deficiency reaches
to a certain degree, it cannot nourish or moisten yang-qi, which results in
deficiency of yang-qi; this is called damage of ying affects yang. Both types
will lead to deficiency in both yin and yang eventually.
D. To guide the diagnostic application
Yin-yang diagnosis based on color and luster of the skin: A brighter color
pertains to yang, while a darker and gloomy color to yin.
Yin-yang diagnosis based on the sound of voice and breathing: Higher
tone, talkativeness and restlessness pertain to yang, while a low and feeble
voice, reticence, and speechlessness to yin. Rough breathing pertains to
yang, while shallow breathing to yin.
Yin-yang diagnosis based on pulse: From the position of the pulse,
cun pertains to yang, while chi pertains to yin; from the pulse rates,
rapid beats pertain to yang and slower ones pertain to yin; and from the
shape of the pulse, the floating, rapid, excessive, slippery, and big pulses
pertain to yang, while deep, slow, thin, small, and deficient pulses pertain
to yin.
In diagnosis, the accurate distinguishing of yin-yang is the key to master
the root of the disease. Eight principles are the fundamental diagnostic
method. Among the eight principles, external, excessive, and heat syn-
dromes pertain to yang, while internal, deficient, and cold syndromes to yin.
E. To guide the application to the treatment
The basic therapeutic principles of traditional Chinese medicine (TCM) are
to maintain the balance of yin-yang, reduce the excess and reinforce the
deficiency. The application of yin-yang theory to guide treatment of disease
is mainly to determine the therapeutic principle and to summarize the med-
icinal property.
2.1 Theory of yin-yang  13

(a) To determine the therapeutic principle


(i) The therapeutic principle for excess of yin and yang
It refers to the excess of yin or yang. It is a case of surplus. When
the excessive yin or yang has not caused the deficiency of the
opposite party, it belongs to the simple excessive case. The thera-
peutic principle is to sedate the excess. For example, excessive
yang causes heat, and the cooling or cold herbs should be
applied to restrict the yang and expel the heat. Vice versa, the
warm herbs should be applied to restrict the yin and expel the
cold.
(ii) The therapeutic principle for deficiency of yin or yang
It refers to the deficiency of yin or yang. The therapeutic principle
is to tonify the deficiency. Deficient yin often results in the inabil-
ity of yang restriction that causes the yin-deficient syndromes. In
this case, it is better not to use the cool-cold herbs to expel the
heat directly. Instead, the principle of nourishing yin and replen-
ishing water should be applied. By nourishing yin, heat due to the
hyperactive yang will be restricted. In the case of a deficiency-cold
pattern due to the excess of yin caused by the failure of deficient
yang to check yin, no dispersing medicine of acrid and warm
nature should be taken to dispel its coldness, but a method of
yang-supporting and fire-supplementing to expel the excessive yin
should be applied.
According to the theory of interdependence of yin-yang, the
methods of seeking yang from yin and seeking yin from yang may
also be considered in the treatment of the deficiency of yin or
yang. When using yang-warming herbs, by adding the yin-nou-
rishing herbs as the subsidiary, it is called seeking yang from yin.
When using yin-nourishing herbs, by adding the yang-supple-
menting herbs as the subsidiary, it is called seeking yin from
yang.
B. Summarization of the properties of the herbal medicine
Generally speaking, when differentiating the nature and properties of the
medicinal herbs, TCM focuses on the nature, the flavors, and the acting ten-
dencies (namely ascending, descending, sinking, and floating). They can
be summarized by the theory of yin-yang.
The nature: It refers to cold, hot, warm, and cool natures of herbs,
which is also called four natures. Among them, cold and cool belong to yin,
while hot and warm pertain to yang. Generally speaking, the herbs that can
reduce or eliminate the heat syndromes pertain mostly to cold-cool nature.
Conversely, the herbs that can reduce or eliminate the cold syndromes
pertain to warm-hot nature.
14  2 The Philosophical Basis of Traditional Chinese Medicine

The five flavors: The flavors refers to acrid, sweet, sour, bitter, and
salty. Among them, acrid, and sweet flavors pertain to yin, while the sour,
bitter, and salty flavors pertain to yin.
Ascending, descending, floating, and sinking: These refer to the
actions when herbs enter into the human body. Herbs with actions of yang-
elevating, exterior-relieving wind and cold-expelling, emesis, and orifice-
opening mostly have the ascending and outward-going properties. They are
characterized by ascending and floating actions, so they belong to yang.
While herbs with actions of purgation, heat-clearing, diuresis, mind-tran-
quilizing, yang-subduing, wind-quenching, digestion-promoting, vomiting-
stopping, and qi-astringing mostly have the descending and inward-going
properties. They are characterized by sinking and descending, so they
belong to yin.

2.2 Five elements theory

Five elements theory belongs to the category of ancient philosophy. It believes


that the world is made of five basic substances with the specific forms, namely
wood, fire, earth, metal, and water. These five substances are in a state of mutual
generation and restriction. Due to this fact, the world moves and changes con-
stantly, and everything in this world is directly or indirectly related. When the
theory of the five elements is applied in TCM, it helps the TCM doctors to recognize
the internal relationships inside the body as well as its connection with its outside
surroundings.

2.2.1 Fundamental concepts and characters of the five elements

Key points
– Fundamental concepts of the five elements
– It refers to the mutual connection and their change of movement among the five elements.
– The characters of the five elements
– Wood is characterized by bending and straightening, fire is the flaming upward, earth is the
sowing and reaping, metal is the working of change, and water is the moistening and descending.

1. Fundamental concepts of the five elements


In Chinese, wu refers to five different subjects, namely wood, fire, earth,
metal, and water. Xing has two meanings. One refers to order, while the
other refers to movement and change. Therefore, wu xing, or the five ele-
ments, refers to the connections, movement, and changes among the five
elements.
2.2 Five elements theory  15

2. The characters of the five elements


The concept of five elements was once the abstract conceptualization of cli-
matic feature and phenological characteristics for five time interval of the
Yellow River basin. Respectively, wood indicates everything grows in warm
spring; fire indicates everything thrives in hot summer; earth indicates
everything transforms in moist late-summer; metal indicates everything
restrains in cool and dry autumn and water indicates everything stores and
hides in cold winter. The feature of five elements can be generalized by cli-
matic characters of spring-warm, summer-hot, late summer-moist, autumn-
dry, and winter-cold, as well as by phenological change characteristics of
growing, thriving, transforming, restraining, and storing. Shang Shu Hong
Fan wrote: “Wood bends and strengthens; Fire burns and flares up; Earth
provides for sowing and reaping; Metal works for change; Water moistens
and flows downward.” Hence, feature of five elements became wider and
abstracter.
With the practice of everyday life and production, characteristics of five ele-
ments were gradually developed and formed by ancient people through their
life experience and recognition toward elements of wood, fire, earth, metal, and
water. The characteristics were mainly used to analyze and generalize the attri-
butes of various things in the five elements, and to study the connection among
different subjects. Therefore, the characteristics of five elements have gone
beyond their concept.
Characteristics of wood: Wood bends and strengthens, which means stems
and branches of a tree can bend, strengthen, and grow upward and outward.
Thus, it is inferred that anything that has the function or property of growing,
developing, and flourishing is attributed to wood.
Characteristics of fire: Fire burns and flares up, which means that fire has
the characters of warmth, heat, and ascending. Thus, it is inferred that anything
that has the function or property of warmth, heat, and ascending is attributed to
fire.
Characteristics of earth: Earth provides for sowing and reaping, which
means that earth can be used for sowing and reaping. Thus, it is inferred that
anything that has the function or property of generating, holding, and receiving
is attributed to earth.
Characteristics of metal: Metal works for change, which means that metal
has the characteristics of clearing and descending. Thus, it is inferred that any-
thing that has the function or property of clearing, descending, and astringing
is attributed to metal.
Characteristics of water: Water moistens and flows downward, which means
that water has the characteristics of moistening and descending. Thus, it is
inferred that anything that has the function or property of cold and coolness,
moistening, and descending is attributed to water.
16  2 The Philosophical Basis of Traditional Chinese Medicine

2.2.2 The classification of the five elements

1. Direct classification
Direct classification is to compare some phenomenon directly with some charac-
teristics of the five elements, so as to get the property of the thing or phenom-
enon in the five elements.
Taking the directions and the five elements as example, the east with more
vital power where the sun rises is similar to characters such as growing, devel-
oping, and flourishing of wood, so east pertains to wood. In the south where it
is hot, plants are flourishing, which is similar to characters such as burning and
flaring of fire, so the south pertains to fire. The west with a declining sign where
the sun sets is similar to characters such as clearing and descending of metal,
so west pertains to the metal. In the north where it is cold, pets are torpid,
which is similar to characters such as cold and storage of water, so the north
pertains to water. In the central region, the climate is mild and governs the four
directions as well engenders the myriad things, so the central region pertains to
earth.
2. Indirect inferring
When a thing or phenomenon with one of the characters of the five elements
has been classified into one of the elements, some other things or phenomena
that are closely related with it can also be brought into this element. This
classification is called indirect inferring. Lots of dampness occur during the
late-summer when it is humid; therefore, dampness pertains to earth. Lots of
dryness occur during the fall; therefore, dryness pertains to metal.
The theory of the five elements categorizes subjects or phenomena by direct
classification or indirect inferring according to the characters of the five ele-
ments. Among the subjects or phenomena that are classified into the same
element, there must be certain inner relationship of either one or another type.
This type of connection is based on the similar characteristics among the same
type of subjects. Table 2.1 shows the attribution of subjects in nature and
human to the five elements.
Tab. .: The attribution of things in nature and human to the five elements

Nature Human body


5
5      Elements  Zang-  Fu-  Sense   
Notes Flavors Colors Changes Climates Directions Seasons viscera viscera organs Constituents Emotions Secretions

Jue Sour Green Germina- Wind East Spring Wood Liver Gall Eye Tendon Anger Tear
tion bladder
Zhi Bitter Red Growth Heat South Summer Fire Heart Small Tongue Vessel Joy Sweat
intestine
Gong Sweet Yellow Transfor- Dampness Center Late- Earth Spleen Stomach Mouth Muscle Thinking Saliva
mation summer
Shang Acrid White Reaping Dryness West Autumn Metal Lung Large Nose Skin Sorrow Nasal
intestine discharge
Yu Salty Black Storing Cold North Winter Water Kidney Urinary Ear Bone Fear Spittle
bladder
2.2 Five elements theory

17
18  2 The Philosophical Basis of Traditional Chinese Medicine

2.2.3 The cycle of generation, restriction, over-restriction, and counter-restriction


in five elements

1. Generation and restriction among the five elements


A. Generating cycles among the five elements
Sheng refers to generation. Generation among the five elements means that
one of the five elements generates and helps another element in the five
elements.
The order of generation among the five elements is as follows: wood
generates fire, fire generates earth, earth generates metal, metal generates
water, and water generates wood.
In the generating relationships among the five elements, each element
has two sides of being generated or generating. The generating one is con-
sidered to be mother, while the one being generated is considered as the
child. Therefore, the generating relationships among the five elements are
so-called mother – child relationship. Take wood as an example. Wood is
generated by water, so water is the mother of wood and wood is the son of
water. Wood generates fire, so wood is the mother of fire, while fire is the
son of wood.
B. Restriction among the five elements
The Chinese character ke refers to restriction. Restriction among the five
elements means that one of the five elements restricts and checks another
element in the five elements. The order of restriction is as follows: wood
restricts earth, earth restricts water, water restricts fire, fire restricts metal,
and metal restricts wood.
In the restricting relationships among the five elements, each element
has two sides of being restricted and restricting. The one being restricted is
the phase that is dominated by another, while the one restricting is the
phase that dominates the other. Take wood for example. The one that
restricts wood is metal and the one that is restricted by wood is earth. Thus,
metal is called the dominator of wood and earth is called the subordinate
of wood.
Generation and restriction among the five elements are two insepar-
able aspects, which expresses concretely that there is restriction within gen-
eration and there is generation within restriction. For example, wood gener-
ates fire and also restricts earth; earth restricts water and also generates
metal. The relationships of restriction within the generation and generation
within restriction can be the key to maintain the coordination and balance
of everything.
2. Over-restriction and counter-restriction among the five elements
These two cycles indicate the abnormal relationships among the five ele-
ments.
2.2 Five elements theory  19

A. Over-restriction among the five elements


Over-restriction means excessive restriction. In five elements, it refers to an
abnormal condition in which one element of the five elements excessively
restricts its restricting element, namely over-restriction. It has the same
sequence as the restricting cycle.
B. Counter-restriction among the five elements
Counter-restriction means the reverse restraint. It refers to an abnormal
condition in which one element of the five elements reversely restrains and
bullies the element that restricts it. Its sequence is just the opposite of the
restricting cycle.
There are two causes that result in over-restriction and counter-restric-
tion. One is due to the one element being overly powerful, which either exces-
sively restrains the element that it normally restrains or reversely restricts the
element that originally restricts it. For example, if wood is too powerful, it will
excessively restrain earth, leading to the deficiency of earth which is called
wood over-restricting earth. As another example, under the condition of too
much power of wood, it is not only being restricted by metal but also reversely
restricts metal. This cycle is called wood counter-restricts metal. The other is
that one element among the five elements becomes too weak, which causes
either the element that restricts it being relatively hyperactive or the element
being originally restricted by it being relatively powerful. Hence, the cycle of
over-restricting or counter-restricting occurs. For example, if the strength of
earth itself gets weaker, then the strength of restriction of earth by wood
becomes relatively enhanced and it will make earth more deficient. This cycle
is called wood over-restricts earth. As another example, when the powerful-
ness of metal gets too weak, it cannot restrict wood anymore and it will be
reversely restricted by wood. This cycle called wood counter-restricts metal.
Both over-restriction and counter-restriction are abnormal restrictions
and they both have differences and similarities. The difference is that over-
restriction has the same sequences as the restricting cycle, except that one
element is being overly restricted, while the counter-restriction follows the
same sequence as the restricting cycle besides the abnormal restricting
cycle. The similarities are that when the over-restriction occurs, the
counter-restricting cycle can appear at the same time, and vice versa.

2.2.4 The application of five elements theory in TCM

1. To explain the physiological functions of the five viscera and their relationships
A. To explain characteristics of the physiological functions in five viscera
The five elements theory classifies the five zang-viscera into the five ele-
ments to explain their physiological functions. For example, the liver
20  2 The Philosophical Basis of Traditional Chinese Medicine

prefers to free flow of qi and tends to be free from obstruction. So its char-
acteristic of the physiological function is to smoothen qi dynamically. This
is similar to the characteristics of wood of growing and flouring. Therefore,
the liver pertains to wood. The rest can be explained in the same order.
B. To explain the inner relationships among the five viscera
Because five zang-viscera are attributed to the five elements, not only their
physiological functions can be explained by this theory but also their inner
relationships can be explained by the generating and restricting cycles.
Generation among the five elements may be used to explain the gener-
ating relationships among the five zang-viscera. For instance, the liver
stores blood to support the heart. Thus wood generates fire and liver pro-
motes heart, and so on.
The restricting relationships among the five zang-viscera can be
explained in term of restriction among the five elements. For instance, the
transformation and transportation by the spleen may prevent the disorder
of kidney (water), which is referred to as earth restricting water. The kidney
(water) yin goes up to prevent the hyperactivity of the heart (fire), which is
referred to as fire restricting fire, and so on.
2. To explain pathological change and their mutual influences
A. The abnormal change of generating cycle means that disease occurs by
following the order of generation or against the order of generation. It
includes two conditions: involvement of the child by its mother and invol-
vement of the mother by its child.
(i) The involvement of the child by its mother means that disease occurs
following the order of generation. It means that a disorder of a mother-
element involves or affects its child-element, leading to both anomalies
from mother to child. Because a mother-element is weak, its child-
element also gets deficient. For example, if a kidney disease affects the
liver, a mother disease involves its child.
(ii) The involvement of the mother by its child means that disease occurs
against the order of generation. It means that a disorder of a child-
element involves or affects its mother-element, leading to both anoma-
lies from child to mother. For example, if a heart disease affects the
liver, a child disease involves its mother.
B. Abnormal change of restriction is over-restriction and counter-restriction. It
means that disease occurs following order of restriction or against the order
of restriction. For example, if a liver disease affects the spleen, which is
called wood over-restricting earth; if a liver disease involves the lung,
which is called wood counter-restricting metal.
3. To guide the clinical diagnosis
The five zang-viscera have certain relationships in the attribution to the five ele-
ments according to the changes of five colors, five flavors, five emotions, and
2.2 Five elements theory  21

pulse condition. Therefore, the theory of the five elements can be used to diag-
nose disease.
According to its attribution to the five elements, the diagnosis can be made
according to the laws of generation and restriction. For example, a patient
whose complexion is greenish with a preference for sour food and a wiry pulse
may be diagnosed as having a liver disease; a patient with spleen deficiency
accompanied with a greenish complexion implies that wood (liver) over-restricts
earth (spleen) with deficiency.
4. To guide the treatment of disease
A. To prevent the changes of disease
During the disease onset, one zang-viscera disease may affect other zang-
viscera. Therefore, when treating the pathological viscera, the other related
zang-viscera should also be treated according to the laws of generation,
restriction, over-restriction, and counter-restriction. Thus, the changes of
disease can be prevented and the recovery can be promoted.
B. To decide the therapeutic principle and method
(i) The therapeutic principle and method to be decided according to the
law of generation
The therapeutic principles decided according to the law of generation
include “tonifying the mother for deficiency and sedating the child for
excess.”
Tonifying the mother for deficiency: This principle is applied in
the deficiency syndrome of both mother and child. For example, if
kidney yin gets deficient and fails to nourish the liver-wood, it implies
that water fails to nourish wood. The therapeutic principle is not only
to deal with the liver but also to nourish kidney yin. Therefore, by
nourishing the kidney, yin will nourish liver.
Sedating the child for excess: This principle is applied in the
excess syndrome of both mother and child. Take for example the liver
fire that gets too hyperactive. The liver is the mother and the heart
is its child. Therefore, sedating heart fire will help to restrict liver
fire.
There are other therapeutic methods applied according to the gen-
erating cycle that mainly include the following.
The method of replenishing water to nourish wood: This method
is also called replenishing the kidney to nourish the liver. It is a method
to nourish the liver by supplementing the kidney so as to astringe liver
yang and is mainly suitable for liver-kidney yin deficiency, or liver-yin
deficiency and liver-yang uprising.
The method of reinforcing earth to strengthen metal: It is also
called invigorating the spleen to benefit the lung. It is a method to
replenish lung qi by replenishing spleen qi and is mainly suitable
22  2 The Philosophical Basis of Traditional Chinese Medicine

during an insufficiency of both the spleen and lung due to the lung qi
deficiency or spleen and stomach deficiency.
The method of assisting fire and strengthening earth: It is also
called warming the kidney and strengthening the spleen. It is a method
to support spleen yang by warming and strengthening kidney yang
and is suitable for a syndrome of yang deficiency of both the spleen
and kidney or a part of patterns of spleen yang deficiency.
It should be pointed out that in terms of generating law among the
five elements, heart belongs to fire and spleen to earth. Fire failing to
generate earth should be understood as the failure of heart fire to
promote spleen-earth. However, since the time when the theory of life
gate was established, there was a change in this concept. Clinically,
the fire refers to the kidney yang (or life gate fire), and seldom means
the heart fire anymore.
The method of mutual generation of metal and water: a method of
nourishing both lung and kidney yin. It is also called as the method of
lung-nourishing and kidney-tonifying and is mainly suitable for the
case when insufficient lung fails to distribute the fluid to nourish
the kidney, or the case of yin deficiency of the lung and kidney due
to the kidney-yin deficiency with failure of essence-qi to go up to
nourish the lung.
(ii) The therapeutic principles and methods according to the restriction
law
The therapeutic principles selected according to law of restriction
include restricting the strong and strengthening the weak.
Restricting the strong: This is a therapeutic principle to restrict the
hyperactive viscera. For example, if the liver qi gets disordered, it can
transversely affect the stomach or spleen and lead to disharmony of
the liver and the stomach, or disharmony of the liver and spleen. The
therapeutic method is to sooth or restrict the liver.
Strengthening the weak: This is a therapeutic principle to support
the functions of the viscera being either over-restricted or counter-
restricted. For example, if the insufficient kidney yin (water) fails to
restrict the heart fire, it is called disconnection between the kidney and
the heart. The clinical manifestations are soreness and weakness of the
lower back and knees, insomnia, spermatorrhea, and so on. The treat-
ment should be nourishing kidney yin along with sedating heart fire.
The therapeutic methods selected according to the law of restric-
tion include the following.
Inhibiting wood to assist earth: It is also called smoothing the
liver and strengthening the spleen. This is a method to treat the case of
failure of the insufficient spleen in transformation and transportation
2.2 Five elements theory  23

due to hyperactivity of liver qi by soothing the liver and strengthening


the spleen. It is mainly suitable for the pattern of excessive depressed
liver over-restricting spleen.
Supporting earth to restrict water: This is a method to treat the
case of accumulation of water-dampness by warming and strengthen-
ing spleen yang, or strengthening the spleen and warming the kidney.
It is mainly suitable for the oedema due to the spleen deficiency failing
to transport and transform the water-dampness. Earth here refers to
spleen, while water means damp pathogen. The definition is a little
different.
Assisting metal to subdue wood: It is also called subduing the liver
and clearing the lung. This is a method to inhibit the hyperactivity of liver
fire by clearing and purifying lung qi. It is mainly suitable for the case of
excessive liver fire affecting the clearing and descending of lung qi.
Sedating the south and tonifying the north: It is also called a
method of fire-sedating and yin-nourishing. South refers to fire (heart
fire) and north to water (kidney yin). This method is to sedate heart-fire
and nourish kidney-water. It is mainly suitable for the case of kidney-
yin deficiency and heart-fire excess. This syndrome is called discon-
nection between heart and kidney.
C. To guide treatment for mental disorder
The emotions originate from the five zang-viscera, and among the latter
there are relationships of generation and restriction. Therefore, there are
the same generating and restricting relationships among the emotions.
Clinically, by applying these restricting relationships, the emotional disor-
ders can be regulated and the disease can be treated. This method is called
the restricting and non-restricting laws of the five emotions.
Sorrow is the emotion of the lung that belongs to metal, while anger is
the emotion of the liver that belongs to wood. Therefore, metal can restrict
wood and sorrow can restrict anger.
Fear is the emotion of the kidney that belongs to water, while joy is the
emotion of the heart that belongs to fire. Therefore, water can restrict fire
and fear can restrict joy.
Anger is the emotion of the liver that belongs to wood, while pensive-
ness is the emotion of the spleen that belongs to earth. Therefore, wood can
restrict earth and anger can restrict pensiveness.
Joy is the emotion of the heart that belongs to fire, while worry is the
emotion of the lung that belongs to metal. Therefore, fire can restrict metal
and joy can restrict worry.
Pensiveness is the emotion of the spleen that belongs to earth, while
fear is the emotion of the kidney that belongs to water. Therefore, earth can
restrict water and pensiveness can restrict fear.
3 Visceral Manifestation

3.1 Summarization of visceral manifestations

Key points
– The categories and common functions of zang-fu organs:
– Five zang-organs include the heart, the liver, the spleen, the lungs, and the kidneys; the
common function of the five zang-organs is to produce and store jing-qi (essence).
– Six-fu organs include the gallbladder, the stomach, the small intestine, the large intes-
tine, the urinary bladder, and the triple burners; the common function of the six-fu
organs is to receive, transport, and transform food.
– The extraordinary fu-organs, which are hollow and resemble the fu-organs in shape and
store essence and resemble the zang-organs in function, include the brain, the marrow,
the bones, the vessels, the gallbladder, and the uterus.

The term zangxiang first appeared in Suwen. Zang refers to internal organs inside the
body. Xiang refers to external manifestations of physiological and pathological phe-
nomenon. The theory of zangxiang (visceral manifestations) mainly focuses on the
physiological functions, pathological changes and relationships of zang-fu organs,
which is the core parts of traditional Chinese medicine (TCM).
The theory of visceral manifestations is mainly based on the zang-organs and
the fu-organs. Zang-fu is a collective term for internal organs, which can be divided
into three categories, namely the zang-organs, the fu-organs, and the extraordinary
fu-organs. Zang-organs include the heart, the liver, the spleen, the lungs, and the
kidneys; collectively called the five zang-organs. The common function of the five
zang-organs is to produce and store jing-qi (essence). Fu-organs include the gall-
bladder, the stomach, the small intestine, the large intestine, the urinary bladder,
and the triple burners; collectively called the six-fu organs. The common function of
the six-fu organs is to receive, transport, and transform food. The extraordinary
fu-organs, which are hollow and resemble the fu organs in shape and store essence
and resemble the zang-organs in function, include the brain, the marrow, the bones,
the vessels, the gallbladder, and the uterus.
The theory of visceral manifestations has already established a comparatively
complete framework in Huangdi Neijing. Later, the doctors further explored and
supplemented on the framework that was originated from the following aspects:
knowledge of ancient anatomy, observation of physiological and pathological phe-
nomenon, and accumulation and conclusion of clinical practice. On the whole, the
theory of visceral manifestations that was formed based on the knowledge of
ancient anatomy and through long-term accumulation of practical experiences
then came into being through observation of various external manifestations
caused by the internal organs utilizing generalization, abstraction, reasoning,
analogy, and other methods.
3.2 Five zang-organs  25

The theory of visceral manifestations is characterized by holism centered by


five-zang organs which embodies as follows: firstly, one zang-organ and one fu-
organ have exterior – interior relationship; secondly, the five-zang organs have
close relationships with the body, organs, and orifices; thirdly, physiological func-
tions of the five-zang organs are closely connected with mind. The theory of visceral
manifestations emphasizes on five-zang organs, attributing six-fu organs, the body,
organs, and orifices, and the mental activity to five-zang organs, and forming five
physiological and pathological systems represented by the heart, the lung, the
spleen, the liver, and the kidney. The five systems promote one another, restrain
each other, and maintain harmony and balance of any circumstances inside the
body, which represents the integrity and unity of human body.

3.2 Five zang-organs

3.2.1 Heart

Key points
– The physiological functions of the heart:
– Governing blood and vessels
– Storing the spirits
– The systemic relationships of the heart:
– The heart is related to the vessels in body constituent, and shines in the face.
– The heart opens into the tongue.
– The heart corresponds to joy in emotion.
– Sweat is the fluid of the heart.

The heart is located in the chest between the two lobes of lung, above the dia-
phragm, which is just like the stamen of lotus. It is surrounded by a protective mem-
brane, the pericardium.
The physiological functions of the heart mainly include two aspects: to govern
blood circulation and to govern mental activities. The systemic relationships of the
heart with the body are as follows: the heart has an exterior – interior relationship
with small intestine and is associated with the vessels in constituent, reflects its bril-
liance in the face, is associated with joy in emotion, with tongue in orifice, and with
sweat in secretion.
1. Functions of heart
A. Governing blood and vessels
The term heart governing blood and vessels was first seen in the Suwen
theory of atrophy. Generally speaking, it means that the heart can push
the blood streaming in the vessels naturally, which in turn means that the
heart governs the blood of the whole body and it also governs all the
26  3 Visceral Manifestation

vessels in the body. Blood circulation and its moistening function depend
on heart qi’s motivation. The vessels all around the body are connected
to heart, forming a net in which blood flows. Therefore heart is named as
the house of blood. The heart is linked with the blood vessels to form
a closed system. Blood can flow within the vessels fluently throughout
the body. The three conditions necessary for normal blood circulation
are as follows: the heart qi must be sufficient, the blood must be plentiful,
and the vessels must not be obstructed. If there is a disorder in any of
the factors, disease will occur. Sufficient heart qi is the most important
factor. The function of the heart governing blood and vessels is manifested
as pulse, facial complexion, tongue color, and the feeling in the chest.
If heart functions well, the pulse is normal, smooth, and harmonious;
complexion is bright and lustrous; and tongue is red and bright. If insuffi-
ciency of heart qi or blood occurs, conditions of pulse, facial complexion,
and tongue color will be abnormal. For instance, pale complexion, pale
and enlarged tongue, fine and weak pulse, and palpitation indicate insuf-
ficiency of heart qi. If there is a blockage of heart vessels, cyanosed
face, dark-purple tongue with petechiae and ecchymoses, rough or inter-
mittent pulse, and pain in the middle or lateral part of the chest will be
manifested.
B. Storing the spirits
The heart storing the spirits is recorded in Suwen, also named as heart con-
trolling the mind.
Shen (spirits) is an important concept in TCM. In a broad sense, spirit refers
to manifestations of life activities, such as physical condition, expression,
and complexion. In a narrow sense, spirit refers to mental activities, includ-
ing spirit, consciousness, and thinking. All of spirit activities are controlled
by the heart, which is an important function of the heart. The function of
heart storing spirits can be manifested as spirit, consciousness, thought,
and sleep. When the function of heart in storing spirit is normal, there will
be high spirit, clear consciousness, acute thinking, and deep sleep. And
when the function of heart in storing spirit is abnormal, there will be
insomnia or dream-disturbed sleep; agitation; slow response; insanity from
mental disturbance caused by phlegm-fire harassing the heart; loss of con-
sciousness; apathia; amnesia; dementia due to phlegm clouding the heart
spirit, or high fever or coma due to fire harassing pericardium. All these
abnormalities can be treated according to the heart condition. The two
functions of the heart are very closely related to each other. The heart
governs blood circulation, and blood is a cardinal basis of substance for
viscus functions. Mental activities are external reflections of the functions
of viscus. So dysfunction of the heart in governing blood circulation often
results in abnormality of the spirits, and vice versa.
3.2 Five zang-organs  27

2. Systematic relations of the heart


A. The heart is related to the vessels in body constituent, and shines in the face
The vessels are governed by the heart. Because the vessels are connected
with the heart all through the body, the heart is related to the vessels in
body constituent. The most adorned tissue by the heart is the face, which
means that the normality of the function of the heart may be reflected by
color of the face or the changes of complexion may serve as a mirror to
show whether the heart functions well. When the heart qi is vigorous,
blood in the vessels is enough and the complexion will be ruddy and lus-
trous. If heart blood is deficient, complexion will be sallow. If the blood is
stagnated, the complexion will be bluish purple.
B. The heart opens into the tongue
The function of the tongue is to taste and speak. If heart functions well,
tongue will be red and bright, taste quickly, and speak fluently. If heart
does not function well, taste will change and tongue rigidity and delirium
may occur. Hence, the tongue can reflect physiological and pathological
conditions of the heart. For example, if heart-yang is deficient, tongue will
be pale, white, tender-soft or enlarged. If heart-yin is deficient, tongue will
be crimson and thin. If heart fire is flaming upward, tongue will be red, and
aphtha may occur. When there is a stagnation of the heart blood, the
tongue will be dark purple or with petechiae and ecchymoses. When the
heart does not function normally in governing mental activities, tongue
rigidity, delirium or aphasia may occur.
C. The heart corresponds to joy in emotion
The function of the heart is related to joy in emotion. Generally speaking,
joy is a reaction to an optimal stimulation from outside information and is
beneficial to health. But overjoy may lead to heart disorder, making the
heart-qi sluggish and the mind unable to concentrate.
D. Sweat is the fluid of the heart
The heart is related to sweat. When a person is nervous or scared, sponta-
neous sweating occurs. Because the heart is cardinal lord of five zang-
organs and six fu-organs and governs mental activities, sweating caused by
spirit is related to heart. Hence, sweat is named as the fluid of the heart.

3.2.2 Lung

Key points
– The physiological functions of the lung:
– Dominating qi and controlling respiration
– Free and regulate the waterways
– The lung links with all the vessels
28  3 Visceral Manifestation

– The systemic relationships of the lung:


– The lung is related to the skin in body constituent, and shines in body hair.
– The lung opens into the nose and produces the discharge.
– The lung corresponds to sorrow and worry in emotion.
– Discharge is the fluid of the lung.

The lung, consisting of the two lobes, is located in the chest. It is compared to the
canopy because of its uppermost position among all the viscus. The main physiologi-
cal functions of the lung are to dominate qi, control respiration, smoothen water
passage, and assemble vessels. The lung is a place for convergence of blood vessels
and helps in charging coordinative activities of qi, blood, and body fluids. The sys-
temic relationships of the lung with the body are as follows: the lung has an exter-
ior – interior relationship with large intestine, and is associated with skin in consti-
tuent, reflects its brilliance in the hair, is associated with sorrow in emotion, with
nose in orifice, and with nasal discharge in secretion.
1. The physiological functions of the lung
A. Dominating qi and controlling respiration
The lung dominating qi and controlling respiration is recorded in Suwen.
Lung dominating qi means “taking charge of the qi in respiration and oper-
ating the qi of the whole body.”
(a) Taking charge of the qi in respiration
The lung taking charge of the qi in respiration is due to dispersing and
descending of lung qi in breathing movement. The lung is the chief
organ for exchanging air between the interior and the exterior of the
body. Human body takes in fresh air and expels waste gas by the lung’s
respiratory function, therefore, to keep the metabolism of the human
body functioning smoothly. If the lung’s functions are abnormal due to
being harmed by external pathogenic factors, respiratory disorders will
occur, such as cough, asthma dyspnea.
(b) Operating the qi of the whole body
The lung operating the qi of the whole body can be divided into two
aspects. The first is that the lung takes part in qi production, especially
pectoral qi. The lung performs respiratory function and inhales fresh
air from nature. The fresh air inhaled by the lung from nature forms
an important source for the formation of qi in human body. The
second is that the lung regulates qi movement of the whole body. The
qi of the lung can be dispersing and descending through the lung qi of
the whole body will be ascending or descending, entering or exiting.
By activating the flow of qi, lung is able to govern diffusion, disper-
sion, purification and descent of qi, as well as regulate the qi of entire
body.
3.2 Five zang-organs  29

B. Free and regulate the waterways


This theory was first recorded in Jingmaibielun of Suwen. It refers to the
function of diffusion, dispersion, purification, and descent. The lung regu-
lates and controls water passage. Through its dispersion, lung qi disperses
body fluids and food essence upward to face and head as well as outward
to skin and hair. It disperses defensive qi to ensure the closing and opening
of the sweat pore to discharge sweat generated after the metabolism.
Through descending function of lung qi, water and food essence are trans-
ported downward and inward to nourish the whole body while the turbid
fluid generated after metabolism is transported downward to become urine
through the urinary bladder. Since the lung is the highest position of
viscera and participates in the water metabolism of the whole body, it is
known as the upper source of water. If there is a disorder in the function of
lung’s freeing and regulating the waterways, it will affect the water metabo-
lism which is manifested as edema, phlegm, and fluid retention.
C. The lung links with all the vessels
Linking refers to gathering whereas all the vessels refer to all blood vessels in
the body. Therefore, lung linking to all the vessels means all blood assem-
bling into the lung through vessels. Through breathing and exchanging
turbid qi with clear qi in the lung, abundant blood in clear qi is transported to
the whole body. Linking with all the vessels is the manifestation of lung gov-
erning dispersing and descending in blood circulation. Through the lung’s
dispersion, lung qi disperses blood outward. Through descending function of
lung qi, blood is transported inward and backward to nourish lung. There-
fore, lung qi is able to help blood circulation. The lung linking with all the
vessels also means that the lung can promote blood circulation for heart. In
clinical settings, the dysfunction of lung qi of dispersing and descending can
result in blood stagnation. Therefore, the function of lung includes three
aspects: firstly, it forms qi and regulates movement of qi; secondly, it regu-
lates water metabolism; and thirdly, it promotes blood circulation. Qi, blood,
and body fluids are the basic materials to form and sustain life activities of
the human body. If qi, blood, and body fluids are in normal condition, a
person will be in good health. In a broad sense, the regulation of qi, blood,
and body fluids of the whole body all depends on the lung. Therefore, TCM
believes that lung governs coordination and is considered the prime minister.
2. The systemic relationships of the lung
A. The lung is related to the skin in body constituent, and shines in body hair
The skin and fine hair are on the surface of the human body. They rely on
the lung’s dispersion of wei qi and nourishment of the body fluids. They are
the first barrier against external pathogens. Through the lung qi’s dispersing
function, the essence can be transported to nourish and warm the skin and
fine hair. When functions of the lung are normal, the skin and fine hair are
30  3 Visceral Manifestation

lustrous; the exogenous pathogenic factors are not be able to invade in the
body. When functions of the lung are abnormal, lung qi is deficient and fails
to diffuse defensive qi onto the skin and fine hair, resulting in polyhidrosis
and common cold. When skin and fine hair are affected by exogenous patho-
genic factors, there will be cough or asthma due to disorder of the lung.
B. The lung opens into the nose
The nose is the passage way for entrance and exit of respiration. It communi-
cates with the lung. Therefore, the nose is the orifice of the lung. Lung has a
close relationship with the nose. The normality of the nose in ventilation and
smelling depends upon the function of the lung qi. When lung qi diffuses
smoothly, the nose will be free from obstruction with keen smelling. If the lung
qi fails in diffusion, it will lead to nasal obstruction and hyposmia. The diseases
of lung are mostly caused by exogenous pathogens through mouth or nose.
C. The lung corresponds to sorrow and worry in emotion
Sorrow and worry are parallel in seven emotions. Due to the similarities
between them, they are put together in five spirits. Excessive sorrow and
worry are extremely harmful to health. In TCM, it is called qi consumption
by overly sorrow and worry. When the lung qi is deficient, the tolerance of
pessimistic stimulation by human body will decrease and will results in the
mood swings and sadness. The deficiency of lung qi and sadness affects
each other. It is easy to create this vicious cycle.
D. Discharge is the fluid of the lung
Snivel is the nasal discharge which nourishes the nose. When the essential
qi in the lung is sufficient, the snivel moistens the nasal cavity and does
not flow outward. If the lung is invaded by exogenous pathogens, it will
affect the nasal secretion and discharge. It can cause the clear nasal dis-
charge due to the cold pathogen as well as the yellow nasal discharge due
to the heat pathogen. It will also cause dry nose due to dry pathogen.

3.2.3 Spleen

Key points
– The physiological functions of the spleen:
– Governing transportation and transformation
– Governing ascent of the clear
– Spleen governs control of the blood
– The systemic relationships of the spleen:
– The spleen is related to the muscle in body constituent and dominates the four limbs.
– The spleen opens into the mouth and shines at the lips.
– The spleen corresponds to thinking in emotion.
– Saliva is the fluid of the spleen.
3.2 Five zang-organs  31

The spleen is located under the diaphragm, in the upper abdomen and left upper
corner of the stomach. There are three physiological functions of the spleen: govern-
ing transportation and transformation, raising the clear, and governing the blood.
The systemic relationships of the spleen with the body are as follows: the spleen
governs the muscles of the body and four limbs, and is associated with thinking in
emotion, with mouth in orifice, and with saliva in secretion.
1. Physiological functions of the spleen
A. Governing transportation and transformation
The spleen is in charge of transforming food and water into essential sub-
stances and transporting essence to the viscera as well as to tissues all over
the body. There are two aspects about this: transforming and transporting
the food and body fluids.
(a) Transforming and transporting the food: Spleen can digest the food
and absorb its essential substances
The spleen can take part in the different stages of food digestion. First,
the spleen qi promotes the digestive function of stomach and small
intestine. After entering the stomach and small intestine, the food is
digested and absorbed. This process actually takes place in the
stomach and small intestine, but it must depend on the promotion of
the spleen qi. Second, spleen qi promotes the absorption of stomach
and small intestine. Stomach and small intestine can digest food into
the essence, and absorb the essence and transport them to the whole
body. The absorption of essence by the stomach and small intestine
must depend on the function of spleen qi. Lastly, the spleen qi sends
up the essence to the whole body. Due to the fact that body fluid and
food are not only the chief source of the nutrients which a human
being needs to keep life activities but also the material basis for produ-
cing qi and blood, TCM believes that spleen provides the material basis
for the acquired constitution and is the source of producing qi and
blood. When spleen qi is abundant, so are the qi, blood, and body
fluids. The functions of viscera and meridians will be normal. If the
spleen loses its function in transformation and transportation, clini-
cally there will appear the manifestations of abdominal distention,
diarrhea, anorexia, lassitude, emaciation, and so on.
(b) Transforming and transporting the body fluids
Transforming and transporting the body fluids refers to the function of
absorbing and transporting the body fluids to avoid fluid retention
inside the body. During the process of fluid metabolism, spleen trans-
ports the body fluids to lung and kidney and excretes them out
through sweat and urination. When the spleen functions properly in
transforming and transporting the body fluids, the pathological stag-
nation of the fluids may be avoided and the equilibrium of water meta-
32  3 Visceral Manifestation

bolism of the body will be maintained. On the contrary, if there is a


dysfunction of the spleen in transforming and transporting the body
fluids, it will lead to stagnation or accumulation of water in the body
and result in the syndrome of damp phlegm or stagnant phlegm, and
even edema. This is the mechanism of the development of damp-syn-
drome, phlegm-syndrome, fluid retention syndrome, and edema result-
ing from the deficiency of spleen.
The two aspects of transforming and transporting the food as well
body fluids by the spleen are interrelated and inter-influenced. The dis-
orders between the two often appear at the same time pathologically.
B. Governing ascent of the clear
Ascent refers to the upgoing motion of spleen qi, while the clear means the
essential substances, including qi and blood. There are two aspects of the
spleen function of governing ascent of the clear.
The spleen qi goes upward and transports the essence up to the heart,
lung, head, and eyes, as well as to nourish the whole body. When the
spleen functions soundly, its qi goes up normally and the essence is
absorbed and distributed normally. Therefore, qi, blood, and body fluids
will be abundant. If the spleen qi fails to ascend the clear and also fails to
transform and transport the food, the essence cannot be absorbed or dis-
tributed, resulting in the deficiency of qi and blood. Therefore, symptoms
of listlessness, dizziness, abdominal distension, and diarrhea may appear.
On the other hand, the doctors often associate the theory of spleen’s func-
tion of ascending the clear with the viscera position. If spleen qi fails to
ascend or conversely sinks down, symptoms of chronic diarrhea and pro-
lapse of the anus, stomach, and kidney will appear.
C. Spleen governs control of the blood
The spleen can keep blood circulating within the vessels, preventing extra-
vasation. Spleen qi plays an important role in this function. The main
mechanism is actually the controlling action of qi. When the function of
spleen is normal in transforming and transporting, qi and blood will be
abundant. Qi will keep blood circulating within the vessels and prevent
extravasation. On the contrary, when the function of spleen is abnormal in
transforming and transporting, it will lead to shortage of the source for gen-
erating qi and blood. Qi deficiency can no longer control the blood circula-
tion and the blood may extravasate from inside of the vessels, thus result-
ing in bleeding. This is called syndrome of spleen failing to control the
blood. It may lead to various kinds of bleeding of the lower parts of the
body such as bloody stool, uterine bleeding, and purpura.
The spleen’s governing transportation and transformation is the most
important among the three functions. If the spleen qi is abundant, transpor-
tation and transformation will be normal, qi and blood will be abundant,
3.2 Five zang-organs  33

five zang-organs will be nourished, and the functions of ascending the


clear and keeping blood circulating within the vessels will be in order.
2. Systemic relationships of the spleen
A. The spleen is related to the muscle in body constituent and dominates the
four limbs
The spleen and stomach are the sources of qi and blood. Only when nour-
ished by the essence which is transformed and transported by spleen and
stomach can the muscles be healthy. The strength of the muscles depends
on the transforming and transporting functions of the spleen and stomach.
When the digestive function of the spleen and stomach is normal, qi and
blood will be abundant, and the muscles will be strong. If the spleen and
stomach are weak, qi and blood are deficient, leading to thin, weak,
and atrophic muscles. Four limbs are the major tissues for sports. The four
limbs demand the nutrition of essence being transformed and transported
by spleen and stomach. The transportation of essence also depends upon
ascending the clear of spleen qi. Therefore, the four limbs are related to the
functions of governing transportation and transformation as well as ascent
of the clear. If there is dysfunction of spleen in transportation and transfor-
mation, there will be scarce supply of nutriment to the limbs and limbs will
be tired and flaccid, resulting even in atrophy. In treating chronic spleen-
stomach disease, characterized by weight loss or fatigue, the spleen and
stomach should be invigorated and qi and blood should be replenished.
B. The spleen opens into the mouth and shines at the lips
The spleen opens into the mouth means that diet and appetite are closely
related to transforming and transporting functions of the spleen and stomach.
If the spleen and stomach transport food normally, the appetite and diet will
be normal. Otherwise, a tasteless, sweet or bitter taste may appear. The color
of the mouth and lips indicates whether qi and blood are sufficient. As the
spleen and stomach are the resources of qi and blood, whether the mouth
and lips are red or moist not only reflects the state of qi and blood but also
reflects the transporting and digesting functions of the spleen and stomach.
C. The spleen corresponds to thinking in emotion
Thinking is one kind of emotion related to spleen. The normal thinking is
not harmful to the body, but over-thinking will influence the body’s normal
activities and cause the qi stagnation. Ascending of the spleen and des-
cending of the stomach is the pivot for qi movement. When qi is congested,
the transportation and transformation gets upset and the action of sending
up the clear is impaired, leading to anorexia, epigastric distention, and
even dizziness and vertigo.
D. Saliva is the fluid of the spleen
Saliva is the thin and clear part of the natural liquid in the mouth. It plays
the role of protecting the oral mucosa and moistening the oral cavity.
34  3 Visceral Manifestation

Saliva is secreted when one is taking in food, making it easier to be swal-


lowed and digested. Under normal conditions, saliva is secreted into the
mouth without spillage. If the spleen qi is deficient and fails to control the
fluid, spillage will occur. Thus, spleen must be treated.

3.2.4 Liver

Key points
– The physiological functions of the liver:
– Governing free flow of qi
– Storing blood
– The systemic relationships of the liver:
– The liver is related to the tendons in body constituent and shines in the nail.
– The liver opens into the eyes.
– The liver corresponds to anger in emotion.
– Tears are the fluids of the liver.

The liver is located in the abdominal cavity, beneath the diaphragm and at the
inside of the right hypochondrium.
The physiological function of the liver is to govern free qi flow and store blood.
The systemic relationships of the liver with the body are as follows: the liver has
an interior – exterior relationship with gallbladder and is associated with the tendon
in body constituent and shines at the nail, with anger in emotion, with eyes in
orifice, and with tear as the fluid of the body.
1. Physiological functions of the liver
A. Governing free flow of qi
The liver can ensure the free movement of qi, blood, and body fluid, as well
as prevent them from stagnation. The function of liver qi’s governing free qi
flow is mainly manifested in the following aspects:
(a) Regulating qi movement
When the liver functions normally in governing free flow of qi, the qi
dynamic will be smooth. Qi, blood, and internal organs will be in a
harmonious state of balance. If there is a disorder in qi flow, it will
affect the functions of the liver. An under-smooth flow of qi will lead to
a stagnation of the liver qi which can result in the pathological
changes of stagnation of qi. It is often manifested as distending pain
and discomfort of the chest, breast, or lateral parts of the lower
abdomen. On the other hand, an overly smoothing flow of qi will give
rise to a hyperactivity of the liver which will result in pathological
changes of adverse rising of liver qi. It is manifested as distending pain
of the head, red face, and eyes as well as irritability.
3.2 Five zang-organs  35

(b) Promoting circulation of blood and body fluids


Qi is the commander of blood and blood is the mother of qi. When the
liver functions normally in governing qi flow, the circulation of blood and
body fluids will be smooth. If the liver dysfunctions in governing free
coursing, it will lead to disorder of qi dynamic with disturbance of blood
circulation. An under-smoothing flow of liver qi will lead to stagnation of
liver qi and blood stasis which manifests as mass in the abdomen with
fixed shape, tumor, and amenorrhea. On the other hand, an overly
smoothing flow of liver qi will give rise to a hyperactivity of liver qi. It will
force blood to go upward and lead to bleeding, such as hematemesis and
hemoptysis. Besides, the abnormality of the liver’s governing free flow of
qi may also lead to disturbance of body fluid metabolism, causing patho-
logical changes of body fluids, dampness, phlegm, and fluid retention.
(c) Regulating the emotion
The liver regulates emotion by regulating the movement of qi and
blood. When the liver functions normally in governing free coursing,
qi dynamic will be smooth as well as the blood circulation, and mood
will be good. If the liver functions insufficiently in governing free flow
of qi, emotions will be easily disturbed. The concrete performance con-
sists of two aspects: on the one hand, if the liver functions insuffi-
ciently in governing free flow of qi, the liver qi will be congested and
the mood will be easily depressed, and a little stimulation may cause
refractory melancholy. On the other hand, if the liver hyper-functions
in governing free flow of qi with hyperactive rise of qi, the mood is
easily to be irritable and a minor stimulation will easily cause rage. On
the contrary, the abnormal emotion can also affect the liver governing
free coursing, resulting in pathological changes, such as liver qi
depression or liver qi ascending counterflow.
(d) Promoting transportation and transformation of spleen and stomach
The function in governing transportation and transformation of spleen
and stomach is closely related to the function of the liver governing
free coursing. The normality of liver’s governing free flow of qi serves
as an important condition for normal ascent and descent of qi of spleen
and stomach The liver and spleen-stomach are located in the middle
burner. Transportation and transformation of spleen and stomach are
based on the coordination between the ascent of spleen and descent of
stomach. It can promote the functions of transportation and transfor-
mation of spleen and stomach. As the liver functions abnormally in
governing free flow of qi, it will not only affect the spleen in ascending
the clear, which manifests as dizziness and diarrhea, but will also
affect the stomach in descending the turbid, which manifests as hiccup
and vomiting, epigastric distention and fullness, or constipation.
36  3 Visceral Manifestation

(e) Smoothing and promoting the bile


Secretion and excretion of bile is controlled by the liver’s function of
governing free flow of qi. When the liver functions normally, the bile
will be normally secreted and excreted. If the liver dysfunctions in gov-
erning free coursing, it will affect secretion and excretion of bile,
resulting in pathological changes of bitter taste, jaundice, and pain in
the hypochondriac region. When the symptoms of dyspepsia due the
gallbladder disorder are presented in the clinical settings, the principle
of coursing the liver and promoting the gallbladder is often applied.
(f) Regulating the ejaculation in men and menstruation in women
The normal function of ejaculation in men and regular menstrual cycle
in women are related to coordination and balance between the func-
tion of liver governing free coursing and the function of kidney storing
essence. When the liver courses flow of qi normally, sperm can be dis-
charged smoothly and moderately in men and menstruation is normal
in women. If the function of kidney storing essence is normal, there
will be normal menses and ejaculation. When liver qi fails to regulate
and becomes congested, in women it will result in delayed menstrua-
tion, dysmenorrheal, and even menopause. In men, it will result in low
libido and difficulty in ejaculation. If the liver qi ascend upward too
much, it will result in early menstruation or excessive menstrual bleed-
ing in women and libido hyperactivity or spermatorrhea.
B. Storing blood
The liver storing blood is first seen in menstrual regulation of Suwen and
Benshen of Lingshu. This function implies that the liver has capability to
store blood and regulate blood volume in circulation. Storing blood includes
two aspects: first, a certain amount of blood is stored in the liver. The blood
nourishes the liver itself to prevent yang-qi of the liver from hyperactivity.
On the one hand, dysfunction of liver in storing blood will lead to blood defi-
ciency in the liver, and, on the other hand, it cannot void liver yang from
rising too much and will lead to ascending hyperactivity of liver yang, liver
fire flaming upward, or liver wind. Second, liver storing certain amount of
blood can prevent bleeding. Dysfunction of liver in storing blood will lead to
various bleeding disorders such as epistaxis, metrorrhagia, or vomiting of
blood. The liver regulating volume of blood is first seen in the chapter of
Wuzangshengchenglun in Suwen. It said: “when a person is in asleep, the
blood will be back to the liver.” Wangbing, a famous doctor in Tang
dynasty, explained it as follows: “liver stores blood while heart governs
blood circulation. When a person is in active, the blood moves into the
vessels; when a person is in quiet, the blood goes back to the liver.” Blood
volume of different parts of the body can adjust itself based on emotion or
surrounding. Peripheral blood volume increases when a person is in active
3.2 Five zang-organs  37

state, and blood stored in the liver is transported to the exterior to support
physical functions. The peripheral blood volume decreases when a person is
in quiet state, and the peripheral blood goes to the liver and gets stored in
the liver. The liver plays an important role in regulating the blood volume,
especially peripheral blood volume. It must be pointed out that the liver reg-
ulating blood volume is based on the liver storing blood. Only when the liver
blood is abundant, can the liver regulate the blood. Therefore, when the liver
is deficient of blood, it will lead to the syndromes of blood deficiency in the
whole body. For example, when liver cannot nourish the eyes, it will lead to
dry eyes or night blindness. When liver cannot nourish the tendons, it will
lead to contracture of muscles and numbness of limbs. When it cannot
nourish chong and ren meridians, it will lead to scanty menstruation or even
amenorrhea. Therefore, liver’s governing free coursing is closely related to
the function of the liver storing blood volume. Liver can transport the blood
to the exterior which is actually the manifestation of the liver governing free
coursing in promoting blood circulation. Liver regulating blood volume is
based on the function of the liver governing free coursing and storing blood.
2. Systemic relationships of the liver
A. The liver is related to the tendons in body constituent and shines in the nail
The tendons, also known as the sinew-membranes, include the tendons
and ligaments. They connect joints and control movement. This kind of
movement depends on the nourishment of blood. Sufficient liver blood can
make the human body endure hard work and recover quickly from exhaus-
tion. If there is a disorder in liver, it can lead to various tendon diseases. If
the liver blood is deficient, tendons cannot be nourished, which can result
in trembling of hands and feet, numbness of limbs, and influent of joint
movement. The nail, including hand and foot nails, is an extension of
tendon. Therefore, there is a saying nail is the extension of tendon. Luster of
the nail depends on the nourishment of liver blood. Sufficient liver blood
ensures dense nail with luster, while insufficient liver blood would cause
thin, frail or even deformed nail without luster due to malnutrition. So, the
luster of nail can reflect the function of the liver. The physiological or
pathological functions of the liver can be judged by the nail in clinical set-
tings.
B. The liver opens into the eyes
The function of eyes is based on the free coursing of liver qi and nourish-
ment of liver blood. The function of the liver is always manifested from the
eyes and its function. If yin or blood of the liver is deficient, there would be
dry eyes, blurred vision, and night blindness. Wind-heat in the liver meri-
dian can lead to red eyes with pain and itching; liver fire flaming upward
can lead to red, sore, and swollen eyes; ascending hyperactivity of liver
yang can lead to dizziness and vertigo; and liver wind can lead to upward
38  3 Visceral Manifestation

staring of the eyes. Because the liver is closely related to the eyes, the func-
tion of the eyes can reflect the function of the liver. Doctors often treat eye
disease from the liver meridian.
C. The liver corresponds to anger in emotion
Anger is the reaction of the body to the outside information. Ancient
Chinese believed that anger was a normal emotion. It is a normal reaction
to be angry when something bad happens. It helps the liver to disperse,
smooth, and regulate. However, sudden anger or constantly being in a bad
mood is easily to damage liver. Therefore, there is a saying in Suwen
yinyang yinxiang da lun, which means “rage injures the liver.”
D. Tears are the fluids of the liver
The tears come from the eyes, so they are the fluids of the liver. Tears
moisten and safeguard the eyes. Wind-heat in the liver meridian or defi-
ciency of the liver and kidney can lead to epiphora. The deficiency of liver
blood or yin deficiency of the liver and kidney can lead to dry eyes.

3.2.5 Kidney

Key points
– The physiological functions of the kidney:
– Storing essence and being in charge of growth, development, and reproduction
– Governing the water metabolism
– Governing the qi reception
– The systemic relationships of the kidney:
– The kidney is related to the bone and marrow in body constituent and shines in the hair.
– The kidney opens into the ears and two lower yin parts.
– The kidney corresponds to fear in emotion.
– Sputum is the fluid of the kidney.

The kidneys are located in the lumbar region, one each along the spine. It stores the
prenatal essence, which is the root of yin-yang for every organ and the origin of life.
Therefore, it is called the root of the prenatal.
The physiological function of the kidney is to store essence, dominate water
metabolism and govern reception of qi.
The systemic relationships of the kidney with the body are as follows: the
kidney is related to the bone in body constituent and shines in the hair, and is asso-
ciated with fear in emotion, with ears and two genital areas in orifice, and with
sputum as the fluid of the kidney.
1. The physiological function of the kidney
A. Storing essence, being in charge of growth, development, and reproduction
Essence has different meanings in TCM. In a broad sense, essence refers to
all basic substances, such as qi, blood, and body fluids; in a narrow sense,
3.2 Five zang-organs  39

it refers to essence stored in the kidney, called simply as the kidney


essence. Kidney essence includes two parts from origin. The first part is
endowed by parents and comes from birth; so it is also called as prenatal
essence. The second part is called acquired essence. It is formed by the
nourishment substance of the body deriving from food and surplus part of
visceral essence which is produced by physiological activities of zang-fu
organs. The prenatal essence and the acquired essence depend on each
other. The prenatal essence must rely on constant replenishment and nutri-
tion of acquired essence for its physiological function, while constant gen-
eration of the acquired essence yet depends on support of vitality of prena-
tal essence. The two parts are combined to form the kidney essence to
sustain life and reproduction. Physiological significance of kidney’s storing
essence is to keep the kidney essence full and forbid it from flowing out. If
the function of kidney’s storing essence is in disorder, it will lead to the
pathological changes of kidney essence deficiency which is caused by
kidney essence flowing outside. The physiological effect of the kidney
essence is to promote the growth, development, and reproduction. The
kidney essence has its own process from waxing to waning. There is a life
law of birth, growth, mature, aging, and death in human body which is
influenced by kidney essence-qi. As seen in the chapter of ShangGuTianZ-
henLun in Suwen, the growth and development of men and women are
closely related to kidney essence. The natural law of birth, growth, mature,
aging, and death is due to the kidney essence. After birth, the kidney
essence begins to grow gradually because of the nourishment of prenatal
and postnatal essence. There appear the phenomena of dental transition
and growth of hair. When kidney essence gets abundant to a certain
degree, one kind of essential substance known as tiangui is produced.
Tiangui is a substance related to reproduction and promotes the develop-
ment of sex organs and maintains normal sex function. As a result, woman
has menarche and man has sperm generated. At middle age, the kidney
essence starts to decline gradually. Subsequently the tiangui gets exhausted,
and accordingly disappears in the end. Thereafter, reproductive function is
lost completely and the person comes into his senile stage. The conditions
for the growth and development of teeth, bone structures, and hair are the
objective indications of the life process. They are the external manifestations
of the kidney essence and are important guidelines in the clinical treatment.
Loose teeth, teeth loss, gray hair, hair loss, weak bones, and infertility are all
signs of premature aging, which indicate deficiency of kidney essence. These
symptoms are also seen in the case of five delayed or five soft syndromes in
infants. Tonifying kidney and supplementing essence are the therapeutic
principles when treating premature aging problems, low libido, and infantile
development issues. Kidney essence plays an important role in physiological
40  3 Visceral Manifestation

activities of the human body. TCM utilizes yin-yang theory to explain the
effect of kidney essence. It can be divided into two parts: functions of moist-
ening and nourishing pertain to kidney yin, while promoting and warming
pertain to kidney yang. Kidney yin and kidney yang are also known as origi-
nal yin and original yang, or genuine yin and genuine yang, which are the
roots of yin and yang of the whole body. Kidney yin and kidney yang restrict
and promote each other to maintain the dynamic balance of human body
physiologically. If this balance is destroyed due to certain factors and cannot
be recovered by itself, then there may occur deficiency of kidney yin or
kidney yang with heat and cold disorder. For example, deficiency of kidney
yang is clinically manifested as cold outlook with cold limbs, low spirit, cold-
ness and pain in the lower back, clear urine with increased volume or
dysuria, enuresis, incontinence, and edema. Deficiency of kidney yin is clini-
cally manifested as vexing heat in the five centers, tidal fever and night
sweat, dizziness, tinnitus, soreness and weakness in the lower back and
knee joints, and spermatorrhea in males. Because kidney yin and kidney
yang are the roots of zang-fu organs, their disorder will lead to disorder of
other zang-fu organs, and vice versa. TCM believes that chronic illness
involves the kidney. Due to the fact that kidney essence is the basis for
kidney yin and kidney yang, the deficiencies of kidney yin or yang are the
manifestations of the deficiency of kidney essence. Therefore, kidney yin and
kidney yang can affect each other, which result in the deficiencies of both
eventually.
B. Governing the water metabolism
Governing the water metabolism refers to the function of kidney’s govern-
ing and regulating the fluid metabolism. Therefore, kidney is also known
as water organ. There are two aspects in this theory. First, every organ
involved in water metabolism is based on the promotion of kidney essence.
The receiving function of the stomach, the dispersing and descending
actions of the lung, the transforming and transporting functions of the
spleen, the regulating and promoting functions of triple burner, and the
opening and closing functions of the urinary bladder are all based on
the warming and qi-transforming functions of the kidney. If kidney is defi-
cient, especially when kidney yang is deficient, the organs involved in the
water metabolism will be abnormal, and there is disturbance in water meta-
bolism. Second, the formation and excretion of the urine depends upon the
warming and qi-transforming functions of the kidney. Excretion of urine
plays a key role in water metabolism. It is the most important route in regu-
lating the whole volume of the body. When fluid in the body increases or
when there is no sweat during cold days, the kidney will transport the
remaining water to the urinary bladder through the qi-transforming func-
tion to form urine and excrete it out. As a result, polyuria occurs and the
3.2 Five zang-organs  41

color of urine is pale. But when fluid in the body decreases or when there is
profuse sweating during summer, the kidney will control the excretion of
the body fluid. As a result, oliguria occurs and the color of the urine is
yellow. The kidney keeps the equilibrium of water metabolism by regulat-
ing the formation and excretion of urine. If there is dysfunction of warming
and qi transformation, pathological symptoms such as oliguria and edema
occur. When kidney qi is not stabilized, it will result in polyuria and fre-
quent urination.
C. Governing the qi reception
Reception means taking in. This function refers to the kidney qi grasping or
holding the clear qi inhaled by the lung from nature to maintain the depth
of respiration to avoid superficial respiration. While the respiration of the
body is controlled by the lung, it must rely on the accepting role of the
kidney. Respiration must be maintained to certain depth so as to promote
normal exchange of internal and external qi. The function of the kidney in
governing qi reception is the concrete embodiment of the storing action of
the kidney in respiration. It is based on the kidney essence. If kidney
essence is deficient and it cannot govern qi reception, the clear qi inhaled
by the lung floats upward and hypopnea occurs, prolonged expiration or
shortness of breath induced only by a little exertion. This is known as the
kidney failing to govern qi reception, and the therapeutic principle will be
tonifying and stabilizing the kidney.
2. Systemic relationships of the kidney
A. The kidney is related to the bone and marrow in body constituent and
shines in the hair
Governing the bones and generating the marrow are an important compo-
nent of the function of kidney essence in promoting growth and develop-
ment. Marrow includes bone marrow, spinal cord, and brain which are
derived from the kidney essence. The growth and development of bones
depends upon the enrichment of the bone. Bone cavity is full of bone
marrow if the kidney essence is sufficient. It is solid and strong if fully
nourished by bone marrow. If the kidney essence is insufficient, the pro-
duction of bone marrow will be reduced. Thus, insufficiency of bone
marrow cannot nourish the bone fully and a malnourished and poor bone
is developed which is soft and weak. In infants it is characterized by late
closure of the fontanel and soft, weak bones; in adults, aching and weak-
ness of the lower back, knees and lassitude, and in old people, fragile and
weak bone. These symptoms are often treated clinically by tonifying the
kidney and supplementing the essence. The strength and growth of teeth
also depends on the kidney essence, which is known as the teeth being the
surplus of the bone. If the kidney essence is sufficient, teeth will be solid
42  3 Visceral Manifestation

and strong. If the kidney essence is insufficient, teeth will be loose and
will be lost in a younger age. The development and maintenance of the
spinal cord and brain are also related to kidney essence. The brain is
called the sea of marrow because the spinal cord is connected with the
brain and forms the brain after it merges into the brain. The function of the
brain is to govern the spirit which depends on the nourishment of the
kidney essence. If the kidney essence is sufficient, so will be the brain
which is characterized by good energy, better vision, and hearings, as well
as quacking thinking ability. If the kidney essence is insufficient, the pro-
duction of brain marrow will be reduced, leading to various pathological
changes such as low spirit, lassitude, tinnitus, dizziness, retarded think-
ing, and pain in the lower back and knees. Hair is also called the extension
of blood and it depends on blood for nourishment. Therefore, it is said that
the hair is the extension of blood. Hair’s life mechanism originates from the
kidney. The kidney stores essence and the essence can turn into blood.
Therefore, it is said that the kidney reflects its brilliance on hair. The
growth, loss, moistening, and withering of hair are related to kidney
essence. In young and middle-aged people, kidney essence is sufficient
and blood is plentiful, so hair will appear lustrous. In old age, kidney
essence is insufficient, so hair will appear gray or white and begins to thin.
Even for young and middle-aged people this may happen if kidney essence
is insufficient.
B. The kidney opens into the ears and two lower yin parts
The hearing ability also relies on the kidney essence. If kidney essence is
sufficient, the sea of marrow is nourished and the ears will have good
hearing ability. If kidney essence is insufficient, the marrow will be deficient
and the ears will become weak, leading to symptoms such as decreased
hearing, tinnitus, and even deafness. Old people tend to be poor in hearing
because the kidney essence declines naturally as they grow old. The two
lower yin parts of the body refer to the anterior and posterior genital areas.
The anterior genitalia govern the functions of urine excretion and birth-
giving, while the posterior genitalia govern the function of stool-expelling.
Although urine is discharged from the bladder, urination depends upon the
steaming and transforming function of the kidney. Hence, urination disor-
ders such as frequent urination, enuresis, oliguria or urodialysis are often
related to the kidney dysfunction. As to the relationship between the kidney
and the reproductive function, nothing will be added to what have been
stated above. Although the removal of feces is controlled by the large intes-
tine, spleen, and stomach, it is also related to the qi transformation of the
kidney. The deficiency of kidney yin may cause the intestinal fluid to dry up,
leading to constipation. The deficiency of kidney yang can lead to constipa-
3.3 Six fu-organs  43

tion caused by yang deficiency, failing to produce yin. It can also lead to
diarrhea due to the cold spleen as well as the accumulation of water and
dampness. The weak kidney may also result in loose stools over a long
period or incontinence.
C. The kidney corresponds to fear in emotion
Fear is an emotional reaction to a fearful situation. Kidney corresponds to
fear in emotion. Excess fear may injure the kidney and make it weak which
result in the incontinence of urine and feces, premature ejaculation, and
miscarriage.
D. Sputum is the fluid of the kidney
Sputum in the mouth belongs to fluid. The thicker part of the sputum
belongs to kidney, while and thinner part belongs to spleen. TCM believes
that sputum is transformed from the kidney essence. Therefore, swallowing
it without spitting out can nourish the kidney essence. If too much sputum
is spitted out, it will damage the kidney essence. Ancient experts who prac-
ticed the Daoyin KungFu would prop the tip of the tongue against the
palate till the saliva became full in the mouth, then swallow it to nourish
the kidney essence. Patients with kidney deficiency or kidney coldness will
often spit out the sputum.

3.3 Six fu-organs

Six fu-organs refer to the gallbladder, stomach, small intestine, large intestine,
urinary bladder, and triple burners. Most of them are hollow organs and their
common functions are to receive, digest, transmit, and excrete the food. Therefore,
they are characterized as sedating but not storing and solid but not full. The
process of food digestion, absorption, and excretion are the results of connection
and cooperation among the six fu-organs.

3.3.1 Gallbladder

The gallbladder is located under the right hypochondriac region, attached to the
liver. It is one of the six fu-organs and belongs to the extraordinary fu-organs. The
gallbladder has exterior – interior relationship with liver.

Key points
– Physiological functions:
– Stores and excretes the bile
– Governs the power of decision
44  3 Visceral Manifestation

1. Stores and excretes the bile


The main function of the gallbladder is to store and excrete the bile. The bile is
transformed by the liver essence. After bile is produced by the liver, it is stored
in the gallbladder and directed by the dredging and dispersing functions of the
liver. Later the bile is excreted into the small intestine to participate in the
process of digestion. Failure of the liver to dredge and disperse of the gallblad-
der itself will affect the excretion of the bile and disturb digestion and absorp-
tion, leading to distending pain in the hypochondriac region, poor appetite,
abdominal distention, and loose stool.
2. Governs the power of decision
The gallbladder is related to psychological activities. It has the function to
govern decision. If the gallbladder qi is deficient, the person might be fearful,
indecisive, and sleepless.

3.3.2 Stomach

The stomach is located below the diaphragm. It connects superiorly with the esopha-
gus and inferiorly with the small intestine. Stomach is an important organ that helps
in the absorption and digestion of food. The spleen is located on the left side of the
stomach, and both are located in the middle-jiao. They form a relationship through
mutual affiliation and connect with their meridians.

Key points
– Physiological functions:
– Governs intake and decomposition of food and drinks.
– Stomach performs its function well when there is descent and free flow.

1. Physiological functions
A. Governs intake and decomposition of food and drinks
Governing the intake simply means that stomach can accept and contain
the food and drinks. Decomposing indicates the beginning stage of food
digestion in the stomach and when food changes into chyme. The function
of the stomach depends on the propelling of stomach-qi. Therefore, it is
very important to protect the stomach-qi during any treatment.
B. Stomach performs its function well when there is descent and free flow
The food and drinks enter the stomach and transform into chyme. The
chyme is then transmitted to the small intestine for further digestion and
absorption. Therefore, the stomach dominates dredging and descending.
Stomach dysfunction leads to poor appetite, bad breath, epigastric disten-
tion and pain, nausea, vomiting, and constipation.
3.3 Six fu-organs  45

3.3.3 Small intestine

The small intestine is located in the abdomen between the stomach and large intes-
tine. It includes duodenum, jejunum, and ileum. The small intestine has the exter-
ior – interior relationship with the heart.

Key points
– Physiological functions:
– Receives and digests the chyme
– Separates the clear from the turbid

1. Receives and digests the chyme


The small intestine receives the chyme from the stomach and retains it for a
certain period of time to further digestion. Dysfunction of the small intestine
will lead to indigestion, abdominal distention and pain, diarrhea, and loose
stool.
2. Separates the clear from the turbid
The clear refers to food nutrients and the turbid refers to the wastes of the food.
After further digestion of the chyme, the small intestine separates the food
essence from the wastes and absorbs the essence and transmits the wastes to the
large intestine. Because the small intestine absorbs a great amount of water, there
is a saying the small intestine dominates thick fluid. If the small intestine is abnor-
mal in separating the clear from the turbid, the stool will be sloppy and the urine
will become scanty, or it may lead to profuse urination and constipation. There-
fore, the therapy for diarrhea in the clinical setting is often to promote urination.

3.3.4 Large intestine

The large intestine is connected with the small intestine at the ileocecal valve in the
upper part and the anus in the lower part. It has the exterior – interior relationship
with lung.

Key points
– Physiological functions:
– Transforms and conveys the waste
– Reabsorbs the redundant water

1. Transforms and conveys the waste


The large intestine receives the waste of food transmitted down from the small
intestine. After absorbing part of the water from the waste, the large intestine
46  3 Visceral Manifestation

transmits the waste downward and transforms it into stool to be excreted from
the anus. Dysfunction of large intestine may lead to diarrhea, purulent blood in
stool, bad breath, abdominal distention or constipation.
2. Reabsorbs the redundant water
Since the large intestine reabsorbs the redundant water from the food residue,
there is a saying the large intestine dominates thin fluid. If food residue remains
in the large intestine for a minimal time, diarrhea may occur, eventually
causing constipation.

3.3.5 Urinary bladder

The urinary bladder’s upper outlet connect to the kidneys through the ureters while
its lower outlet connects with the urethra. The urinary bladder has exterior – interior
relationship with the kidney.

Key points
– Physiological functions:
– Stores urine
– Discharges urine

1. Physiological functions
A. Stores urine
The urine is produced by kidney-qi transformation and is stored in the
urinary bladder. Therefore, the function of the urinary bladder depends on
the functions of kidney. If kidney-yang is deficient, the bladder will close
and open abnormally. It will result in profuse night urination, enuresis,
and incontinence of urine.
B. Discharges urine
Urine can be excreted naturally out of the body through qi-transforming
function of the kidney and the urinary bladder. If the kidney and the
bladder lose their functions, it will lead to dripping urination, incontinence
of urine, anuria, frequent urination, urgent urination, odynuria, and so on.
Usually, acute micturition disorders are related to urinary bladder while
chronic cases are related to the kidney.

3.3.6 Triple-jiao

The triple-jiao refers to the upper-jiao, middle-jiao, and lower-jiao. It belongs to one
of the fu-organs. No organ has close relationship with triple-jiao.
3.3 Six fu-organs  47

Key points
– Concept:
– The triple-jiao belongs to one of the fu-organs. It refers to the upper-jiao, middle-jiao and
lower-jiao.
– Affiliation of the zang-fu organs:
– The upper-jiao: heart, lung, above diaphragm
– The middle-jiao: spleen, stomach, liver, gallbladder, below diaphragm and above naval
– The lower-jiao: kidney, urinary bladder, small intestine, large intestine, below naval
– Total physiological functions:
– The passage way for the transportation of primordial-qi and fluids.
– Upper-jiao is like mist.
– Middle-jiao is like foam.
– Lower-jiao is like ditch.

1. Total physiological functions


A. Opening the passage for primordial-qi
The triple-jiao is the passage way for the primordial-qi, which is distributed
to all parts of the body to nourish tissues and promote the physiological
functions of viscera. Moreover, the function of the triple-jiao is to affect the
whole body’s function of qi movement and qi transformation. Therefore,
there is a saying, The triple-jiao governs the whole body qi as well as controls
the qi movement and qi transformation.
B. Transporting the body fluids
The triple-jiao is a major passage way of fluid distribution and excretion.
Obstruction of the triple-jiao may affect the functions of the lung, the
spleen and the kidney, leading to phlegm and edema.
2. Respective physiological functions of the triple-jiao
A. The upper-jiao is like a mist
The chest area above the diaphragm is the upper-jiao which includes the
heart and lung. The upper-jiao distributes qi, blood, and body fluids to the
heart, lungs, and head, just like fog permeating everywhere.
B. The middle-jiao is like a foam
The middle-jiao refers to the upper abdominal areas below the diaphragm
and above the naval. It includes the spleen, stomach, liver, and gallbladder.
The middle-jiao has the function of digestion, absorption, and distribution of
food essence to produce qi and blood.
C. The lower-jiao is like a ditch
The lower-jiao refers to the lower abdominal areas below the naval. It
includes the kidney, the urinary bladder, and intestines. The lower-jiao
excretes wastes like drainage.
48  3 Visceral Manifestation

3.4 Extraordinary fu-organs

Key points
– The concept of extraordinary fu-organs:
– Extra fu-organs include the brain, the marrow, the bones, the vessels, the gallbladder,
and the uterus.
– Extraordinary fu-organs are similar to the fu-organs in morphology and similar to the zang-
organs in function. They have no exterior – interior relationships, except the gallbladder.

Extraordinary fu-organ includes the brain, the marrow, the bones, the vessels, the
gallbladder, and the uterus. The gallbladder excrete promotes digestion and is
similar to the functions of the fu-organ, and it also stores bile and is similar to the
functions of zang-organ. Therefore, the gallbladder not only belongs to the six-fu
viscera but also to the extraordinary fu-viscera. Extraordinary fu-organs have no
exterior – interior relationships and the five elements attribution, except the gall-
bladder. Sections 3.4.1 and 3.4.2 will focus only on the functions of the brain and the
uterus. The physiological functions of other extraordinary fu-organs have been dis-
cussed in other sections.

3.4.1 Brain

The brain is located in the skull and is composed of marrow.

Key points
– Physiological functions:
– Dominate life activities.
– Dominate mental activities.
– Dominate sensation and movement.

1. Physiological functions
A. Dominate life activities
The brain is the vital center which dominates important life activities, such
as respiration and heartbeat.
B. Dominate mental activities
The functions of the brain attribute to the heart and belong to the five zang-
organs. When the brain is normal in function, the person will have good
energy and will be in full vigor with clear mind, quick thinking, good
memory, fluent speech, and normal emotion. On the contrary, abnormal
function of brain will lead to sag, retard thinking, amnesia, and even
mental disorders.
3.4 Extraordinary fu-organs  49

C. Dominate sensation and movement


The eyes, ears, mouth, nose, and tongue are the external orifices of the five
organs. They are located in the head and face and are connected with the
brain. Therefore, the brain controls the five sensory functions as well as the
movement. When the brain is in normal function, it provides good vision
and audition, normal olfactory sense and speech, as well as powerful
limbs. On the contrary, it will cause dim vision, deafness, anosmia, slow
motion, dyskinesia, and speech problems.
2. Physiological relations
The function of the brain attributes to the five zang-organs and is closely asso-
ciated with the twelve meridians as well as the eight extraordinary meridians.
For example, the heart houses the mind, the lung houses the corporeal soul, the
liver houses ethereal soul, the spleen houses thought, and the kidney houses
the essence. Clinically, mental activities are mostly related to the heart, the
liver, and the kidney. The heart governs the mind and all mental activities, the
liver governs dredging and dispersing functions as well as regulates mental
activities, and the kidney stores essence in order to produce marrow to nourish
the brain. That is why mental diseases are usually treated by regulating the
heart, the liver, and the kidney.

3.4.2 Uterus

Key points
– Physiological functions:
– Governs menses and pregnancy.

1. Physiological functions
A. Governs menses
The uterus governs menses. The production of menstruation is a reflection
of the viscera, qi, blood, fluid, and meridians acting on the uterus. There-
fore, the developmental condition of the uterus influences the production
of menstruation.
B. Pregnancy
Normal menstruation results in the normal fertile ability in women.
2. Physiological relation
The physiological functions of the uterus are related to the kidney, heart, liver,
spleen, qi, blood, body fluids, and the chong and ren meridians. The level of
essence storing in the kidney and the regulation of the chong and ren meridians is
especially important. The essence stored in the kidney can promote genital growth.
Tiangui produced by kidney essence is considered as the basic conditions of main-
taining normal menstruation and conceiving fetus. The main component of the
50  3 Visceral Manifestation

menses is blood. The heart governs blood. The liver stores blood and promotes cir-
culation of blood. The spleen serves as the source of qi and blood controls blood
circulation inside the vessels. Therefore, the function of uterus is closely related to
the heart, the liver, and the spleen. The chong and ren meridians originate from
the uterus. They propel qi and blood to nourish the uterus and conceive fetus. If
the functions of chong and ren meridians are abnormal, it will result in irregular
menstruation and will result in metrorrhagia, amenorrhea, and infertility.

3.5 The relationships among the zang-organs and fu-organs

1. The heart and the lung

Key points
– The physiological relationships
– Pectoral qi:
– The heart governs the blood and vessels while the lung dominates qi and governs
respiration.
– Blood circulation:
– The heart governs the blood circulation while the lung links with all the blood
vessels.

The relationships between heart and lung include two aspects. On the one
hand, the heart governs the blood while the lung governs the qi. On the other
hand, the heart governs blood circulation while the lung governs respiration.
Physiologically, blood circulation depends on the propelling of heart-qi and the
assistance of lung-qi. Lung-qi also depends on heart blood because heart blood
helps to distribute the lung-qi through the whole body. If the blood circulation
is normal, respiration will be smooth and regular. Pathologically, deficiency or
stagnation of lung-qi will lead to stasis of heart blood with the symptoms of pal-
pitation, cyanosis of the lips, and a purplish tongue. Insufficiency of heart-qi or
stagnation of heart blood will lead to deficiency of lung-qi or the rebellious lung
qi which is characterized by cough, asthma, and chest oppression.
2. The heart and the spleen

Key points
– The physiological relationships:
– Blood circulation: Heart governs blood vessels and spleen controls blood.

The relationships between heart and spleen are presented in the areas of blood
generation, blood circulation, and emotional aspects. Physiologically, heart
governs the blood and stores the spirits while spleen governs the blood and is
3.5 The relationships among the zang-organs and fu-organs  51

the source of blood. Therefore, the heart and spleen has close relationship in
regards to the generation and movement of the blood. When the functions of
spleen qi are normal in transformation and transportation and the production of
blood is abundant, it will support the heart and stabilize the emotion. When
blood circulates in the vessel, it not only relies on the movement of heart-qi but
also on the support of spleen qi so as not to let the blood spill outside the blood
vessels. Pathologically, if the spleen loses its functions in transformation and
transportation which leads to insufficiency of blood generation or blood loss, it
will result in heart blood deficiency. On the other hand, over-pensiveness will
lead to deficiency of heart blood and spleen qi which will eventually result in
the deficiency in both heart and spleen.
3. The heart and the liver

Key points
– The physiological relationships:
– Blood circulation: Heart governs blood circulation and liver stores blood.
– Mental activities: The heart is in charge of mental activities and the liver regulates
emotional activities.

The relationships between the heart and liver are signified as circulation of blood
and regulation of mental activities. Physiologically, blood is stored in the liver
and distributed through the whole body by the heart. The normal blood-moving
function of the heart relies on the dispersing and blood-regulating functions of
the liver. On the other hand, the heart is in charge of the mental activities while
the liver governs dredging, dispersing, and emotional regulating activities. The
heart and liver are closely related to each other in regulating mental and emo-
tional activities.
Pathologically, it is often seen the patterns of heart and liver blood stasis,
heart and liver blood deficiency, and exuberant fire of heart and liver, for
example, deficiency of both liver and heart blood will lead to symptoms of pale
complexion, palpitation, dizziness, dry and lusterless nails, and scanty and light-
colored menstruation.
4. The heart and the kidney

Key points
– The physiological relationships:
– Heart-kidney interaction.
– Heart-kidney noninteraction.
– Heart-kidney fluids nourish each other.

The relationship between the heart and kidney is mainly manifested as coordi-
nation between water and fire as well as interdependence of essence and spirit.
52  3 Visceral Manifestation

According to the yin-yang theory, yin and yang must coordinate physiologically
leading to the origination, development, and changes of things, and according
to the theory of ascent-descent of yin-yang or water-fire, the one that is located
superiorly should descend and the one situated inferiorly should ascend. The
heart lies in the upper-jiao which belongs to fire in the five elements; therefore,
the heart-fire should go down to warm the kidney-water. The kidney lies in the
lower-jiao which belongs to water in the five elements theory; therefore, the
kidney-water should go upward to assist the heart-yin for restricting heart yang.
Such coordination between the upper fire and lower water is called coordination
between heart and kidney.
The heart governs mental activities while the kidney stores essence to
produce marrow. Therefore, the heart and kidney maintain the mental activ-
ities simultaneously. Pathologically, if kidney-yin fails to nourish heart-yin
due to insufficiency, or heart-fire fails to descend to warm kidney-water, it
will lead to imbalance between the heart and kidney. Symptoms such as
insomnia, irritability, tinnitus, lower back soreness and seminal emission
appear.
5. The lung and the spleen

Key points
– The physiological relationships:
– Generation of qi: The lung controls breathing and governs qi while spleen governs
transportation and transformation of food essence.
– Fluid metabolism: The lung regulates the water passage while the spleen governs
the transportation and transformation of the fluids.

The relationships between lung and spleen are mainly reflected on the coordi-
nation between the generation of qi and water metabolism. Physiologically, the
lung controls breathing and governs qi. The spleen is the source of nutrients for
the growth and development of qi and blood. The generation of qi, especially
the pectoral qi, depends upon the combination of the fresh air inhaled by the
lung and the food essence transformed and transported by the spleen. As for
the fluid metabolism, the lung regulates the water passage and belongs to the
upper source of water, while the spleen transforms and transports water to guar-
antee generation and distribution of water. The lung distributes water to all
parts of the body and the spleen absorbs and transports water as well as perme-
ates water upward to lung. This harmonious balance between the lung and the
spleen is needed for a smooth fluid metabolism. Deficiency of spleen and lung
qi will lead to shortness of breath, no desire to speak, poor appetite, and loose
stool. If it affects the metabolism of fluid, it may lead to edema, cough, asthma,
and profuse phlegm.
3.5 The relationships among the zang-organs and fu-organs  53

6. The lung and the liver

Key points
– The physiological relationships:
– Regulation of qi movement: The liver governs the ascending of qi while the lung
governs the descending of qi.

The relationships between the lung and the liver are signified by the interdepen-
dence and coordination of the qi movement. Physiologically, the lung governs
purification and descent while the liver governs ascent and dispersion. The
coordination between the ascent of liver qi and the descent of lung qi plays an
important regulatory role in the whole body’s qi dynamic.
Pathologically, too much fire in the liver or overly descent of liver qi will consume
lung yin which leads to the symptoms of cough, chest pain, and hemoptysis.
7. The lung and the kidney

Key points
– The physiological relationships:
– Respiratory movement: The lung governs respiration while the kidney governs qi reception.
– Fluid metabolism: The lung regulates the water passage while the kidney governs
the fluid.
– Lung and kidney yin nourish each other.

The relationships between the lung and kidney are mainly manifested as
mutual dependence in respiratory movement, water metabolism, and yin gen-
eration. Physiologically, the lung is the upper source of water and the kidney
governs the water. On the one hand, the lung transmits the water downward to
kidney by diffusion and descent of lung qi. On the other hand, the diffusion and
descent functions of the lung qi depend upon the transforming and steaming
functions of kidney yang. The lung and kidney act on each other to maintain
the normal process of water metabolism. In regards to the respiratory move-
ment, the lung controls respiration and governs the qi while the kidney stores
essence and governs reception of qi. Respiratory movement is governed by
the lung, but the lung’s function of controlling respiration needs assistance
by the kidney’s function of reception of qi. Therefore, the body can keep the
depth of inspiration and secure the harmony of respiratory movement. In addi-
tion, lung yin and kidney yin promote each other. Kidney-yin is the root of
every organ; therefore, the lung-yin depends upon the nourishment of kidney-
yin. The relationships between the lung and kidney are similar to the relation-
ships of mother – son according to theory of the five elements. The lung fluid
helps the kidney yin. They promote each other to keep the sufficiency and
balance between them. According to TCM theory, it is also called mutual promo-
54  3 Visceral Manifestation

tion of metal and water. Pathologically, disorder of the lung and kidney func-
tions, will cause disturbance in water metabolism, which will result in symp-
toms like oliguria, edema, cough, asthma, and phlegm. If both lung and kidney
qi are deficient, it will disturb respiratory movement, resulting in shortness of
breath and frequent dyspnea. Yin deficiency of both lung and kidney will cause
symptoms of dry cough, tidal fever, and lower back soreness.
8. The liver and the spleen

Key points
– The physiological relationships:
– Digestion: The liver governs the free flow of qi while the spleen governs transporta-
tion and transformation.
– Blood circulation: The liver stores blood while the spleen controls blood.

The relationships between the liver and the spleen are manifested in two
aspects: one is the interdependence of qi free-flowing as well as the transforma-
tion and transportation and the other is coordination of blood-storing and
blood-controlling. As for digestion, the liver governs free flow of qi while the
spleen governs transportation and transformation. The liver governs free flow of
qi, regulates qi dynamic, promotes the bile, and improves the transforming and
transporting functions of spleen and stomach. Therefore, the liver governing the
free flow of qi is the foundation of a healthy transporting function of the spleen.
The liver stores the blood while the spleen is the source of qi and blood as well
as controls the blood. When the spleen qi is abundant, the blood will be suffi-
cient, and then the liver can store it. The liver and spleen cooperate with each
other to prevent blood loss as well as to promote the movement of qi and blood.
If the liver fails in governing flow of qi, it will lead to failure of the spleen in
transportation and transformation; there will appear the syndromes of dishar-
mony between liver and spleen with symptoms like chest fullness, poor appe-
tite, abdominal distension, and diarrhea. If deficient spleen cannot produce or
control the blood, it will cause bleeding which leads to the insufficiency of liver
blood. If the liver cannot store the blood or the spleen cannot control the blood,
the blood will escape from the vessels with symptoms like menorrhagia and
uterine bleeding.
9. The liver and the kidney

Key points
– The physiological relationships:
– Essence and blood originate from the same source.
– Interdependence of storage and discharge.
– The liver yin and the kidney yin nourish each other.
3.5 The relationships among the zang-organs and fu-organs  55

The relationships between liver and kidney are mainly marked by mutual
transformation between essence and blood, interdependence of storage and
discharge, and mutual generation of yin essence. Physiologically, essence and
blood come from the same source. The liver stores blood and the kidney stores
essence. Both blood and essence come from the food essence transformed and
transported by the spleen and the stomach. Sufficient blood in the liver makes
it possible for the kidney to store essence and abundant kidney essence pro-
vides necessary nourishment for the liver. That is why the liver and kidney
share the same origin and yi and gui share the same origin. The other is the
interdependence of storage and discharge. The liver governs free flow of qi
while the kidney dominates storage. Both are opposite and yet complementary
to each other. The discharge of liver affects the function of the kidney, while
the storage of kidney can prevent over-discharge of the liver qi. The two
aspects support each other to coordinate the functions of menstruation and
ejaculation. In addition, the liver yin and the kidney yin nourish each other.
Kidney yin is the root source of every yin organ. Thus, the relationship
between the kidney and liver is mother – son according to theory of the five
elements. Therefore, liver yin and kidney yin invigorate each other so as to
restrict liver-yang to maintain balance of yin-yang between kidney and liver.
Pathologically, deficiency of kidney-essence may lead to insufficiency of liver
blood, while insufficiency of liver blood can cause deficiency of kidney-
essence. It eventually results in symptoms such as dizziness, tinnitus, deaf-
ness, lower back soreness, and lower sexual function. If the discharge of the
liver and storage of the kidney are not in harmony, there may appear disorders
of irregular menstruation, impotence, spermatorrhea, or erectile dysfunction.
If the kidney yin is insufficient, it may lead to deficiency of liver yin and hyper-
activity of liver yang, resulting in symptoms like dizziness, irritability, dry
eyes, and lower back soreness.
10. The spleen and the kidney

Key points
– The physiological relationships:
– Prenatal versus postnatal: The spleen is the root of the postnatal essence and
kidney is the root of the prenatal essence.
– Fluid metabolism: The spleen governs the transportation and transformation of
water while the kidney governs water metabolism.

The relationships between spleen and kidney are essentially reflected by the
mutual promotion of prenatal and postnatal essence as well as their cooperation
in water metabolism. The spleen is the root of prenatal essence and kidney is
the root of postnatal essence. The transforming and transporting functions of
spleen qi depend on the steaming function of kidney yang. The abundance of
56  3 Visceral Manifestation

essence-qi in the kidney also depends on the nourishment of the postnatal


essence by the spleen. The spleen and kidney promote each other, which is vital
to life activities. The warming and qi-transforming functions of kidney yang are
helpful to transform and transport water of spleen. Both organs coordinate with
each other in the process of water metabolism. Pathologically, spleen and
kidney, prenatal and postnatal essence affects each other, which can cause the
syndrome of yang deficiency of both spleen and kidney with the manifestations
of coldness and pain in the abdomen, diarrhea with undigested food, and
edema.

3.5.1 The relationships among the six fu-organs

1. Coordination in the process of digesting, absorbing, and excreting food


Although gallbladder, stomach, small intestine, large intestine, urinary bladder,
and triple-jiao are different in functions, they are all organs for transmitting
water and food. After the food enters the mouth, being accepted and digested in
the stomach, it is transmitted to the small intestine where the chyme is further
digested by separating the clear from the turbid. The clear is transported
throughout the whole body by the function of the spleen. The turbid is trans-
ported down into the large intestine and becomes stool to be discharged out of
the body through dryness and transformation functions of the large intestine.
When the small intestine separates the clear from the turbid, it also absorbs
body fluid which has something to do with the total amount of urine. The water
stored in the urinary bladder will be excreted out of the body through the qi
transformation of the kidney and triple-jiao. During the digestion process, the
liver helps the gallbladder to excrete bile into the small intestine to promote
digestion. The triple-jiao, the passage of water with its qi-transformation, is also
involved in the digestion, absorption, and excretion of food. The six fu-organs
affect one another pathologically. For example, disturbance of the large intes-
tine in transmission and transformation not only leads to obstruction to cause
constipation but also affects the regular descent of the stomach qi which can
cause halitosis and belching.
2. Six fu-organs function well when they are not obstructed
Six fu-organs transport and transform food and water. They constantly
perform the functions of receiving, transmitting, and excreting. Therefore, it
is appropriate for them to be kept clear and free from obstruction. Clinically,
the disease of six fu-organs is often presented as obstructive syndrome. As for
the treatment, tonifying or sedating, the principle should be focused on
unblocking the six fu-organs to promote the normal food transformation and
transportation.
3.5 The relationships among the zang-organs and fu-organs  57

3.5.2 The relationship between the five zang-organs and six fu-organs

1. The heart and the small intestine


The external and internal relationship between the heart and small intestine is
formed by the connections between their meridians. Physiologically, the heart
meridian of hand shaoyin affiliates to the heart and connects with the small
intestine, while the small intestine meridian of hand taiyang affiliates to small
intestine and connects with the heart. Pathologically, if heart fire gets hyperac-
tive, the heat may be transported into the small intestine through the meridian,
which will lead to the dysfunction of the small intestine with dysphoria, sores
in the mouth, oliguria, and painful urination.
2. The lung and the large intestine
The external and internal relationship between the lung and large intestine is
formed by the connections between their meridians. The lung meridian of hand
taiyin affiliates to the lung and connects with the large intestine, while the large
intestine meridian of hand yang ming affiliates to large intestine and connects
with the lung. Physiologically, the purification and descent of lung qi help to
normalize the transporting function of large intestine. The smooth conveyance
by the large intestine is also beneficial to lung qi’s purification and descent. The
large intestine governs the thin fluid, while the lung controls the water passage.
They both coordinate with each other in the process of water metabolism.
Pathologically, heat obstruction in the lung can affect the large intestine in con-
veyance of the waste which can cause constipation. On the contrary, constipa-
tion caused by heat obstruction in large intestine will lead to adverse rising of
lung qi with manifestations as asthma, chest oppression, and cough.
3. The spleen and the stomach
The spleen and the stomach form an exterior – interior relation through their meri-
dian’s connection and affiliation. The physiological relationship between the
spleen and the stomach includes the following three aspects: first, coordination in
reception and transportation. The spleen governs transportation and transforma-
tion while the stomach controls reception and digestion. They both cooperate with
each other in digestion and absorption of food. Second, mutual influence of ascent
and descent. Spleen qi governs the rise of the clear while stomach qi controls the
descent of the turbid, both of which restrict and assist each other. The spleen and
the stomach play the pivotal role in descending and ascending of qi activities.
Third, mutual promotion between dryness and dampness. The spleen is a zang-
organ pertaining to yin which prefers to dryness and dislikes dampness. The
stomach is a fu-organ pertaining to yang which prefers to moisture and dislike
dryness. The spleen is easily encumbered by dampness while the stomach is easily
invaded by heat. Pathologically, the disorders between spleen and stomach tend
to affect each other. Simultaneously, it can result in symptoms of anorexia, abdom-
inal distension, vomiting, dizziness, and diarrhea. Symptoms such as abdominal
58  3 Visceral Manifestation

distention and diarrhea are often seen in spleen disorder while poor appetite, easy
hunger, and stomach are often seen in stomach disorder.
4. The liver and the gallbladder
The liver and the gallbladder form exterior – interior relationships through their
meridian’s connection and affiliation. The secretion and excretion of the bile
are regulated and controlled by liver’s function in governing free flow of qi.
The smooth excretion of the bile is beneficial to liver’s function in governing
free flow of qi. The liver is in charge of making strategy, but decision-making
depends on the gallbladder. If the two organs cooperate closely, it will result in
normal emotion and good decision-making. Pathologically, liver and gallblad-
der often affect each other. Symptoms such as bitter taste in the mouth and
jaundice are often associated with liver qi congestion.
5. The kidney and the urinary bladder
The kidney and urinary bladder form an exterior – interior relationship through
their meridian’s connection and affiliation. The turbid part of water in the body
is transformed into urine by qi-transforming function of the kidney and trans-
ported down into the bladder, while the discharge of urine is the main function
of the bladder. At the same time, it is adjusted by the function of qi-transform-
ing and qi-controlling of the kidney. The relationship between the kidney and
the urinary bladder lies in their interdependence and mutual coordination in
the production, transformation, and excretion of urine. Pathologically, if kidney
qi is deficient, it will affect excretion of urine with manifestations of lower back
soreness, dysuria, and enuresis. If there is damp-heat in the urinary bladder, it
will impair the kidney which can result in symptoms like frequent urination,
urgent urination, and painful urination.
Qi, blood, and body fluids are the basic substances which constitute the
human body and maintain its life activity. Qi is a very active and refined sub-
stance while blood is a red liquid circulating within the vessels. Body fluids is a
general term for all normal liquids in human body. Qi, blood, and body fluids
constitute and sustain functions of organs, meridians, tissues, and orifices.
They are metabolized by the functional activities of the viscera and meridians.
Therefore, qi, blood, and body fluids are closely related to the organs, tissues,
and meridians physiologically.
4 The Theory of Qi, Blood, and Body Fluids

4.1 Qi

Key points
– Concept of qi:
– Qi is a kind of very active and refined substance that is in constant movement, which
constitutes human body and maintains its life activity.
– Production of qi:
– Congenital qi is related to kidney. Acquired qi is related to lung and spleen.
– Function of qi:
– Propelling, warming, defending, controlling, and transforming.
– Movement of qi:
– Ascending, descending, exiting, and entering.
– Classification of qi:
– Primordial qi, pectoral qi, nutritive qi, and defensive qi.

4.1.1 Concept of qi

Qi is one kind of simple understanding to natural phenomenon by the ancients. As


early as the Dynasty of Spring-Autumn and Warring States, materialistic philosophers
believed in qi as universal origin and the most basic substance forming the whole world.
And everything in the universe was produced by motion and changes of qi. This kind of
view was introduced into the medical domain to explain human activities and it was
also widely applied to many aspects, such as physiology, pathology, diagnosis, treat-
ment, and health maintenance. According to traditional Chinese medicine, qi is a very
active and refined substance that constitutes human body and maintains its life activ-
ities. Qi produces everything in the universe, while humans are created by nature. There-
fore, human body which includes zang-fu, meridians, five sense organs, and nine ori-
fices is also created by the substances of qi. Meanwhile, the maintenance of life activities
depends on the functions of qi. For example, after the clear qi and food enter the body,
they turn into qi of various organs through the metabolic process. The sufficient qi make
organs and tissues play their roles to maintain and promote life activities normally.

4.1.2 Production of qi

The production of qi is divided into two aspects: congenital qi and acquired qi. The
congenital qi is inherited from parents before birth, including the essence qi stored
in parents’ kidney when embryo was created. It also includes food essence from
mother. The acquired qi refers to nutritional substances (food and water essence)
60  4 The Theory of Qi, Blood, and Body Fluids

after birth as well as the fresh air from nature. Therefore, kidney essence, diet nutri-
ents, and fresh air are the substantial basis to produce qi. Production of qi mainly
depends on physiological functions of the viscera, especially the lung, spleen – sto-
mach, and kidney. Among them, congenital essence-qi inherited from parents is
stored in the kidney and is the most primitive basis to produce qi, the food essence-qi
is acquired from diet and transformed by spleen, and the fresh air is inhaled by the
lung. Hence, viscera qi throughout the whole body is produced by the combination
and close coordination of the functions of the lung, spleen, and kidney. Production
of qi is affected by many factors, such as poor constitution, deficiency of kidney
essence, poor nutrition, decreased fresh air inhalation due to polluted environment,
or dysfunctions of the lung, spleen, or kidney.

4.1.3 Movement of qi

The motion of qi is called qi dynamic. The moving style of qi can be classified into four
kinds, namely ascending, descending, exiting, and entering. Qi reaches all parts of
the body, including zang – fu organs and meridians. All the viscera and tissues are
areas for qi to ascend, descend, exit, and enter. Therefore, although qi is too fine to be
measured, its motion can be embodied by all kinds of physiological activities of
viscera and meridians. For example, lung controls dispersing and descending to regu-
late respiration. The process of dispersing and exhaling the turbid embodies qi’s
ascending and exiting movement, while the process of descending and inhaling the
lucid embodies qi’s descending and entering movement. For example, spleen and
stomach are the main places for digestion. Spleen-qi is suitable for ascending the
lucid while stomach-qi is suitable for descending the turbid. Interaction of ascending
spleen-qi and descending stomach-qi completes the process of food digestion. As
another example, the heart belongs to fire and is located in the upper part of the
body, while the kidney belongs to water and is located in the lower part of the body.
Heart and kidney need to coordinate well in order to maintain the balance of yin and
yang (water and fire). Other life activities, such as the production and circulation of
blood as well as the metabolism of body fluids, are all as a result of qi dynamic. In
general, the generating, transforming, and essence-storing functions of five-zang
organs are mainly ascending, while the receiving, transporting, and transforming
functions of six-fu organs are mainly descending. It should be pointed out that each
zang- or fu-organ may differ from each others in its moving style of qi. The liver and
spleen qi tend to ascend, while the lung and stomach qi tend to descend. Overall
speaking, the ascending, descending, exiting, and entering movements of qi are the
basic characters of functional activities of viscera and tissues. The process of qi move-
ment is the process of life activities. In fact, all functional activities of human body are
embodied by qi movement. Thus, qi movement is the basic condition to maintain life
activities. Only if the qi movement coordinates well, will there be normal physiological
4.1 Qi  61

function of the organs. If the movement of qi is broken down, it will result in patholo-
gical changes and cause diseases. If the qi movement stops, the end of life occurs.

4.1.4 Functions of qi

Qi is the basic substance to maintain the life activities. It plays an important role in the
body. The physiological functions of qi are characterized in the following five aspects.
1. Propelling function
The propelling function of qi refer to its strong movement. It can move and
stimulate the physiological functions of all the organs as well as promote develop-
ment and growth of human body. For instance, kidney-qi can promote human
growth and reproduction; heart-qi can promote blood circulation; spleen-qi and
stomach-qi can boost digestion and absorption of food; and qi of lung, spleen, and
kidney can propel metabolism of body fluids. If qi is deficient or stagnated, it may
result in hypofunction of the viscera, sluggish growth and development, indiges-
tion, retarded blood circulation, abnormal metabolism of body fluids, and so on.
2. Warming function
Qi is the source of thermal energy and can make the body warm. The warming
function is characterized in three aspects:
1. To produce heat to maintain the normal body temperature.
2. To warm zang – fu organs and meridians to maintain their normal physio-
logical function.
3. To maintain normal circulation of blood and body fluids.

Disorder of qi-warming function will result in hypothermia, cold extremities, dys-


function of zang – fu organs, and poor circulation of essence, blood, and body fluids.
2. Defending function
A healthy qi can guard the body surface, resist invasion of exogenous patho-
gens, and fight against the pathogens and expel them out. The concrete perfor-
mance is in two aspects:
1. Before the onset of disease, if the defensive qi is plentiful, it will safeguard
the body surface as well as tighten the skin and striae enough to resist inva-
sion of pathogens.
2. After the onset of disease, healthy qi will fight against the evil qi, expel
them out of the body, and promote recovery as early as possible. Hence,
when the defending function of qi is strong enough, not only is it hard for
the evil qi to invade the body but also help the disease to be cured easily. If
the defending function of qi gets weaker, the resistant ability will fall
down gradually and the exogenous pathogens will attack the body easily.
Moreover, the weakened qi may lead to long-term retention of the patho-
gens, resulting in deteriorated disease or even death.
62  4 The Theory of Qi, Blood, and Body Fluids

4. Controlling function
This function refers to the ability of blood and fluid controlling so as to prevent
them from losing unduly. For example, spleen-qi can control blood, make blood
circulating inside the vessels, and prevent the blood from flowing outside the
vessels; lung-qi or defensive qi can control sweat; spleen-qi or kidney-qi can
control intestinal fluid; and kidney-qi can control urine or sperm as well as control
its secretion and excretion to prevent excessive loss. If the controlling function of
qi is weakened, it will lead to loss of fluid great quantities. For example, failure of
qi to control blood may cause bleeding; failure of qi to control body fluids may
lead to polyhidrosis, polyuria, or urinary incontinence; and failure of qi to control
sperm may result in spermatorrhea or premature ejaculation. In addition, qi defi-
ciency in intestines can cause chronic diarrhea or fecal incontinence.
5. Qi transforming function
Qi can produce and promote various changes through the motion of qi. Because qi
is spread all over the body, production and maintenance of visceral functions as
well as metabolism and inter-transformation among the essential substances are
all dependent on the qi transformation. For example, functions of spleen and
stomach depend on the movement of spleen – stomach qi. Digestion and absorp-
tion of foodstuff depend on heart qi and lung qi, wherein the food essence is trans-
formed into qi, blood, and body fluids. Some body fluids become sweat and urine
by lung’s dispersing function and kidney’s evaporating functions. Thus, series of
material and energy metabolism are all manifestations of qi transforming function.

4.1.5 Classification of qi

According to its origin, distribution, and function, qi is classified into the following
categories: the primordial qi, pectoral qi, nutritive qi, defensive qi, visceral qi, and
collateral qi. The latter two will be introduced in detail in other related chapters.
1. Primordial qi
The primordial qi refers to the most fundamental and important qi of human
body and is the motivating power of life activity.
A. Production of the primordial qi
The qi comes mainly from the innate essence and transformed from the
kidney essence of the parents. It is nourished by the food essence after
birth. Therefore, the production, prosperity, and declination of the pri-
mordial qi has direct relationship with constitution from prenatal
essence as well as the absorbing function of the postnatal essence. The
postnatal essence is especially important for production and vigor. Even
if the prenatal essence is poor, as long as the postnatal essence is strong,
it will still be able to supplement the primordial qi gradually. Thus, the
function of spleen and stomach is very important to primordial qi.
4.1 Qi  63

B. Distribution of the primordial qi


The primordial qi is the prenatal qi. It is originated from kidney and distrib-
uted to all parts of the body through triple-jiao. It reaches everywhere to
the zang-fu organs internally as well as to skin externally.
C. Function of primordial qi
The physiological functions of the primordial qi mainly manifest into two
aspects: the primordial qi stored in the kidney can boost and regulate
growth, development, and reproduction of the body, and the primordial qi
spreading to the whole body can activate, promote, and regulate the phy-
siological activities of the viscera, meridians, tissues, and organs. It is the
power of the life activities. Plentiful primordial qi can strengthen the
human constitutions as well as activate viscera and meridians.
2. Pectoral qi
The pectoral qi, also called daqi, is the qi accumulating in the thorax. Because
the thorax is the part where the pectoral qi gathers, it is called the sea of qi or
danzhong.
A. Production of pectoral qi
The pectoral qi is a combination of natural fresh air inhaled by the lung
and the food essence transformed by spleen-stomach. Hence, prosperity
and decline of pectoral qi are influenced directly by the respiratory function
of lung and transportation and transformation functions of spleen.
B. Distribution of pectoral qi
Accumulating in the thorax, the pectoral qi permeates the heart and the
lung as well as distributes in the area of Dan Tian (life gate) and reaches
the point of (Qijie ST30).
C. Function of pectoral qi
The pectoral qi mainly has two functions:
1. It flows through the respiratory tract to promote the respiratory move-
ment of the lung and it also governs the respiratory and vocal functions.
2. It permeates and warms the heart and vessels to promote circulation of
blood and qi. Hence, the strength of the pectoral qi is closely related to
the condition of respiration, the rhythm and strength of heart beats,
and circulation of qi-blood. If the pectoral qi is sufficient, it will lead to
harmonious breath, distinct speech, clear voice, and smooth pulse.
3. Nutritive qi
The nutritive qi, also called rongqi, refers to a kind of qi circulating within the
vessels and having nutritive function. It is the important component of blood.
Therefore, the name nutritive-blood is often mentioned. Compared to the defen-
sive qi, the nutritive qi pertains to yin, so it is also called nutritive-yin.
A. Production of nutritive qi
The nutritive qi mainly comes from the food. It is the essence transformed
and absorbed by spleen and stomach. The productive location of nutritive
64  4 The Theory of Qi, Blood, and Body Fluids

qi is spleen and stomach in middle-jiao, and the food essence is the mate-
rial basis of its production.
B. Distribution of nutritive qi
The nutritive qi flows inside the vessels to circulate throughout the body.
Interiorly, it reaches the viscera while exteriorly it reaches the limbs and
joints. This cycle is repeated without stopping.
C. Function of nutritive qi
The physiological functions of the nutritive qi show two aspects: to
produce blood and to nourish the whole body. Containing rich nutrient, as
the nutritive qi flows into the vessels, it becomes an important part of
blood. Therefore, nutritive qi is the main material basis for the production
of blood; it travels inside the vessels and provides essential nutritive mate-
rials for the physiological activities of all the viscera, meridians, tissues,
and organs, as well as maintains its normal physiological function.
4. Defensive qi
The defensive qi refers to the qi circulating outside the vessels and having pro-
tective function to the body. Compared with the nutritive qi, it belongs to yang;
therefore, it is also called defensive-yang.
A. Production of defensive qi
The defensive qi comes from the food essence of the spleen and stomach.
B. Distribution of defensive qi
The defensive qi has very strong vitality. Therefore, it is not restricted by
the vessel passages and travels outside the vessels. It distributes through
the whole body as well as the body surface.
C. Function of defensive qi
The physiological functions of defensive qi can be generalized by the fol-
lowing three aspects:
(a) Protecting the body surface and resisting the invasion of the exogen-
ous pathogens: Skin and muscles are the most important barrier to
resist exogenous pathogens. Lung spreads the defensive qi to the body
surface and strengthens the striae to increase the resistant ability.
Insufficient defensive qi may lead to decreased resistant ability and
apt to be invaded by exogenous pathogens.
(b) Warming muscle, skin, and viscera: The defensive qi is the origin of
energy. It spreads all over the body to warm muscle, skin, and viscera
as well as make them strong and lustrous.
(c) Regulating the opening and closing of the striae, controlling the excre-
tion of the sweat, and maintaining the normal body temperature.

Although both nutritive qi and defensive qi come from the same food
essence, they differ in property, distribution, and physiological function.
The nutritive qi comes from the most essential part of the food essence,
4.2 Blood  65

flowing inside the vessels and having the function of producing blood and
nourishing the whole body; so it belongs to yin. The defensive qi comes
from the most active and powerful part of food essence, flowing outside the
vessels and having the function of defending the body surface and
warming the body; so it belongs to yang. Only when the nutritive qi and the
defensive qi coordinate with each other, can they exert their own physiolo-
gical function, respectively.

4.2 Blood

Key points
– Concept of blood:
– The blood is a red liquid material circulating within the vessels and possessing nourish-
ing and moistening functions.
– Production of blood:
– Food essence and kidney essence.
– Functions of blood:
– Nourishing and moistening function.
– Material foundation for mental activities.

4.2.1 Concept of blood

The blood is a red liquid material circulating within the vessels and has the nourish-
ing and moistening functions. It is one of the basic substances which constitutes the
human body and maintain its life activity. Comparing with qi, blood belongs to yin.
So blood is also called yin-blood.

4.2.2 Production of blood

Blood is produced from the two origins. The first origin is the transformation
from the food essence. Food is converted into the essence through the decomposi-
tion by stomach as well as the transformation and transportation by spleen,
where the pure and refined part is being transformed into the nutritive qi. The
nutritive qi permeates the vessels and combines with body fluid to become blood.
The second origin comes from the transformation of kidney essence. Kidney
essence is the source of life. Essence is stored in the kidney and transformed into
marrow, which can be changed into blood. Because food essence transformed
and transported by spleen-stomach is the most important and basic material of
the blood production, the prenatal kidney essence also depends on the postnatal
66  4 The Theory of Qi, Blood, and Body Fluids

food essence to replenish. Therefore, the transforming and transporting function


of the spleen and stomach play an important role in the production of blood.
Hence, there is a saying the spleen and stomach are the source for the production
of qi and blood.

4.2.3 Functions of blood

1. Nourishing and moistening function


Blood consists of nutritive qi and body fluids. Nutritive qi is produced from
food essence. Body fluids can moisten the whole body. Hence, the main func-
tion of blood is to nourish and moisten the whole body. Blood circulates in
the vessels from internal organs to external skin and orifices throughout the
whole body. It nourishes and moistens all the organs and tissues to guarantee
their normal physiological functions. Therefore, if the blood is sufficient and
all the organs are nourished by it, it will manifested by healthy facial complex-
ion, well-developed and strong muscles, lustrous skin and hair, and nimble
movements.
3. Material foundation for mental activities
Although the mental activities are dominated by heart, they are also closely
related with the other internal organs. Blood nourishes and strengthens the
internal organs. Therefore, it can produce and maintain the normal mental
activities. It is the main material foundation for the mental activities. Sufficient
blood can nourish and harmonize the internal organs. It is manifested as good
spirit, clear mind, and smart thinking. Blood deficiency may lead to malnour-
ishment of the internal organs and the inability to make the right decision. It is
manifested as palpitation, insomnia, lots of dreams, irritability, and somno-
lence.

4.2.4 Blood circulation

Vessels house the blood. Relatively closed-flow vessels are the prerequisites for
normal blood circulation. Blood flows inside the vessels and is restricted by it. It
recycles endlessly to irrigate the whole body. Normal blood circulation depends on
the promoting and controlling functions of the visceral qi. Movement of qi ensures
constant blood circulation, while the controlling of qi restrict the blood to circulate
within the vessels. These two functions cooperate harmoniously to keep blood cir-
culation normal. Abundant heart-qi can maintain the normal beats and promote
constant circulation. Hence, heart-qi is the basic power for blood circulation. Lung
dominates qi, links with all the vessels, and helps heart to circulate the blood. Liver
dominates the free flow of qi and regulate the qi dynamic. Hence, the dispersing
4.3 Body fluids  67

and descending action of lung and soothing action of liver are important auxiliary
factors for normal circulation. Spleen govern the blood. The blood circulation inside
the whole body depends on the governing and controlling functions of the spleen to
prevent it from spilling outside the vessels. In addition, liver can store blood and
regulate the blood volume to prevent bleeding. Therefore, functions of liver and
spleen are also important factors to maintain normal blood circulation. Overall
speaking, the normal blood circulation depends on the coordination of the heart,
lung, spleen, and liver, as well as the moving and controlling function of qi. Defi-
cient qi can lead to slow movement and congestion of blood which will result in
blood stasis. On the other hand, if the controlling function of qi is weak, blood will
spill outside of the vessels, which will lead to various hemorrhaging conditions. In
addition, the blood circulation is also influenced by the flow of the vessels and
body temperature. For example, phlegm and blood stasis can oppress vessels and
lead to impediment of blood circulation and local obstruction. Injuries from falls
and other external force may burst vessels and cause bleeding. Blood has a like-
warm-and-aversion-to-cold character. Hence, cold may slow down the blood circula-
tion and cause stasis, while heat may accelerate the blood circulation and cause
hemorrhage.

4.3 Body fluids

Key points
– Concept of body fluids:
– Body fluid is a general term for the entire normal liquids in the body.
– Metabolism of body fluids:
– The metabolism of body fluids is related to lung, spleen and kidney, among which kidney
is the most important.

4.3.1 Concept of body fluids

Body fluids is a general term for the entire normal liquids in the body. It is also the
basic material constituting the human body and maintaining the life activities.
Body fluids are mainly the fluid in or metabolized by viscera and tissues, including
secretory liquids (such as the nasal discharge, tears, and saliva) and excretory
liquids (such as sweat, urine). Comparing with qi, body fluids pertain to yin. There-
fore, it is often called yinjin or yinye, which means the “yin fluid.” Body fluids can
be subdivided into two parts of jin (thin fluid) and ye (thick fluid). They differ in
character, distribution, and function. Generally speaking, the lucid and thin type is
jin. It has more fluidity, moves more freely, and distributes onto the skin, muscles,
and orifices. Its main function is to moisten the organs, surface, and orifices. The
68  4 The Theory of Qi, Blood, and Body Fluids

dense and thick type is called ye. It has with less fluidity and mainly distribute into
the skeleton, joints, viscera, and brain-marrow to play the nourishing and lubricat-
ing function. Although jin and ye are different to some degree, they all come from
food essence, transformed by the spleen-stomach and distributed inside as well as
outside the vessels along with qi and blood. They supplement and transform to
each other and have no specific differences. However, ye exhaustion is more severe
than jin impairment pathologically.

4.3.2 Metabolism of body fluids

1. Production of body fluids


Body fluids come from the food essence, mainly produced by spleen, stomach,
and intestines. After entering into the stomach, the food is decomposed by
stomach and transformed by spleen. The function of separating the clear from
the turbid by the small intestine produces the body fluids. Large intestine can
also absorb parts of liquids to dry the feces during the process of transporting
the wastes. It is thus clear that production of body fluids is influenced by the
two factors: one is the sufficient liquid intake and the other is the dominant
function of spleen coordinating with stomach and small and large intestines.
2. Distribution of body fluids
After production, body fluids is distributed in the whole body through the
coordination of spleen, lung, kidney, and triple-jiao. First, spleen-qi ascends
body fluids to the lung; then, lung is the upper source of water, regulating the
waterways. By diffusing action, the lung further disseminates body fluids
upward and outward; by descending action, it further sends body fluids
inward and downward. After metabolism, body fluids is transported to the
kidney. The kidney governs water. Through the steaming action and qi trans-
formation by the kidney yang, the clear part of the fluid is sent up to the lung
and the spleen to be used again and throughout the whole body. Smoothness
of the water passage in triple-jiao and free flow of the liver qi also help the dis-
tribution of the body fluids. In addition, liver dominates the governing and
smoothing function of free flow of qi. Distribution of body fluids also depends
on the movement of qi. Therefore, liver plays a coordinating function in the
fluid metabolism.
4. Excretion of body fluids
After body fluids is utilized by human body, its surplus and the metabolized
wastes should be discharged outside of the body timely. It is mainly the result
of functional collaboration of lung, kidney, large intestine, and urinary bladder.
Lung dominates dispersing and associates skin and hair as well as the body
fluids excreted as sweats from the skin or steam from the respiratory tract;
kidney governs water and changes the turbid into urine and being excreted by
4.3 Body fluids  69

bladder; large intestine dominates the transmission and the feces inside is
being mixed with some water. Hence, there are four ways to excrete the surplus
water and metabolized wastes: sweat, exhaled breath, urination, and defeca-
tion. Among them, urination is the key link regulating the dynamic balance of
the body fluids metabolism. Overall speaking, the metabolism of body fluids is
a complicated process. It is affected by the functions of the different organs,
among which the lung, spleen, and kidney are the most important, especially,
the function of the kidney. If there is a disorder in viscera’s function, the meta-
bolic process of the body fluids will be influenced, which will result in defi-
ciency or disorder of the body fluids. It will lead to the pathological changes of
damp-phlegm and edema.

4.3.3 Function of body fluids

1. Moistening and nourishing


There is a large amount of water and nutrients in the body fluids which are
extensively distributed in the viscera, sense organs, orifices, body constituents,
and limbs. They play an important role in moistening the whole body. For
example, jin is distributed into the body surface to moist skin, muscle, and ori-
fices. It smoothes the skin and muscle as well as make the hair luscious and ori-
fices nourished and clear; ye spreads into the joints and marrow to make the
movement free and flexible as well as strengthens the bone and consolidates
the brain marrow.
2. Components of the blood
The body fluids from the food essence combine with the nutritive qi to transform
into blood. Therefore, it is one of the important components of the blood and
the basic liquid substances in the blood.
3. Participation in the regulation of yin-yang balance
Fluid metabolism plays an important role in regulation the yin-yang balance.
Body fluids pertains to yin. Plentiful body fluids may restrain excessive heat-
yang to maintain harmonious balance of yin-yang and cold-heat of the body. In
addition, body fluids can change into sweat. Sweating disperses body heat,
weakens yang-pathogen, and regulates the body temperature. Fluid metabolism
often adapt to the changes of life activities and environment, through which it
can regulate yin-yang and maintain the normal body temperature.
4. Assisting in waste excretion
Through the metabolic process, body fluids carry various metabolic wastes to
the related parts or excretory organs. By visceral qi-transformation, the wastes
are excreted outside the body in time to guarantee the normal physiological
function of different organs.
70  4 The Theory of Qi, Blood, and Body Fluids

4.4 The relationships among qi, blood, and body fluids

Key points
– Relationship between qi and blood:
– Qi is the commander of blood (qi produces, circulates, and controls blood) and blood is
the mother of qi (blood nourishes and carries qi).
– Relationship between qi and body fluids:
– Qi generates, circulates, and controls body fluids, while body fluids carry qi.
– Relationship between blood and body fluids:
– They come from the same origin and can change from each other.

Qi, blood, and body fluids are the basic substances constituting and maintaining
the human body. They differ in property, function, and distribution. However, they
connect and promote each other physiologically. During the onset of disease, they
affect each other.

4.4.1 The relationship between qi and blood

Qi belongs to yang, being invisible and active. It governs warming and moving func-
tion. Blood belongs to yin which is visible and quiet. It has the function of nourish-
ing and moistening. They both originate from food essence produced by spleen-
stomach and kidney essence. They connect and produce each other to maintain the
life activities together. The relationship between qi and blood can be generalized as
qi is the commander of blood and blood is the mother of qi.
1. Qi is the commander of blood
A. Qi produces blood
Qi produces blood refers to qi participating and promoting in the process of
blood formation. It is characterized by two aspects: nutritive qi can trans-
form and generate blood. It is main foundation for blood production. The qi
dynamic of spleen, stomach, heart, lung, and kidney is the power house for
blood formation. Good diet, sufficient source of nutritive-qi, and strong qi of
zang-fu organs will generate sufficient blood. On the other hand, deficient
nutritive-qi and weak zang-fu qi can weaken the qi dynamic, which will
result in blood deficiency syndromes due to the weakened blood source.
B. Qi moves blood
Qi moves blood refers to the power which moves the blood to circulate inside
the vessel. In general, the heart qi promotes and strengthens the heart beat
to move the blood circulation; lung qi disperses, descends, and helps blood
movement; the liver qi regulates the qi dynamic as well as maintains the
blood movement. Therefore, blood depends on the qi movement to circulate
4.4 The relationships among qi, blood, and body fluids  71

and reach to various parts of the body. If qi gets deficient and fails in propel-
ling or qi gets congested, it will result in blood stagnation. The disorder of qi
dynamic can also cause the disturbances of blood circulation, such as bleed-
ing superiorly caused by adverse rise of qi.
C. Qi controls blood
Qi controls blood refers to qi having the function to keep blood circulating
within the vessels and preventing it from extravasation. This is a specific
embodiment of controlling function of qi and is mainly related with the
blood-controlling function of the spleen qi. If deficiency of the spleen qi fails
to control blood within the vessels, it will cause various kinds of hemorrhage.
2. Blood is the mother of qi
A. Blood nourishes qi
Blood contains abundant nourishment. It can provide material foundation
for generation and functional activity of qi so as to make qi replenished
timely and appropriately. The abundant blood provides qi with nourish-
ment. If blood gets deficient and fails to nourish qi, it may cause qi defi-
ciency.
B. Blood carries qi
Qi circulates only when it attaches to blood. This is to prevent it from escap-
ing due to its dispersing nature. Blood is the carrier for qi. Due to its invi-
gorating power of movement, especially the defensive qi, it has to attach to
a body for the blood to circulate normally. Clinically speaking, the hemor-
rhaging patients are often presented with the dangerous signs of qi collap-
sing followed by blood loss.

4.4.2 The relationship between qi and body fluids

1. Qi generates body fluids


Qi generates body fluids refers to qi having the effect of promoting the produc-
tion of body fluids, which is produced by absorption and digestion of the food
essence by spleen-stomach qi. If the spleen-stomach qi is sufficient along with
the good digestive and absorptive function, the production of body fluids will
be prosperous. On the contrary, if the spleen-stomach qi is deficient along with
the decreasing function of digestion and absorption, the generation of body
fluids will be short.
2. Qi moves body fluids
Qi moves body fluids refers to qi having the ability to move the distribution
and excretion of the body fluids. The movement of qi is the power of distribu-
tion and excretion of the body fluids. The qi of lung, spleen, kidney, and triple-
jiao moves and distributes the body fluids through the entire body. Through
the qi transforming function of lung, intestines, kidney, and urinary bladder,
72  4 The Theory of Qi, Blood, and Body Fluids

it can turn the remaining fluid and the metabolic wastes into the sweats and
urination. They can be discharged out of the body timely. The distribution
and excretion of body fluids depend on qi transformation and coordination
of the viscera such as the lung, spleen, kidney, and triple-jiao. If qi of the
above-mentioned viscera are deficient or congested, it will hinder the fluid
distribution and excretion which can result in damp congestion and phlegm
retention.
A. Qi controls body fluids
Qi controls body fluids refers to qi having the effect to astringe the body
fluid and preventing it from losing unduly. For example, lung and defen-
sive qi can control sweat; spleen and kidney qi can control saliva; kidney
and urinary bladder qi can control urine; and so on. If qi is deficient and
fails to control, it will lead to abnormal loss of body fluids which is mani-
fested as polyhidrosis, polyuria, and drooling.
B. Body fluids conveys qi
Fluid conveys qi refers to body fluids having the function of carrying qi. Qi
has to attach to the body fluids so as to exist inside the body and spread to
the whole body. In clinical setting, severe vomiting, diarrhea, and sweating
can cause fluid loss in a great quantity which will result in qi collapse and
death.

4.4.3 The relationship between blood and body fluids

Physiologically, blood and body fluids originate from the same source. Both are pro-
duced from food essence and depend on the transforming and transporting function
of the spleen and stomach. Meanwhile, fluid is also the component of blood. After
being absorbed by the spleen and stomach, body fluids are transported upward to
heart and lung to combine with the nutritive qi to become blood. Also, fluid and
blood can convert to each other. When the outside fluid permeates into vessels, it
becomes part of the blood, but when the blood inside the vessels gets out, it melts
with the body fluids. This reflects the interdependent and interchangeable relation-
ship between them. Due to the close relationship between the body and the body
fluids physiologically, they also affect each other pathologically. If too much blood
loss happens, large amount of the body fluids outside the vessels will permeate into
the vessels. Along with the blood deficient signs, fluid-injuring symptoms such as dry
mouth, throat, or skin and oliguria may appear. Hence, for patients with blood loss,
diaphoretic therapy is prohibited. On the contrary, massive loss of body fluids may
cause the liquid part of blood to leak outside the vessels, which will result in empty
blood vessels, blood and fluid dryness, and blood stasis. Therefore, strong purgative
and blood-breaking medicine should be used with great caution in patients with fluid
loss due to diaphoresis.
5 Theory of Meridians and Collaterals

5.1 Overview of the theory of the meridians


and collaterals

Key points
– The concept
– It is a passage of transporting qi and blood, connecting zang-fu, tissues, and limbs as well as
combining the body into an organic whole.
– The composition of the meridian and collateral system:
– Meridians:
– Twelve regular meridians
– Eight extra meridians
– Twelve divergent channels
– Collaterals:
– Fifteen divergent collaterals
– Superficial collaterals
– Minute collaterals
– The affiliated portions:
– Twelve meridian musculatures
– Twelve cutaneous areas
– Zang-fu organs

5.1.1 The concept of the meridians and collaterals

The system of meridians and collaterals consists of meridians, collaterals, and its
affiliated portions. It is the passages transporting qi and blood, connecting the
viscera with other tissues and limbs, and combining the body into an organic whole
(Table 5.1).

Tab. .: The difference between meridians and collaterals

Meaning Distribution Shape Routes

Meridians Trunk Run through deeper layer Thick and Vertical


of the body big
Collaterals Branch Run through the superficial Thin and Crisscross
parts of the body small

5.1.2 Composition of the meridian

The meridian is a system consisting of meridians, collaterals, and its affiliated


portions.
74  5 Theory of Meridians and Collaterals

1. Meridians
Meridians consist of three categories:
(a) Regular meridians
(b) Extra meridians
(c) Divergent meridians

There are 12 regular meridians, including three yin meridians of hand, three
yang meridians of hand, three yin meridians of foot, and three yang meridians
of foot, which are collectively called 12 meridians or 12 regular meridians. They
are the main passages for the qi-blood circulation. The 12 meridians have their
own starting and terminating points, running regions, connecting orders,
certain regularities in distribution, and trend in the limbs. They have direct rela-
tionship of affiliation with viscera in the body. There are eight extra meridians,
namely, du, ren, chong, dai, yinqiao, yangqiao, yinwei, and yangwei meridians,
collectively called eight extra meridians. They play the role of governing, com-
municating, and regulating the qi and blood of the 12 meridians. Twelve diver-
gent meridians are the meridians branching out from the 12 meridians. They run
through the chest, the abdomen, and the head. Their main function of the 12
divergent meridians is to strengthen the communication between the two exter-
nally–internally related meridians inside the body.
2. Collaterals
Collaterals are the smaller branches of meridians. They run through the superfi-
cial parts of the body without regular circulating routes. Collaterals are divided
into divergent collaterals, superficial collaterals, and minute collaterals. The
divergent collaterals are the larger and major collaterals. They include each of
the 12 meridians, du and ren meridians as well as other large collaterals of the
spleen meridian, which is collectively known as the 15 divergent collaterals.
These are the main parts of the collaterals which strengthen the qi and blood
movement. Their major functions are to strengthen communication in the exter-
ior of the body between the two externally–internally related meridians in the
12 meridians. The superficial collaterals run superficially of the body and often
appear in the surface. The minute collaterals are the smallest collaterals. They
branch from the larger collaterals, then gradually become thinner and smaller,
and eventually distribute throughout body. They can strengthen the communi-
cation among the tissues and the circulation of qi-blood.
3. Interior relationship
Twelve meridians connect with its affiliated viscera. The fu-viscera pertain to
yang, while the zang-viscera pertain to yin. The three yin meridians of hand
relate to lung, heart, and pericardium in thorax; the three yin meridians of foot
relate to spleen, liver, and kidney in the abdomen; the three yang meridians of
foot relate to stomach, gallbladder, and urinary bladder; and the three yang
meridians of hand relate to large intestine, triple-jiao, and small intestine. The
5.2 Twelve meridians  75

12 regular meridians connect with their respective viscus. For example, the lung
meridian of hand taiyin belongs to lung and connects with large intestine, while
the large intestine meridian of hand yangming belongs to large intestine and
connects with lung. The two internally and externally correlated meridians
affect each other physiologically and pathologically.
4. Exterior relationship
Exterior relationship refers to the connection between the meridians and the super-
ficial portions of the body through the 12 meridian musculatures and the 12 skin
areas. The 12 meridian musculatures connect with the limbs and bones as well as
dominate joint movement. The movement of the 12 meridians reflects the superfi-
cial location which is called the 12 skin portions. The above four parts consist of
the meridian systems. The relationships among them are shown in Figure 5.1.

Twelve regular meridians


Eight extra meridians: they govern, communicate, and regulate qi-blood in the 12 meridians
Meridians
Twelve meridian divergence: strengthen the communication in the interior of the body between the
two externally-internally related meridians
Fifteen divergent collaterals: strengthen the communication in the exterior of the body between the
two externally-internally related meridians
Collaterals
Superficial collaterals: run and appear in the surface
Minute collaterals: the thinnest and the smallest collaterals
Interior relationship: The five zang-viscera and the six fu-viscera
The affiliated portions The 12 meridian musculatures
Exterior relationship
The 12 skin areas

Fig. 5.1: Exterior relationship

5.2 Twelve meridians

Key points
– The name of 12 meridians:
– The lung meridian of hand taiyin–the large intestine meridian of hand yangming.
– The pericardium meridian of hand jueyin–the triple-jiao meridian of hand shaoyang.
– The heart meridian of hand shaoyin–the small intestine meridian of hand taiyang.
– The spleen meridian of foot taiyin–the stomach meridian of foot yangming.
– The liver meridian of foot jueyin–the gallbladder meridian of foot shaoyang.
– The kidney meridian of foot shaoyin–the bladder meridian of foot taiyang.
– The travelling route of the 12 meridians:
– The three yin meridians of hand–start from the thoracic cavity to the ends of fingers.
– The three yang meridians of hand–run from the ends of fingers to the head and face.
– The three yang meridians of foot–run from the head and face to the end of toes.
– The three yin meridians of foot–run from the end of toes to the abdomen and thorax.
76  5 Theory of Meridians and Collaterals

– Distribution of the 12 meridians:


– The taiyin and yangming meridians are distributed over the anterior border.
– The jueyin and shaoyang meridians are distributed along the midline.
– The shaoyin and taiyang meridians are distributed over the posterior border.
– The connecting route of the 12 meridians (detailed in the text).

5.2.1 Nomination of 12 meridians

The 12 meridians distribute symmetrically along the right and left sides of the body
and respectively run along the medial or lateral side of the upper or lower limbs.
Each meridian belongs to an individual zang- or fu-organ. The hand meridians run
along the upper limbs, while the foot meridians run along the lower limbs. The yin
meridians run along the medial side of the limbs affiliated with the zang-viscera,
while the yang meridians run along the lateral side of the limbs affiliated with the
fu-viscera. Generally speaking, the taiyin and yangming meridians are distributed
over the anterior border, the shaoyin and taiyang meridians are distributed over the
posterior border, and the jueyin and shaoyang meridians are distributed along the
midline. The name of the 12 meridians is demonstrated in Figure 5.2.

Yin meridians Yang meridians


the lung meridian of hand taiyin – anterior border
– the large intestine meridian of hand yangming
the pericardium meridian of hand jueyin – midline
Upper limbs – medial Lateral
– the triple-jiao meridian of hand shaoyang
the heart meridian of hand shaoyin – posterior border
– the small intestine meridian of hand taiyang
the spleen meridian of foot taiyin – anterior border
– the stomach meridian of foot yangming
the liver meridian of foot jueyin – midline
Lower limbs – medial Lateral
– the gallbladder meridian of foot shaoyang
the kidney meridian of foot shaoyin – posterior border
– the bladder meridian of foot taiyang

Fig. 5.2: Nomination of 12 meridians

5.2.2 Route and connection of the 12 meridians

The three yin meridians of hand all start from the thoracic cavity to the ends of fingers,
and connect with three yang meridians of hand related exteriorly and interiorly. The
three yang meridians of hand run from the ends of fingers to the head and face, and
connect with the three yang meridians of foot sharing the same name. The three yang
5.2 Twelve meridians  77

meridians of foot run from the head and face to the ends of toes, and connect with the
three yin meridians of foot related exteriorly and interiorly. The three yin meridians of
foot run from the ends of toes to the abdomen and thorax, extend to the head, and
connect with the three yin meridians of the hand in the thoracic cavity. Thus, the 12 mer-
idians connect with each other and travel through the entire body.
A. The travelling route of the 12 meridians:
(a) The three yin meridians of hand–start from the thoracic cavity to the ends
of fingers
(b) The three yang meridians of hand–run from the ends of fingers to the head
and face
(c) The three yang meridians of foot–run from the head and face to the ends of
toes
(d) The three yin meridians of foot–run from the ends of toes to the abdomen
and thorax
B. The connection of the 12 meridians:
(a) The three yin meridians of hand → the three yang meridians of hand: the
exteriorly and interiorly related meridians connect at the ends of fingers.
(b) The three yang meridians of hand → the three yang meridians of foot: the
same name meridians connect at the head and face.
(c) The three yang meridians of foot → the three yin meridians of foot: the
exteriorly and interiorly related meridians connect at the ends of toes.
(d) The three yin meridians of foot → the three yin meridians of hand: they
connect in the thorax.

5.2.3 Distribution of the 12 meridians

The distribution of the 12 meridians on the body surface has certain laws.
1. The four limbs
Yin meridians all run in the medial sides of the limbs while yang meridians in
the lateral side of the limbs. There are three yin meridians in the medial side, so
are the yang meridians in the lateral side. In the medial side of the upper limbs,
taiyin meridian run in the anterior border, jueyin meridian in the midline, and
shaoyin in the posterior border. In the medial side of lower limbs, in the region
8 cun above the medial malleolus, taiyin meridians in the anterior border,
jueyin meridian in the midline, and shaoyin in the posterior border; while at the
region 8 cun below the medial malleolus, jueyin meridians in the anterior
border, taiyin meridian in the midline, and shaoyin in the posterior border. In
the lateral side of the upper and lower limbs, yangming run in the anterior
border, shaoyang meridian in the midline, and taiyang meridian in the posterior
border.
78  5 Theory of Meridians and Collaterals

2. Head and face


Yangming meridians run over the face and the forehead, taiyang meridians run
over the nape, shaoyang meridians run along the lateral sides of the head, and
jueyin meridians run on the vertex.
3. The trunk
The three yang meridians of the hand run over the scapula. The three yin meri-
dians of the hand all emerge from the armpit. Among the three yang meridians of
the foot, the yangming meridian runs over the front (the chest and abdomen), the
taiyang meridian runs along the back, and shaoyang meridian runs along the side
of the body. The three yin meridians of the foot run over the chest and abdomen.
The meridians running on the chest and abdomen from the medial to the lateral
are the kidney meridian of foot shaoyin, the stomach meridian of foot yangming,
the spleen meridian of foot taiyin, and the liver meridian of foot jueyin.

5.2.4 Exterior–interior relationship

The 12 meridians form six pairs of exterior–interior relationships through the com-
munication of their divergent meridians and collaterals. The taiyang and the shaoyin
meridians exteriorly–interiorly relate to each other, so do the shaoyang and the
jueyin meridians and the yangming and the taiyin meridians.

5.2.5 Circulating sequence of the 12 meridians

The 12 meridians are the main passageways for the circulation of qi-blood. Qi-blood
of the whole body is produced from food essence through transformation by the
spleen and stomach in the middle-jiao. The 12 meridians distribute inside and outside
the human body. Qi-blood circulation in the meridians follows a certain flow and
infuse order. Figure 5.3 shows the sequence of circulation.

Lung meridian of hand taiyin Large intestine meridian of hand yangming

Spleen meridian of foot taiyin Stomach meridian of foot yangming

Heart meridian of hand shaoyin Small intestine meridian of hand taiyang

Kidney meridian of foot shaoyin Urinary bladder meridian of foot taiyang

Pericardium meridian of hand jueyin Tri-jiao meridian of hand shaoyang

Gallbladder meridian of foot shaoyang Liver meridian of foot jueyin

Fig. 5.3: Circulating sequence of the 12 meridians


5.2 Twelve meridians  79

5.2.6 Travelling routes of the 12 meridians

1. The lung meridian of hand taiyin


The lung meridian originates from the middle-jiao, running downward to
connect the large intestine; returning upward, it runs along the openings of
the stomach (the lower opening is pylorus and the upper one is cardia),
passes through the diaphragm, and enters the lung, its belonging organ. It
then ascends to the throat, and transversely runs to the superolateral
aspect of the chest (Zhongfu, LU1). It comes out from the axilla, descends
along the anterior border in the flexor aspect of the upper limb, passes
through the cubital fossa, and enters the cunkou (the radial artery at the
wrist for pulse feeling); then it arrives at the thenar eminence and reaches
the radial side of the tip of the thumb (Shaoshang, LU11). The branch:
emerges from the proximal part of the wrist (Lieque, LU7) and runs along
the dorsal side of the palm to the radial side of the tip of the index finger
(Shangyang, LI1) where it links to the large intestine meridian of hand
Yangming (Figure 5.4).

1. Zhongfu
2. Yunmen
3. Tianfu
Yunmen 4. Xiabai
Zhongfu 2 5. Chize
1
Tianfu 6. Kongzui
Xiabai 3 7. Lieque
4
8. Jingqu
9. Taiyuan
Chize
5 10. Yuji
Kongzui 11. Shaoshang
6

Lieque
7
8 Jingqu
Yuji 9
10 Taiyuan
11
Shaoshang

Fig. 5.4: Lung meridian of hand taiyin

2. The large intestine meridian of hand yangming


The large intestine meridian of hand yangming originates from the radial side of the
tip of the index finger (Shangyang, LI1). Passing through the dorsum of the hand, it
runs upward along the anterior border in the extensor aspect of the upper limb and
arrives at the anterior aspect of the shoulder joint. Then it runs backward to the site
80  5 Theory of Meridians and Collaterals

beneath the spinous process of the seventh cervical vertebra (Dazhui, GV14), and
runs forward and downward to the supraclavicular fossa (Quepen, ST12). There it
enters the thoracic cavity to connect with the lung, and further passes through the
diaphragm, terminating at the large intestine, its belonging organ.
The branch: Emerging from (Quepen, ST12), it runs upward through the neck to
the cheek and enters the gums of the lower teeth. Then returning and running
by the mouth, it crosses the opposite meridian at the philtrum and runs further
to the site beside the opposite wing of the nose (Yingxiang, LI20), where it con-
nects the stomach meridian of foot Yangming (Figure 5.5).

1. Shangyang
Futu 2. Hegu
Tianding 12 13
Jugu Yingxiang 3. Pianli
11
Dazhui 10
Heliao 4. Quchi
9
8 5. Zhouliao
Jianyu
7
6. Binao
Binao 7. Jianyu
6
8. Jugu
Zhouliao 5
9. Dazhui
4 10. Tianding
Quchi
11. Futu
12. Heliao
Pianli 3 13. Yingxiang
Hegu 2

1 Shangyang

Fig. 5.5: Large intestine meridian of hand yangming

3. The stomach meridian of foot yangming


The stomach meridian of foot yangming originates from the site beside the
wings of the nose (Yingxiang, LI20), and ascends along the bridge of the nose to
the root of the nose where the left and the right meridians meet. It then runs lat-
erally to the inner canthus where it meets the bladder meridian of foot taiyang.
It then runs downward along the lateral side of the bridge of the nose and
enters the upper gums of the teeth. Returning to the corner of the mouth and
curving around the lips, it meets the opposite meridian at the mentolabial
groove (Chengjiang, GV24). Turning back, it runs along the posterior–inferior
border of the mandible to the site of the anterior angle of the mandible (Daying,
ST5); then it ascends in front of the ear, passing through (Shangguan, GB3), and
runs along the anterior hairline and reaches the forehead.
Branch in the face: Emerging in front of (Daying, ST5), it runs downward to
Renying (ST9). Along the throat it runs backward and downward to (Dazhui,
5.2 Twelve meridians  81

GV14). Turning back, it runs forward to (Quepen, ST12); then it runs deep into
the thoracic cavity, descends through the diaphragm, enters the stomach, its
belonging organ, and connects with the spleen.
The straight portion: Starting from (Quepen, ST12), it runs downward along
the midclavicular line and by the umbilicus all the way to (Qijie, ST30), superior
to the inguinal groove.
Branch in the lower opening of the stomach: Coming out from the lower
opening of the stomach (pylorus), it descends along the inside of the abdomen
to (Qijie, ST30), where it joins the straight portion. Then it runs downward
along the anterior aspect of the thigh to the knee. Descending along the anterior
border of the lateral aspect of the tibia, it arrives at the dorsum of the foot, then
enters the lateral side of the tip of the second toe (Lidui, ST45).
Branch in the leg: Emerging from the site 3 cun below the knee (Zusanli,
ST36), it descends and enters the lateral side of the tip of the middle toe.
Branch in the dorsum of foot: Arising from (Chongyang, ST42), it runs
forward to the medial side of the tip of the big toe (Yinbai, SP1), where it links
the spleen meridian of foot taiyin (Figure 5.6).

Touwei
8
9 Chengqi
10 Renying
7 1
Quepen Xiaguan 2
Sibai
6 3 Juliao
Ruzhong 11 4 Dicang
12 Jiache 5
Rugen
Daying
Burong 13

1. Chengqi 15. Qichong


Tianshu 14 2. Sibai 16. Piguan
Qichong 15 3. Juliao 17. Futu
Piguan 16
4. Dicang 18. Liangqiu
5. Daying 19. Dubi
Futu 17 6. Jiache 20. Zusanli
7. Xiaguan 21. Lanweixue
Liangqiu 18
Dubi 19 8. Touwei 22. Shangjuxu
Zusanli 20
9. Renying 23. Fenglong
Lanweixue 21
22 Shangjuxu
Fenglong 23 10. Quepen 24. Xiajuxu
24 Xiajuxu
11. Ruzhong 25. Jiexi
Jiexi
25 12. Rugen 26. Chongyang
Lidui 26 Chongyang
27 13. Burong 27. Lidui
14. Tianshu

Fig. 5.6: Stomach meridian of foot yanming


82  5 Theory of Meridians and Collaterals

4. The spleen meridian of foot taiyin


The spleen meridian of foot taiyin originates from the medial side of the tip
of the big toe (Yinbai, SP1). Running along the junction of the red and the
white skin in the medial aspect of the foot, it ascends by the anterior border
of the medial malleolus and along the midline of the medial aspect of the leg
to the site 8 cun above the medial malleolus, where it crosses over and
further runs in front of the liver meridian of foot Jueyin. It ascends along the
anterior border of the medial aspect of the thigh, enters the abdomen, arrives
at the spleen, its belonging organ, and connects with the stomach. Running
upward through the diaphragm, it runs alongside the esophagus, reaches the
root of the tongue, and scatters its collaterals over the lower surface of the
tongue.
The branch: Arising from the stomach, it ascends through the dia-
phragm and enters the heart, linking the heart meridian of hand Shaoyin
(Figure 5.7).

11
Zhourong

10 Shidou

12 Dabao
Daheng
9
Chongmen
8

Xuehai
7

1. Yinbai 7. Xuehai

6 Yinlingquan 2. Gongsun 8. Chongmen


5 Diji 3. Shangqiu 9. Daheng

Sanyinjiao 4. Sanyinjiao 10. Shidou


4
Shangqiu 5. Diji 11. Zhourong
3 Gongsun 6. Yinlingquan 12. Dabao
2
1
Yinbai

Fig. 5.7 Spleen meridian of foot taiyin

5. The heart meridian of hand shaoyin


The heart meridian of hand shaoyin starts from the heart and emerges and
spreads over the heart system. It then goes downward through the diaphragm
5.2 Twelve meridians  83

to link the small intestine. The branch from the heart system runs alongside the
esophagus to join the eye system. The straight branch from the heart system
ascends through the lung and then turns downwards, emerging from the axil-
lary fossa (Jiquan, HT1). From there, it runs along the posterior border of the
medial aspects of the upper line and passes through the cubital fossa to the pisi-
form bone proximal to the palm, and finally enters the palm, where it reaches
the radial tip of the litter finger (Shaochong, HT9) to link with the small intes-
tine of hand taiyang (Figure 5.8).

Jiquan
1

1. Jiquan
2. Shaohai
Shenmen
3. Tongli 2
Shaohai 4

4. Shenmen
Shaochong
5. Shaofu 6
Tongli
6. Shaochong 3
4
Shenmen Shaofu
5
Shaochong
6

Fig. 5.8: Heart meridian of hand shaoyin

6. The small intestine meridian of hand taiyang


The small intestine of hand taiyang starts from the ulnar side of the tip of
the little finger (Shaoze, SI1). Running along the dorsum of hand and the poster-
ior border of the lateral aspect of the upper arm and passing the elbow, it
reaches the shoulder joint region. Circling around the scapular region, it con-
verges over the shoulder (Dazhui, GV14) and then turns downwards to link with
the heart. From there, it descends along the esophagus, passes through the
diaphragm, reaches the stomach, and finally enters the small intestine to which
it pertains (Figure 5.9).
84  5 Theory of Meridians and Collaterals

Jianzhongshu
1. Shaoze
12
Tinggong Quanliao 2. Houxi
Jianwaishu 11
15 16
10
Quyuan 8 Naoshu Tianrong 3. Yanggu
9 14
7
Tianzong Tianchuang 13 4. Yanglao
Jianzhen
5. Zhizheng
6. Xiaohai
7. Jianzhen
Xiaobai 6 8. Naoshu
9. Tianzong
10. Quyuan
Zhizheng 11. Jianwaishu
5

12. Jianzhongshu
Yanglao
4 13. Tianchuang
Yanggu 3
Houxi 2 14. Tianrong
Shaoze 15. Tinggong
1
16. Quanliao

Fig. 5.9: Small intestine meridian of hand taiyang

Its branch from the supraclavicular fossa (Quepen, ST12) ascends along the
lateral neck to the cheek. Then it reaches the outer canthus and enters the ear
(Tinggong, SI19).
Another branch separating from the cheek ascends through the infraorbital
region to the inner canthus (Jingming, BL1), and connects with the bladder mer-
idian of foot taiyang.
7. The bladder meridian of foot taiyang
The bladder meridian of foot taiyang starts from the inner canthus (Jingming,
BL1), ascends to the forehead, and joins the opposite meridian at the vertex
(Baihui, GV20).
The branch emerging from the vertex reaches to the upper area of the ear.
The straight branch of the meridian leaving from the vertex turns back to the
occipital bone and enters the cranial cavity to connect with the brain. Then it
reemerges and descends to the nape (Tianqzhu, BL10) and joins at (Dazhui,
GV14). Along the medial side of the scapula and parallel to the vertebral
column (1.55 cun lateral to the dorsal midline), it descends to the lumbar region
(Shenshu, BL23) and enters the abdominal cavity from the deeper layer of the
muscles along the lumbar region to link with the kidney and pertains to the
urinary bladder. The branch stemming from the lumbar region runs downward
parallel to the spine. Passing through the buttocks, it descends along the poster-
ior border of the lateral side of the thigh into the popliteal fossa (Weizhong,
BL40). The branch emerging from the neck runs downward along the medial
border of the scapula. From (Fufen, BL41), it runs along the region 3 cun lateral
to the spine and reaches the hip joint. From there, it goes downward along
5.2 Twelve meridians  85

the lateral aspect of the thigh and meets the previous branch from the loin
in the popliteal fossa. Then it descends through the gastrocnemius, reaching
the posterior aspect of the external malleolus (Kunlun, BL60), where it runs
along the lateral side of the foot dorsum to the lateral side of the tip of the
little toe (Zhiyin, BL67) to connect with the kidney meridian of foot shaoyin
(Figure 5.10).

5 Tongtian Chengguang 4
3 Quchai
2
6 Zanzhu Jingming
Tianzhu 1

7 Dazhu
Fufen 15
8 Feishu
9
Xinshu
Ganshu 10
11 Shenshu
Pishu
12
13 Shangliao
Zhibian 16
14 Huiyang
17

Chengfu 17. Chengfu


1. Jingming 9. Xinshu
18. Weizhong
2. Zanzhu 10. Ganshu 19. Weiyang
3. Quchai 11. Pishu 20. Chengshan
Weiyang 18 Weizhong
19 4. Chengguang 12. Shenshu 21. Feiyang
5. Tongtian 13. Shangliao 22. Kunlun
Feiyang 21 20
Chengshan 6. Tianzhu 14. Huiyang 23. Pushen
Shenmai 22 Kunlun 7. Dazhu 15. Fufen 24. Shenmai
Zhiyin 25 24 23
Pushen 8. Feishu 16. Zhibian 25. Zhiyin

Fig. 5.10: Urinary bladder meridian of foot taiyang

8. The kidney meridian of foot shaoyin


The kidney meridian of foot shaoyin starts from the plantar surface of the
little toe and runs obliquely toward the center of the sole (Yongquan, KI1).
Emerging from the lower aspect of the tuberosity of the navicular bone
(Rangu, KI2), it runs behind the medial malleolus where one of its branches
enters the heel. Then it ascends along the posterior border of the medial side
of the lower leg to the medial side of the popliteal fossa and goes further
upward along the posteromedial aspects of the thigh to the coccygeal region
(Changqiang, GV1), where it runs through the vertebral column, enter the
kidney, and links with urinary bladder. The branch emerging from the thigh
root runs alongside the perineum to the lower abdomen. Then it goes upward
along the region 0–5 cun lateral to the abdominal midline to the subclavian
86  5 Theory of Meridians and Collaterals

region (Shufu, KI27). The branch stemming from the lung joins the heart and
runs into the chest to meet with the pericardium meridian of hand jueyin
(Figure 5.11).

12
Shufu

Bukuo 11 Youmen
10

Huangshu 9

Henggu 8

Yingu 7 1. Yongquan 7. Yingu


2. Rangu 8. Henggu
Zhaohai 3. Zhaohai 9. Huangshu
Rangu 3 Taixi 4. Shuiquan 10. Youmen
Yongquan 2
1 6 5 5. Dazhong 11. Bukuo
Dazhong
Shuiquan 6. Taixi 12. Shufu
4

Fig. 5.11 Kidney meridian of foot shaoyin

9. The pericardium meridian of hand jueyin


The pericardium meridian of hand jueyin originates from the chest and pertains
to the pericardium. Then it descends through the diaphragm and successively
links with the upper, middle, and lower jiao. Its branch from the chest runs
inside the chest, emerges from the coastal region, and ascends to the subaxil-
lary region from the point 3 cun below the axilla (Tianchi, PC1). Then it runs
along the medial line of the upper arm to the cubital fossa and passes through
the wrist, entering the palm (Laogong, PC8). Then along the radial side of the
middle finger, it comes out at its radial tip (Zhongchong, PC9). Another branch
from the palm runs along the ulnar side of the ring finger to its tip (Guanchong,
TE1), where it connects with the triple-jiao meridian of hand shaoyang
(Figure 5.12).
5.2 Twelve meridians  87

1. Tianquan
2. Tianchi
3. Quze
4. Ximen
5. Jianshi
Tianchi
2 6. Neiguan
1
7. Daling
Tianquan
8. Laogong
Quze 9. Zhongchong
3

Ximen
4 Jianshi
5
6 Neiguan
Laogong
7 Daling
8

Zhongchong
9

Fig. 5.12: Pericardium meridian of hand jeuyin

10. The triple-jiao meridian of hand shaoyang


The triple-jiao meridian of hand shaoyang originates from the ulnar side of the
tip of the ring finger (Guanchong, TE1) and runs upward along the dorsum of
the wrist to (Yangchi, TE4). Running upward between the ulna and the radius, it
passes through the olecranon and runs along the lateral side of the upper arm
to the shoulder region where it moves into the supraclavicular fossa (Quepen,
ST12) and spreads in the chest to link with the pericardium. Then it descends
through the diaphragm to successively distribute into the upper, middle, and
lower jiao.
One branch from (Danzhong, CV17) runs upward and emerges from the
supraclavicular fossa (Quepen, ST12). It reaches the shoulder and the back of
the neck (Dazhui, CV14) where it crosses and meets its opposite branch. Then
it ascends to the neck and runs along the posterior border of the ear (Yifeng,
TE17), reaching the region superior to the apex of the ear. From there, it turns
downward to the cheek and terminates in the infraorbital region. Another
branch separating from the retro auricular region enters the ear. Then emer-
ging along the anterior aspect of the ear in front of (Shangguan, GB3), it
crosses the previous branch at the cheek and reaches the outer canthus (Tong-
ziliao, GB1) to connect with the gallbaldder meridian of foot shaoyang
(Figure 5.13).
88  5 Theory of Meridians and Collaterals

9
8 Sizhukong
Tianliao Jiaosun 15
Jianliao 12 14
Heliao
13
Yifeng Ermen
11
Tianyou 10
Tianjing
7

Zhigou
6 Huizong
5
4
1. Guanchong 9. Tianliao
Yangchi Waiguan
3 2. Zhongzhu 10. Tianyou
Zhonghzu 2 3. Yangchi 11. Yifeng
Guanchong 4. Waiguan 12. Jiaosun
1
5. Huizong 13. Ermen
6. Zhigou 14. Heliao
7. Tianjing 15. Sizhukong
8. Jianliao

Fig. 5.13: Tri-jiao meridian of hand shaoyang

11. The gallbladder meridian of foot shaoyang


The gallbladder meridian of foot shaoyang originates from the outer canthus
(Tongziliao, GB1) and ascends to the forehead (Hanyan, GB4) and runs down-
ward to the retro auricular region (Wangu, GB12) where it turns upward along
the forehead to the area above the eyebrow (Yangbai, GB12). Curving back to
(Fengchi, GB20), it runs along the neck to the shoulder and meets the oppo-
site branch at (Dazhui, GV14) where it runs forward into the supraclavicular
fossa (Quepen, ST12). The branch originating from the retro auricular region
enters the ear, emerges in front of the ear, and then reaches the posterior part
of the outer canthus. Another branch from the outer canthus descends to
(Daying, ST5) where it meets the branch of hand shaoyang running at the
neck. After meeting the previous branch at the supraclavicular fossa
(Quepen, ST12), it enters the chest, passes through the diaphragm to connect
with the liver, and pertains to gallbladder. Emerging from qichong, it runs
along the margin of the pubic hair and goes transversely to the hip region
(Huantiao, GB30).
The straight branch descends from the supraclavicular fossa (Quepen,
ST12) to the axilla. Along the lateral side of the chest and through the hypochon-
drium, it continuously descends to meet with the previous branch at (Huantiao,
GB30) where it descends along the lateral side of the thigh and knee. Descend-
ing along the lateral aspect of the fibula to its lower end, it reaches the anterior
aspects of the external malleolus. Then it runs along the dorsum of the foot and
reaches the lateral side of the tip of the fourth toe (Zuqiaoyin, GB44). Another
5.2 Twelve meridians  89

branch separating from the dorsum of the foot (Zulinqi, GB41) runs forward and
emerges from the lateral side of the great toe. Turning back, it passes through
the nail and ends at its hairy region to connect with the liver meridian of foot
jueyin (Figure 5.14).

32 Toulinqi
Wangu
1 Yangbai
4
Fengchi 5
Tongziliao
6

Jianjing

7
Yuanye
8
Riyue
Jingmen 9
Weidao
10 1. Tongziliao 12. Huantiao
Juliao 11
12
2. Yangbai 13. Fengshi
Huantiao
3. Toulinqi 14. Zhongdu
Fengshi 13
4. Wangu 15. Yanglingquan
14
Zhongdu 5. Fengchi 16. Waiqiu
6. Jianjing 17. Yangjiao
Yanglingquan 15

7. Yuanye 18. Guangming


8. Riyue 19. Xuanzhong
Waiqiu 16 17 Yangjiao
9. Jingmen 20. Qiuxu
Guangming 18
Xuanzhong 19 10. Weidao 21. Zulinqi
Qiuxu 2021 11. Juliao 22. Zuqiaoyin
Zulinqi 22 Zuqiaoyin

Fig. 5.14: Gallbladder meridian of foot shaoyang

12. The liver meridian of foot jueyin


The liver meridian of foot jueyin starts from the dorsal hairy region of the great
toe where it goes upward along the dorsum to (Zhongfeng, LR4), 1 cun in front
of the medial malleolus. From there, it continuously ascends along the anterior
border of the medial side of the knee, it runs along the medial aspect of the
thigh into the pubic region where it curves around the external genitalia, and
goes up to the lower abdomen. Ascending through (Zhangmen, LR13) and
(Qimen, LR14), it enters the abdomen, runs along the stomach, and distributes
in the costal and the hypochondriac regions. Ascending along the posterior
aspect of the throat to the nasopharynx, it connects with the eye system and
emerges from the forehead where it goes up to the vertex (Baihui, CV20) to
connect with the governor vessel.
One branch from the eye system descends inside the cheek and curves
around the inner surface of the lips. Another branch starting from the liver
90  5 Theory of Meridians and Collaterals

ascends through the diaphragm and enters into the lung, where it connects with
the lung meridian of hand taiyin (Figure 5.15).

Qimen
8
Zhangmen
7

Jimai 6
1. Dadun
Yinlian 5
2. Zhongfeng
3. Ligou
Ququan 4
4. Ququan
5. Yinlian
6. Jimai
7. Zhangmen
Ligou 8. Qimen
3

2 Zhongfeng
1 Dadun

Fig. 5.15: Liver meridian of foot jueyin

5.3 Eight extra meridians

The concept of eight extra meridians: du, ren, chong, dai, yinqiao and yangqiao,
and yinwei and yangwei meridians. Extra means “different.”
Their distributions are not as regular as the 12 meridians. They also do not have
exterior–interior relationship among themselves.

Key points
– The physiological functions of eight extra meridians:
– Strengthen the connection with 12 meridians.
– Regulate qi-blood in 12 meridians.
– Closely related with some viscera.

There are eight extra meridians, namely du, ren, chong, dai, yinqiao, yangqiao,
yinwei, and yangwei meridians, collectively called eight extra meridians. They can
govern, communicate, and regulate qi-blood in the 12 meridians.
5.3 Eight extra meridians  91

5.3.1 Concept and functions of eight extra meridians

As we know, extra means “different.” Their distribution and relationship with the
viscera are not regular like 12 meridians. They also do not have direct connection
with the viscera and exterior–interior relationship among themselves. The physiolo-
gical functions of eight extra meridians mainly present with the following three
aspects.
1. Strengthen the connection with the 12 meridians
In the running and distributing process, eight extra meridians crisscross with
other meridians to strengthen the connection with the 12 meridians.
2. Regulate qi-blood of the 12 meridians
Eight extra meridians run vertically, transversely, and crosswise among the 12
meridians. When qi-blood of the 12 meridians gets overabundant, it will flow
into the eight extra meridians for storage. As qi-blood of the 12 meridians gets
deficient, the qi-blood stored in extra meridians will flow out for compensation
so as to irrigate and supply for the tissues.
3. Be closely related with some viscera
The eight extra meridians are relatively communicated closely with some
viscera, such as the liver, kidney, uterus, brain, and marrow. Among them, the
uterus, brain, and marrow directly communicate with the eight extra meridians.
They affect each other physiologically and pathologically.

5.3.2 Distribution and physiological functions of the eight extra meridians

1. Du meridian
A. Circulating routes
The du vessel starts from the uterus, exits downward at the perineum, and
moves upward along the spinal column to (Fengfu, GV16) at the nape,
entering the brain. Then it ascends to the vertex and winds along the fore-
head, nose, and upper lip to the frenulum of the upper lip. One branch
from the coccyx and sacrum region pertains to the kidney. Another branch
from the lower abdomen ascends through the umbilicus and passes the
heart to the throat where it reaches the mandible. Curving round the lips, it
goes up and ends below the eyes (Figure 5.16).
92  5 Theory of Meridians and Collaterals

Shenting Baihui
Yintang 12 11

Suliao 13
14 15 Fengfu
Renzhong 10
Yamen
9
Yinjiao Dazhui
8 Taodao
7
6 Shenzhu

5 Zhiyang
1. Changqiang 9. Yamen
2. Yaoshu 10. Fengfu
Mingmen 3. Yaoyangguan 11. Baihui
4
Yaoyangguan
3 4. Mingmen 12. Shenting
Yaoshu
2 5. Zhiyang 13. Yintang
1 Changqiang
6. Shenzhu 14. Suliao
7. Taodao 15. Renzhong
8. Dazhui 16. Yinjiao

Fig. 5.16: Du meridian

A. Basic function
Du meridian in Chinese means controlling or governing.
(a) Governing all the yang meridians
The du meridian runs along the midline on the back and meets many
times with three meridians of hand and foot as well as the yang meri-
dian. With the function of regulating qi and blood in yang meridians
and commanding all yang meridians of the body, it is considered as
the sea of yang meridians.
(b) Linking with the brain and pertaining to the kidney
The du meridian enters the skull to link with the brain and goes into
the abdomen to pertain to the kidney. The kidney, known as the sea of
marrow, can produce marrow and brain which indicates that they are
closely related to the du meridian.
(c) Controlling reproduction
The du meridian controls the reproductive function, especially for male.
2. Ren meridian
A. Circulating routes
Ren meridian starts form the uterus and descends downward at the peri-
neum. It ascends along the anterior medial line to the throat where it
reaches the mandible, curves round the lips, and moves along the face to
the infraorbital region. One branch from the uterus runs upward along the
spinal column with the chong meridian (Figure 5.17).
5.3 Eight extra meridians  93

1. Huiyin
14
Chenjiang 2. Qugu
13
Tiantu 3. Zhongji
4. Guanyuan
12 Shanzhong 5. Shimen
Jiuwei 6. Qihai
11
10 7. Shenque
Zhongwan Shangwan
9 8. Xiawan
8 Xiawan 9. Zhongwan
Shenque 7 10. Shangwan
6
5 Qihai 11. Jiuwei
Shimen 4
Zhongji 3 Guanyuan 12. Shanzhong
2
Qugu 13. Tiantu
14. Chengjiang
1
Huiyin

Fig. 5.17: Ren meridian

B. Basic function
Ren in Chinese means “take charge, or be responsible.”
(a) Governing all the yin meridians
Ren meridian runs along the abdominal midline and frequently meets
with the three yin meridians of hand or foot. With the functions of reg-
ulating qi and blood in the all yin meridians and governing all the yin
meridians in the body, it is also called the sea of yin meridian.
(b) Governing uterus and pregnancy
Ren in Chinese means pregnancy. Ren meridian, originating from the
uterus, is in charge of regulating menses and promoting the female
reproductive function. It is closely related to pregnancy. Therefore, there
goes the saying ren meridian is in charge of the uterus and pregnancy.
3. Chong meridian
A. Circulating routes
Chong meridian starts from the uterus, descends at the perineum, and
passes through the (Qichong, ST30) where it runs along both the sides of
the umbilicus with the kidney meridian of foot shaoyin to spread over the
chest. Then it ascends to the throat and goes around the lips, and finally
reaches the infraorbital region. One branch originates from the kidney, des-
cends to the (Qichong, ST30), and enters the popliteal fossa along the
medial side of the leg. It reaches the bottom of the foot along the medial
side of the tibia. With another branch out of the posterior region of the
94  5 Theory of Meridians and Collaterals

medial malleolus, it runs to the dorsum of the foot and finally enters the
great toe. Another branch out of the uterus moves backward to connect
with the du meridian and ascends along the spinal column.
B. Basic function
Chong in Chinese means “communication center.” With the regulation of qi
and blood in all meridians, Chong is considered as the communication
center of qi and blood.
(a) Regulating qi and blood in the 12 main meridians
Chong meridian, which ascends to the head and descends to the foot
along the spinal column, is in charge of regulating qi and blood in the
12 main meridians and serves as the linchpin for the circulation of qi
and blood. Therefore, it is known as the sea of 12 main meridians.
(b) Regulating menstruation
Chong meridian, also known as the sea of blood, originated from the
uterus and is in charge of regulating menstruation and promoting
reproduction (Figure 5.18).

1. Guanyuan
2. Hengu Youmen
3. Dahe Futonggu
4. Qixue Yindu 12
5. Siman 11
Shiguan
10
6. Zhongzhu Shangqu 9
8
7. Huangshu Huangshu 7
Zhongzhu 6
8. Shangqu 5 1 Guanyuan
Siman 4
9. Shiguan 3
Qixue 2
10. Yindu
Dahe
11. Futonggu
Hengu
12. Youmen

Fig. 5.18: Chong meridian


5.3 Eight extra meridians  95

4. Dai meridian
A. Circulating routes
Dai meridian starts from the hypochondrium and obliquely descends to
(Daimai, GB26) where it transversely runs around waist. The parts of dai
meridian below the abdomen directly falls to the lower abdomen.
B. Basic function
(a) Constricting all meridians
Dai meridian, the only meridian running transversely around the
waist, acts as a belt to control all the longitudinally running meridians.
(b) Protecting the fetus and regulating leucorrhea
The damage of dai meridian may lead to miscarriage and abnormal
vaginal discharge (Figure 5.19).

1. Daimai
2. Weidao
Daimai
3. Wushu 1

2
3
Wushu Weidao

Fig. 5.19: Dai meridian

5. Yinqiao and yangqiao meridians


A. Circulating routes
Qiao meridians appear in pairs and consist of yinqiao meridian and yang-
qiao meridian, both of which originate from below the ankle and runs sepa-
rately along the right and left sides of body.
Yinqiao meridian starts from (Zhaohai, KI6), below the inner malleolus,
and runs along the medial side of the lower leg of the external genitalia.
Then through the abdomen and chest, it enters the supraclavicular fossa
(Quepen, ST12) and emerges in front of (Renying, ST9). Passing through the
side of nose, it reaches the inner canthus where it meets with the yangqiao
meridians (Figure 5.20).
96  5 Theory of Meridians and Collaterals

3
Jingming

1. Zhaohai
2. jiaoxin
3. Jingming

Jiaoxin 2
Zhaohai 1
Fig. 5.20: Yinqiao meridian

Yangqiao meridian starts from (Shenmai, BL62) below the external malleo-
lus and ascends along the posterior of the external malleolus. Along the
abdomen, the posterior and lateral sides of the chest, through the scapular
regions, lateral side of the neck, along the mouth corner, it finally reaches
the inner canthus where it meets the taiyang meridians of hand and foot as
well as yinqiao meridian. It then goes upward to the hairline and curves
down to the back of the ear where it meets the gallbaldder meridian of foot
shaoyang at the nape (Figure 5.21).

Jingming
Chengqi 1011 Fengchi
12 1. Pushen
Juliao 9 8
Dicang 7 Jugu 2. Shenmai
6 5
Jianshu 3. Fuyang
Naoshu
4. Juliao
5. Naoshu
6. Jianshu
Juliao 7. Jugu
4 8. Dicang
9. Juliao
10. Chengqi
11. Jingming
12. Fengchi

Fuyang
3
Shenmai Pushen
2 1
Fig. 5.21: Yangqiao meridian
5.3 Eight extra meridians  97

B. Basic function
Qiao in Chinese means “agile and nimble movement.”
(a) Controlling the movements of the extremities
Both yinqiao and yangqiao meridian have the function of regulating the
muscular movements and communicating yin-yang in the body, which
makes the movements of the extremities more vigorous and nimble.
(b) Governing the opening and closing of the eyes
Since yinqiao and yangqiao meridians meet with each other at the
inner canthus, they are believed to provide the nourishment for the
eyes and control the opening and closing of the eyelids.
(c) Governing yin-yang of the right and left of the whole body, respectively
Ancient people held that yinqiao and yangqiao meridians govern yin-
yang of the right and left of the whole body, respectively, that is to say,
yinqiao meridian control the yin of the right and left side of the whole
body, while yangqiao meridian controls the yang of the right and left
side of the whole body.
6. Yinwei and yangwei meridians
A. Circulating routes
Yinwei meridian starts from the medial aspect of the lower leg and runs
upward along the medial side of the lower limb to the abdomen. From there,
it runs along with the spleen meridian of foot taiyin to the hypochondriac
region where it meets with the liver meridian of foot jueyin. It then further
ascends to the throat to meet the ren meridian at the neck (Figure 5.22).

1. Zhubin
2. Chongmen 8 Lianquan
7
3. Fushe Tiantu
4. Daheng
6
5. Fuai Qimen
5
6. Qimen Fuai
4
7. Tiantu Daheng 3 Fushe
2
8. Lianquan Chongmen

1
Zhubin

Fig. 5.22: Yinwei meridian


98  5 Theory of Meridians and Collaterals

Yangwei meridian starts from below the external malleolus and ascends
along with the gallbaldder meridian of foot shaoyang. It goes upward
along the lateral side of the lower limb and passes through the posterolat-
eral side of trunk to the axilla from where it reaches the shoulder. Through
the neck, retro auricular region, it arrives at the forehead to distribute over
the side of the head and nape, where it meets the du meridian neck
(Figure 5.23).

Muchuang
1. Jinmen Benshen Zhengying
7 9
2. Yangjiao Toulinqi 6 10 Chengling
8 11
12 Naokong
3. Naoshu Yangbai 13 14
15
Fengfu
4. Tianliao Fengchi
Jianjing 5
Yamen
5. Jianjing 4
Naoshu 3 Tianliao
6. Toulinqi
7. Benshen
8. Yangbai
9. Muchuang
10. Zhengying
11. Chengling
12. Naokong
13. Fengchi
14. Fengfu
15. Yamen

Yangjiao
2

1 Jinmen

Fig. 5.23: Yangwei meridian

B. Basic function
Yinwen and yangwei meridians serve to connect with the whole yang and
yin meridians in the body. They also play an important role in regulating
the strength of qi and blood.
5.4 Physiological functions and applications of the meridians  99

5.4 Physiological functions and applications of the meridians

Key points
– Physiological functions of the meridian:
– Communicate exterior–interior and superior–inferior relationships.
– Connect viscera and joints.
– Convey qi-blood in the whole body.
– Nourish the viscera and tissue.
– React and conduct the life information.
– Regulate the functional balance for the body.

5.4.1 Physiological functions of the meridian

1. Communicate and connect viscera and organs


The meridian communicates and connects viscera, tissue, and organs by the fol-
lowing four ways.
A. Connection between the viscera and extremities
The viscera and extremities connect each other with 12 meridians. Twelve
meridians affiliate interiorly with the viscera. Qi in the meridian communi-
cates with the 12 meridian musculatures and distributes over the 12 skin
areas. Thus, the 12 meridians link the peripheral tissues of skin, tendons,
muscles, and joints with the internal organs.
B. Connections among the viscera, the five sense organs, and the nine orifices
Eyes, ears, nose, mouth, tongue, inguinal, and coccygeal regions are the
areas where all meridians pass through. Moreover, 12 meridians internally
belong to the viscera. Therefore, the sense organs and orifices connect with
the inner organ through the meridian. Some of them are the sprout and
opening of the five zang-viscera. For example, the liver meridian of foot
jueyin belongs to the liver and connects with the gallbladder, and runs up
to link the eye connector. So the liver opens in the eyes.
C. Connections among the viscera
Each of 12 meridians affiliates and connects with a zang-viscus and a fu-
viscus. Therefore, it can strengthen the communication between the two
externally–internally related zang- and fu-viscera. Meanwhile, some of the
meridians communicate with several viscera, while some viscera will have
several meridians to reach to. For example, the kidney meridian of foot
shaoyin not only affiliates with the kidney and connects with the bladder but
also passes through the liver, enters the lung, and connects with the heart.
Thus, it forms multiple communications among zang-organs and fu-organs.
D. Connections among the meridians
There are certain linking and flowing orders among the connections of the
12 meridians. There are also many crosses and intersections which add the
100  5 Theory of Meridians and Collaterals

relations among the meridians and the divergent collaterals, forming an


annular system preliminarily. The 12 meridians and the eight extra meri-
dians communicate with each other in a crisscross manner. The eight extra
meridians communicate with each other among themselves as well. They
become a complete regulating system.
2. Convey qi-blood in the whole body and nourish the viscera and tissue
Every organ and tissue of the human body needs nourishment by qi-blood in order
to maintain and play their normal physiological function. As the passage way for the
movement of qi-blood, the meridians transport qi-blood to the whole body, nourish
all the organs, fight against the external pathogens, and defend the body system.
3. Conduct life information and regulate functional balance for the body
The meridian system acts like a net to sense and transfer different information
from both inside and outside of the body. It then conveys the information to zang-
fu organs, sense organs, orifices, and extremities according to its nature, charac-
teristics, and measurement. It can reflect and regulate the functional status of the
body. The meridian system can circulate qi-blood and link up the whole body.
Twelve meridians can coordinate yin-yang. Eight extra meridians can regulate
qi-blood. Therefore, the meridian system can regulate functional balance for the
body. When disease occurs due to the disharmony of qi-blood and yin-yang, acu-
puncture, moxibustion, or massage treatment as well as breathing exercise can
regulate and trigger the self-adjusting function of the body.

5.4.2 Application of the theory of the meridian

1. Explanations of the pathological changes


(a) Become the passageway for transmitting the pathogens
(b) Reflect interior pathological changes
2. Guidance for the diagnosis of disease
(a) Differential diagnosis according to the belonging which meridian
(b) Acupoints pressing
3. Guidance for the clinical treatment
(a) Elect the acupoints along the meridians
(b) Select the herbal according to different meridians

Constitutional theory was first discussed in Neijing and became a theory of


Chinese medicine during the Ming and Qing Dynasties. The theory is a combina-
tion of biology, anthropology, psychology, and medicine science. It mainly dis-
cusses human constitution’s forming process, feature, type, diversity, and the
relationship with the occurrence and development of the disease. Constitutional
theory is a part of Chinese medicine and has an important significance in
guiding health maintenance, prevention, and rehabilitation.
6 Constitutional Theory

6.1 Concept of constitutional theory

Key points
– Basic concept of constitution:
– Constitution means the relatively stable comprehensive characteristics in morphological
structure, physiological function, and mental activities, which is determined by heredi-
tary and acquired factors in the life process of human individual.

6.1.1 Basic concept of constitution

Constitution refers to the relatively stable and comprehensive characteristics in


morphological structure, physiological function, and mental activities, which is
determined by hereditary and acquired factors of a human being. In other words, the
constitution is physiologically manifested in the individual’s differences upon func-
tion, metabolism, and reaction toward the external stimulus; while pathologically, it
is manifested in the susceptibility to some pathogenic factors and the tendency of the
onset as well as the changes of certain diseases. Constitution is actually the indivi-
dual’s physiological activity based on the common characteristics of the human phy-
siology. Constitution affects body’s resistance against disease as well as the adapt-
ability toward nature and social environments. It also influences disease patterns
and individual’s reaction toward treatment. In this case, it will present the distinct
individuality in the process of birth, death, illness, and aging. The offspring’s consti-
tution is directly affected by their parents’, which is the foremost factor of one’s con-
stitution. The constitution based on the genetic factors plays an important role on the
entire life time. Everybody has his or her own relatively stable and specific living
habits. These postnatal living environments promote the formation of the constitu-
tion as well as the stability, transformation, and change of the constitution. The con-
stitutional theory is based on the traditional Chinese medicine theory. It studies the
concept, formation, characteristics, patterns, and differences of the normal constitu-
tion as well as its influences upon the onset, development, and evolution of the
disease. It guides the clinical diagnosis, prevention, and treatment of disease. There-
fore, this theory pertains to the normal constitutional study in Chinese medicine.
Emphasis of the research on the constitution can not only help to grasp the indivi-
dual’s biological but also analyze the law of occurrence, development, and transmis-
sion of the disease. It plays an important role in diagnosis, treatment, health mainte-
nance, disease prevention, and rehabilitation.
102  6 Constitutional Theory

6.1.2 Signs and characteristics of constitution

The evaluation index of constitution involves morphological structure, body’s


functional level, level of physical fitness, level of exercise, psychological devel-
opment level, and adaptability, and so on. The healthy constitution refers to
the relatively harmonious state between body and spirit, which is a whole for
morphological structure, physiological function, psychological character, and
adaptability to environments. It is based on the genetic factors and the active
postnatal cultivation. Harmonies, as well as the unity of the body and mind,
are the signs of the healthy constitution. The detailed signs are mainly as
follows:
1. Good physical development, healthy and strong body shape, well-proportioned
body type, and normal body weight.
2. Rosy and lustrous facial complexion with bright eyes, shining hair, and elastic
skin and muscle tone.
3. Power voice, clean and strong teeth, good hearing, moderate pulse, good sleep,
and normal urination and defecation.
4. Flexible movement, with good physical performance in sports and work.
5. Good energy, optimistic mood, sensitive feeling, and strong will.
6. Good attitude, calm, rational, creative, and independent.
7. Strong adaptability, strong resistance to interference, negative stimulation, and
diseases.

In general, every individual has his or her own constitution. As a unity of body
and mind, everyone has his or her unique characteristic which is reflected in the
differences of morphology, function, and psychology. The diversity is complicated
and differs from person to person. Constitution is originated from the prenatal
essence and nourished from the postnatal essence. The prenatal essence deter-
mines the relative stability and individual’s specificity, while the postnatal essence
determines the variability. Constitution also has characteristic of continuity and
predictability.

6.2 Factors affecting constitution

Key points
– Factors affecting constitution are:
– Natural endowment, age, gender, diet, work, rest, and emotional and geographical
factors.
6.2 Factors affecting constitution  103

6.2.1 Relationship of the constitution to viscera, meridians, essence, qi, blood,


and body fluids

Viscera, meridians, essence, qi, blood, and body fluids are the basic substances of
constitution. Structural and functional varieties of the viscera and meridians and the
abundance and distribution of essence, qi, blood, and body fluids are all the impor-
tant factors to determine the constitution. The constitution reflects the deviant condi-
tion of the essence, qi, yin, and yang of viscera through the differences in morphology,
function, and mental state. Actually, it is the comprehensive embodiment of intrinsic
characters of the viscera, meridians, sensory organs, and orifices. It is also the actual
reflection of deviant conditions of viscera, meridians, essence, qi, blood, yin, and
yang. Therefore, the research in constitution lies in the study of differentiation of the
visceral manifestation. The difference in formation and function of visceral manifesta-
tion is the important basis for different constitutions. The waxing and waning state of
viscera decides the diversity of constitution. The morphological and functional charac-
teristics of the viscera are the most basic factor composing and determining the differ-
ences upon the constitution. Under the interaction between the hereditary factor of
the individual and the environmental factor, different individuals often show com-
paratively advantageous or disadvantageous tendency of a certain visceral manifesta-
tion system. The meridians are the passages of qi-blood circulation, as well as the
structural foundation which communicate and coordinate the functions of the viscera.
The constitution is mainly manifested through the exterior morphological characteris-
tic, while the meridians transmit essence, qi, blood, and body fluids to the body. Dif-
ferent individuals show different external appearances due to differences in the
waxing and waning of yin-yang of the viscera, as well as the condition of qi-blood in
the meridians. The essence, qi, blood, and body fluids are the important material
foundations which determine the characteristics of constitution. The waxing and
waning of essence-qi, the amount of meridians-qi, and blood determine the strength
of constitution and influence its type. Therefore, the essence, qi, blood, and body
fluids are the important substances to determine the individual’s physiological and
constitutional characteristics. Besides, the abundance or deficiency of essence also
links to the age. The constitution of the old is generally characterized by essence
deficiency.

6.2.2 Factors which affect the constitution

Any factors that affect the functional activities of viscera, meridians, essence, qi,
blood, and body fluids can influence the constitution. Constitution is determined by
the prenatal essence and influenced by the postnatal factors. The internal and exter-
nal environments are composed from the many factors of prenatal and postnatal
essences. They form different constitutions under different affecting factors.
104  6 Constitutional Theory

1. The prenatal essence


The prenatal essence is the basis and precondition of constitution. Everything
that is received inside the uterus is generally called the prenatal condition. The
quality of the reproductive essence from parents determines the condition and
type of constitution of their offsprings. Generally speaking, if the constitutions
of the parents are strong, so will be the offsprings, and vice versa. Therefore,
the prenatal condition is the key and foundation to the formation of one’s con-
stitution. However, the development and the types of the constitution are also
affected by the other factors. Some hereditary diseases can be transmitted to the
offspring by the parents. The specific constitution is not a true disease until it is
induced by a certain acquired factor. This kind of disease usually does not out-
break until they are triggered by certain postnatal factors. It is found from the
modern research that many diseases has the obvious trend of family heredity,
such as hypertension, diabetes, asthma, dyslipidemia, breast cancer, stomach
cancer, colorectal cancer, lung cancer, depression, and Alzheimer’s disease.
2. Factor of age
In the changing process of birth, growth, prime, aging, and death, with the
change of essence of the viscera, and mind and physiological activities, indivi-
dual’s constitution varies. The constitution gradually gets stable and matured at
the end of adolescence. From adolescence to age 35, there are often obvious
constitutional changes among women, while not so much in men. There is not
much constitutional changes from age 35 to 49. Constitution often changes
obviously after menopause. And the constitution of the old gradually declines.
There is more deficient constitution among the senior populations. In this group
of people, it is often the deficient syndromes combined with the damp-phlegm.
3. Difference of gender
The male and female constitutions are the most basic types among human
beings. Male pertains to yang and female to yin. Therefore, male is often charac-
terized by being masculine, tall, strong, good for heavy work, being extroverted,
and broad minded. The female is mostly characterized by being gentle and
quiet, small and slender, good for some gentle and detailed work, being intro-
verted sentimental, and subtle. In addition, because women have the special
physiological conditions of menstruation, leucorrhea, and pregnancy, their con-
stitution changes through these periods. For male, kidney is the prenatal condi-
tion, while essence and qi are the root. For female, liver is the prenatal condi-
tion, while blood is the root. Therefore, male is often qi-deficient and female is
often blood-deficient pathologically, and compared to female, male is more sen-
sitive to pathogens. It is found in the study that female’s tolerance and immu-
nity are stronger than male, so is the life expectancy.
4. Dietary factor
Diet is nutritional source after birth, which is very important for the life activity.
The dietary structure and nutritional condition have a deep effect on constitution.
6.2 Factors affecting constitution  105

Long-term dietary habit and the quality of the food will affect the change of body
components. Generally speaking, sufficient and high-quality food intake will
produce better physical figure and good constitution, while insufficient or poor
quality food intake will result in smaller body shape and weaker constitution.
However, overeating and overindulgence in heavy and greasy food, even though
the body shape is bigger, often leads to qi deficiency and damp congestion with
weaker constitution. On the other hand, simple food with sufficient nutrition, as
long as not starving, often leads to better constitution and good qi-blood circula-
tion without damp-phlegm congestion.
5. Factor of work and rest
Work and rest are other important factors affecting the constitution. The proper
manual labor or exercise can make bones and muscles stronger, the movement
of joint more flexible, qi dynamic smoother, qi-blood more coordinative, and
the visceral function more powerful. The appropriate rest is helpful to maintain
the physical and psychological health, as well as to keep a good constitution.
Long-term over-ease with less exercise will make the muscles flabby, the circu-
lation of qi-blood unsmooth, and the spleen-stomach hypo function which
result in the constitution of phlegm congestion.
6. Emotional factor
Emotion refers to the psychological activities including joy, anger, worry, pen-
siveness, sorrow, fear, and frighten. The harmonious emotion results in good
constitution, while a drastic or prolonged emotional stimulus will result in
negative influence on the constitution. It will form certain type of constitution.
When that happens, the same emotional stimuli will be triggered and cause
impairment of the viscera. Therefore, a vicious circle develops. The qi-depressed
constitution is commonly seen in clinic. Qi depression can accumulate heat to
cause fire, as well as impair yin and consume the body fluids which lead to the
constitution of yang heat and yin deficiency. Qi stagnation can produce blood-
stasis constitution. The changes of constitution caused by emotional changes
also have a particular relationship with the onset of certain diseases. For
example, a person with liver depression constitution who easily gets persistent
anxiety and depression will be predisposed to cancer diseases. Therefore, by
keeping a good mental state is very beneficial to the constitutional health.
7. Geographical factors
By living in a certain region for a long period of time, one’s constitution can be
affected by its water, soil, climate, habits, and customs. Generally speaking,
people in the north are mostly strong in physique, with tight muscles. They tend
to suffer from yang-deficient syndromes with the cold viscera. Comparatively,
people in the southeast are mostly thin in physique, with loose muscles. They
tend to suffer from yin-deficient syndromes with damp-heat. People live near
the oceans often have dampness or phlegm in constitution. Severe climatic
environment cultivates people with strong body and bold personality, and
106  6 Constitutional Theory

easeful climatic environment fosters delicate physique and gentle character. In


Chinese medicine, treatment according to the local condition is always a treat-
ment principle, namely, considering that the constitution is different in popula-
tion of different regions.
Overall speaking, a specific constitution formed by the prenatal condition is
usually deeply rooted. Under the equal postnatal condition of cultivation,
whether the constitution is strong or weak is mainly determined by the prenatal
essence. However, the postnatal cultivation is also of importance to constitu-
tion. If one pays attention to health maintenance, follows proper diet and scien-
tific principles in diet along with balanced work and rest, emotions, as well as
the normal sexual activity, his or her constitution will get better, and better
based on the prenatal essence. Or the weaker constitution will turn into the
stronger constitution. It then will serve the purpose of aging-slowing, disease-
resolving, and longevity.

6.3 Classification of constitution

Key points
– Constitution can be classified as:
– Yin-yang balanced constitution.
– Yang-inclined constitution.
– Yin-inclined constitution.

The classification of constitution is an important method of understanding and mas-


tering the constitutional differentiation. In Chinese medicine, the classification of
constitution is mainly guided by the holism concept. It is based on the basic theory
of Chinese medicine which includes the theories of yin-yang, five elements, viscera,
essence, qi, blood, and body fluids. These theories are used to ascertain different
constitutions of different individuals. The concrete methods include yin-yang classi-
fication, five elements classification, viscera classification, body shape classification,
and natural disposition classification. In the “Research on criterion of constitutional
classification and foundation of methodology system in Chinese Medicine” presided
by professor WangQi from Beijing University of Chinese Medicine, the constitution is
classified into nine categories. It includes the types of qi deficiency, dampness-heat,
yin deficiency, qi depression, blood stasis, yang deficiency, phlegm dampness, and
specially gifted constitution. It has been confirmed as a criterion of The Chinese Asso-
ciation of Chinese Medicine, and has gotten the comprehensive application as a stan-
dardized approach to identify the constitutional type in Chinese medicine. Generally
speaking, human constitution is divided into three categories according to its func-
tion, that is, the yin-yang balanced constitution, yang-inclined constitution, and
yin-inclined constitution.
6.3 Classification of constitution  107

6.3.1 Balance constitution

The yin-yang-balanced constitution is a more harmonious constitution. Typical con-


stitutional features are as follows: strong physique, normal body shape, bright and
ruddy complexion, bright and piercing light in eyes, optimistic personality, open-
mindedness and tolerant attitude, moderate intake of food, smooth urination and
defecation, pink and moist tongue, even and moderate pulse with vitality, good
sleep, good energy, agile strong self-adjustment, and good adaptability. People with
this type of constitution are not easily affected by the exogenous pathogenic factors,
and seldom become ill. Even if suffering from an illness, they may mostly present
with an exterior and excessive syndrome which are easily cured. If they get proper
cultivation after birth, they will mostly live longer.

6.3.2 Yang-inclined constitution

The yang-inclined constitution means a constitutional type which has the character-
istics of being more excited, inclined to heat, and excessive movement. The constitu-
tional features are as follows: thin body shape but strong, slightly red complexion,
or greasy skin, extroverted personality, hyperactive, easily being irritable, poorly
self-controlled, large intake of food, good digestion and absorption, aversion to heat
and preference to cold, or higher body temperature, easily sweating while moving,
thirsty, red lips and tongue, slightly rapid pulse, energetic and fast-moving, and
stronger libido. On the onset of disease, this type of people tend to present with the
heat and excessive syndromes which often develop into the constitutional type of
yang-hyperactive, yin deficiency, or phlegm fire.

6.3.3 Yin-inclined constitution

Yin-inclined constitution often refers to the constitutional type which has the character-
istics of being more inhibited, inclined to cold, and stillness. The constitutional fea-
tures are as follows: bigger body shape but weak, easily to get tired, slightly white but
little lustrous complexion, introverted personality, being fond of stillness and little
movement, scared and being easily frightened, poor appetite, average digestion and
absorption, aversion to cold and prefer to heat, or lower body temperature, low energy,
slower reaction, and weaker libido. On the onset of disease, this type of people tend to
present with cold and deficient syndromes which often develop into constitutional type
of yang deficiency, phlegm-dampness, or phlegm stasis. It should be pointed out that
the terms used in classifying the constitution, that is, yin deficiency, yang deficiency,
hyperactive yang, phlegm and fluid retention, and blood stasis are different from the
names of syndrome used in syndrome differentiation. The syndrome is an analysis to
108  6 Constitutional Theory

the nature of a disease, while the constitution reflects one kind of individual particula-
rities existing under the non-disease state. The constitution is the foundation of the
disease. The fundamental basis of many chronic illnesses is the result of their own con-
stitution. Under this circumstance, the name of the syndrome might be the same as the
original type of constitution, which shows the intrinsic relationship between the consti-
tution and the syndrome.

6.4 Application of the constitution theory

The differences manifested in the process of a disease depend on the constitution.


The constitutional differentiation plays an important role in determining the onset,
the changes, and the prognosis of the disease, as well as on the reaction to the treat-
ment. Therefore, constitution has a close relationship to the etiology, pathogen,
pathogenesis, syndrome differentiation, treatment, prevention, and life mainte-
nance. The constitutional theory has an important value in the clinical setting. The
principle of suiting treatment to the individual, which is emphasized in Chinese medi-
cine, is the reflection of constitutional theory applied in the clinic, as well as the
reflection of the individualized treatment principle.

6.4.1 Explanation of the susceptibility of individual to certain pathogens

Constitutional factor determines the individual’s susceptibility and tolerance toward


certain pathogens, as well as the tendency of disease onset. The constitution reflects
the physiological waxing and waning of yin, yang, cold, or heat inside the body,
which determines the differences of its function. Therefore, it has a different reaction
toward the external stimuli and tolerance. Generally speaking, people inclining to
yang constitution tend to be easily invaded by wind, summer-heat, heat pathogen,
and tolerant to cold. Lung is easily damaged by the wind evil, while yin-qi of lung-
stomach or liver-kidney is impaired after being invaded by summer-heat pathogen.
People inclining to yin constitution tend to be easily invaded by cold and dampness
pathogen and tolerant to heat. Also, it make disease move toward inward more
easily which often damages yang-qi of spleen and kidney. The spleen-yang always
gets depressed by dampness, and discharge and swelling will occur due to the
internal dampness induced by the external dampness. And children always have
diseases due to the external pathogen or improper diet since they are deficient in qi
and blood. In addition, an overweight person often has problems related to damp-
phlegm which causes stroke. A thin person often has more fire inside the body and
often develops whooping cough. Kidney is often deficient among older people and
they tend to develop phlegm pathogen and cough. All these show that the constitu-
tional differences are the main causes for developing different diseases. Besides,
6.4 Application of the constitution theory  109

the hereditary and congenital diseases, as well as the allergic body type are all
closely related to the individual’s constitution.

6.4.2 Illustrating the etiology

The constitutional condition determines the onset and development of the disease.
Constitution is the reflection of waxing and waning of healthy qi. A person with
strong constitution will have enough healthy qi to resist invasion of pathogen, while
a person with weaker constitution will have weaker healthy qi and poor resistance
as well as being invaded by the pathogens. Individual’s specific constitution or the
defect is also the key factor to cause emotional disorder.

6.4.3 Explaining the pathological changes

1. Constitutional factor determines the transformation of pathogenesis


Transformation of disease means that disease changes according to constitution.
The general rule is: person with yin deficiency and excess of yang has a hyperfunc-
tional activity, whose disease is easily turning to heat after the invasion of patho-
gen; person with yang deficiency and excess of yin tends to have a hypofunctional
activity, whose disease is easily turning to cold after the invasion of pathogen;
person with the fluid deficiency and blood exhaustion tends to present with the
dryness after the invasion of pathogen; person with the qi deficiency and excess of
damp often suffer from the dampness after the invasion of pathogen.
2. Constitutional factor determines the prognosis of the disease
The prognosis of disease refers to transmission of disease stage in the viscera and
meridians, as well as transformation and changes of disease nature. Constitution
mainly affects the prognosis of disease through two aspects. One aspect is that the
condition of healthy qi determines onset and prognosis of disease. People with
stronger constitution always have sufficient healthy qi and stronger ability to resist
the exogenous pathogen. This group of people does not get easily sick. Even if they
are sick, they are not deficient and always present with excess syndrome along with
shorter course of disease. On the other hand, people with weaker constitution not
only easily suffer from diseases but the disease also migrates into deeper location. It
can cause constant change of disease onset as well as impose critical and dangerous
condition. This group of people also has a lingering disease course and becomes dif-
ficult for them to recover in the later stage of disease. Sometimes, it results in some
chronic illness. The other aspect is that constitution affects the prognosis of the
disease by determining transformation of pathogens. For example, individual with
yang-excess and yin deficiency always develops heat disease after being invaded,
while person with yin-excess and yang deficiency mostly develops cold disease.
110  6 Constitutional Theory

6.4.4 Guiding syndrome differentiation

The specificity of the constitution determines the tendency of clinical type after the
onset of disease. Constitution is the basis of differential diagnosis. It determines the
types of syndrome. First of all, when attracting a same type of disease, different
manifestations of the syndromes will be different due to different constitutions,
which is called the same disease with different syndromes, determined by the consti-
tution. The other condition is different diseases with the same syndrome, that is,
people present with the same type of syndrome when invaded by different patho-
gens or suffer from different diseases due to the same or similar constitution. There-
fore, the constitutional differences are the physiological basis of the two conditions.
And the constitution is the intrinsic basis of the formation of the syndrome.

6.4.5 Guiding treatment

Differential diagnosis is the basic principle and character of the Chinese medicine
treatment. The differences among the individual constitution determine the diversity
of syndrome, treatment method, and medicine. Due to the fact that constitution is
affected by prenatal condition, age, gender, living environment, and emotional dis-
tress, the treatment principle is based on each individual’s constitution.
1. Applying treatment according to different constitutions
Constitutions are different in yin, yang, strong, weak, cold, or heat aspects. In
clinic, treatment principle is always made according to the patient’s constitu-
tion. This type of principle is to regulate the imbalance of constitution, which is
to treat the root of the disease. For example, for patients with constitution of
yang deficiency, when suffering from a cold-damp illness, medicine of hot
nature should be prescribed, while, for patients with constitution of yin defi-
ciency, medicine of cooling and moist nature should be prescribed. Therefore,
the principle of the same syndrome with different diseases and different syn-
dromes with the same disease should be applied in the treatment.
2. Cautions and contraindications when applying acupuncture and Chinese herbal
medicine according to constitutional characteristics
In treatment, application of acupuncture and medicine should be based on the
individual’s constitution. Treatment should end once the illness is resolved to
protect the healthy qi.
A. Nature and flavor of Chinese herbal medicine
Generally speaking, people with yang-inclined constitution should be
treated with medicine of sweet-cold, acid-cold, salty-cold, and mild nature.
Try to avoid the pungent, hot, warm, or dispersed herbs. People with yin-
inclined constitution should be treated with warming and tonifying herbs
and avoid the bitter-cold or fire-sedating herbs.
6.4 Application of the constitution theory  111

B. Dosage
In general, people with strong constitution also have stronger drug toler-
ance and can be given larger doses of medicine. People with weak constitu-
tion should be treated with mild and low dose of medicine.
C. Indication and contraindication of acupuncture
People with the different constitutions will react differently toward the pain
tolerance and needling sensation.
3. Paying attention to the posttreatment care maintenance
Posttreatment care involves many measures and balances, including medicine,
diet, emotional comforts, and living habits. The care should be applied carefully
according to the individual’s constitution. For patient with yang-inclined consti-
tution, at the beginning stage of recovery, warm and pungent food such as dog
meat, lamb, and longan should be avoided. And for those with yin-inclined con-
stitution, medicine and food with stickiness and sourness, such as GuiBan,
BieJia, and WuMei, should be avoided.

6.4.6 Guiding the health maintenance

A good health maintenance plan is to select different methods according to different con-
stitutions. Methods of health maintenance in Chinese medicine permeate throughout all
the daily life. It includes principles of seasonal health, emotional balance, regular daily
activity, normal resting and exercising schedule, and proper diet, all of which should be
considered according to the constitution. For example, in dietary aspect, person with
yang-inclined constitution should consume more cooling food and avoid the hot; person
with yin-inclined constitution should consume warm food and avoid the cold; and
person who is overweight should consume more plain food and avoid the greasy ones.
In emotional aspect, different emotional balances should be applied according to indivi-
dual’s constitution in order to keep balance of mind and improve mental health. For
people with qi depression constitution, psychological counseling should be focused on
removing emotional stagnation and eliminating bad mood. For people with yang-defi-
cient type of constitution, they tend to have less energy and courage, are indifferent, and
less confident. Treatment should focus on helping them to build confidence toward life.
Music therapy should also be based on the individual’s psychological state. These
methods play an important role in protecting health and reinforcing constitution. Patho-
genesis refers to the onset of a disease. Any etiological factor acting on the body can
cause occurrence of disease. Pathogenesis is a theory studying the mechanism of the
onset of disease, namely, studying the law and influential factors how the body turns to
disease from health or subhealth.
7 Onset of Disease
In this chapter, the basic mechanism of disease onset will be mainly discussed. It is
based on the relationship between vital qi and pathogenic factors. In Chinese medi-
cine, the occurrence of disease involves two aspects: vital qi and pathogenic factors.
The invasion of pathogenic factors is an important factor causing disease, while defi-
ciency of vital qi is an intrinsic factor. When pathogenic factors defeat vital qi,
disease occurs.

7.1 Concepts of pathogenesis

Pathogenesis refers to the course of the onset of a disease. When human body is dis-
turbed by certain disease-induced factors such as vital qi interacting with pathogenic
factors, imbalance inside the body or imbalance between the external environment
and inside of the body leads to disharmony in qi, blood, yin, and yang, abnormal
metabolism of viscera and meridians, or pathological change of morphostructure.
Thus, a series of clinical symptoms and signs (including various abnormal clinical
changes detected in modern medicine) occur, and the human body deviates from
normal condition (namely, health). The course of disease onset is, namely, the strug-
gle between the pathogenic qi and the vital qi.

7.2 Cardinal principle of disease onset

Key points
– Basic mechanism of disease onset:
– Deficiency of vital qi plays a leading role.
– Pathogenic qi is an important condition.
– Struggle between the vital qi and the pathogenic qi determines the onset of the disease.

Generally speaking, despite the complication of disease onset, it mainly contains


two aspects: vital qi and pathogenic qi. Disease onset is the contradictory struggle
between the pathogenic qi and the vital qi. Struggle is the key to the occurrence and
development of a disease. Specifically speaking, deficiency of vital qi is the intrinsic
factor the pathogenic qi is an important condition. Struggle between the vital qi and
the pathogenic qi determines whether disease occurs. In Chinese medicine, vital qi
is emphasized for its leading role, but pathogenic qi is not ruled out in disease
onset. Besides, under certain circumstances, pathogenic qi can play a leading role in
disease onset.
7.2 Cardinal principle of disease onset  113

7.2.1 Deficiency of vital qi is the intrinsic factor for the pathogenesis

1. Concept of vital qi
Vital qi, usually abbreviated as “the vital,” exists in contrast with pathogenic qi.
Vital qi is a general term for normal physiological function of human body as
well as the ability to maintain the health. It includes the abilities of self-regulation,
environmental adaptation, disease prevention, and persistence, as well as self-
recovery vital qi is closely related to essence, qi, blood, and body fluids as well
as to the structure and function of viscera, meridians, and collaterals. In addi-
tion, it is concerned with one’s mind, spirit, cognitive level, and life style.
Essence, qi, blood, and body fluids are the basic material to sustain functional
activities of viscera and meridians. When human body has abundant essence,
qi, blood, and body fluids along with normal structure and function of viscera
and meridians, vital qi will be sufficient. Therefore, essence, qi, blood, and
body fluids are the determining factors for vital qi.
2. Manifestation of vigorous vital qi
Whether vital qi is vigorous can be seen from the following points:
(a) The ability of self-regulation to accommodate oneself to external and inter-
nal environment, to keep yin and yang in balance, and to maintain one’s
health.
(b) The ability of self-defense to prevent invasion of exogenous pathogenic
factors from entering the body.
(c) The ability of resisting pathogenic factors to drive it out during disease
occurrence.
(d) The ability of self-recovery to restore health after the onset of disease or
from weakness.
3. The function of vital qi during disease onset
A. Deficiency of vital qi is the intrinsic factor of exogenous pathogen invading
and disease occurring
In Chinese medicine, vital qi is very important in the onset of disease. Gen-
erally speaking, when vital qi is vigorous or pathogenic qi is not very
strong, pathogenic factors can hardly invade the body, or though invading,
unlikely to causing disease. Under this condition, the functions of yin,
yang, qi, blood, viscera, and meridians are normal; the vital qi can defend
pathogenic qi; and no disease occurs. When vital qi becomes too weak to
resist pathogenic qi or pathogenic qi is stronger than vital qi, the patho-
genic factors invade the body and disturb the normal physiological activ-
ities and functions of viscera, resulting in disease. Deficiency of vital qi can
be manifested in two aspects: first, the weak ability of disease prevention
and resistance as well as recovery; second, the pathogenic factor is too
strong to overcome the defending ability of vital qi. Both aspects can lead
to invasion of pathogenic factors, making the functions of viscera abnormal
114  7 Onset of Disease

and cause disease. Although disease onset is concerned with both vital and
pathogenic qi, the decisive factor is vital qi. In most cases, pathogenic
factors cause disease followed by deficiency of vital qi. Therefore, the
strength of vital qi is the intrinsic factor of whether disease can be induced.
Generally, pathogenic factors cannot injure the body alone without defi-
ciency of vital qi. For example, in the same living environment of influenza
outbreak, someone with vital qi deficiency will more likely get infected,
whereas someone without vital qi deficiency will not get infected.
B. The degree of deficiency of vital qi is related to the course and severity of
disease
In general, when pathogens are invading, the person with vigorous vital qi
has more superficial diseased location and short-diseased course because
vital qi is vigorous enough to expel pathogens sooner; while the one with
deficiency of vital qi, will always have deeper diseased location and cannot
recover easily because vital qi cannot be exited until pathogens invade the
interior. There is also exceptional case that when invasion is serious, the
struggle between vigorous vital qi and pathogens is so severe that serious
illness occurs.

7.2.2 Pathogenic qi is an important factor to cause the disease

1. Concept of pathogenic qi
Pathogenic qi is a general term for various pathogenesis, usually abbreviated as
“pathogen.” It includes six exogenous pathogens, pestilential qi, internal injury
due to mental disorders, improper diet, injury from overstrain and idleness,
traumatic injuries, parasites, drug abuse, doctor’s faults, phlegm-fluid reten-
tion, and blood stasis.
2. The role of pathogenic qi in pathogenesis
A. Pathogenic qi is an important factor to cause disease
In disease onset, vital qi is emphasized for its leading role, but patho-
genic qi should not be ignored. The invasion of pathogenic factors plays a
significant role in the disease onset. In certain conditions, even if vital qi is
not deficient, it is hard to avoid invasion of some pathogenic qi, such as
high temperature, gunshot wound, and injuries by insects and animals.
In addition, during prevalence of pestilential qi, almost everyone fall ill
because of severe pathogenic qi. So under certain circumstances, patho-
genic qi can play a leading role in disease onset, and avoiding poisonous
factors is important in health maintenance to prevent the occurrence of
disease.
B. Pathogenic qi influences the nature, location, syndrome, course and sever-
ity of a disease
7.2 Cardinal principle of disease onset  115

The property of pathogenic can decide the nature of disease. Generally


speaking, invasion by yang pathogen tends to cause excess-heat syndrome,
while yin pathogen is likely to cause excess-cold syndrome. Different patho-
genic factors invading the body can cause different diseases in organs or
viscera and meridians, which is decided by the feature of pathogenic qi.
Furthermore, pathogenic qi is closely related to the syndrome of disease.
For example, dysenteric pathogen causes dysentery and malarious patho-
gen causes malaria. Besides the constitutional factors, the pathogenic qi
also determines the severity of a disease. When the pathogenic qi is mild,
the disease condition tends to be mild, but when the attack is serious, the
condition is severe. Some pathogenic qi also decides the course of a disease.
For example, diseases caused by dampness usually have long duration and
are difficult to heal.
C. Impairment of pathogenic qi to vital qi
Pathogenic qi impairing vital qi is mainly manifested in three aspects: (1)
causing loss of essence, qi, blood, and body fluids, which leads to dysfunc-
tions; (2) causing injury of organs, which leads to abnormal change of
tissue structure; and (3) altering one’s constitution or characteristic.

7.2.3 Struggle between pathogenic and vital qi determines the progress and
prognosis of disease

The struggle between the pathogenic and the vital qi runs through the course of a
disease. It not only determines whether there would be the onset but also affects its
development and final sequelae. Chinese medicine holds that vital qi is very impor-
tant in the struggle. The intensity of vital qi determines the disease onset, deficiency
or excess nature of pathological change, and the prognosis. Insufficient vital qi with
pathogenic qi lingering causes many chronic diseases. In the occurrence and devel-
opment of a disease, both deficiency of vital qi and invasion of pathogenic qi are
essential factors. Comparatively speaking, the leading role of vital qi is more impor-
tant in the course of a disease. Under normal circumstances, when vital qi is vigor-
ous, qi and blood are abundant, the functions of viscera are normal, and pathogenic
qi can hardly invade the body. When vital qi becomes weaker, failing to resist patho-
genic qi, pathogenic qi invades the body and leads to disease. Therefore, deficiency
of vital qi is the intrinsic factor causing disease, and interference of pathogenic qi is
the extrinsic factor causing disease. Nowadays, this sagacious view of Chinese medi-
cine still has important practical significance for people to maintain health and
prevent diseases.
Etiology refers to cause of disease. It is also called pathogenic factors. Etiology is
an important component of theoretical system of Chinese medicine. It expounds proper-
ties and pathogenic characteristics of various pathogenic factors. It also discusses influ-
116  7 Onset of Disease

ences of pathogenic factors acting on human body’s structure and physiological func-
tions. Etiology is very important to treatment based on syndrome differentiation. There
are three methods to seek causes of disease in Chinese medicine. First, some causes
can be found by analyzing the conditions of disease onset. For example, by observing
changes in human body after experiencing the alteration of environment. Some can be
understood by observing emotional disorder caused by exterior stimulation. Second,
invisible pathogenesis can be speculated by analogy method. For instance, nature of
wind is characterized by constant movement and rapid change. It can make trees
shake. When symptoms like headache, aversion to wind, sweating, migratory arthral-
gia, or pruritus occur, which are similar to the characters of wind, the body may be
invaded by wind-evil. As another example, dampness belongs to water with nature of
yin and is characterized by being heavy, turbid, viscous, and stagnant. When symptom
like heavy sensation in head and body, turbid excretion, or edema in legs occurs, the
body may be invaded by dampness-evil. Third, and the main method, is to seek cause
by syndrome differentiation. It is a way to differentiate causes according to the clinical
manifestations of disease and through analysis of symptoms and signs. For example,
when the symptom is similar to the characters of cold-evil such as aversion to cold,
spasm of limbs, or sweat pore closing, it is considered being attacked by cold. To some
extent, the way of seeking causes uses analogy method for reference. Etiology is not
only the result of syndrome differentiation but also the basis of treatment. Seeking the
correct cause of disease can gain decisive treatment effect. So seeking the causes by
syndrome differentiation plays an important role in mastering the essence of etiology in
Chinese medicine. Causes of Chinese medicine are relative. Under normal conditions,
wind, cold, summer-heat, dampness, dryness, and fire are normal climatic changes in
nature. Joy, anger, worry, anxiety, sadness, fear, and surprise are human’s normal emo-
tional activities. However, under exceptional conditions, they will cause disease and
become pathogens. Moreover, in the course of a disease, cause and effect are often
interactive. An effect in one pathological stage may be a cause in another stage. Exam-
ples are as follows: phlegm, stagnant fluid, blood stasis, and calculus are pathological
outcomes of a disturbance of the functions of viscera, qi, and blood which also may
become new pathological factors causing other diseases.
In this chapter, the causes are classified into four categories: exogenous patho-
gens (including six pathogenic factors and pestilential qi), endogenous pathogens
(including internal injury due to mental activities, improper diet, and injury from
overstrain idleness), pathogens from pathological products (including phlegm, stag-
nant fluid, blood stasis, and calculus), as well as other pathogens (including trau-
matic injuries, medicine pathogens, and iatrogenic disease).
8 Etiology

8.1 Exogenous pathogens

Exogenous pathogens invade the human body from the outside via the surface of
the body, mouth, or nose and cause diseases. Diseases caused by exogenous patho-
gens are called exogenous diseases.

8.1.1 Six evils

Key points
– Concept of six evils:
– Pathogenic wind, cold, summer-heat, dampness, dryness, and fire-heat.
– Common pathogenic characteristics:
– Exogenous, seasonal, regional, concurrent, and transformational.

1. Concept of six evils


Six qi refers to the six normal climatic changes in nature, including wind, cold,
summer heat, dampness, dryness, and fire heat. As human beings have adapted
to the climatic changes through their long-term life activities, normal climatic
changes will not cause diseases. Six evils is a collective term used for the six
kinds of exogenous pathogens including wind, cold, summer heat, dampness,
dryness, and fire heat. When climate changes abnormally, such as abnormal
cold in spring or abnormal heat in autumn, six qi changes sharply, or the body
resistance becomes weak due to a deficiency of vital qi; then the six qi turns
into six evils and causes diseases. Whether the six qi turns into six evils or not
depends on an individual’s vital qi. Any change in weather conditions can
trigger illness. The key component depends on an individual’s adaptive and
defensive abilities.
2. Common characteristics of six evils
A. Exogenous character
The six evils usually invade the body through the surface, mouth, or nose.
At an early stage, diseases caused by exterior pathogens are manifested as
aversion to cold, fever, and floating pulse. The disease will progress deeper
and become more severe if the exterior syndrome is not cured.
B. Seasonal character
Diseases caused by six evils often show obvious seasonality. For example,
more diseases are caused by the wind in spring, more heat in summer,
more dampness in late summer, more dryness in autumn, and more cold in
winter.
118  8 Etiology

C. Regional character
Diseases caused by six evils are closely related to the living and working
environments. Generally speaking, more diseases are caused by cold or
dryness in northwest highland because of higher altitude and colder
weather, and by dampness or heat in southeast coastal areas because of
lower altitude and more hot and humid weather. More people suffer from
damp diseases in damp environment, and people working at high tempera-
tures are vulnerable to diseases caused by fire heat.
D. Concurrent character
Each of the six evils can not only cause disease alone but can also combine
with each other, such as exterior syndrome caused by wind cold or wind
heat invading the lung and dampness heat hindering middle jiao. More-
over, there are cases when three of them combine to cause a disease, such
as arthralgia syndrome, caused by wind, cold and dampness, or wind,
dampness and heat.
E. Transformational character
Transformational character refers to the nature of a syndrome caused when
the six evils may exchange under certain conditions. For example, external
wind cold syndrome may turn into interior heat syndrome when the body is
invaded by wind cold pathogens. The transformation is related to constitu-
tion. In general, those with a constitution of yin deficiency and yang excess
tend to transform into heat or dryness syndrome and those with yang defi-
ciency and yin excess tend to transform into cold or dampness syndrome.

3. Respective pathogenic characteristics of six evils


A. Wind pathogen

Key points
– Pathogenic characteristics of wind pathogen:
– Wind is a yang pathogen, characterized by dispersion, and tends to
attack yang portion of the body.
– It is characterized by constant movement and rapid change.
– It is the most important factor that triggers a disease.
– It is characterized by mobility.

(a) Concept of wind pathogen


Wind pathogen refers to exogenous pathogenic factors characterized
by mobile, light, upward, and outward movement. Wind prevails in
spring, but it may occur in any season. So invasion by wind pathogen
may often occur in spring, but it is not limited to spring only. When
weather is abnormal or the resistance of the body becomes weak, wind
pathogen invades the human body and cause illness.
8.1 Exogenous pathogens  119

(b) Nature and pathogenic characteristics of wind pathogen


– Wind is a yang pathogen, characterized by dispersion and tends to
attack yang portion of the body
Wind pathogen, being mobile and having upward and outward
movement, is a yang pathogen. It is apt to invade the upper portion
of the body (head and face), yang meridians, and body surface. It
results in headache, dizziness, aversion to wind and cold, as well
as fever.
– Wind is characterized by constant movement and rapid change
Constant movement implies that diseases caused by wind patho-
gen possess the feature of migration. For example, in migratory
arthralgia invaded by wind pathogen, there is migratory pain
in joints, which reflects the character of wind. Rapid change denotes
that wind pathogen can cause many diseases, and these diseases
are characterized by quick and diverse change. For instance, urti-
caria, which is caused by wind pathogen, is characterized by pruri-
tus shifting in different locations and rising one after another.
– Wind is characterized by mobility
Diseases caused by wind pathogen are manifested as vertigo,
trismus, rigid neck, convulsion of the limbs, and opisthotonus.
Tetanus is an example.
– Wind is the most important factor that triggers a disease
Wind pathogen, a leading exogenous pathogenic factor, is the precur-
sor of exogenous pathogens. Other pathogens such as cold, summer
heat, dampness, dryness, and fire heat usually follow the wind to
invade the human body. Wind cold, wind heat, and wind dampness
attacking exogenously are examples. Therefore, the ancients used the
general term wind pathogen for exogenous pathogens.

B. Cold pathogen

Key points
– Pathogenic characteristics of cold pathogen:
– Cold is a yin pathogen, which tends to damage yang qi.
– Cold is characterized by condensation and stagnation.
– It is also characterized by contraction.

(a) Concept of cold pathogen


Cold pathogen refers to the exogenous pathogen characterized by cold,
coagulation, and contraction. Cold is prevalent in winter. So more dis-
eases are caused by cold in winter. Diseases caused by cold can also
occur in other seasons due to exposure to rain or a sudden drop in air
120  8 Etiology

temperature. There is a difference between cold attack and cold stroke


according to the different locations invaded by the cold pathogen. The
case when cold pathogen attacks the body surface and suppresses the
defensive yang is called a cold attack, while the case when cold patho-
gen directly invades the interior of the body and damages the visceral
yang qi is known as a cold stroke.
(b) Nature and pathogenic characteristics of cold pathogen
– Cold is a yin pathogen, which tends to damage yang qi
Cold pertains to yin. When cold pathogen invades the body, inter-
nal yang qi is not powerful enough to expel cold and may be
damaged by yin cold. For example, as cold pathogen attacks the
exterior, defensive yang will get suppressed and will be marked by
aversion to cold and fever. If cold directly invades the spleen and
stomach, it can damage the spleen yang and result in epigastric
pain with a feeling of cold, vomiting, and diarrhea. If cold attacks
the lung and spleen, it can damage the functions of dispersion,
transportation, and transformation, which result in cough, tachyp-
nea, thin sputum, or edema.
– Cold is characterized by condensation and stagnation
The circulation of qi, blood, and body fluids depends on the
warming and promoting of yang qi. Invasion of the body by cold
pathogen may block the movement of yang qi and cause stagna-
tion of qi and blood in meridians. In that case, pain occurs,
which can be relieved by warming and aggravated by cold.
Symptoms vary with the parts attacked by cold. If cold invades
the body surface, pain in the head and limbs will occur. If cold
directly invades the interior, cold or colic pain in chest,
stomach, and abdomen will occur. Moreover, if cold pathogen
invades the skin, chilblain will occur due to the stagnation of qi
and blood.
– Cold is characterized by contraction
Contraction means traction and constriction. When cold pathogen
invades the body, it may block the qi activity, tighten the striae,
and constrict the tendons. If cold pathogen attacks the body
surface, it may close striae and result in aversion to cold, fever,
and anhidrosis. If it invades meridians and the blood vessel, it will
result in pain in the head and body, difficulty in stretching, and
pale or black skin. If it invades the joints, symptoms of spasm and
pain in limbs and joints will occur. Moreover, cold pathogen may
invade viscera, causing cramping pain in the belly.
8.1 Exogenous pathogens  121

C. Summer-heat pathogen

Key points
– Pathogenic characteristics of summer-heat pathogen:
– Summer-heat is a yang pathogen characterized by burning heat.
– Summer-heat is characterized by rising and dispersion, and is apt to
consume qi and body fluids.
– Summer-heat tends to disturb the heart – mind balance, and causes
liver-wind stirring.
– Summer-heat is likely to be combined with dampness.

(a) Concept of summer-heat pathogen


Summer-heat pathogen refers to exogenous pathogen characterized by
burning heat, qi consuming, fluid damaging, as well as causing thirst
and drowsiness.
Summer heat prevails only in summer. There is yin summer heat and
yang summer heat in Chinese medicine. Sunstroke due to exposure to
hot summer for a long time pertains to yang summer heat, while dis-
eases in summer caused by cold pertains to yin summer heat. More-
over, summer heat is a pure exogenous pathogen and there is no such
thing as endogenous summer heat.
(b) Nature and pathogenic characteristics of summer-heat pathogen
– Summer heat is a yang pathogen characterized by burning heat
Summer heat is transformed from fire-heat qi of summer. As fiery
hotness belongs to yang, summer heat is a typical yang pathogen.
People affected by summer heat often show various symptoms of yang
heat, such as high fever, restlessness, flushed face, and a surging
pulse. Both summer heat and heart belong to fire in the five element
theory. Therefore, summer heat invading the human body tends to
disturb the heart and the mind, results in dysphoria, and even cause
sudden unconsciousness. Besides, because liver belongs to wood, just
as fire is likely to ignite wood, summer heat tends to cause liver wind
stirring and spasm in limbs, stiff neck, and even opisthotonus, which
is called summer wind or summer epilepsy in ancient medical books.
– Summer heat is characterized by rising and dispersion and is apt
to consume qi and body fluids
Rising refers to the ascending summer heat. It tends to invade the
head and disturb the heart and the mind. Dispersion may cause exces-
sive sweating; qi and fluid damage, which can lead to thirst; and
scanty and brownish urine. Meanwhile, qi exits the body along with
sweat, which results in qi deficiency with the symptoms of shortness
of breath, weakness, and tiredness. Therefore, if summer heat invades
the body, deficiency syndrome of qi and body fluids (yin) will occur.
122  8 Etiology

– Summer heat is likely to be combined with dampness


It is often rainy and wet in summer. So summer heat tends to
combine with dampness to cause diseases, especially in those who
have inner damp constitution. Besides fever and polydipsia, dis-
eases caused by summer heat combined with dampness are often
manifested as lassitude of limbs, chest distress, nausea and vomit-
ing, loose stool, and yellowish and greasy tongue fur.

D. Dampness pathogen

Key points
– Pathogenic characteristics of dampness pathogen:
– Dampness is a yin pathogen, apt to block qi movement and damage yang-qi.
– It is characterized by heaviness and turbidity.
– It is characterized by stickiness and stagnation.
– It is characterized by descending and is apt to attack yin locations.

(a) Concept of dampness pathogen


Dampness means presence of excess water or humidity. Dampness
pathogen refers to exogenous pathogen characterized by heavy turbid-
ity, stickiness, stagnation, and descending.
Dampness is the predominant qi in late summer. The period when the
season is changing from summer to autumn is the dampest time of a
year. More diseases are caused by dampness in late summer. In addi-
tion, diseases can also be caused due to overexposure to rain, or living
or working in humid places. Therefore, diseases caused by dampness
are common in all seasons. Moreover, endogenous dampness can be
caused by failure of the spleen in transportation. Though diseases
caused by exogenous dampness are different from those caused by
endogenous dampness, that is, spleen insufficiency, they often influ-
ence each other in the disease process. The invasion of dampness can
affect the transportation and transformation function of the spleen,
thus leading to intergeneration of dampness. On the other hand,
patients with water-dampness retention due to the deficiency of spleen
are vulnerable to invasion of exogenous dampness.
(b) Nature and pathogenic characteristics of dampness pathogen
– Dampness is a kind of yin pathogen, apt to block qi movement and
damage yang qi
The nature of dampness is similar to that of water, and thus it is a
yin pathogen. The spleen is susceptible to dampness pathogen
because it has aversion to dampness. When dampness pathogen
invades the human body, it causes the disorder of the spleen,
8.1 Exogenous pathogens  123

makes spleen yang unable to work, as well as causes retention of


water and dampness. Thus, symptoms like anorexia, abdominal
distension, diarrhea, tiredness, or edema may occur.
Dampness pathogen is apt to block the qi dynamic, which can lead
to disharmony of qi in ascending and descending. Thus, symptoms
such as chest distress, epigastric distention, loose stool, and
scanty urine may occur.
– Dampness is characterized by heaviness and turbidity
Because dampness pertains to water, which has certain weight,
diseases caused by dampness are characterized by heaviness. For
example, when dampness pathogen invades the body surface,
symptoms like heaviness of the head and body or severe pain of
limbs will occur. If it invades meridians and joints, it will prevent
the yang qi from spreading and symptoms like numbness of skin
or severe joint pain will occur. Moreover, diseases caused by
dampness are usually marked by turbid excretion and secretion.
When dampness pathogen stays on the upper part of the body,
patients’ face looks dusky and more eye secretion appears. If it
stays in the large intestine, there will be symptoms of loose stool
or diarrhea, purulent, and bloody dysentery with mucus. When it
goes downward, there is turbid urine or excessive yellow vaginal
discharge in the case of women. If it spreads over the skin, symp-
toms like sores and ulcers, eczema, or filthy pus will occur.
– Dampness is characterized by stickiness and stagnation
This is mainly reflected in two aspects. The first is the sticky
symptom, which means invasion by damp pathogen mostly leads
to sticky and greasy discharges and secretions, as well as thick
and greasy tongue fur, among other symptoms. The second is lin-
gering course, which means diseases caused by damp pathogen
usually have a prolonged course, relapse repeatedly, and are diffi-
cult to be cured, such as eczema or fixed arthralgia.
– Dampness is characterized by descending and is apt to attack yin
locations
Dampness is similar to water and is characterized by downward
flow. So invasion by damp pathogen mostly leads to symptoms of
lower part of the body, such as edema in legs, diarrhea, vaginal
discharge, among other symptoms. Moreover, invasion by damp-
ness pathogen can directly disturb the spleen and stomach,
leading to dyspepsia.
124  8 Etiology

E. Dryness pathogen

Key points
– Pathogenic characteristics of dryness pathogen:
– Dryness is characterized by aridity and is apt to consume body fluids.
– Dryness has the tendency to impair the lung.

(a) Concept of dryness pathogen


Dryness prevails in autumn. It is an exogenous pathogen that damages
the body fluids. Besides, dryness pathogen often invades the lung, liver,
and large intestine, and especially has the tendency to impair the lung.
(b) Nature and pathogenic characteristics of dryness pathogen
– Dryness is characterized by aridity and is apt to consume body
fluids
Dryness pathogen invading the body is most likely to consume
body fluids because it is characterized by aridity, thus resulting in
various symptoms such as dry mouth, nose, or throat; dry or even
chapped skin; lusterless hair; scanty urine; and constipation. This
kind of disease prevails in autumn or in northwest regions of China.
– Dryness has the tendency to impair the lung
The lung is a tender organ and requires moisture for its function-
ing, and shows aversion to dryness. It governs qi and controls
respiration as well as is connected externally to the skin and hair.
It is also associated with the nose orifice. Dryness pathogen invad-
ing the body through the mouth or nose is most likely to consume
lung fluid and result in failure of the lung in diffusing and des-
cending. The symptoms are characterized as dry cough with little
sputum or sticky sputum that is difficult to be expectorate, blood-
stained sputum, asthma, and chest pain. The lung and large intes-
tine are in an exterior and interior relationship, so the exhaustion
of body fluids in the lung will result in lack of moistening of the
large intestine and will be manifested as dry stool.

F. Fire-heat pathogen

Key points
– Pathogenic characteristics of fire-heat pathogen:
– Fire heat is a yang pathogen characterized by burning upward.
– Fire heat is likely to consume body fluids and damage qi.
– Fire heat is apt to stir up wind and cause bleeding.
– Fire heat is likely to disturb the heart – mind balance.
– Fire heat is likely to cause sores and abscesses.
8.1 Exogenous pathogens  125

(a) Concept of fire-heat pathogen


Fire-heat pathogen refers to exogenous pathogen characterized by
burning upward, being likely to consume body fluids, exhausting qi,
stirring up wind, and causing bleeding, sores. or abscesses. Heat pre-
vails in summer. But fire-heat diseases can be seen in all four seasons.
(b) Nature and pathogenic characteristics of fire-heat pathogen
– Fire heat is a yang pathogen characterized by burning upward
Both fire and heat are yang in nature, so fire-heat pathogen is a
yang pathogen. Invasions lead to heat symptoms such as high
fever, flushed face, and surging and rapid pulse. Besides, due to
the characteristic of flaring upward, fire-heat pathogen often
invades the upper part of the body and is manifested as headache,
tinnitus, sore throat or toothache, thirst, sweating, swollen gums,
and aptha, among other symptoms.
– Fire heat is likely to consume body fluids and qi
Fire heat is likely to force body fluids to dry up and consumes yin
fluid. Thus, it is characterized by thirst, dry throat and tongue,
yellow and scanty urine, as well as dry stool. Moreover, qi will be
exhausted as a result of body fluids consumption, causing symp-
toms of qi deficiency such as fatigue and short breath.
– Fire heat is apt to stir up wind and cause bleeding
Fire-heat pathogen is apt to burn liver meridians and cause internal
stirring up of liver wind. So it is also called extreme heat causing
wind. It is characterized by high fever, spasm of the limbs, upward
staring of the eyes, and opisthotonos. Moreover, fire-heat pathogen
invading the blood vessels may accelerate blood circulation, even
burn the vessels and force blood to flow outside of vessels, thus
leading to bleeding symptoms such as hematemesis, epistaxis, hema-
tochezia and hematuria, echymosis, as well as uterine bleeding.
– Fire heat is likely to disturb the heart and mind
Fire heat corresponds with heart. So diseases caused by fire patho-
gen are usually manifested as distraction of the heart and mind,
such as restlessness, insomnia, even mania, unconsciousness, and
delirium, among others.
– Fire heat is likely to cause sores and abscesses
Fire-heat pathogen invades into the blood and may accumulate in
a local area, causing ulceration of muscles. It can result in sores
and abscesses marked by redness, swelling, and burning pain.
Clinically, it is often accompanied by heat symptoms such as
fever, restlessness, or thirst.
126  8 Etiology

8.1.2 Pestilential pathogens

Key points
– Pathogenic characteristics of pestilential pathogens:
– Strong infectivity and epidemicity.
– Abrupt onset and serious condition.
– Diseases vary with pestilential pathogens while the same disease has similar symptoms.

1. Concept of pestilential pathogens


Pestilential pathogens are the kind of exogenous pathogens with strong infectiv-
ity. They are also called pestilential qi, toxic qi, poisonous qi, epidemic qi, and
special pathogens. The species of pestilential pathogens, their pathogenic char-
acters, and treatments have been discussed in Treatise on Pestilence written by
Wu Youxing 200 years earlier than the discovery of bacteria and other microor-
ganisms. The writer attributed the cause of surgical infection to pestilential
pathogen instead of fire pathogen, which made great contribution to the theory
of epidemic febrile disease. Due to the earlier formation of the pestilential theory
foundation, there were many inventions on preventing pestilential pathogens in
Chinese medicine. Variolation is one of them. The ancients found that wearing
clothes of infected patients or inoculation via nose could prevent epidemic dis-
eases effectively, which was later learned by E. Jenner, who invented the small-
pox vaccine in the early nineteenth century. Disease syndromes vary with differ-
ent pestilential pathogens, which include many contagious diseases in modern
medicine such as smallpox, cholera, plague, SARS, dengue fever, erysipelas of
the face, mumps, bacillary dysentery, scarlet fever, and diphtheritis.
2. Causes for the occurrence and epidemic of pestilential pathogens
A. Abnormal climates
Prolonged drought, heat, flood, damp fog, and malaria can all breed and
spread pestilential pathogens that cause contagious diseases. For example,
parasitic diseases are related to the flood, and miasma or malaria is related
to climatic conditions in south of the Five Ridges.
A. Environmental and food pollution
Unsanitary environments such as polluted water or air can help the pesti-
lential pathogens to multiply. Polluted or unclean food can also cause the
onset of pestilences. For instance, pestilent dysentery and acute infectious
hepatitis are caused by unclean diet.
C. Lack of strict preventive measures
Pestilential pathogens are strongly infective. If there is a lack of strict pre-
ventive measures, pestilences will occur or be epidemic.
D. Social factors
The occurrence and epidemic of pestilential diseases are closely related to
social conditions. War chaos and famine can cause pestilences to spread
8.2 Endogenous pathogens  127

widely. If effective preventive and treatment measures are taken to main-


tain social stability, good working and living conditions, as well as eco-
nomic prosperity, pestilences can be controlled effectively.
3. Pathogenic characteristics of pestilential pathogens
A. Strong infectivity and epidemicity
Pestilential pathogens can be transmitted in crowds through air or food. In epi-
demic regions, few can avoid getting infected. With strong infectivity and epi-
demicity, pestilential pathogens can cause diseases to spread to large areas.
B. Acute onset and serious condition
Pestilential pathogens have strong toxicity and often invade the body in
combination with heat, poisonous fog, and malaria. So diseases caused by
them are more sudden and severe than others caused by internal injury or
the six evils. These epidemic invasions are most likely to consume body
fluids, disturb the mind, cause bleeding, stir up wind, and impair important
viscera such as the heart, kidney, and liver. So the mortality rate of some
pestilent diseases is very high.
C. Same pestilential qi lead to similar symptoms
There are many different types of pestilential qi. One pestilential qi can
induce one pestilential disease, and every pestilent disease can have
similar symptoms. Different pestilential qi will present different symptoms.
Take mumps for example; it is often manifested as swelling in the cheeks
or behind the ear for every patient. It is also pointed out in Treatise on Pesti-
lence that some pestilential pathogens invade animals only while other
invade humans only, which is determined by their specificity.

8.2 Endogenous pathogens

Endogenous pathogens cause diseases that are generated internally and directly
impair viscera. They mainly include the internal injury due to seven emotions,
improper diet, overstrain, and over-idleness.

8.2.1 Internal injury due to mental disorders

Key points
– Pathogenic character of internal injury due to mental disorders:
– Impair the viscera, mainly the heart organ.
– Affect the viscera qi movement first (rage causes qi to go upward, excessive joy causes qi
to relax, grief causes qi to be consumed, great fear causes qi to sink, overthinking causes
qi to depress, and oversurprise causes qi to be disordered).
– Disease condition will be aggravated by emotional disturbance.
128  8 Etiology

1. Concept of internal injury due to mental disorders


Mental disorders refer to joy, anger, worry, thinking, sorrow, fear, and surprise.
They are the normal physiological reactions to external stimulations. Under
normal conditions, they do not cause diseases. Only when the emotional stimu-
lations are too abrupt, violent, prolonged, and beyond one’s adaptability, they
may cause disturbances of qi movement and impairment of viscera, and dis-
eases then occur. This is what is called internal injury due to seven emotions.
Moreover, whether the seven emotions will turn into pathogenic factors or not
depends on an individual’s tolerance. For example, if two people are experien-
cing the same emotional stimulation, one with weak tolerance is more likely to
fall ill and have difficulty in recovering than the stronger person.
2. Pathogenic character of internal injury due to mental disorders
A. Impair the viscera, injure the heart first
Internal injury due to mental disorders can directly impair the correspond-
ing viscera. For example, rage hurts the liver, leading to upward adverse
flow of liver qi or liver fire flaming, both of which can consume yin blood
of the liver. Overjoy hurts the heart, leading to slackened heart qi, and the
spirit will be unable to rest. Excessive sorrow hurts the lung, leading to con-
sumption of lung qi. Great fear hurts the kidney, causing loss of kidney qi.
Overthinking hurts the spleen, causing stagnation of qi movement, and
leading the spleen to fail in transformation and transportation. Oversur-
prise hurts the heart or the gallbladder, causing the heart to fail to control
the mind, the gallbladder to fail in making decisions, and leading to palpi-
tation. It is a general rule that mental disorders impair the corresponding
viscera. But because the heart holds the spirit and is the master of five zang
viscera and six fu viscera, it plays a decisive role in emotional activities.
When mental disorders cause diseases, they impair the heart first, and then
affect the other viscera.
B. Affect the viscera qi movement first
Internal injury due to seven emotions is most likely to cause disorder of
the viscera qi movement. Because of different stimulating factors, different
emotional changes may cause various changes of the viscera qi movement.
That is, rage causes qi to go upward, excessive joy causes qi to be relaxed,
grief causes qi to be consumed, great fear causes qi to sink, overthinking
causes qi to be depressed, and oversurprise causes qi to be disordered.
Rage causes qi to go upward. Rage may cause liver qi to go adversely
upward, and blood follows the adverse qi movement and also goes
upward. Symptoms such as flushed face with congested eyes, restlessness,
insomnia, and even hematemesis and sudden coma may occur. Liver qi
perversion may affect the spleen and stomach, resulting in their dysfunc-
tion. Liver fire due to stagnated liver qi may impair the lung. Excessive joy
8.2 Endogenous pathogens  129

causes qi to be relaxed. Normally, joy can smooth the circulation of qi and


blood as well as put the mind at ease. However, overjoy will make heart qi
slacked and the spirit will be unable to rest. It is manifested as absent
mindedness and mental confusion. Grief causes qi to be consumed. Exces-
sive sorrow will result in depression and consumption of lung qi. It is
characterized by low spirit, chest distress, shortness of breath, fatigue,
and lassitude. Great fear causes qi to sink. Syndromes such as pale face,
dizziness, and even coma may occur. Excessive fear will make kidney qi
unconsolidated and make it sink downward. It is characterized by inconti-
nence of urine and feces, spermatorrhea, miscarriage, and weakness of
knees. Oversurprise causes qi to be disordered. Sudden surprise may cause
disorder of the heart qi and make heart spirit uncontrollable. It is charac-
terized by panic attacks and palpitation. Overthinking causes qi to be
depressed. It may make spleen qi stagnant and cause it to fail in transfor-
mation and transportation. It is characterized by loss of appetite, abdom-
inal distention, and loose stool. Besides, overthinking may cause con-
sumption of heart blood, which is manifested as palpitation, insomnia,
and amnesia. This is the heart spleen deficiency syndrome induced by
overthinking.
C. Disease condition will be aggravated by mood swings
Normally, positive emotions can benefit the recovery of diseases. However,
negative emotions may aggravate the disease condition or make it deterio-
rate rapidly. For example, if a patient with hypertension becomes enraged,
liver yang and blood will suddenly rise, leading to sudden coma or hemi-
plegia. If a patient with heart disease experiences sudden emotional upset,
it can aggravate conditions such as stenocardia and myocardial infarction.
Sudden death might even occur.

8.2.2 Injury due to improper diet

Key points
– Causes for injury due to improper diet:
– Improper eating habit.
– Insanitary diet.
– Imbalanced diet.

1. Concept of injury due to improper diet


Proper diet is essential for the human body to maintain life activities. It is the
main source of qi, blood, yin, and yang. However, improper eating habit and
unhealthy and imbalanced diet are the important factors leading to disease.
130  8 Etiology

2. Causes for injury due to improper diet


A. Improper eating habit
Food should be taken on time and the food quantity should be moderate.
The quantity of food should differ according to age, constitution, and phy-
sical condition. Both starvation and overeating can result in disease. Star-
vation means obvious insufficient ingestion of food. It may lead to a reduc-
tion of the source of production of qi and blood due to shortage of food.
Prolonged shortage of diet may cause deficiency of qi and blood and result
in lusterless complexion, shortage of breath, fatigue, dizziness, or sponta-
neous sweating. Overeating means excessive ingestion of food. It may
impair the spleen and stomach and result in epigastric or abdominal disten-
tion with pain, foul belching and acid regurgitation, vomiting, as well as
diarrhea. It even causes reverse flow of qi and leads to sudden coma, which
is called coma due to improper diet. Infants are prone to be impaired by
overeating because their spleen and stomach are weak. Prolonged food
accumulation can cause infantile malnutrition, and then vexing heat in
hands and feet, emaciation with sallow complexion, abdominal fullness,
and distention, making the children prone to crying. Overeating can also
affect circulation of qi and blood, causing stagnation of meridians, and
lead to hemorrhoids, carbuncle, and abscess. Moreover, during earlier
stage in recovering from a disease, overeating may cause the disease to
reoccur. Improper order of eating is also harmful to health. For example, it
is wrong to have meals first and then drink soup or eat dessert and fruits.
B. Insanitary diet
Insanitary diet refers to eating unclean food, such as deteriorated or poiso-
nous food. Insanitary diet can cause dysfunctions of intestines and
stomach such as abdominal pain, vomiting, and diarrhea. It also can lead
to infectious diseases such as cholera, ileotyphus, and hepatitis. Consum-
ing food polluted by parasites can cause verminosises. It is characterized
by occasional abdominal pain, addiction of singular things, and emaciation
with sallow complexion. If deteriorated or poisonous food is consumed,
food poisoning will occur. It is manifested as severe abdominal pain, vomit-
ing and diarrhea, even coma or death. Ancient physicians had paid great
attention to food poisoning. We should emphasize on this condition more
in modern times.
C. Imbalanced diet
Diet should be reasonably arranged and only then can it supply the nutri-
tion to the human body. Diet predilection easily results in deficiency of
some nutrients and then causes diseases.
(a) Predilection for cold or hot food
Excessive intake of cold food can impair yang qi of the spleen and
stomach. Cold dampness thus occurs internally, which is characterized
8.2 Endogenous pathogens  131

by abdominal cold pain and diarrhea. Predilection for spicy hot food
can cause heat accumulation in the stomach and intestines, leading to
thirst, abdominal distention and pain, constipation, or hemorrhoids.
(b) Predilection for the five tastes
Acid, bitter, sweet, pungent, and salty tastes correspond to five
viscera. Preference for food with a certain taste for a long time can
cause preponderance of its corresponding viscera and lead to diseases.
Patients should especially pay attention to suitable food tastes, or else
the disease will be aggravated.
(c) Predilection for greasy or sweet food
Predilection for greasy or sweet food may cause abdominal fullness
and distention, or furunculosis, diabetes, hyperlipemia, or hyperten-
sion.
(d) Predilection for alcohol
Wine is the essence of food and is hot in nature. Proper drinking can
promote blood circulation and relax joints. Overdrinking, however,
will impair the spleen and stomach and produce internal dampness
heat. Internal fire heat can burn stomach meridian and force blood to
go upward, marked by hematemesis and bleeding from teeth or nose.
If there is heat stagnation in the intestines, kidney, or bladder, hemato-
chezia and hematuria may occur.
(e) Parorexia
Parorexia refers to intake of inedible food, such as raw tea, rice or
paper, or even soil, stone, and insects. The causes for this kind of pre-
dilection are phlegms or stagnation. For patients with predilection who
have normal diet and no thirst, parasitosis may be the cause.

8.2.3 Injury due to overstrain and over-idleness

Key points
– Pathogenic character of injury due to overstrain and over-idleness:
– Physical overstrain consumes qi.
– Mental overstrain impairs the heart and spleen.
– Sexual overstrain consumes kidney essence.

1. Concept of injury due to overstrain and over-idleness


It refers to disease caused by imbalance of work and rest.
2. Classification and pathogenic character of injury due to overstrain and overease
A. Overstrain
It refers to body injury due to overstrain. It includes physical overstrain,
mental overstrain, and sexual overstrain.
132  8 Etiology

(a) Physical overstrain


It mainly refers to prolonged physical overwork leading to disease.
Overexertion can cause consumption of qi at first and then impairment
of the spleen. It can even affect the liver, which is characterized by
fatigue and tiredness, shortness of breath, spontaneous sweating, and
poor appetite. Long-term overexertion can also injure muscles, tendons,
and bones.
(b) Mental overstrain
It refers to long-term intense mental work, continuous emotional upset,
or great mental trauma. Mental overstrain is the characteristic of con-
suming yin and blood, impairing the heart, liver, spleen, and stomach.
Thus, symptoms such as palpitation, insomnia, dizziness, amnesia, poor
appetite, abdominal distension, vomiting, and diarrhea will occur.
(c) Sexual overstrain
It refers to excessive sexual activities, masturbation, or early preg-
nancy or too many births, which consume kidney essence. Clinical
manifestations include ache and weakness in waist and knees, vertigo,
tinnitus, spermatorrhea, abnormal vaginal discharge, hot flash, impo-
tence, and emaciation.
B. Overease
It refers to lack of labor and exercise, including physical and mental over-
idleness.
(a) Physical over-idleness
No physical exercise over a long period can cause stagnation of qi and
blood, dysfunction of the spleen and stomach, as well as deficiency of
vital qi. Diseases caused by it are often marked by abdominal disten-
sion, poor appetite, fatigue, palpitation, shortness of breath, and
sweating. And these symptoms can be alleviated by suitable physical
exercise.
(b) Mental over-idleness
Mental over-idleness may exist with physical over-idleness. Lack of
brainwork for a long period can cause reduced brain function, which is
called use it or lose it. Then it will lead to indifferent expression, low
spirit, reluctance to eat, fatigue, dullness, amnesia, dementia, or psy-
chopathy. Furthermore, depression due to mental over-idleness can
cause stagnation of qi and result in various emotional diseases.

8.3 Pathogens from pathological products

A disease is a complicated pathological process with specific manifestations caused by


pathogens. In the process, there is particular pathological change and manifestation
8.3 Pathogens from pathological products  133

at every stage. Phlegm, retained fluid, stagnant blood, and calculus are pathological
products in the course of a disease due to dysfunction of viscera. For the whole course
of a disease, they are pathological products in the former stage, and may become new
pathogens in the latter stage. It means that pathological products stagnated in the
body may cause new disorders and lead to new diseases.
Pathogens from pathological products include phlegm, retained fluid, blood
stasis, and calculus.

8.3.1 Water-dampness, phlegm, and retained fluid

Key points
– Concept of water-dampness, phlegm, and retained fluid
– Causes for water-dampness, phlegm, and retained fluid: Exogenous six evils, internal injury
due to seven emotions, and improper diet cause dysfunctions of viscera and metabolic disor-
ders of fluid.
– Pathogenic characters of water-dampness, phlegm, and retained fluid:
– Flowing with qi throughout the body.
– Variability and complexity.
– Lingering pathological condition and prolonged duration.
– Blocking circulation of qi and blood, affecting visceral functions.
– Blocking the orifices and disturbing the spirit.

1. Concept of water-dampness, phlegm, and retained fluid


Water dampness, phlegm, and retained fluid are the pathological products of
water metabolism disorder. They are also the secondary pathogens. Water-damp-
ness means edema due to failure of spleen in transporting and transforming
water. Generally, phlegm is thick and turbid, while retained fluid is thin and clear.
There are broad and narrow senses of the concept of phlegm. In a narrow sense, it
refers to the respiratory secretion called visible phlegm. In a general sense, it is
invisible and changing phlegm resulting from metabolism disorder of body fluids.
It can flow with qi movement throughout the body and cause different diseases
according to its accumulative locations. For example, if it runs in the intestine, it
will cause intestinal gurgling sounds. If it flows into the hypochondrium, it can
cause cough with referred pain. It stagnates in the limbs to cause body pain. It
invades the lung to cause asthma. It invades the heart to cause dizziness. Phlegm
accumulated in the heart can lead to palpitation, coma, and demented diseases.
It can cause vomiting due to accumulation in stomach as well as result in
crewels, hemiplegia, and deep multiple abscesses due to its flow throughout meri-
dians, tendons, and bones. In a nutshell, diseases caused by phlegm are diverse.
2. Formation of phlegm and retained fluid
Causes for phlegm and retained fluid are exogenous six evils, pestilent patho-
gens, and internal injury due to seven emotions, improper diet, as well as
134  8 Etiology

overstrain and over-idleness. All of the above-mentioned pathogens can cause


water metabolism disturbances and fluid stagnation due to dysfunctions of
viscera. The formation of phlegm and retained fluid is mainly related to the
lung, spleen, kidney, liver, triple burners, and bladder.
A. Improper diet
Too much intake of greasy food can impair the spleen and stomach in
failing to transform water and dampness, causing phlegm and retained
fluid. Indulgence in drinking may also lead to phlegm disease due to accu-
mulation of damp heat.
B. Internal injury due to seven emotions
Excessive grief, rage, fright, or joy can lead to disorder of the qi movement,
stagnation of meridians, obstruction of nutritive qi and defensive qi, as well
as interior water-dampness accumulation; thus phlegm and turbidity occur.
Phlegm disease, which is caused by dysfunction of the spleen affected by liver
due to emotional depression, is the most common in this kind of diseases.
C. Exogenous six excesses
The lung may fail to distribute body fluids due to wind cold pathogen
attacking the body. The spleen will be impaired due to invasion of damp-
ness pathogen. Besides, fire heat can condense the body fluids leading in
phlegm and dampness to occur internally.
D. Dysfunctions of viscera
Formation of phlegm and dampness is mainly related to the lung, spleen,
kidney, liver, triple burners, and bladder. The lung, which are in charge of
qi, regulate waterways. If it fails to disperse body fluids, phlegm and tur-
bidity will occur. The function of the spleen is transportation and transfor-
mation of water-dampness. Disharmony of the spleen and stomach will
cause phlegm. Kidney also plays a leading role in water metabolism, and
deficiency of kidney yang can also lead to stagnation of water-dampness.
Triple burners offer the pathway for circulation of water fluids, and the
bladder controls discharge of water. Their dysfunctions will cause water
retention, which will cause phlegm to form. Phlegm caused by liver dys-
function results from qi stagnation and water accumulation. Besides,
depression of heart yang or deficiency of heart qi also causes phlegm.
3. Pathogenic characters of water-dampness, phlegm, and retained fluid
A. Flowing with qi throughout the body
Phlegm and retained fluid can flow with qi and go everywhere, internally
to viscera and meridians while externally to skin. Qi movement will be
obstructed where phlegm is retained. If it stays in the meridians, it will
cause the channels to be obstructed. It also can lead to stagnation of lung
qi due to its accumulation in the upper burner, dysfunction of the spleen
and stomach due to accumulation in the middle burner, as well as difficulty
in urinating due to flow into the lower jiao.
8.3 Pathogens from pathological products  135

B. Variability and complexity


Diseases caused by water-dampness can vary depending on the constitu-
tions of patients. Manifestations of this kind of disease are also changeable
with disease progress. Phlegm and retained fluid are caused due to differ-
ent reasons and they change all the time. There is an old saying, “Diseases
are mainly haunted by phlegm,” or “Rare diseases are usually caused by
phlegm.”
C. Lingering pathological condition and prolonged duration
Water-dampness, phlegm, and retained fluid are a result of accumulation
of body fluids and are characterized by heaviness, turbidity, stickiness, and
stagnancy. Diseases caused by them often have longer courses and cannot
be healed in a short time. Water-dampness, phlegm, and retained fluid are
often caused by deficiency of yin, yang, qi, and blood in the body. It is
more difficult to expel them due to the weak resistance and dysfunction of
viscera. Moreover, phlegm and retained fluid can lead to other diseases or
aggravate disease conditions. Vital qi has been consumed to a certain
extent when these pathological products occur. So it is also very difficult to
treat the combination of deficiency excess syndromes.
D. Blocking the circulation of qi and blood, affecting the visceral functions
Water-dampness, phlegm, and retained fluid are substantial pathogens.
They will inevitably block the circulation of qi movement, causing chest
distress and abdominal distension. When they block the meridians, scro-
fula, and subcutaneous nodule, numbness will occur. When they stagnate
in the lung, cough and asthma will occur. When the stagnation is in the
heart, angina, and even coma, will occur.
E. Being prone to disturbance of the spirit
When phlegm turbid disturbing internally, it tends to cause lucid yang
failing to rise and lead to dizziness and low spirit. Phlegm heat will disturb
the heart, causing coma and dementia.

8.3.2 Blood stasis

Key points
– Causes for blood stasis: qi deficiency, qi stagnation, blood cold, blood heat, consumption of
body fluids, and traumatic injury.
– Pathogenic character of blood stasis: pain, swelling, bleeding, cyanosis, intermittent pulse.

1. Concept of blood stasis


Blood stasis refers to a pathological product resulting from the stagnation of
blood within the body. It includes both blood flowing out of meridians and
sluggish blood inside the meridians. In ancient literature, it is also termed as
136  8 Etiology

blood clotting, blood accumulation, sluggish blood, and so on. Blood stasis can
block circulation of qi and blood and affect normal functions of viscera, which
leads to new diseases. It is a secondary pathogen just like phlegm and retained
fluid.
2. Causes of blood stasis
There are two main aspects involved in the formation of blood stasis. One type
of blood stasis is due to abnormal flow of blood caused by traumatic injuries.
The other is due to unsmooth flow of blood due to qi deficiency, qi stagnation,
blood cold, or blood heat resulting from various pathogenic factors.
A. Qi deficiency leading to stagnant blood
Qi is the commander of blood, and deficient qi cannot promote circulation
of blood, which causes blood stagnation. Qi deficiency can also induce
weak resistance to exogenous pathogens, affecting functions of viscera and
blocking qi movement, thus leading to blood stasis. Moreover, if bleeding
caused by qi deficiency cannot be eliminated promptly, it will also cause
blood stasis. Causes for qi deficiency include inherent shortage, lack of
health maintenance, aeipathia, or improper diet. Therefore, when treating
blood stasis, it is essential to tonify qi followed by promoting blood circula-
tion and removing blood stasis.
B. Qi stagnation leading to blood stasis
Emotional distress, phlegm dampness, and food retention can block qi
movement and cause unsmooth flow of blood leading to blood stasis.
C. Blood cold leading to blood stasis
Exogenous cold pathogen or interior exuberance of yin cold can impair yang
qi and cause it to fail in promoting blood circulation, thus leading to blood
stasis. Besides, blood vessels will become constricted due to invasion of cold
pathogen and aggravate the blood stagnation. This condition is described as
follows: blood will get congealed due to cold. Clinically, treatment of
warming yang to dispel cold is often used in blood stagnation syndrome.
D. Blood heat leading to blood stasis
Exogenous warm heat pathogen or endogenous fire heat can make blood
concentrated and lead to blood stagnation. Moreover, blood mixed up with
fire heat will burn blood vessels and abnormal flow of blood occurs, which
leads to blood stagnation. Clinically, treatment method of clearing heat and
cooling blood is often used in diseases caused by blood stagnation.
E. Consumption of body fluids leading to blood stasis
Heat pathogen, excessive sweating, vomiting and diarrhea, or mistaken use
of diuretic can consume body fluids. Deficiency of the spleen and lung, or
stagnation of phlegm dampness, can also cause shortage of body fluid
sources. If blood is compared to a boat, body fluids can be compared to
water, which can carry the boat. So the consumption of body fluids can
cause unsmooth circulation of blood and lead to blood stasis.
8.3 Pathogens from pathological products  137

F. Traumatic injury leading to blood stasis


Tumbling, injury by swords or beasts, and overloading can all lead to
bleeding and abnormal flow of blood. If this kind of bleeding cannot be
expelled timely, it will become stagnant blood.
Abnormal flow of blood caused by internal injury left inside the body can
also cause unsmooth circulation of blood, leading to blood stagnation.
Furthermore, both stagnant blood and phlegm turbidity are pathological
products in the course of diseases. They can affect each other. Their basic
mechanism is to cause the stagnation of qi and blood as well as the block-
age in the collaterals.
3. Pathological character of blood stasis
Stagnant blood can affect circulation of qi and blood, causing pain, bleeding,
blockage of meridians, tumor in the viscera, as well as bruises on the body
surface. Their clinical features are as follows:
(a) Pain. Pain caused by blood stasis is usually manifested as fixed and stab-
bing. It will be aggravated by pressure or become worse at night. Distension
pain can be caused by blood stasis resulting from qi stagnation.
(b) Swelling. Swelling caused by blood stasis is manifested as a fixed hard
lump. Local bruise on the body surface or abdominal mass can be pal-
pated.
(c) Bleeding. Stagnant blood staying in the body can affect circulation of qi
and blood, leading to bleeding. It is often characterized by purplish blood
with clots.
(d) Cyanosis. It is often marked by purplish lip and nails, dark purplish tongue,
purpura, phlebeurysma under the tongue, dark complexion, scaly dry skin,
spider angioma, or blue veins in the abdominal wall.
(e) Intermittent pulse. Diseases caused by blood stagnation are often mani-
fested as thin, wiry, deep, or intermittent pulse.

8.3.3 Calculus

Key points
– Concept of calculus
– Causes for calculus: improper diet, internal injury of seven emotions, deficiency of kidney
essence, parasitic infection, improper use of medicine, foreign body deposits, and traumatic
injury.
– Pathological character of calculus: usually stays in the liver, gallbladder, stomach, kidney, and
urinary bladder.
– Prolonged clinical courses with mild or severe conditions.
– Blocking the qi movement and impairing the vessels.
– Pain.
138  8 Etiology

1. Concept of calculus
Calculus refers to a mineral-like pathological product located in certain parts of
the body. It can obstruct many locations of the body and mainly the gallbladder
and kidney. Besides, it can occur in the nose, eyes (including corneal, atria, and
tear gland), ears, or pulmonary alveoli. And tophi caused by abnormal metabo-
lism can be seen in any part of the body except for the central nervous system.
Calculus is also a secondary pathogen. It can cause new diseases such as stran-
guria, and jaundice.
2. Causes of calculus
A. Improper diet
Indulgence in spicy or greasy foods can cause the formation of damp heat
internally, which will affect the liver and gallbladder and lead to bile stag-
nation, hence, biliary calculus. If damp heat goes downward and affects
the kidney and bladder, then renal or vesical calculus will occur.
B. Internal injury due to seven emotions
Emotional distress can cause stagnation of qi movement, which leads to
calculus. Excessive emotional changes may impair the liver and kidney,
causing retention of bile or urine as well as resulting in calculus.
C. Deficiency of kidney essence
Constitutional deficiency, chronic illness, aging, or weakness will cause
deficiency of kidney essence, which leads to deficient fever consuming the
body fluids and results in calculus.
D. Parasitic infection
Roundworm invading the biliary tract can lead to local infection and
obstruction as well as cause biliary calculus.
E. Improper use of medicine
Long-term use and overdose of certain kinds of medicine will cause dys-
function of viscera or medicine remaining in the body, leading to calculus.
F. Foreign body deposits
If some foreign bodies stay in a certain cavity of the body for a long time,
some metabolic materials will deposit and surround it to cause calculus. It
often occurs in the nose, kidney, gallbladder, and bladder.
G. Traumatic injury
If traumatic injuries (including operation) impair the biliary tract, they can
cause stenosis or obstruction, leading to bile stagnation and calculus.
Moreover, calculus is related to one’s age, gender, physical quality, and
living habits. It can also be caused by other diseases.
3. Pathological characters of calculus
Manifestations of diseases caused by calculus differ greatly because of the dif-
ferent locations where the calculus stays. Generally, calculus can cause stagna-
tion of qi and blood as well as impair the viscera. The basic mechanism of calcu-
lus is qi stagnation while pain is the main symptom.
8.4 Other pathogens  139

A. Calculus usually stays in the liver, gallbladder, stomach, kidney, and


urinary bladder
Smooth flow of liver qi governs the production and excretion of bile; the
steaming function of kidney qi affects the formation and discharge of urine.
So dysfunction of the liver and kidney can lead to calculus. Calculus is
prone to staying in the liver, gallbladder, kidney, bladder, and stomach.
B. Prolonged clinical course with mild or severe conditions
The formation of calculus usually results from accumulation of dampness
and heat, which is hard to expel, causing a long course of disease. Its clinical
manifestations differ greatly due to the difference in calculus size and loca-
tion. Generally speaking, patients with small calculus show milder disease
condition and even without clinical symptom. Too large calculus may be
manifested as severer condition, obvious symptoms, and frequent onset.
C. Tending to block qi movement and impair the vessels
As a substantial excess pathogen, calculus staying in the body will block qi
movement and affect the circulation of qi, blood, as well as body fluids. It
can cause local distending pain. In a severer condition, calculus can impair
the blood vessels and cause bleeding.
D. Pain
Pain caused by calculus is marked by paroxysmal dull pain, distending pain,
and even colic pain. It is the characteristic of intermittency. The extreme pain
caused by calculus can disappear immediately when calculus is dissolved.

8.4 Other pathogens

Besides exogenous pathogens, endogenous pathogens, and pathogenic products,


there are other reasons for occurrence of diseases. It includes unexpected injuries
(including traumatic injury and toxicosis), iatrogenic pathogens (including medicine
abuse, therapist fault, and needle infection), and congenital factors (including fetal
transmission and inheritance). Medicine abuse and iatrogenic pathogens will be
mainly discussed in this chapter.

8.4.1 Medicine abuse

Key points
– Pathogenic characters of medicine abuse:
– Usually manifested as toxic symptoms.
– Acute onset with severe disease conditions.
– Aggravating the condition and causing new disease.
140  8 Etiology

1. Concept of medicine abuse


Medicine abuse refers to a pathogenic factor caused by improper administration
of medicine. This is called drug-induced disease. Medicine is used for treating
disease, but overdose or mistaken use of it can cause disease.
2. Causes for medicine abuse
A. Toxic reaction due to poisonous medicine
Medicine itself is poisonous, which is common in herb, animal, and mineral
drugs. For example, monkshood with hot nature is extremely poisonous. If it
is not processed or boiled properly, it will cause toxicosis. Misuse of centi-
pede with histamine and alpha hemolysin will cause hemolytic reaction.
Overuse of cinnabar can lead to chronic mercury poisoning. Manifestations
of drug poisoning vary according to the different medicines taken. Generally
speaking, mild poisoning can cause dizziness, palpitation, nausea, vomiting,
numb tongue, diarrhea, or constipation. Severe poisoning will lead to
muscle vibration, restlessness, aggravated jaundice, shortness of breath, sali-
vation, dysuresia, drop in blood pressure, bleeding, cyanosis, or even death.
B. Misuse of medicine
Every medicine has its own indication. Treatment should be done in
accordance with the proper indication. For example, normally, for patients
with deficiency, tonifying treatment should be done, but some patients
cannot endure the tonifying therapy, including those with stagnation of
dampness hot pathogen, blockage of spleen and stomach qi, and retained
lochia in women. Another example is, for patients with excess pathogens,
purgative medicine should be used commonly. But if there is deficiency of
vital qi, purgative medicine will become a pathogenic factor and lead to
disease.
3. Pathogenic character of medicine abuse
A. Usually manifested as toxic symptoms
Mistaken or overuse of poisonous medicine will cause dizziness, palpita-
tion, nausea, vomiting, numb tongue, diarrhea or constipation, muscle
vibration, restlessness, jaundice, cyanosis, bleeding, coma, and even death.
B. Acute onset with severe disease conditions
Abuse of extreme poisonous medicine often causes acute poisoning with
severe conditions, impairing important viscera, and even leading to death.
C. Aggravates disease condition and causes new diseases
Improper use of medicine will cause aggravation of disease and lead to
new diseases. For example, unsuitable medicine used by pregnant women
can cause miscarriage, defect fetus, or fetal death.
8.4 Other pathogens  141

8.4.2 Iatrogenic pathogen

Key points
– Causes for iatrogenic pathogens:
– Improper speech.
– Illegible writing.
– Misdiagnosis.
– Improper treatment.

1. Concept of iatrogenic pathogen


It refers to a pathogenic factor resulting in disease aggravation or onset of other
diseases caused by a doctor’s faults.
2. Causes for iatrogenic pathogen
A. Improper speech
Rude or inappropriate words spoken by a doctor can cause patient’s aver-
sion to treatment. If the doctor tells about the disease conditions that
should not be known by patients, patients will become overloaded in
thought, which can cause disease aggravation or onset of new diseases.
B. Illegible writing
Illegible writing or using rare medicinal name in prescriptions can cause
mistakes. It will delay treatment and cause disease aggravation.
C. Misdiagnosis
Misdiagnosis or delayed treatment will lead to mistakes in treatment or onset
of new disease. For example, if a deficiency syndrome is misdiagnosed as
excess with many purgative medicines being prescribed, or an excess syn-
drome is misdiagnosed as deficiency with tonifying medicine being used,
disease condition will be aggravated even to the stage of being dangerous.
D. Improper treatment
Medical accidents can be caused by ignorance or roughness during the
treatment. For example, improper needling in the chest or back can cause
pneumothorax; overexertion in medical massage may cause fracture. In
Suwen, it is discussed about acupuncture therapy that doctors should con-
centrate on treatment, which is called feel like standing upon the edge of an
abyss, holding needles like holding a tiger.
E. Pathogenic character of iatrogenic pathogen
Different iatrogenic factors can cause different diseases or syndromes.
Improper words are similar to internal injury due to emotional activities in
pathogenic character. Pathogenic character of illegible writing is similar to
medicine abuse while improper treatment is similar to traumatic injury.
They are discussed in other relevant chapters.
Pathogenesis refers to mechanism of occurrence, development, and
change of a disease. It reveals characteristics and principles of disease
142  8 Etiology

onset and progress. Therefore, analysis of pathogenesis is the internal evi-


dence and the theoretical guidance of the clinical treatment based on syn-
drome differentiation. Pathogenesis includes general pathogenesis, sys-
tematic pathogenesis, symptom pathogenesis, and the progress of the
diseases. General pathogenesis includes exuberance and debilitation
between vital and pathogen pathogens, imbalance of yin and yang, disor-
ders of qi and blood, as well as the disorders of fluids metabolism. Sys-
tematic pathogenesis includes pathogenesis of viscera, body, and orifices
as well as five endogenous pathogens. Exogenous pathogenesis includes
patho mechanism of six phases, defense qi nutrient blood, as well as triple
burners. Meridians pathogenesis includes 12 meridians and 8 extra chan-
nels. Progress of disease refers to transmission and changes among viscera,
meridians, and tissues. It is significant to clinical treatment based on syn-
drome differentiation, early treatment, and control of the disease advance-
ment. Pathogenesis is a theory of discussing and clarifying principles of
pathological changes. It elaborates interrelationship between parts and the
whole, viscera and its accessories, internal and external environments. It is
based on the functional changes resulting from combined actions as well
as taking into account individuality and diversity. Pathogenesis of Chinese
medicine implies profound recognition of life activities and contributes to
enrichment of life science.
9 Pathogenesis

9.1 Exuberance and debilitation between vital and pathogen

Key points
– Concepts of pathogen, vital qi, deficiency, and excess
– Deficient or excessive changes:
– Mixture of deficiency and excess.
– Inter-transformation between deficiency and excess.
– True – false of deficiency and excess.
– Prognosis of disease:
– Domination of vital qi with decline of pathogen.
– Struggle between pathogen and vital qi.
– Domination of pathogen with decline of vital qi.
– Withdrawal of pathogen with decline of vital qi.
– Deficiency of vital qi with pathogen lingering.

9.1.1 Concept of pathogen, vital, exuberance, and debilitation

This concept refers to the exuberant and debilitating changes in the struggle between
body resistance and pathogenic qi in the course of disease. The struggle not only deter-
mines the onset, development, and final prognosis of disease but also affects changes
of deficient or excessive syndromes. The course of diseases is a process of struggling
between the vital and the pathogen as well as its exuberance and debilitation changes.
In the course of disease development, the struggle between the vital and patho-
gen always varies. In the struggle, the pathogen declines as the vital grows, and vice
versa. With the growth and decline of the vital and pathogen, disease is marked by
two different essences, namely, the changes of deficiency and excess.
1. Pathogen
Pathogen refers to all kinds of pathogenic factors in general.
2. The vital
Vital refers to vital qi, a summarization of normal body functions including
defensive ability, disease-resistance ability, and recovery ability.
3. Deficiency syndrome
A. Concept
Concept refers to deficiency of vital qi and weak resistance to disease. It is a
pathological manifestation with deficiency of vital qi as dominant aspect of
the contradiction mainly marked by insufficiency of essence, qi, blood,
and body fluids; hypo-function of viscera and meridians; and low body
resistance. Drastic pathological reaction is difficult to appear in the struggle
of vital qi and pathogens due to deficiency syndrome.
144  9 Pathogenesis

B. Etiology
Causes for deficiency of vital qi involve two aspects. One aspect is from
the deficiency in pre-natal qi which is often due to weak essence, or imbal-
ance of post-natal qi which is due to weak constitutions. This aspect
belongs to the category of pure deficiency without any pathogen. The other
is from sequel of a disease or chronic case which results from the damaged
vital qi unable to fight against pathogen. The long-term or serious diseases
cause consumption of qi, blood, body fluids, and essence. Besides, inva-
sion of pathogens can lead to over-consumption of refined nutrient
substances.
C. Pathological manifestations
Deficiency of vital qi is often manifested as emaciated body, fatigue, palpi-
tation, sweating, weak voice (caused by qi deficiency), sallow complexion,
dizziness (caused by blood deficiency), urinary and fecal incontinence,
pressure-relieved dull pain (caused by viscera deficiency), feverish feelings
in five centers (caused by yin deficiency), weakness and soreness in lower
back and knees, aversion to cold with cold limbs (caused by yang defi-
ciency), and feeble pulse.
4. Excess syndrome
A. Concept
Concept refers to the exuberant pathogen with sufficient vital qi, or a
pathological manifestation with super-activity of pathological qi as the
dominant aspect of the contradiction. In such cases, pathogens are exces-
sive and vital qi is strong enough to fight against pathogens. Thus, the
struggle between the vital and pathological qi is severe. It is clinically indi-
cated by a series of excessive symptoms.
B. Etiology
Causes for the excessive pathogens include invasions of six exogenous
evils or pestilential qi, stagnations of pathological products or visible
pathogens (such as phlegm, retained fluids, water-dampness, blood stasis,
food retention, and parasites), as well as internal injury due to emotional
distress. All of them can cause dysfunctions of viscera, meridians, qi,
blood, and body fluid.
C. Pathological manifestations
Excessive syndrome usually occurs at the early or middle stage of the
disease. The struggle between vital and pathogenic qi is violent because
even though the pathogenic qi is strong, the vital qi is not weak enough.
Clinically, it is often manifested by the syndromes of excessive syndromes
such as blockage of the skin and meridians, hypo-activity of internal
organs, as well as qi and blood stagnation. It is characterized by stagnation
of pathogenic heat, obstruction of phlegm-turbid and water-dampness,
dyspepsia, and constipation. It is often manifested as high fever, mania,
9.1 Exuberance and debilitation between vital and pathogen  145

loud and hoarse voice, impalpable abdominal pain, constipation and food
stagnation, and full and forceful pulse.
The concept of deficiency or excess pathogenesis in endogenous
miscellaneous diseases is different from that of exogenous diseases. In
endogenous miscellaneous syndromes such as phlegm, fluid retention,
blood stasis, parasites, and food stagnation, excessive syndromes refer to
syndrome with invasion of pathogens and deficient syndromes refers to
syndrome with deficiency of vital qi. But in exogenous diseases, excess syn-
drome refers to syndrome with severe struggle between vital and pathogenic
qi and deficiency syndrome is the syndrome with low disease-resistance.
Generally speaking, when pathogenic qi invades the body, pathogens
impair the vital qi while the vital qi also resists against and expel pathogens.
Therefore, the struggle between vital and pathogenic qi not only determines
development and prognosis of disease but also affects the changes of defi-
ciency or excess syndrome. In fact, in the process of disease development,
balance between the vital and pathogen is altered. If the vital qi is sufficient,
it is apt to expel pathogens and disease may get better or get cured. If patho-
genic qi is exuberant, it will impair and consume the vital qi, and disease
can be aggravated.

9.1.2 Changes of deficiency or excess

Excess and deficiency between the pathogen or the vital qi can not only result in the
simple pathological changes but can also lead to various changes in the prolonged
and complicated courses of disease, including mixture of deficiency and excess,
inter-transformation between deficiency and excess, and true-false of deficiency and
excess.
1. Mixture of deficiency and excess
Mixture of deficiency and excess refers to a pathological condition in which the
struggle between vital and pathogenic qi leads to coexistence of exuberant
pathogens and declined vital qi in the course of a disease. It involves two
aspects: deficiency syndrome mixed with excess and excess syndrome mixed
with deficiency. It may be caused by stagnant pathogens impairing vital qi due
to improper treatment of a disease or by blockages of water-dampness, phlegm,
and fluid retention, as well as blood stasis resulting from deficient vital qi
failing to expel pathogens.
A. Deficiency syndrome mixed with excess
This syndrome refers to a pathological condition in which predominance
of deficient vital qi mixes with excessive pathogens. For example, in a case
of edema caused by spleen yang deficiency which fails to transport and
transform water pertains to deficiency syndrome, and the retention of
146  9 Pathogenesis

water pertains to excess syndrome. This kind of pattern is mainly due to


deficiency with excess as the secondary syndrome.
B. Excessive syndrome mixed with deficiency
This syndrome refers to a pathological change in which predominance of
excessive pathogenic qi mixes with deficient vital qi. For example, in exo-
genous febrile disease, invasion of exuberant heat pathogen causes excess
heat syndrome marked by high fever, sweating, constipation, red tongue,
and rapid pulse. At the same time, heat pathogen causes consumption of
body fluids, leading to qi deficiency syndrome marked by thirst, wanting to
drink water, scanty urine, fatigue, and shortness of breath. This kind of
syndrome is characterized by primary excessive syndrome with secondary
deficient syndrome.
The primary and secondary for deficiency or excess syndrome,
respectively, should be determined by analyzing the stage and amounts of
pathogens and vital qi. In clinic, there are also other mixture of deficiency
and excess syndromes such as exterior excess mixed with interior defi-
ciency, exterior deficiency with interior excess, deficiency in the lower
and excess in the upper, and deficiency in the upper and excess in the
lower.
2. Inter-transformation between deficiency and excess
Inter-transformation between deficiency and excess refers to pathological con-
version between deficiency and excess in the course of disease, including the
transformation of excessive syndrome into deficiency and excessive syndrome
resulted from deficiency.
A. Transformation of excess into deficiency
In the process of a disease, conversion of the pathological nature from
excess to deficiency may occur from impairment of vital qi and viscera due
to delayed or improper treatment. For example, exterior cold or exterior
heat syndrome which pertains to excessive syndrome at the early stage will
transform into the deficient lung and spleen syndromes manifested as ema-
ciation, poor appetite, lusterless complexion, shortness of breath, and
fatigue as a result of improper treatment of the exogenous disease.
B. Excessive syndrome resulted from deficiency
Excessive syndrome resulted from deficiency means that vital qi is origin-
ally deficient or viscera function become declined, which leads to dysfunc-
tion of qi, blood, and body fluids, thus resulting in stagnation of excessive
pathogens such as blood stasis, phlegm, fluid retention, and water-damp-
ness. It is a syndrome of obvious excessive pathogenic qi with declined
vital qi. For example, edema caused by kidney-yang deficiency is mani-
fested as symptoms of both deficient kidney-yang and water retention.
This pathological change is similar to that of a mixture of deficiency and
excess.
9.1 Exuberance and debilitation between vital and pathogen  147

2. True – false syndrome between excess and deficiency


This syndrome refers to a pathological condition that the nature of a disease is
not in accordance with its clinical manifestations under some particular circum-
stances. Generally speaking, the symptoms in the clinical setting often match
the root issues. However, under certain specific circumstances, some false
symptoms might appear. Therefore, in the clinical setting, we must make differ-
ential diagnosis in order to identify the real disease pattern. Due to the opposite
manifestations between true and false, it often results in the true deficient syn-
drome with false excessive symptoms and true excessive syndrome with false
deficient symptoms.
A. True deficient syndrome with false excessive symptoms (symptoms of
excess in extreme deficiency)
This symptom is often caused by deficiency of qi and blood as well as the
weakened viscera. For example, symptoms of abdominal distension and
pain can be caused by spleen dysfunction. But the abdominal distension is
not acute, and the pain can be alleviated by pressure. It is different from
that of excessive syndrome. Moreover, when there is extreme deficiency of
yang qi in the body, false excessive symptoms such as mental excitement,
flushed face, and restlessness will occur.
B. True excessive syndrome with false deficient symptoms (deficiency mani-
festing with extreme excess)
It refers to some syndromes with extreme exuberance of pathogens in
nature. Clinically, it may be manifested as deficiency symptoms. It is often
caused by stagnations of heat, phlegm, food, damp-heat constipation,
abdominal pain aggravated by pressure, tidal fever, and delirium. On the
other hand, it might be presented with the false deficient symptoms such
as pale complexion, cold limbs, and fatigue symptoms.
Overall speaking, in the course of a disease, deficiency or excess is
relative in pathogenesis. Clinically, we need to keep an objective and rela-
tive view when analyzing the changes of pathogenesis.

9.1.3 The relationships among pathogen, vital qi, excess, and deficiency as well
as the outcome of disease

During the early and middle stage of the disease, struggle between vital and patho-
genic qi is violent along with the pathological reaction. And the changes of growth
and decline between vital qi and pathogens can lead to the different prognosis. It
includes the following types.
1. Domination of vital qi with decline of pathogen – recovery
Domination of vital qi with decline of pathogen refers to the best result of a
disease that vital qi defeats pathogenic qi, pathogens being declined or expelled
148  9 Pathogenesis

and the disease recovers. It is the common ending to many diseases. Recovery
attributes to sufficient vital qi of the body, strong resistance to pathogens, or
proper treatment. It indicates that the damage of pathogens to the body is
coming to an end or disappearing; the visceral functions along with the balance
of yin and yang are resumed. Apart from the patient’s own health condition and
resistance against diseases, timely and proper treatment are essential to the
recovery of a disease.
2. Confrontation between pathogen and vital qi – the lingering stage of the disease
Confrontation between pathogen and vital qi refers to a pathological course in
which vital and pathogenic qi are in a very close condition and cannot defeat
each other, leading to a lingering phase. In this stage, pathogens are stagnated
at certain locations and cannot be expelled or move inward. No matter where
the pathogens stagnate, treatment of strengthening the vital qi and eliminating
pathogens should be taken simultaneously.
3. Exuberance of pathogen with decline of vital qi – disease aggravation or even to
death
Exuberance of pathogen with decline of vital qi refers to a pathological course
in which the vital qi becomes weaker and fails to resist against exuberant patho-
genic qi, and the disease is aggravated. It involves two pathological conditions:
for an ordinary patient with a relatively stable vital qi, the more exuberant the
pathogens are, the more serious the disease condition will be; and for the same
invasions of the pathogens, the weaker the body is, the more serious the disease
condition will be. An example is the six exogenous evil syndromes. Its common
pathological change is the impairment of the defensive-yang with more superfi-
cial disease location and milder condition. However, if the vital qi is very defi-
cient or the invasion of pathogenic qi is too strong, special transmissions of
disease such as double contraction, direct attack, or direct penetration into
nutrient-blood may occur.
Double contraction refers to both exterior and interior meridians being
invaded by exogenous pathogens. The extensive and serious damage to the
vital qi is often seen in exterior – interior concurrent disease such as cold or
heat in both exterior and interior.
Direct attack refers to the attack of exogenous pathogens directly to three
yin meridians rather than transmitting from the three yang meridians. It indi-
cates more serious disease conditions. If cold pathogen directly attacks taiyin
meridian and impairs the spleen yang, abdominal pain and diarrhea may occur.
If cold pathogen directly attacks shaoyin meridian and impairs the heart and
kidney, cold limbs and feeble and impalpable pulse may occur.
Direct penetration into nutrient-blood refers to a process of the warm-heat
disease, attacks of the pathogens rapidly penetrate into the nutrient-blood
stage rather than being expelled at the defensive or qi stage. It indicates a critical
stage of disease in which nutrient-yin is impaired and blood is consumed. This
9.1 Exuberance and debilitation between vital and pathogen  149

condition can be caused by misuse of purgative drugs for disease invaded by exo-
genous cold pathogen. It may occur at the later stage of exogenous heat disease
with syndrome of yin or yang depletion. If prompt treatments are not taken, there
will be exhaustion of essence, qi, blood, and body fluids as well as the feebleness
of viscera functions. It can even cause death.
Death refers to the end of life activity, yin-yang dissociation, and perma-
nent end of the whole physiological function of the body. There are two types of
deaths: physiological and pathological. The former refers to a natural death
without disease. The later refers to death due to a disease or an accident. Patho-
logical death is an undesirable end resulting from an aggravated disease with
pathogenic qi defeating declined vital qi.
4. Withdrawal of pathogen with decline of vital qi – recovery period
Withdrawal of pathogen with decline of vital qi is often seen in recovery stage
of a serious disease. It refers to a pathological course in which the pathogenic qi
have been expelled and the damaged vital qi is waiting to be restored. It is
usually caused by severe impairment of vital qi due to excessive pathogenic qi,
or overtreatment by diaphoresis, vomiting, or purgation which results in elimi-
nation of pathogens followed by severe damage to vital qi. It can also be seen in
patients with deficient vital qi.
5. Deficiency of vital qi with pathogen lingering – lingering stage
Deficiency of vital qi with pathogen lingering refers to a pathological stage of a
disease in which the vital qi has been weakened and pathogenic qi has not been
expelled thoroughly. It is a disease condition with pathogenesis of the deficient
vital qi with pathogen lingering. Under this condition, the vital qi has been
impaired by pathogens but not been defeated, and the pathological qi has
declined after resistance of vital qi. The weakened vital qi fails to drive patho-
gens outside which causes residual pathogens lingering inside. If disease condi-
tion is relatively stable, disease can be cured. However, if the disease lingers
with unstable condition, it may frequently occur and account for disease
turning from acute to chronic, prolonged disease, or existence of some prog-
nosis even to death. Therefore, measures should be taken to break the lingering
pathological deadlock and to gain the recovery.
Sequelae refers to the end of a pathogenic course of the disease or the dis-
appearance of the symptoms during the recovery which only leaves malfunc-
tions and malformations of the body, such as tremor of limbs, physical abnorm-
ality, aphasia, dementia, and hemiplegia. Sequelae are different from disease
lingering. The former is an end of a disease and the latter is a lingering stage or
the chronic course of disease.
Moreover, there is a form of a disability that results from traumatic injuries
such as gunshot, swords, falling, and beasts, leading to permanent damage or
deformation of the body. Both the sequelae and disability involve semiperma-
nent end of a disease.
150  9 Pathogenesis

9.2 Imbalance of yin and yang

Key points
– Types of imbalance of yin and yang:
– Preponderance of yin or yang.
– Abnormal debilitation of yin and yang.
– Mutual impairment of yin and yang (yin impairment affecting yang, vice versa).
– Mutual repelling of yin or yang (preponderant yin repels yang, preponderant yang repels yin).
– Transformation of yin and yang (yin syndrome transforming into yang syndrome, yang
syndrome transforming into yin syndrome).
– Depletion of yin or yang (yin depletion, yang depletion).

9.2.1 Concept of imbalance of yin and yang

Imbalance of yin and yang is a series of pathological changes marked by imbalance


of growth and decline of yin and yang in the process of a disease occurrence and
development. It includes the exuberance of yin or yang, debilitation of yin or yang,
mutual impairment of yin and yang, mutual repelling of yin and yang, transforma-
tion of yin and yang, and depletion of yin or yang. Among them, exuberance and
debilitation of yin or yang are the most basic pathological changes.
Being healthy refers to balance and harmony between yin and yang of the
human body. It is marked by moderate body temperature, being mobile or stillness
freely, and normal qi movement and physiological activities. Imbalance of yin-yang
is the most basic pathomechanism for various diseases. Various pathogenic factors
acting on the body, such as exogenous six excesses, mental disturbance, improper
diet, injuries from overstrain, or idleness, may lead to an imbalance of yin and yang
which can cause diseases. So the imbalance of yin and yang is the inner basis of the
onset and development of diseases.

9.2.2 Types of imbalance of yin and yang

1. Exuberance of yin or yang


Exuberance of yin or yang refers to a pathological change in which excessive
pathogenic qi is the primary aspect of contradiction. Yang excess is character-
ized by an excessive heat syndrome resulting from exuberant yang without yin
deficiency. Yin excess is characterized by excessive cold syndrome resulting
from exuberant yin without yang deficiency.
Growth of yang results in decline of yin and growth of yin leads to decline
of yang. They are called preponderance of yang makes yin suffer, and preponder-
ance of yin makes yang suffer. They are inevitable trend in the progress of exu-
berance of yin or yang.
9.2 Imbalance of yin and yang  151

A. Exuberance of yang
Exuberance of yang refers to a pathological change marked by exuberance
of yang, hyperfunction of viscera and meridians, as well as the excessive
heat pathogen. It is usually caused by invasion of exogenous warm-heat
pathogens, interior transformation of heat from cold pathogen, internal
injury due to mental activities, transformation of five emotions into fire, or
fire-heat transformed by qi stagnation, blood stasis, phlegm-turbid, and
food retention. Generally, an excess of yang leads to heat syndrome. Yang
is characterized by hotness, motion, and dryness. So syndromes caused by
excessive yang may manifest as fever, restlessness, red tongue with yellow
fur, and rapid pulse. In addition, excess of yang may impair yin marked by
thirst, oliguria, and constipation. This situation is called preponderance of
yang makes yin suffer.
B. Preponderance of yin
Preponderance of yin refers to a pathological change marked by exuberance
of yin, hypofunction of viscera, meridians, and accumulation of pathologi-
cally metabolic products. It is usually caused by invasion of cold-dampness
pathogens or over-intake of cold food, leading to inner stagnation of cold-
dampness. An excess of yin will cause cold syndrome. Generally speaking,
yin is characterized by cold, stillness, and dampness. So syndrome caused
by excessive yin may manifest as cold body, fond of warmth, being not
thirsty, white-furred tongue, and tight or slow pulse. Moreover, excessive
yin usually causes consumption of yang qi, leading to cold symptoms such
as aversion to cold, abdominal pain, clear urine, and loose stool, which is
called preponderance of yin makes yang suffer.
2. Debilitation of yin or yang
It is a pathological change caused by deficiency of yin essence or yang qi of
human body. When deficient yang cannot restrain yin, deficient cold syndrome
will occur, or vice versa.
A. Debilitation of yang
Debilitation of yang refers to a pathological change of a decreased body
functions caused by deficiency of yang qi and shortage of thermogenesis.
The reasons for this condition are various, including congenital deficiency,
postnatal malnutrition, internal injury due to overstrain or idleness, or
impairment of yang qi due to prolonged disease. Generally, it is marked by
cold symptoms such as pale complexion, intolerance of cold and cold
limbs, pale tongue, slow pulse, deficient symptoms of listlessness, clear
abundant urine, and diarrhea with undigested food. Deficient yang qi
mainly relates to the spleen and kidney, especially kidney. Kidney-yang
takes charge of all the yang qi in the whole body. The decline of kidney
yang (deficiency of vital gate fire) is very important in the pathogenesis of
yang decline. Mechanism of yang deficiency leading to cold is that deficient
152  9 Pathogenesis

yang qi cannot restrict yin and is lack of warming function, causing hypo-
functions of meridians and viscera, slow blood circulation and body fluids,
stagnation of water fluid, thus inner exuberance of yin-cold occurs.
B. Debilitation of yin
Debilitation of yin is a pathological change in which yin is deficient due to
consumption of essence, blood, and body fluids, and is a condition when
yin fails to restrict yang. It results in relative excess of yang and asthenic
body hyperfunction. The reasons include injury due to excessive mental
activities transforming into fire and impairing yin, or consumption of yin
fluid due to prolonged diseases. In clinical manifestations, the deficient-
heat syndrome due to insufficient yin fluid failing to restrict yang qi occurs,
which is marked by vexing heat in chest, palms and soles, bone-steaming
tidal fever, flushed face with hot eyes, emaciation, night sweating, dry
mouth and throat, red tongue with thin coating, and thin and rapid pulse.
Yin deficiency may occur in five viscera, but mainly involves the liver and
kidney. Prolonged yin deficiency of other viscera will ultimately affect the
liver and kidney. In clinic, syndromes of yin deficiency in the lung and
kidney along with yin deficiency in the liver and kidney usually occur. Defi-
ciency of kidney yin is of vital importance due to kidney yin being the
leader of yin in the body.
3. Mutual impairment of yin and yang
Mutual impairment of yin and yang means that the deficiency of either yin or
yang may involve in opposite aspect, thus resulting in deficiency of both yin
and yang. It includes yin impairment involving yang and yang impairment
involving yin. Because the kidney stores vital essence, it is the foundation of
yang qi and yin fluid all over the body. Mutual impairment of yin and yang is
apt to occur under the circumstance of which kidney yin or yang is impaired.
A. Yin impairment affecting yang
Yin impairment affecting yang means that consumption of yin fluid affects
yang qi and causes inadequate production or exhaustion of yang qi due to
shortage of what it depends on. It results in deficient syndrome of both yin
and yang with a predominance of yin deficiency. For example, chronic con-
sumptive diseases such as spermatorrhea, night sweating, and loss of
blood, which badly impair yin essence of human body, can cause inade-
quate resources of producing yang qi. It can gradually lead to syndrome of
yang deficiency marked by spontaneous sweating, intolerance to cold, and
diarrhea with undigested food in the stool.
B. Yang impairment affecting yin
Yang impairment affecting yin means that deficiency of yang qi affects yin
fluid and causes inadequate production of yin fluid, resulting in deficiency
syndrome of both yin and yang with a predominance of yang deficiency.
For instance, edema caused by deficient yang qi fails to promote water
9.2 Imbalance of yin and yang  153

fluid and causes water-dampness retention. But with its development, yin
is consumed due to the deficient yang, and syndrome of yin deficiency will
occur marked by emaciation, vexation, and thirst, and even spasms.
4. Repelling of yin and yang
Repelling of yin and yang refers to a pathological change in which either yin or
yang is of extreme excess inside and rejects its opposite aspect outside. It is a
kind of special pathogenesis in the imbalance of yin and yang, including pre-
ponderant yin repelling yang and preponderant yang repelling yin. Its mechan-
ism is that yin or yang is extremely exuberant or weak, and the excessive one
blocks internally rejecting the other aspect externally which leads to breakdown
of interdependence of yin and yang. Repelling of yin and yang can be mani-
fested as disease of true cold syndrome with false heat symptoms and true heat
syndrome with false cold symptoms.
A. Preponderant yin repelling yang (true cold and false heat)
Preponderant yin repelling yang, also called as the repelling yang syndrome,
refers to a pathological state of true cold syndrome with false heat symptoms
caused by exuberant yin pathogens or with yang deficiency forcing extre-
mely declined yang to go outside. For example, patients with extremely
declined yang qi and extremely exuberant deficient cold can show symp-
toms such as pale complexion, severe cold limbs, listlessness, chillness,
cowered lying, and feeble and impalpable pulse. If the disease is aggravated,
false heat symptoms will occur, such as floating red complexion, mutter,
restlessness with dysphoric heat, sudden increase of appetite, and huge but
unrooted pulse. In ancient medicine books, sudden flushed zygomatic
region like being putting on the make-up is called as floating yang, while
sudden increase of appetite is called as sudden spurt of appetite prior to col-
lapse. Both of them are sudden spurts of activities before collapsing, which
pertain to false manifestation of vitality in Chinese medicine inspection.
B. Preponderant yang repelling yin (true heat syndrome with false cold symp-
toms)
Preponderant yang repelling yin, also called as repelling yin syndrome,
refers to a pathological state of true heat syndrome with false cold symp-
toms, in which extreme heat pathogens is deep inside the body. It causes
stagnant yang-heat failing to reach the limbs. It is a serious syndrome char-
acterized by excess heat in essence. For example, at extremely exuberant
stage of exogenous heat disease, heat symptoms occur, such as continual
strong fever, dysphoria, thirst, and red tongue with yellow fur, and rapid
and strong pulse. If the disease is aggravated, false cold symptoms such as
cold limbs and deep pulse will occur. Cold limbs are also called as yang
faint or heat faint. In Treatise on Febrile Diseases, this syndrome is called as
“more exuberant the heat is, the more serious the faint is; the weaker the
heat is, the milder the faint is.”
154  9 Pathogenesis

5. Transformation between yin and yang


In the process of disease, imbalance of yin and yang can also be manifested as
transformation between yin and yang, including yin syndrome transforming
into yang syndrome and yang syndrome transforming into yin syndrome.
A. Yang syndrome transforming into yin syndrome
This transformation means that heat-natured diseases with preponderance
of yang qi in essence can be turned into cold-natured diseases when the
excessive yang aggravates to certain extent. For instance, at the early stage
of some acute exogenous diseases, manifestations of excessive heat patho-
gens can occur, such as high fever, thirst, chest pain, cough, red tongue,
and yellow fur. But improper treatment or too excessive invasion of patho-
gens may cause acute yin-cold manifestations such as sudden declined body
temperature, cold limbs, cold sweating, and feeble and impalpable pulse.
B. Yang syndrome transforming into yang syndrome
This transformation refers to cold-natured diseases with preponderance of yin
qi in essence which can be turned into heat-natured diseases when the exces-
sive yin aggravates to a certain extent. For example, at the early stage of cold,
yin syndrome manifested as wind-cold pathogens invading body surface is
marked by serious aversion to cold, mild fever, headache and bodily pain,
joint pain, running nose with nasal congestion, no sweating, cough, thin and
white furred tongue, and floating tense pulse. Improper treatment or being
with heat constitution can cause yang syndrome manifested as high fever,
sweating, being vexed, thirst, red tongue, yellow fur, and rapid pulse.
6. Depletion of yin or yang
Depletion of yin or yang refers to a pathological state of dying illness caused by
sudden massive loss of yin fluid or yang qi of the body. Depletion of yin or yang
is a severe syndrome of the disease which can be caused by high fever, profuse
sweating, infections, poisoning, excessive vomiting, diarrhea, loss of blood,
and untreatable prolonged diseases. Among them, profuse perspiration and
excessive loss of blood are most apt to cause exhaustion of yin or yang because
sweat and blood pertain to yin fluid. Yin fluid will be exhausted following the
loss of sweat and blood, while yang qi will also be depleted due to its failing to
be attached to yin fluid. Therefore, depletion of yin or yang will cause decline of
the opposite aspect. The differential diagnosis and treatment should be taken
into considerations.
A. Yang depletion
Yang depletion is a critical collapsing state due to the sudden and massive
loss of yang qi of the body. Generally speaking, it is caused by a sudden
massive loss of yang qi due to failure of vital qi to fight against excessive
exogenous pathogens, deficiency of vital qi and overstrain, or overuse of
diaphoresis. In addition, yang depletion due to chronic consumptive disease
usually results from collapse due to serious depletion of yang qi along with
9.3 Disorders of qi, blood, and body fluids  155

deficient yang going outward. Yang depletion is often manifested as pale


complexion, cold limbs, listlessness, even coma, chillness, profuse sweat-
ing, cold sweat, and feeble and impalpable pulse. Yang depletion indicates
critical condition of diseases. Because of interdependence of yin and yang,
yang exhaustion will cause depletion of yin. Therefore, exhaustion of yin
and depletion of yang occur in succession, leading to death.
B. Yin depletion
Yin depletion is a critical collapse state due to the sudden and massive loss
of yin fluid of the body. Yin depletion is usually caused by excessive heat
pathogen or prolonged stagnation of heat pathogen which greatly consumes
yin fluid, or the massive consumption of yin fluid due to chronic consump-
tive diseases. Yin exhaustion is manifested as flushed complexion, dys-
phoria, even coma and deliration, thirst, dyspnea, warm limbs but hyper-
hidrosis with a tendency to collapse, or continual sweating, hot and sticky
sweat, deep red and mirror tongue without fur, and rapid but feeble pulse.
Due to interdependence of yin and yang, yin depletion will make yang to
lose its attachment and escape outward, and finally lead to the end of life.
In conclusion, pathogenesis of imbalance of yin and yang is a mechan-
ism for illustrating, analyzing, and synthesizing all pathogenic phenomena
of the body. It is based on the theories of restriction, growth, and decline;
interdependence; and complementation as well as inter-transformation
between yin and yang. Therefore, preponderance of yin or yang is closely
related to decline of yin or yang, and yin depletion is closely related to
yang depletion. Therefore, the kinds of pathogenic imbalance of yin and
yang are not unfixed and will change along with the disease conditions.

9.3 Disorders of qi, blood, and body fluids

Key points
– Disorders of qi
– Qi deficiency, disorder of qi movement (qi stagnation, qi sinking, reversed flow of qi, qi block-
age, and qi exhaustion).
– Disorders of blood
– Blood deficiency, blood stasis, blood heat, and blood cold.
– Disharmony between qi and blood
– Qi stagnation with blood stasis, qi deficiency with blood stasis, failure of qi to control blood,
qi exhaustion following blood damage, and deficiency of both qi and blood.
– Disorders of body fluids
– Deficiency of body fluids and retention of water-dampness.
– Disharmony among qi, blood, and body fluids
– Water retention with qi stagnation, qi exhaustion following fluid damage, fluid exhaustion with
blood dryness, fluid shortage with blood stasis, and blood stasis with fluid retention.
156  9 Pathogenesis

9.3.1 Disorders of qi

Disorders of qi refer to the various pathological changes due to qi deficiency result-


ing from inadequate production or excessive consumption, abnormal qi movement,
and hypofunction of qi which include qi deficiency and disorder of qi movement.
Disorder of qi movement includes qi stagnation, qi sinking, reversed flow of qi, qi
blockage, and qi exhaustion.
1. Qi deficiency
A. Concept
Qi deficiency refers to the pathological changes in which original qi is defi-
cient with loss of normal functions, causing hypofunction of viscera and
weak resistance to diseases.
B. Causes for qi deficiency
Many factors may lead to qi deficiency. It includes congenital deficiency,
postnatal malnutrition, inadequate production of qi due to dysfunctions of
the lung, spleen, and kidney, excessive qi exhaustion due to overstrain and
prolonged diseases, or hypofunction of qi due to being weak with age. It is
often seen in chronic diseases, aged or weak patients, deficient diseases,
and recovery phase of diseases.
C. Clinical manifestations
Qi deficiency is characterized by shortage of qi, no desire to speak, fatigue,
dizziness, spontaneous sweating, frequent cold, thin body, and weak
pulse. Fatigue and lack of strength are typical cases among them. Besides,
qi deficiency of different viscera manifests different symptoms. For exam-
ples, qi deficiency of lung is characterized by hypofunctions of its dominat-
ing qi and respiration as well as convergence of vessels. Qi deficiency of
heart is characterized by hypofunctions of governing blood and housing
spirits. Hypofunctions of digesting food and transforming food essence
occur due to qi deficiency of spleen and stomach. Qi deficiency of liver is
characteristic by hypofunction of governing regulation and storage of
blood. Kidney qi deficiency is characterized by hypofunction of storing
essence, generating marrow, sealing and storing as well as inspiration.
Since the lung is in charge of qi in the body, and the spleen is the source
for the production and transformation of qi and blood, primordial qi
depends on the cultivation of lung and spleen qi. So qi deficiency of spleen
and lung directly affects the generation of original qi. In clinic, syndromes
of qi deficiency mainly refer to spleen qi deficiency and/or lung qi defi-
ciency. Original qi is the basis of all kinds of qi. Due to the close relation-
ships between qi and blood as well as body fluids, deficient original qi can
not only cause qi stagnation but also affect blood and body fluids which
lead to relevant diseases. For example, qi deficiency can cause blood defi-
ciency, blood stasis and bleeding, as well as dysbolism of body fluids. For
9.3 Disorders of qi, blood, and body fluids  157

instance, deficiency of spleen qi failing to transform food essence may


cause shortage of generating blood which leads to blood deficiency.
Besides, phlegm and fluid retention result from deficiency of spleen qi
failing to transform water-dampness normally. Failing to control blood or
saliva may cause bleeding or drooling.
2. Disorder of qi movement
Disorder of qi movement refers to the pathological changes characterized by qi
stagnation, reversed flow of qi, qi sinking, qi blockage, and qi exhaustion due to
disturbance of qi in its ascending, descending, exiting, and entering movement.
A. Qi stagnation
Qi stagnation refers to a pathological state of hindered flow of qi in some
viscera or meridians. It mainly results from emotional depression, retention
of phlegm, dampness, foodstuff accumulation, or stagnant blood and inva-
sions due to traumatic injury or overstrains. Qi stagnation may cause dys-
functions of some viscera and meridians and is characterized by stuffy sen-
sation, swelling, or distended pain. Qi stagnation is closely related to
dysfunctions of the liver, lung, spleen, and stomach because these viscera
are of great importance in regulating qi movement. So in clinic, qi stagna-
tion syndrome often manifests as qi blockage of lung, liver, spleen, and
stomach. Generally speaking, qi stagnation pertains to excess syndrome,
but it can also be caused by a deficiency syndrome. For example, qi stagna-
tion in middle-jiao can result from qi deficiency of the spleen and stomach
failing to transform and transmit. The same condition may occur in the
liver.
B. Reversed flow of qi
Reversed flow of qi is a pathological change in which the excessive upward
flow of qi or failure of qi to descend results from disorders of visceral qi. It
is often caused by emotional injury, improper diet, or retention of phlegm-
turbidity. This disorder of qi movement mostly occurs in the lung, stomach,
and liver. For example, the adverse flow of lung qi can cause cough with
dyspnea while the adverse rising of stomach qi leads to nausea, vomiting,
belching, or hiccups. The adverse flow of liver qi brings about distending
pain of head, red complexion and eyes, and susceptibility to anger.
Besides, because the liver stores blood, serious adverse rising of liver qi
can lead to reversed flow of blood manifested as hemoptysis, hematemesis,
or coma due to blockage of the clear orifices. Adverse rising of qi usually
pertains to excess syndrome, but it can also cause deficiency syndromes.
For example, deficiency of the lung causes failure to descend, and lung qi
rises adversely; deficiency of kidney qi failing to control respiring qi can
cause reverse flow of qi; and adverse rising of stomach qi may result from
deficient stomach failing to make qi descend.
158  9 Pathogenesis

C. Qi sinking
Qi sinking refers to a pathological change characterized by powerless lifting of
qi with failure to ascend due to qi deficiency. Qi sinking develops from qi defi-
ciency and is closely related to the spleen. Deficiency of spleen qi is apt to
cause qi sinking which is usually called as sinking of the middle qi. If the
spleen qi is deficient failing to lift viscera of the body, prolapses of some
viscera will occur such as gastroptosis, nephroptosis, metroptosis, and recto-
cele followed by abdominal distension, lower back sinking sensation, repeated
desire to defecate, shortness of breath, fatigue, low voice, and feeble pulse.
D. Qi blockage
Qi blockage refers to a pathological change caused by depression and
blockage of qi movement in viscera and meridians. It often results from
obstructions of phlegm-turbidity or dampness-heat along with the symp-
toms of sudden unconsciousness.
E. Qi exhaustion
Qi exhaustion refers to a pathological state of extreme qi deficiency with a
critical tendency of collapse. It is caused by escaping of vital qi due to
massive consumption of qi, blood, and body fluids in the body, and extre-
mely declined functions of viscera. It is closely related to the exhaustion of
yin and yang, and they often interact as both cause and effect.

9.3.2 Disorder of blood

Disorder of blood is a pathological state caused by declined blood nourishing func-


tions or abnormal blood circulation due to inadequate generation or excessive con-
sumption of blood which includes blood deficiency, blood stasis, blood heat, and
blood cold.
1. Blood deficiency
A. Concept
Blood deficiency refers to a pathological change in insufficiency of blood
and its declined nourishing function.
B. Causes
Blood deficiency may result from five reasons. First is massive loss of blood
such as hematemesis, epistaxis, menorrhagia, or bleeding due to traumatic
injury and no new blood can be promptly replenished. The second reason
is the shortage of blood production due to deficient spleen and stomach
failing in transformation and transportation, or declined functions of the
heart, liver, and lung. The third one is consumption of nutritive-blood due
to prolonged diseases, chronic consumption, or overstrains. The forth one
is blood stasis which hinders generation of new blood. The last reason is
declined blood nourishing function due to aging or weak body.
9.3 Disorders of qi, blood, and body fluids  159

C. Clinical manifestations
Blood deficiency failing to nourish viscera causes declined visceral func-
tions which is characterized by dizziness, sallow complexion, and pale lips,
tongue, and nails. Moreover, deficiency of blood is closely related to dys-
function of the heart, liver, spleen, and kidney due to the fact that heart is
in charge of blood and vessels, liver stores blood, the spleen is the source
for production and transformation of qi and blood, and kidney essence can
be turned into blood.
2. Blood stasis
A. Concept
Blood stasis refers to a pathological state of slow or unsmooth circulation
of blood, or blood escaping outside from the vessels. Bleeding which per-
tains to blood stasis often results from fire-heat pathogens forcing blood cir-
culation in a disorder, excessive heat with yin deficiency burning vessels, qi
deficiency, blood stagnation, or traumatic injury. Massive bleeding can not
only cause deficiency of both qi and blood which leads to hypofunction of
viscera but also result in qi escaping with blood exhaustion, even leading
to yin-yang dissociation and death.
B. Causes
Blood stasis usually results from unsmooth blood circulation due to qi stag-
nation, slow circulation due to qi deficiency, phlegm-turbid stagnating
vessels, and coagulation of blood due to invasion of cold pathogen, boiled
down of blood due to invasion of heat pathogen, or traumatic injuries.
Moreover, stagnant blood which is a pathological product of blood stasis
can block vessels and then lead to blood stasis.
C. Clinical manifestations
When blood stasis blocks in certain locations of viscera or meridians, symp-
toms of slow and unsmooth blood circulation may occur. It is often mani-
fested by fixed pain even with the formation of swelling which is accompa-
nied by dark complexion, scaly skin, cyanotic lips and nails, as well as
ecchymosis. Pathologically, blood stasis often affects qi deficiency, qi stag-
nation, blood cold, and blood heat. Therefore, apart from blood cold and
blood heat patterns, it is often accompanied by the pathological changes
such as qi deficiency, qi stagnation, and blood deficiency.
3. Blood heat
A. Concept
Blood heat refers to a pathological change caused by accelerated circula-
tion or bleeding resulting from heat in the blood.
B. Causes
Blood heat often results from impairment in blood due to invasions of exo-
genous heat pathogen or fire-heat transformed by cold pathogen or emo-
tional depression.
160  9 Pathogenesis

C. Clinical manifestations
Blood heat can cause accelerated blood circulation or abnormal blood flow,
disturbed mind, as well as concentration of blood and body fluids. It is char-
acterized by blood loss, bleeding, disturbed mind, and damage of yin.
4. Blood cold
A. Concept
Blood cold is a pathological change in slow or sluggish blood circulation
caused by cold in the blood.
B. Causes
It is often due to invasion of cold pathogen or yang deficiency.
C. Clinical manifestations
Due to blood coagulation resulting from cold, blood cold is mainly charac-
terized by slow and unsmooth blood circulation, manifested as numbness
with cold pains in limbs, hands, and feet, or cold pain in the heart and
abdomen, and abnormal menstruation in women.

9.3.3 Disharmony between qi and blood

Qi is closely related to blood, manifested as the interdependence in physiology and


interplay in pathogenesis. Since qi can promote, warm, generate, and control blood,
disorder of qi will inevitably affect blood. Disharmonies between qi and blood
include qi stagnation with blood stasis, qi deficiency with blood stasis, failure of qi
to control blood, qi exhaustion following blood, and deficiency of both qi and blood.
1. Qi stagnation with blood stasis
Qi stagnation with blood stasis refers to a pathological change in which
depressed qi movement makes sluggish flow of blood which leads to the con-
currence of qi stagnation and blood stasis. It may result from obstruction of
blood circulation due to stagnant flow of qi, or from traumatic injuries. It is
characterized by distending pain, ecchymosis, and abdominal mass. Moreover,
it is closely related to the liver and the heart. Being able to govern regulating qi,
the liver is critical in qi movement. The heart is in charge of blood vessels with
function of promoting blood circulation, so dysfunction of the heart can cause
blood stasis leading to qi stagnation.
2. Qi deficiency with blood stasis
Qi deficiency with blood stasis refers to a pathological state in which sluggish
flow of blood results from qi deficiency leading to the concurrence of qi defi-
ciency and blood stasis. Qi deficiency in a milder condition may cause slow
flow of blood. If more serious deficiency of qi occurs in some location of the
body, it will fail to promote blood flow and result in blood stasis. It is mani-
fested by symptoms due to the malnourishment in the meridians such as feeble
limbs even with amyotrophy, dry or scaly skin, or pruritus.
9.3 Disorders of qi, blood, and body fluids  161

3. Failure of qi to control blood


Failure of qi to control blood is a pathological state in which deficient qi fails to
keep blood flow inside the vessels and leads to various bleeding symptoms
such as hemoptysis, hematemesis, hemorrhinia, ecchymosis, hematochezia,
hematuria, and uterine bleeding. It also includes sinking of spleen qi causing
hematochezia and uterine bleeding.
4. Qi exhaustion following blood damage
Qi exhaustion following blood damage refers to a pathological state of defi-
ciency or exhaustion of both qi and blood caused by massive qi exhaustion fol-
lowing heavy bleeding. It often results from traumatic bleeding, uterine bleed-
ing, or postpartum hemorrhage.
5. Deficiency of both qi and blood
Deficiency of both qi and blood is a pathological state of concurrence of defi-
cient qi and blood which is usually caused by consumption due to prolonged
disease, loss of blood followed by depletion of qi, or inadequate production
of blood due to deficient qi or bleeding. It is characterized by pale or sallow
complexion, shortness of breath, fatigue, thin body, palpitation, insomnia,
dry skin, or numbness of limbs. Qi and blood is the material basis for physio-
logical activities of viscera and meridians in the body. Production and circula-
tion of qi and blood depend on the normal functions of viscera. Therefore,
there is an interplay relationship between viscera and qi and blood in patho-
genesis.

9.3.4 Metabolic disorders of body fluids

Metabolic disorders of body fluids refer to the pathological conditions in which


imbalance between generation and excretion of body fluids causes disturbance of
body fluids in producing, transporting, distributing, and excreting. It leads to stag-
nation and overflow of water fluid. Metabolism of body fluids, being a complicated
physiological course, is closely related to the lung, spleen, and kidney. Abnormal
function of any viscera can cause metabolic disorder of body fluids which results in
syndromes of consumption of fluid, fluid exhaustion, endogenous dryness, or reten-
tion of water-dampness or phlegm.
1. Deficiency of body fluids
Deficiency of body fluids is a pathological condition with a series of dry symp-
toms caused by scanty body fluids failing to nourish and moisten the viscera,
orifices, skin, and hair. It often results from excessive consumption of body
fluids due to dry-heat pathogen, pathogenic fire caused by excessive mental
activities, fever, burning, too much sweating, vomiting, diarrhea and urine, loss
of blood, or overuse of hot medicines. It can be caused occasionally by inade-
quate intake of water fluid.
162  9 Pathogenesis

Deficiency of body fluids can be divided into consumption of jin (essence)


and exhaustion of ye (fluid) according to different degree of the consumption.
There are differences between jin and ye in quality, distribution, and physiologi-
cal function. So, deficiency of jin is different from deficiency of ye in pathogen-
esis and clinical manifestations. Jin is thin and watery with more fluidity which
can moisten blood vessels and nourish viscera as well as moisten skin and ori-
fices externally. It is easy to be consumed and to escape; however, it is also
easily replenished. So, consumption of jin is often manifested as excessive
sweating in hot summer, thirst due to high fever, dry mouth, nose, and skin in
dry climate, deep sunken eyes, shriveled muscles, and even spasm caused by
excessive sweating, diarrhea, and urination. Ye is thicker with less fluidity
which nourishes the viscera, replenishes the marrow in the bone, brain, and
spine, and lubricates the joints. It is not likely to be consumed, but once con-
sumed, it cannot be rapidly replenished. Exhaustion of ye is often manifested as
symptoms of yin fluid depletion such as light-red tongue without fur or with
little fur caused by prolonged disease impairing yin, dry lip and tongue, emacia-
tion, withered skin and hair, and even tremors of hands and feet. Consumption
of jin and exhaustion of ye are different in pathogenesis and manifestations,
but they depend on each other in physiology and interplay in pathogenesis
because they are originally as integrity whole. Generally speaking, consumption
of jin (which is milder) is definitely not accompanied by exhaustion of ye, but
the consumption of the latter (which is more serious) is definitely accompanied
by the former. Both of them can be manifested as symptoms of endogenous
dryness. As body fluids and blood share the same source, deficiency of body
fluids definitely causes deficiency of yin blood which leads to endogenous defi-
cient heat and wind due to blood dryness. Besides, deficiency of body fluids
can reduce blood and cause unsmooth flow of blood which leads to blood
stasis. The existence of qi depends on the body fluids while metabolism of body
fluids depends on qi movement. So, massive loss of body fluids may lead to
exhaustions of qi, yin, or yang.
2. Retention of water-dampness
Fluid distribution and excretion are the two important links in the metabolism
of body fluids. Even though different, they both can result in abnormal stagna-
tions which can be the basic causes for the pathological products such as endo-
genous water-dampness, phlegm, and retained fluid. Disorder of distribution of
body fluids refers to a kind of pathological state in which body fluids cannot be
normally distributed, leading to slow flow or stagnation, and resulting in endo-
genous water-dampness and phlegm. It mainly involves the lung in diffusing
and ascending, the spleen in transforming and transporting, the liver in regulat-
ing, the kidney in transforming, and triple burners in water passage. In addi-
tion, the dysfunction of spleen is mostly apt to cause disorder in distribution of
body fluids. Disorders in excretion of body fluids is a pathological state of
9.3 Disorders of qi, blood, and body fluids  163

edema caused by retention of water fluid due to hypofunction of body fluids in


transformation into sweat and urine. Transformation of body fluids into sweat
mainly depends on the diffusing and dispersing actions of the lung. Transfor-
mation of body fluids into urine mainly depends on the steaming and qi trans-
forming actions of the kidney, and also relies on the descending action of the
lung. Declined functions of both lung and kidney can cause retention of water
fluid and lead to edema. In addition, the steaming and qi transforming of
kidney play a dominating role in the excretion of body fluids. Although there
are differences between distribution and excretion of body fluids, they also
interplay and interact as both cause and effect, resulting in endogenous water-
dampness, phlegm, and retained fluid. Moreover, metabolic disorders of body
fluids can also lead to pathological changes in stagnation of qi movement.

9.3.5 Disharmony among qi, blood, and body fluids

Disharmony among qi, blood, and body fluids mainly includes water retention with
qi stagnation, qi exhaustion following fluid, fluid exhaustion with blood dryness,
fluid deficiency with blood stasis, and blood stasis with fluid retention.
1. Water retention with qi stagnation
Water retention with qi stagnation is a pathological state of stagnation of water,
qi, or phlegm caused by disorders of metabolism of body fluids due to qi defi-
ciency or qi stagnation. Movement of visceral qi can promote circulation of
water and body fluids. Qi deficiency in the lung, spleen, kidney, or liver and qi
stagnation in the liver, spleen, or lung definitely causes disorders of distribution
and excretion of body fluids, leading to stagnations of water-dampness which is
characterized by subcutaneous nodule, numb limbs, goiter, difficult urination,
edema, and tympanites. Conversely, water-dampness or phlegm can hinder cir-
culation of qi movement. For example, if retained fluid stagnates in the lung,
causing qi blockage of lung, symptoms as cough with dyspnea may occur. If
retained fluid represses yang qi in the heart, it may cause palpitation and heart-
ache. When it stagnates in the middle-jiao, depressing qi movement of spleen
and stomach, it will lead to sleep, abdominal fullness and distention, poor
appetite, nausea, and vomiting. If retained fluid stays in limbs, blocking circula-
tion of qi and blood in the meridians, edema with distending pain in limbs will
occur. So in clinic, treatment should be taken based on pathological changes
caused by water, qi, and phlegm.
2. Qi exhaustion following fluid damage
Qi exhaustion following fluid damage is a pathological state of exhaustion of
both qi and yin caused by qi exhaustion due to massive loss of body fluids. It
usually results from too much consumption of body fluids due to high fever,
excessive sweating, or vomiting and diarrhea.
164  9 Pathogenesis

3. Fluid exhaustion with blood dryness


Fluid exhaustion with blood dryness refers to a pathological state of endogen-
ous heat and wind due to blood dryness resulting from deficiency or even
exhaustion of the body fluids. Body fluids are an important component of the
blood, while both come from essence of water and food. Fluid exhaustion with
blood dryness may be caused by consumption of fluid due to high fever or
empyrosis, massive loss of blood, or by tuberculosis. It is characterized by vexa-
tion, dry nose and throat, emaciation, or dysphoria fever in chest, palms, and
soles, dry skin or even pruritus with exfoliation, red tongue with little fluid, and
thin and rapid pulse.
4. Fluid deficiency with blood stasis
Fluid deficiency with blood stasis is a pathological state of unsmooth flow of
blood with deficiency of body fluids. Sufficient body fluids is an important con-
dition for blood to circulate smoothly. Deficiency of body fluids may cause defi-
ciency of blood and lead to blood stasis. Fluid deficiency with blood stasis often
results from high fever, empyrosis, vomiting, diarrhea, massive sweating, or
prolonged disease. It is characterized by deep red tongue or petechia, dry skin
or exfoliation, or macula.
5. Blood stasis with fluid retention
Blood stasis with fluid retention refers to a pathological state in which
unsmooth blood circulation leads to stagnation of body fluids which later on
causes retention of blood, water, phlegm, and blood stasis. Body fluids inside
the vessels can promote blood circulation, and effused blood can become body
fluids. Fluids and blood come from the same origin. Stagnation of blood defi-
nitely affects circulation of body fluids which can cause blood stasis and fluid
retention. If body fluids accumulate and lead to phlegm and fluid retention or
edema which hinder circulation of blood and cause blood stasis, stagnations
between blood and water, and retention of phlegm, stagnant blood will finally
occur. The clinical manifestations for stagnation of water and blood stasis are
amenorrhoea with dropsy, edema, or swelling, dark tongue, or uneven pulse.
Phlegm and blood stasis retained in the body is characterized by abdominal
mass, accumulation, dysphagia, dysmenorrheal, amenorrhea, sterility, goiter,
and gangrene of fingers or toes. So, for these stubborn syndromes, treatments
should be taken to invigorate blood circulation, clear water-dampness, expel
blood stasis, and reduce phlegm at the same time.
10 Principles of Prevention and Treatment
of Diseases

10.1 Principles of disease prevention

Key points
– Principles of prevention:
– The criteria of preventing the occurrence, development, and transmission of diseases
according to the etiology and mechanism.
– Preventive treatment of diseases:
– The criteria of measurements taken prior to the onset of a disease.

Disease prevention means taking certain actions in advance to prevent a disease


from occurring and progressing. Prevention has always played an important role in
Chinese medicine. Treating disease before it arises is an idea put forward in Huangdi
Neijing (Huangdi’s Inner Classic of Medicine) long time ago. It has great influence on
the formation and development of preventive medicine. Preventive principles refer
to the criteria of preventing a disease from occurrence and progress according to its
etiology and mechanism.

10.1.1 Disease prevention prior to its outbreak

Disease prevention means taking certain actions in advance to prevent occurrence of


a disease. It was also known as cultivating life or preserving health in ancient times.

10.1.2 Controlling the development of an existing disease

Once a disease has already occurred, early diagnosis and treatment are essential to
prevent the disease from worsening.
1. Early diagnosis and treatment
Early diagnosis and treatment are the key to disease recovery. Treatment is also
necessary for the prevention of the disease aggravation.
2. Controlling the progress of a disease
The progress of any disease follows its own unique patterns. Hindering the pro-
gress of a disease is a major measure to prevent its aggravation. For example,
since liver disease is most likely to influence spleen, measures should be taken
to strengthen the spleen in order to prevent the influence in treatment of liver
disease. It is an effective way to control the progress of the disease.
166  10 Principles of Prevention and Treatment of Diseases

10.2 Principles of treatment

Key points
– Routine treatment:
– Routine treatment refers to the treatment of a disease adverse to its manifestations, also
known as allopathic treatment.
– It includes the following:
– Treat cold with heat, treat heat with cold, treat deficiency by tonifying, and treat excess
by drainage.
– Contrary treatment:
– Contrary treatment refers to the treatment of a disease agreeable to its false manifesta-
tions, also being named coactions treatment.
– It includes the following:
– Treat coldness with cold, treat heat with heat, treat the flowing by promoting its flow,
and treat obstruction with tonics.

The treatment principles are the rules to be followed in all treatments. They are formu-
lated under the guidance of holism and treatments based on syndrome differentiation.
They are the universal guiding principles for the determination of treatment methods,
formulas, and medicinals in the clinic settings. A treatment principle is different from
a treatment method. Guided by the former, the latter refers to detailed therapeutic
rules and methods in accordance with various syndromes. They include major thera-
peutic methods of diaphoresis, emesis, purgation, harmonizing, warming, clearing,
eliminating, and reinforcing. There are a lot of treatment principles and methods in
Chinese medicine. The treatment principles are discussed in this chapter.

10.2.1 Treating the root of a disease

Treating the root refers to seeking the fundamental cause of a disease and focusing
the treatment on it. This is the cardinal principle for differential diagnosis and treat-
ment in Chinese medicine. According to the principle, traditional Chinese medicine
(TCM) formulates the basic treatment principles based on the severity and the clini-
cal manifestation.
1. Routine treatment versus contrary treatment
A. Routine treatment
Routine treatment refers to the treatment of disease adverse to its manifes-
tation, also known as allopathic treatment. It uses the formulas and herbs
which act against its syndromes to treat. It is applicable to a disease with
its nature in conformity with its manifestations. For example, a heat syn-
drome is marked by heat signs, a cold syndrome by cold signs, a deficient
syndrome by deficient signs, and an excess syndrome by excess signs.
10.2 Principles of treatment  167

Routine treatment includes methods of heating what is cold, cooling what


is hot, tonifying what is deficient, and reducing what is excessive.
(a) Treat cold with heat: A cold syndrome with cold manifestations should
be treated with warm or hot recipes. For example, relieving an external
syndrome with warm drugs is used to treat a wind-cold syndrome of
external type, and warming interior with hot drugs is used to treat a
cold syndrome of internal type.
(b) Treat heat with cold: A heat syndrome with heat manifestations should
be treated with cool or cold recipes. For example, relieving an external
syndrome with cool drugs is used to treat a wind-heat syndrome of
external type, and relieving interior with bitter-cold drugs is used to
treat heat accumulation in the stomach and intestines.
(c) Treat deficiency by tonifying: A deficiency of vital qi with deficiency
signs should be treated with tonifying recipes. It includes methods of
tonifying yang, and qi, nourishing yin, and enriching the blood.
(d) Treat excess by purging: Excess of pathogenic qi with excess signs
should be treated with purgative recipes. It includes methods of disper-
sing and removing indigestion, dispelling retained water, promoting
blood circulation by removing blood stasis, and expelling parasites.
B. Contrary treatment
Contrary treatment refers to the treatment of a disease agreeable to its false
manifestations, also being named coactions treatment. It is applicable to
complicated morbid states in which the nature of a disease is not comple-
tely in conformity with its manifestations. Although the treatment is going
on with the false manifestations of the disease, it is aiming at the root of
the disease. Contrary treatment mainly includes treating cold with cold,
treating heat with heat, treating obstruction with tonics, and treating flow
by promoting its flow.
(a) Treat cold with cold: Diseases of true heat syndrome with false cold
symptoms should be treated with cold or cool medicinals. For
example, in the stage of extreme internal heat of some exogenous dis-
eases, there may appear false cold signs of extremely cold limbs, with
true heat signs of hyperpyrexia, restlessness, thirst, red tongue, and
full and rapid pulse due to predominant yang rejecting yin. So it still
needs cold or cool medicinals such as Baihu decoction for treatment.
When the pathogenic qi of yang heat is cleared away, false cold disap-
pears subsequently.
(b) Treat heat with heat: Diseases of true cold syndrome with false heat
symptoms should be treated with warm or hot medicinals. In treatment
of this kind of diseases, aiming the root, warm or hot medicinals
should be used. When the pathogenic qi of cold yin is cleared away,
false heat disappears subsequently.
168  10 Principles of Prevention and Treatment of Diseases

(c) Treat obstruction with tonics: Obstructive diseases with true deficiency
syndromes and false excess symptoms are treated with tonifying med-
icinals, also known as relieving obstruction with tonics. It is suitable for
syndromes of obstruction and stagnation caused by deficiency. For
example, abdominal distension and fullness caused by deficiency of
spleen and qi stagnation should be treated by tonifying spleen and
replenishing qi. When the spleen and stomach function normally in
transportation, distension and fullness disappear spontaneously as
well as constipation due to deficiency of qi, dysuria due to deficiency
of kidney function, and amenorrhea due to blood exhaustion.
(d) Treat the flowing by promoting its flow: Diseases with true excess syn-
dromes and false deficiency symptoms should be treated with purga-
tive medicinals. It is applicable to syndromes of diseases caused by
stagnation of excess pathogens, for example, dysentery caused by
stagnation of damp-heat in the large intestine. Treatment is focused on
clearing heat, promoting dampness, moving qi, and relieving the stag-
nation. Once damp and heat are cleared away, diarrhea ceases sponta-
neously. Other examples are diarrhea due to food stagnation and
metrorrhagia due to blood stasis. They can be treated with stagnation-
relieving, blood-invigorating, and stasis-resolving herbs. Thus, this
treatment principle is called treating flowing by promoting its flow.

Routine treatment is the general treatment criteria which go against the mani-
festations of diseases while contrary treatment is a method which goes with the
false manifestations of diseases. Besides, both of them focus on the root of a
disease, so they embody the basic treatment principle of treating the root.
2. Treating root or branch aspect of diseases
A. Concept of root or branch aspect
The root and the branch treatments are relative concepts with multiple
meanings. They are used to explain the primary and the secondary relation-
ships among various contradictions in the course of a disease. In the course
of a disease, its root and branch aspects are determined by the develop-
ment of the disease. For instance, viewing the two sides of the vital and
pathogenic qi, vital qi is the root and pathogenic qi is the branch. In terms
of etiology and manifestation, etiology is the root and manifestation is the
branch. According to the order of diseases, an old or a primary disease is
the root while a new or a secondary disease is the branch.
B. Applications of root and branch treatment
In the complicated cases, there will be different treatment aspects of root
and branch with regard to the onset and severity of the diseases. Gener-
ally speaking, the root is the primary contradiction or the primary aspect
of a contradiction, while the branch is the secondary contradiction or the
10.2 Principles of treatment  169

secondary aspect of a contradiction. However, under some exceptional


circumstances, the primary and secondary relationships of a contradic-
tion can be changed. Namely, the branch becomes the primary aspect
of the contradiction, while the root becomes the secondary aspect tem-
porarily. Only by resolving the primary contradiction of a disease, after
distinguishing the root from the branch, can the essence of a treatment
be grasped. Therefore, the treatment principles should be as follows:
“in urgent conditions, treat the branch; in moderate conditions, treat
the root and treat both root and branch.”
(a) Treating the branch in urgent conditions: During disease onset, if the
branch is acute and severe, then it should be treated first to increase
the life expectancy of the patient. For example, bleeding should be
stopped to avoid massive blood loss and relief should be provided
when a patient is suffering from dyspnea to avoid apnea, which might
otherwise lead to death. After the bleeding has been stopped and the
breathing has been stabilized, further diagnosis and treatment aiming
the root of disease should be done. As another example, for patients
with hyperpyrexia, intense pain, unconsciousness, or hyperspasmia,
regardless of the reason behind the cause, emergency measures should
be taken first to bring down the fever and to relieve the pain and
spasm. Moreover, for those who suffer from a chronic disease and
newly contract other pathogens, the old disease is the root aspect
and the new contradiction is the branch aspect. In routine treatment,
the exogenous contraction will be treated first, and then the old
disease will be treated after the new disease is cured. It can, thus, be
concluded that treatment of the branch in an emergency situation is an
expedient measure to create a favorable condition for treating the root.
The final goal will be to focus on a better treatment for curing the root
of the disease.
(b) Treating the root in moderate conditions: For a chronic disease or
during the recovery stage of an acute disease, treatment should be
focused on the root aspect. The branch aspect of a disease will be
cured subsequently when the root issue is resolved, because it usually
originates from the root aspect. In general, if the branch aspect of a
disease does not affect the treatment of the root aspect or does not
endanger a patient’s life, then in such moderate conditions the treat-
ment should be based on the principle of treating the root. For
example, consider coughing due to tuberculosis, where the lung and
kidney yin deficiency is the root aspect, while cough is the branch
aspect. Therefore, the treatment should focus on nourishing yin of the
lung and kidney, which is the root. Moistening the yin fluid of the lung
and kidney will relieve the cough naturally. As another example, at a
170  10 Principles of Prevention and Treatment of Diseases

later stage of an acute disease, the pathogenic qi is eliminated, while


the vital qi is still deficient. In such a condition, the treatment should
be focused on the root to tonify the vital qi, which will cure the branch
aspect of the disease simultaneously.
(c) Treating the branch and the root simultaneously: When the branch
and root aspects of a disease are both severe, treatment should be
focused on both. For a complicated disease, where the branch and root
aspects are of equal importance as they interlace with each other, treat-
ment should be aiming at both the branch and the root simultaneously
because the disease will not be cured if only one aspect is considered.
For example, consider cold caused by qi deficiency. Qi deficiency is
the root aspect, and cold is the branch aspect. In such conditions,
simply tonifying qi will cause stagnation of pathogenic qi and cold
cannot be cured, and simply relieving external syndrome will impair
the vital qi. Therefore, only by tonifying qi and relieving external syn-
drome simultaneously, or by treating both root and branch aspects,
the cold can be cured.

10.2.2 Strengthening the vital and dispelling the pathogen

Strengthening the vital and dispelling the pathogen are an important principle in
clinical treatment. The struggle between the vital and the pathogenic qi determines
the progress of a disease. When the pathogen gains the upper hand, the disease pro-
gresses, and when the vital gains the upper hand, the disease subdues. Thus, the
treatment should be carried out to change the ratio of strength between the two
sides, improve the vital qi, eliminate the pathogenic qi, and speed up the recovery
process.
1. Concepts of strengthening the vital and dispelling the pathogen
A. Strengthening the vital
Strengthening the vital refers to tonifying the vital qi, strengthening the
constitutions, and improving the body’s resistance against the disease and
the ability to recover. The specific measures to replenish the qi, blood, and
body fluids are diverse, including drugs, acupuncture and moxibustion,
qigong, regulation of emotions and diet, and physical exercise. Tonifying
the deficiency is the specific application of this principle.
B. Dispelling the pathogen
Dispelling a pathogen refers to the elimination of the pathogenic qi, reliev-
ing the invasion, and impairment of pathogenic qi. The specific measures
to remove the pathogens include drugs, acupuncture and moxibustion, and
massage. Treating excess with drainage is the specific application of this
principle.
10.2 Principles of treatment  171

2. Application of strengthening the vital and dispelling the pathogen


In general, strengthening the vital is used for a deficient syndrome, while dis-
pelling the pathogen is used for an excessive syndrome. If a syndrome is mixed
with deficiency of vital qi and excess of pathogenic qi, it should be treated by
both strengthening the vital and dispelling the pathogen. During the treatment,
attention should be paid to differentiate the primary from secondary and degree
of urgency, so that strengthening the vital and dispelling the pathogen can be
taken up in the order of importance and priority.
A. Strengthening the vital
Strengthening the vital is applicable to a deficiency syndrome in which
deficiency of vital qi is the primary contradiction and pathogenic qi is not
exuberant. It is realized by tonifying and replenishing. For instance, qi defi-
ciency is treated by tonifying qi, blood deficiency by enriching the blood,
yang deficiency by strengthening the yang, and yin deficiency by nourish-
ing the yin.
B. Dispelling the pathogen
Dispelling the pathogen is applicable to an excess syndrome in which exu-
berance of pathogenic qi is the primary contradiction and meanwhile vital
qi does not decline. It is enforced by purgation. Treatment methods such as
diaphoresis, emesis, purgation, heat-clearing, and stagnation-resolving are
all guided by this principle. For example, diaphoresis is used to relieve
excessive external syndrome, phlegm and retained food due to pathogens
retained in the chest are treated by emesis, heat accumulation in the
stomach and intestines are treated by purgation with bitter cold drugs, and
accumulation of heat and fire are treated by clearing heat and purging fire.
C. Combining strengthening the vital with dispelling the pathogen
The combined method is applied to complicated diseases mixed with defi-
ciency of vital qi and excess of pathogenic qi. For such syndromes, if vital
qi is not reinforced, pathogenic qi will increase, whereas if pathogenic qi is
not eliminated, vital qi will be impaired further. Therefore, in such condi-
tions, strengthening the vital combined with dispelling the pathogen
should be used. According to the degree of deficiency of vital and excess of
pathogen, this principle can be applied as follows:
(a) Strengthening the vital prior to dispelling the pathogen: This method is
applied to the syndromes of deficiency of vital qi with excess of patho-
genic qi, in which vital qi cannot withstand attack. Though there is
excess of pathogenic qi, vital qi should be first reinforced by tonifying
as it is too weak to withstand the attack. When vital qi becomes vigorous
enough to withstand the attack, treatment should be given to eliminate
the pathogen. For instance, for patients with parasite accumulation,
since the spleen qi has already declined to extremes and cannot
withstand pesticides, vital qi should be first strengthened by tonify-
172  10 Principles of Prevention and Treatment of Diseases

ing the spleen and benefiting the qi. When deficiency of the spleen
qi is gradually relieved, treatment measures should be taken to dispel
the parasites.
(b) Dispelling the pathogen prior to strengthening the vital: This method is
applied to the syndromes of excess of pathogenic qi with deficiency of
vital qi, where the pathogens should be eliminated urgently but the
vital qi can still withstand the attack. Under this circumstance, patho-
gens should be eliminated first by purgation, followed by regulation
and tonification. For example, consider blood deficiency caused by
blood stasis, metrorrhagia, and metrostaxis. If blood stasis continues,
metrorrhagia and metrostaxis cannot be stopped and blood deficiency
will worsen. So, blood stasis should be dispelled by invigorating the
blood and tonifying the blood afterward.
(c) Strengthening the vital as the main focus while dispelling the patho-
gen: This method applies the principle of strengthening the vital as the
main focus of treatment while dispelling the pathogen at the mean
time. It is suitable for syndromes with deficiency of vital qi as the
primary contradiction and exuberance of pathogenic qi as the second-
ary contradiction. For such syndromes, if vital qi is not reinforced,
pathogenic qi will become more exuberant, whereas if pathogenic qi is
not eliminated, vital qi will be impaired further. In treating this kind of
diseases, the principle should be strengthening the vital and dispelling
the pathogen simultaneously. For instance, for the syndrome of blood
stasis in the heart vessels caused by heart qi deficiency, treatment
should focus on tonifying heart qi along with invigorating blood and
removing blood stasis. Because qi serves as the commander of the
blood, vigorous qi of heart can promote circulation of blood, and then
the blood stasis will be removed. Blood, the mother of qi, can carry qi
in its circulation. So, after blood stasis is eliminated, the qi stagnation
can be relieved. The two aspects are dependent upon and supplemen-
tary to each other.
(d) Dispelling the pathogen as the main focus while strengthening the
vital: This treatment principle emphasizes on dispelling the pathogen
as the main focus and strengthening the vital is secondary. It is
applied to the syndromes with exuberance of pathogenic qi as the
primary contradiction and deficiency of vital qi as the secondary. For
such syndromes, if pathogenic qi is not eliminated, vital qi will be
impaired further, whereas if vital qi is not reinforced, pathogenic qi
will become more exuberant. Therefore, treatment should be focused
on dispelling the pathogen and simultaneously be combined with
strengthening the vital. For example, damage of yin by heat should
mainly focus on clearing the heat first and then nourishing the yin.
10.2 Principles of treatment  173

3. The specific methods of application of strengthening the vital and dispelling the
pathogen are as follows:
A. Single
(a) Application
– Strengthening the vital – applicable to a deficiency syndrome.
– Dispelling the pathogen – applicable to an excess syndrome.
B. Combined
(a) Application
– Applicable to complicated diseases mixed with deficiency of vital
qi and excess of pathogenic qi.
– Strengthening the vital combined with dispelling the patho-
gen – applicable to syndromes mixed with deficiency and excess
in which deficiency of vital qi is the primary contradiction.
– Dispelling the pathogen combined with strengthening the
vital – applicable to syndromes mixed with deficiency and excess,
in which excess of pathogenic qi is the primary contradiction.
C. Alternate
(a) Application
– Applicable to complicated diseases mixed with deficiency of vital
qi and excess of pathogenic qi.
– Dispelling the pathogen prior to strengthening the vital – applicable
to syndromes with excess of pathogenic qi in which vital qi can
still withstand attack though deficient.
– Strengthening the vital prior to dispelling the pathogen – applicable
to syndromes with deficiency of vital qi which cannot withstand
attack.

10.2.3 Regulating yin and yang

According to the TCM, the fundamental mechanism behind the occurrence of a


disease is the disharmony of yin and yang. Different syndromes of cold, heat, defi-
ciency, and excess occur due to the deficient or excessive change in yin or yang.
Therefore, regulating yin-yang and restoring their relative balance and coordination
is the fundamental treatment principle. This principle includes two aspects: elimi-
nating the surplus and supplementing the deficiency.
1. Eliminating the surplus
This principle is to treat syndromes with an excess of yin or yang by reducing it
in order to restore the balance and harmony. An excess of yin or yang is often
due to the invasion of yin or yang pathogens. Therefore, the principle of elimi-
nating the surplus should be applied, that is, cooling what is hot, or clearing
away yang heat with cold-natured remedy is used for an excess-heat syndrome
174  10 Principles of Prevention and Treatment of Diseases

due to exuberance of yang heat, and heating what is cold, or dispelling yin cold
with heat-natured remedy for an excess-cold syndrome due to exuberance of
internal yin cold. Due to the mutual restriction between yin and yang, the exu-
berance from either will affect the other as well as result in deficiency and will
lead to difficulty in recovery.
2. Supplementing the deficiency
This principle is applied to treat syndromes with the debilitation of yin or yang
by supplementing insufficient yin or yang and restoring the balance between
them. Debilitation of yin or yang includes deficiency of yin, deficiency of yang,
and deficiency of both yin and yang. Therefore, treatment principles should be
applied accordingly.
A. Nourishing yin to restrict yang
This therapeutic principle nourishes yin to restrict relatively excessive
yang. It is applied for yin deficiency. Yin cannot restrict yang due to its defi-
ciency and yang becomes preponderant. As a result, the syndrome of defi-
ciency-heat occurs, which should be treated by nourishing yin so as to
restrict yang, that is, nourishing yin to restrict hyperactivity of yang.
B. Tonifying yang to restrict yin
This therapeutic principle tonifies yang to check preponderant yin. It is
applied to yang deficiency. Yang cannot restrict yin due to its deficiency
and yin becomes preponderant. As a result, the syndrome of deficiency-
cold occurs, which should be treated by tonifying yang so as to restrict yin,
that is, supporting yang to eliminate preponderance of yin.
C. Supplementing both yin and yang
This principle is to treat the syndromes of both yin and yang deficiency. Yin
deficiency should be treated by nourishing yin, yang deficiency by tonify-
ing yang, and deficiency of both yin and yang by supplementing both yin
and yang. In clinical application, attention should be paid to differentiate
which side is more predominant so that nourishing yin and tonifying yang
can be taken up in the order of importance.
(a) Seek yang in yin: This principle involves adding yang-tonifying herbs
in the yin-nourishing formula. It is applied to the syndromes of yin
deficiency or deficiency of both yin and yang with yin deficiency as
the primary contradiction. Based on the theory of interdependence
between yin and yang, inferiority of either yin or yang may affect
each other. Therefore, when treating the syndrome of yin deficiency,
nourishing yin only cannot reinforce deficient yin, and tonifying
yang only will damage yin further. So, if nourishment of yin is sup-
plemented by tonifying yang, the source of yin will last continuously.
This syndrome of deficiency of both yin and yang always manifests
in the cases of severe deficiency of yin, which can hardly produce
yang.
10.2 Principles of treatment  175

(b) Seek yin in yang: This principle involves adding yin-tonifying herbs
to the yang-nourishing formula. It is applicable to yang deficiency or
deficiency of both yin and yang with yang deficiency as the primary
contradiction. Based on the theory of interdependence between yin
and yang, treating the syndrome of yang deficiency by tonifying yang
alone will impair yin while nourishing yin alone will make yang
escape. So, if tonifying yang supplemented by nourishing yin, the
source of yang will last infinitely. This syndrome of deficiency of both
yin and yang is always caused by long-term deficiency of yang.

10.2.4 Regulating qi and blood

Qi and blood are the essential substances for the maintenance of life activities and
also the material basis of functional activities of organs and tissues. Therefore, regu-
lating qi and blood is not only a therapeutic principle aiming at disorders of qi and
blood but also an important principle of treating diseases.

10.2.5 Regulating the viscera

Guided by the holism concept, the rule of regulating the viscera is stipulated accord-
ing to the disorder of visceral function. The detailed methods are made according to
the theory of five elements, the relationship among the viscus, and the characteris-
tics of the viscus.

10.2.6 Three optimal treatment administrations

1. Treatment in accordance with chronological conditions


This treatment principle is applied according to the time, person, and place
which are affected by many internal and external factors. Therefore, in clinical
treatment, seasonal climates, geographic environments, and individual differ-
ences should all be taken into account, and appropriate methods should be
selected according to the specific conditions.
The treatment principles are based on the features of the seasonal cli-
mates. Since the seasonal variations of the weather affect the human body to a
large extent physiologically and pathologically, treatment and prescription
should be selected accordingly. For example, in spring and summer, when
weather changes from warm to hot and yang qi ascends, the striae of body
become looser. During this period, even for external contraction of wind-cold,
pungent-warm dispersing herbs, such as Ma Huang and Gui Zhi, should be used
176  10 Principles of Prevention and Treatment of Diseases

cautiously so as not to impair qi and yin due to excessive dispersion. In autumn


and winter, when weather turns cold from cool and yin becomes preponderant
with decline of yang, the striae become tighter and yang qi retreats interiorly.
So, herbs with cool or cold nature, such as Shi Gao and Bo He, should be used
cautiously to avoid impairment of yang qi. Therefore, for different seasons and
climates, the herbal dosage as well as the nature of the herbs (cold or hot)
should be selected accordingly, which means the use of Xiang Ru in summer is
like the use of Ma Huang in winter, and Ma Huang should not be used in
summer and Shi Gao should not be used in winter.
2. Treatment in accordance with geographic conditions
This treatment principle is based on the different features of geographic envir-
onments. In different regions and geographic environments, there are different
climatic conditions and customs. Therefore, patient’s constitutions and physio-
logical conditions vary as well. The treatment principle should be selected
accordingly. For example, in the northwestern highlands of China, it is cold
and dry with little rainfall. So, disease of wind-cold and dryness are commonly
seen and usually treated by pungent-moistening formula, while cold-cool and
dry remedy should be used cautiously. In the southeastern coastal regions of
China, it is hot and damp with plentiful rainfall. So, disease of damp-heat is
commonly seen and should be treated by heat-clearing and damp-resolving
herbs, while damp-inducing herbs with warm or hot nature should be used with
great care.
3. Treatment in accordance with individuality
This treatment principle is based on different age groups, genders, constitu-
tions, living habits, and occupations.
A. Age
Different age groups often present with different physiological conditions
and pathological changes. Aged people often suffer from deficiency syn-
drome or syndrome of deficiency-excess in complexity due to deficient qi
and blood as well as decline of physiological functions. They should be
mainly treated by tonifying methods. Even when there are excess patho-
gens, drastic medicine, large dosage, and long-term treatment are not advi-
sable. As to children, they are vigorous in physiological functions, but their
qi and blood are not sufficient enough and their viscera are tender and deli-
cate. For them, drastically purgative remedies should be avoided, tonics
should be carefully used, and dosages should be smaller.
B. Gender
Women differ from men physiologically. Women have special conditions
such as menstruation, leucorrhea, pregnancy, and delivery, which all need
to be considered when prescribing. For example, during pregnancy, drugs
of drastic purgation and blood stasis-breaking, water-promoting, moving,
and toxic herbs should be forbidden or used cautiously. After childbirth, in
10.2 Principles of treatment  177

case of deficiency of qi and blood, breast-feeding and lochia should be


taken into account.
C. Constitutions
Different types of constitutions not only produce direct effect on the occur-
rence of a disease but also result in different responses to the medicinal
treatment. Therefore, constitutional factors must be taken into considera-
tion in treatment. For instance, for the same disease, individuals with con-
stitution of yin deficiency and yang excess should be treated cautiously by
herbs of warm, hot, pungent, and dry nature, while those with constitution
of yang deficiency and yin excess should contraindicate herbs of cold, cool,
and raw and cold food. The ones with strong constitution and high toler-
ance can be treated by large dosages of drastic herbs, while those of weak
constitution and low tolerance should be treated by small dosages of mild
herbs. In addition, attention should also be paid to the individual’s psycho-
logical state, occupational features, working conditions, and living environ-
ments, for they are all related to the occurrence of a disease.

In conclusion, patient’s individual characteristics and physical environment should


all be taken into consideration when it comes to treatment. The three considerations
of time, person, and place fully embody the holism and syndrome differentiation of
the Chinese medicine. It is well applied in clinical practice. Only by comprehensively
observing the conditions and concretely analyzing the specific circumstance can one
gain a better treatment.
References
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Union Medical University Press.
3. HU DP. 2004. Etiology and Pathogenesis Theory of Traditional Chinese Medicine. Beijing: China
Union Medical University Press.
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Press of Traditional Chinese Medicine.
5. GAO SH, WANG J. 2012. Basic Theories of Traditional Chinese Medicine. 2nd Version. Beijing:
People’s Medical Publishing House.
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