JOURNAL OF CHINESE MEDICINE NUMBER 33 MAY 1990
ZI WU LIU ZHU
MIDNIGHT-NOON EBB-FLOW THEORY
TANG SHUDE, WANG GULIANG, WANG XIANYAN
In Chinese medicine Zi Wu Liu Zhu forms a basic part of the
theory of the Jingluo. It concerns the circulation of Qi and
Blood in the Jingluo at specific times of the day and night.
Since under physiological and pathological conditions the
circulation of Qi and Blood in the human body is intimately
related to blood pressure, we examined and surveyed 100
cases of primary hypertension. Blood pressure reducing
medication was discontinued and through the 24 hour
period, measurement of the blood pressure was conducted
and the difference in blood pressure at various times was
recorded.
Of the 100 cases 80 were men and 20 women, and the age
range was 24-67 years. All were questioned about their
history of hypertension and underwent a physical
examination, routine urine test, examination of the eye,
electrocardiogram, Kidney scan, and analysis of blood
potassium levels. Investigation of non-obvious heart and
kidney disorders, sequelae of stroke, myocardial
embolism and malignant hypertension as well as the origin
of the hypertension was also conducted. During the period
before stopping the anti-hypertensive medication, blood
pressure measurement was taken at the following hours: 4,
8, 12, 16, 20, 24. The average measurements of the diastole
and systole of all the patients at these times were then
established and these values were mutually compared and
analysed.
The blood pressure at each four hour interval was com-
pared with every other interval. Once the statistics were
analysed, the following results were found. The systole
and diastole between the following groups: 24 hours and
4 hours, 20 and 16, 8 and 16, and 8 and 12 showed no
statistical significance (p < 0.05). However for the remain-
ing 11 groups there was a clear statistical significance. (P
< 0.05-0.01). The blood pressure at 16 and 20 hrs was at it’s
greatest, whilst at 4 hrs was at it’s lowest.
Zi Wu Liu Zhu is a very important part of the theory of
TCM. It’s origins lie in the naive materialistic theories of the
ancients as well as the method of differentiation of
syndromes. It is based on the wholistic perception of man
and his environment.
Through observation of natural phenomena such as the
movements of the sun and moon, the arrival and departure
of the cold and hot seasons, day break and dusk and the
ebb and flow of the tides etc, this country’s medical workers
through the ages recognized that these continuous and
repetitive changes occurred according to set rules. The
Zang fu are the centre of the body, with Qi and Blood as the
connecting agents that link all the organs into a unified
system, thus making possible all sorts of physiological
functions. These physiological functions in their move-
ments follow the cyclical changes of the natural
environment, particularly reflected in the day/night cycle.
“Zi” (midnight) and “Wu” (Midday) reflect the growth and
decline of Yin and Yang. In reference to the 24 hour cycle,
in the Zi time (23-1) the Yin Qi reaches it’s most extreme.
After that the Yin begins to decline and the Yang Qi starts
to increase. At the Wu time (11-13) the Yang Qi is at it’s most
extreme, after which it begins to decline, and the Yin Qi
starts to increase. Thus the Zi and Wu represent the pivotal
points of the growth and decline of the day and night, and
Yin and Yang.
The original meaning of “Liu Zhu” (ebb and flow) is the
circulation of the water system, it’s dissipating and it’s
gathering together. Zi Wu Liu Zhu describes the circulation
of Qi and Blood in the Jing Mai. It explains that the
physiological functions of the body will follow the diurnal
rhythm and vary according to the changing of time.
In the Yuan dynasty, Hua Bo Ren said “The Jing mai serve
as pathways for the Qi and blood and so circulate the Yin
and Yang and nourish the whole body. Starting in the
Middle Jiao and from there pouring into the hand Tai Yin
and hand Yang Ming, the Qi belongs to the ‘Ping Dan’ time,
like the dew drops that fall at dawn. The Qi flows day and
night, reaches the end then starts again”.
The ‘Ping Dan’ time here refers to the Yin time (the 3rd of
the earthly branches, 3-5am). At this time the Qi and Blood
will exit from the Middle Jiao and flow and pour into the
hand Tai Yin Lung channel. In the Mao time (4th earthly
branch) it will flow and pour into the hand Yang Ming
Large Intestine channel, in the Chen time (5th) it will flow
and pour into the foot Yang Ming Stomach channel, in the
Ji time (6th) it will flow and pour into the ....Spleen channel,
in the Wu time (7th) it will flow and pour into the ...Heart
channel, in the Wei time it will flow and pour into the
....Small Intestine channel, in the Shen time it will flow and
pour into the ..Bladder channel, in the You time it will flow
and pour into the .....Kidney channel, in the Shu time it will
flow and pour into the ...Pericardium channel, in the He
time......into the Sanjiao channel, in the Zi time.......into the
Gall Bladder channel, in the Chou time......into the Liver
Channel, and then it returns to the Lung channel.
Thus the Qi and Blood flow in every channel for a period of
two hours, and just like the tides of the sea, will ebb and
flow, reaching a high point followed by a low point,
entering every channel at its time of fullness, and leaving it
at the time of emptiness.
We believe that the origin of essential hypertension and
Kidney Qi Xu are very closely connected. In the chapter “On
Heavenly Truths in Ancient Times” in the book the Su Wen,
it is stated: “At 5 eights the Kidney Qi begins to weaken,
the hair falls and the teeth wither.” That is to say that at the
age of 40 years in men, and 35 in women, the hair will begin
to drop out and the teeth will loosen and fall out. Weakness
of Kidney Qi will lead to lack of harmony between Yin and
Yang. This is the basic pathology of essential hypertension
which is seen in the middle aged and elderly. The Kidney
stores Jing and is also the root of the Original Yin. When the
Kid Qi is weak, it will necessarily give rise to Xu of Yin and
a preponderance of Yang. The Zheng Zhi Zhun Sheng
(Standards of Diagnosis and Treatments) states “there is
Wind, Damp, Cold, Heat, Blood stasis, Stagnation of Qi,
and Phlegm, they are all Biao; there is Kidney-Xu, this is the
Ben”. This explains that the crux of this disease is Kidney
Xu.
We discovered that during the 24 hour cycle, it is during the
Shu time and the Shen time that the systole and diastole
measurements were highest. The Shen time corresponds
to the Bladder channel. The Bladder and Kidney have an
interior/exterior relationship and their respective Luo chan-
nels inter-connect. The You time corresponds to the the
Kidney channel. Although measurements were not taken
during the You time, it was inferred that the blood pressure
41 41
 JOURNAL OF CHINESE MEDICINE NUMBER 33 MAY 1990
was also quite high. According to present day investiga-
tions, the Kidney function peaks at around 5 pm, this is
also the time that the Qi and Blood of the Kidney and
Bladder channels is most vigorous according to Zi Wu Liu
Zhu. Since Kidney Qi Xu will lead to Kidney Yin Xu and
subsequent preponderance of Yang, so the blood Pressure
will be at it’s highest.
Why is it that at the Shu time the blood pressure is also so
high? The Shu time corresponds to the Pericardium channel.
The Pericardium and Heart channels are intimately
connected. Since the Pericardium is the envelope around
the Heart, it has the function of protecting it. The ancients
believed that the functions of the Heart are mostly carried
out by the Pericardium, and that the Pericardium performs
a shielding function, thus preventing external pathogens
from entering the Heart. As stated, essential hypertension
mostly originates from Kidney Qi Xu which leads on to Yin
Xu and Yang rising. When the Qi and Blood circulate to the
Pericardium channel, the Yin Xu and preponderance of
Yang will be very obvious, thus leading to a rise in blood
pressure. And because the Heart channel has much Qi and
little blood, at the time that the Qi and blood circulate to
the Heart channel, there is little influence from the Xu of
Kidney Qi, and this is the reason that the blood pressure at
this time is not very high.
So what in fact does the Zi Wu Liu Zhu mean in medicine?
To summarize, it can help in diagnosis, in prevention of
disease, and especially to choose the most auspicious time
to treat the patient. Because of this, in the past few years a
new direction in the study of medicine has evolved - when
to select the treatment time. Many scholars outside China
have performed trials investigating left heart failure due to
hypertension. It has been found it mostly occurs between 11
4242
pm - 1 am. When patients are given a suitable amount of
vasodilators and a small amount of diuretics at 10 pm, this
can prevent left heart failure. The rate of spread of cancer
cells is more rapid at certain times
compared to others. Since X-rays can easily damage the
body, this damage can be limited by choosing the correct
time to treat the cancer.
The earliest Chinese medical texts take into account the
importance of treatment of disease at different times..
Zhang Zhong Jing of the eastern Han dynasty, in his classic
the Shang Han Za Bing Lun, refers to this on a number of
occasions. From examining this text it is apparent that
much emphasis was put on the correct treatment time. For
example in the use of Shu Qi San to treat malaria it is
specified that it should be taken before the development of
an attack, along with half a qian of water. This “before
development” method of treatment is essential for the
treatment of malaria. This is one example of how the
ancients took time into account in the treatment of disease.
In the same text, in the use of Ma Huang Lian Qiao Chi Dou
Tang it is specified that the decoction be taken 3 times a day,
with priority at midday. Ban Xia Hou Po Tang should be
taken 3 times a day and once at night, whilst Li Zhong Wan
should be taken 3-4 times a day and twice at night.These
examples all highlight the importance of treatment at
specific times.
We think that essential hypertension in patients whose
blood pressure is highest between the Shen and Shu times
(4-8pm), will benefit more from treatment by tonifying the
Qi, nourishing the Yin and subduing the Yang before 4pm
than at any other time. This is because 4-8pm is the time that
Kidney Qi Xu is most obvious.