The Huang Di Neijing (The Yellow Emperors Classic of Medicine) and

its impact in the development of Chinese Medicine

Yin and Yang, the two principles in nature, and the four seasons are the beginning and the end of everything
and they are also the cause of life and death. Those who disobey the laws of the universe will give rise to
calamities and visitations, while those who follow the laws of the universe will remain free from illness, for they
are the ones who have obtained the Tao, the Right Way.
(The Huang Di Neijing translated by Maoshing, 1995)

Introduction – Historical background

During the Warring States period (475 BC-221AD) China experienced great change in its
social structure, philosophy, science and culture (Yanchi, 1995; Jingfeng et al, 1995). This
had a profound effect on the development of Traditional Chinese Medicine (TCM). One
book which stood out during this period was the Huang Di Neijing (The Yellow Emperors
Classic of Medicine) (Henceforth the Neijing) (Yanchi, 1995; Jingfeng et al, 1995). The
Neijing consists of two books:
● Plain questions (Suwen) - Which dealt with human anatomy, physiology, aetiology
of disease and provided a holistic view of the relationship between man and nature
(Maoshing, 1995).
● Miraculous Pivot (Lingshu) - provided detailed descriptions on the channels and
collaterals, acupuncture and moxibustion (Maoshing, 1995).
The authors1 of the Neijing built on the long years of accumulation, documentation of
experience and repeated trial and error, thus raising the practical experience of TCM to the
level of theory. This laid the theoretical building blocks for the development of Chinese
Medicine over the next 2000 years and beyond (Jingfeng et al, 1995).

1 Legend suggests that Huang Di was an ancient emperor in China (2695-2589 B.C.) with Qi Bo as his
physician; the Classic of Internal Medicine was considered to be part of a dialogue between them on the
aspects of pharmacy and medicine. In truth it was probably a product of various unknown authors during
the Warring states period (Yanchi, 1995)
The Neijing recorded ancient anatomic knowledge of the human body: the length of various
bones and vessels and the sizes and volumes of the internal organs. It set forth the aetiology
of many illnesses and defined principles for its prevention, diagnosis and treatment (Huang
1995; Yanchi 1995). It advocated the holistic concept of unity between the human body
and the surrounding environment by emphasising, on the one hand, that the body is
an inseparable whole, and, on the other hand, that man is closely related to the natural
environment

One area in which the Neijing excels is the employment of the ancient philosophical theories
of yin and yang, zang-fu and the five elements/phases, to explain the principles of differential
diagnosis and treatment according to the season the disease occurs, the geographical location
of the patient during the manifestation of the disease and the patient’s individual condition
(Jingfeng et al, 1995). I shall examine each of these in turn.

Yin and Yang - Relative opposites (See Figure 1).

Originally the terms yin-yang were used to indicate the relation of an object to the sun, the
aspect facing the sun being yang and that in the shadow being yin (Yanchi, 1995). The Neijing
brought the ancient theory of yin and yang into the framework of medicine, making it a mode
of thinking and a philosophical basis for the development of the basic theory of TCM. It
stated that any object in nature is both a unified whole and whole comprised of two parts
with opposing qualities (Jingfeng et al, 1995). This theory permeates the whole Neijing. The
Suwen suggests "The law of yin and yang is the natural order of the universe, the foundation of all things,
mother of all changes, the root of life and death" (Maoshing, 1995).

The theory of yin and yang in nature comprises of:

● Opposition - Yin and yang are opposite cycles or stages of the same spectrum but are also
relative, nothing is totally yin or yang. Each contains an aspect of the other.
● Interaction and consumption - Yin and yang are not static they interact and change into
each other, e.g. day changes into night.
● Interdependence between yin and yang - although different ends of the same spectrum,
one can not exist without the other. Everything has a polemic nature but they also
 depend on each other (Yanchi 1995).
● Balance of yin and yang - yin and yang are in a constant state of harmony that is controlled
by adjustment of the relative levels of yin and yang. When one is out of balance this
causes the other to adjust accordingly (Yanchi 1995).

Figure 1. The Yin-yang symbol (Kaptchuk , 1983)

Yin-yang was used to summarise all aspects of medicine including physiology, pathology,
diagnosis and prevention of disease. The Suwen states;
● Physiology: “The body is born with a definite shape all parts of which are related to yin and yang”
(Maoshing, 1995).
● Pathology: “excessive yin will cause disease of the yang type, while excessive yang will lead to diseases of
the yin type” (Maoshing, 1995).
● Diagnosis. “when inspecting the patients complexion and feeling his pulse, a good doctor firsts
differentiates between yin and yang." (Maoshing, 1995).
● Treatment: “diseases of the yang type should be treated by replenishing the yin, and diseases of the yin
type should be treated by replenishing the yang." (Maoshing, 1995).

The Neijing holds that a disease arises when the balance of yin and yang is upset “ when yin
and yang are in equilibrium, the body is in good health; when yin and yang are separated from each other, life
comes to an end." (Maoshing, 1995)

The Zang-Fu Theory - "Organ Pictures"

The term zang-fu was initially recorded in the Neijing and suggested the idea that the functions
and pathological changes of the internal organs can be observed on the exterior of the body.
It purports that "Zang is situated in the interior, yet it manifests itself on the exterior. This is called
the organ picture." (Yanchi 1995, Maoshing, 1995) Therefore, organ picture not only refers
to the presence of the internal organs themselves as in Western medicine, but also to their
physiological functions, their emotional aspects, related channels and the manifestations
of their pathological changes (See Table1). This theory has remained at the centre of TCM
theory (Jingfeng et al, 1995)..

Table1. The Zang-fu system according to Neijing (Maoshing, 1995, Yanchi, 1995)
Five Zang Five Fu Organs Five Sense Organs Channels Storage of Related
Organs Tissues and Orifices Emotion
Heart Small intestine Vessel Tongue Heart channel of hand- Consciousness Joy
shao-yin, small intestine
channel of hand-taiyang
Liver Gallbladder Tendon Eye Liver channel of foot- Soul Anger
jueyin, gall-bladder
channel of foot-
shaoyang
Spleen Stomach Muscle Mouth Spleen channel of foot- Intention Pensiveness
taiyin, stomach channel
of foot-yangming
Lung Large Skin Nose Lung channel of hand Vitality Grief
Intestine taiyin, large intestine
channel of hand-
yangming
Kidney Urinary Bone Ear, genitals Kidney channel of foot- Determination Terror
bladder and anus shaoyin, urinary bladder
channel of foot-taiyang

Zang-fu pertains to the internal organs, each of which can be classified into three groups
according to their physiological functions; the five zang organs include the heart, lung,
spleen, liver and kidney; the six fu organs include the gallbladder, stomach, small intestine,
large intestine, urinary bladder, and the triple jiao; additionally there are the extraordinary fu
organs which include the brain, bone marrow, bone, blood vessels, the gallbladder and the
uterus (Jingfeng et al, 1995). According to the Neijing;
● Each zang organ has its specific function, all share a common physiological property: to
engender and store essence and qi2. The essence, qi, blood and body fluids are kept in

2The concept qi can be translated as ‘air’, ‘vapour’ or breath. Within the body it is considered the vital
energy that permeates the body.
 them (Jingfeng et al, 1995).
● Each fu organ has a specific function, all share a common physiological property: to
contain, transport and digest food taken in and excrete the wastes. The extraordinary fu
organs store essence and qi, but are considered closed organs (Jingfeng et al, 1995).

According to the Sacred Teachings in the Suwen each of the zang-fu organs is personified as a
certain character to explain their significance within the body; for instance Qi Bo states
"The heart is the sovereign of all organs and represents the consciousness of one's being. It is responsible for
intelligence, wisdom, and spiritual transformation. The lung is the advisor. It helps the heart in regulating the
body's qi. The liver is like the general, courageous and smart. The gallbladder is like a judge for its power of
discernment." (Maoshing, 1995).

Although the theory of the zang-fu organs was originally based on fragmentary anatomical
knowledge, it has since gone much further, and has eventually evolved into a unique
theoretical system of physiology and pathology, one that goes far beyond the limits of
the knowledge about the zang-fu organs acquired through anatomy of the human body.
(Kaptchuk, 1983).

Integration
One of the strengths of the Neijing lies in its integration of theories, notably yin-yang, zang-fu
and the five elements. The idea of integrity emerges from the theory of yin and yang. (Yanchi,
1995; Jingfeng et al, 1995). The theory pervades all of Chinese science; according to it,
any object in nature is both unified whole and a whole composed of 2 parts and opposing
qualities, notably yin and yang. The quote below shows how the zang-fu can be categorised
according to yin and yang. (Yanchi, 1995; Jingfeng et al, 1995).

Chapter 5 of the Suwen suggests: "in terms of the zang-fu organs the heart, liver, spleen, lungs and
kidneys are the zang organs, since they are yin in nature and their function is transformation and storage.
The gallbladder, stomach, large intestine, small intestine, bladder and san jiao (the 3 viscera cavities
responsible for fluid metabolism) are the six hollow organs and they are considered yang. Their function is
reception and passage." (Maoshing, 1995).
From a physiological viewpoint the zang-fu could be considered to be at the centre with the
channels aiding communicating throughout the body. The zang-fu also work together in pairs;
these pairs, in opposition to each other, explain the functioning of the whole organism e.g.
the liver (yin) and the gallbladder (yang) (Yanchi, 1995).

Another theory of TCM, the five elements or phases explains the nature and quality of
the relationship between the zang-fu. The five elements wood, fire, earth, metal and water have
differing qualities. According to the Neijing the liver corresponds to wood, heart to fire, and the
lungs to metal. (Yanchi, 1995; Jingfeng et al, 1995). This provides a model for the interaction
among the organs of the body and for the transmission of disease. This theory provides a
framework for viewing the elements of any system, the relationship between these elements,
and the pattern and motion that results from their interaction.

Each of the zang and fu organs corresponds to one of the five elements; thus the relationship
among the elements is the relationship among the organs. It also the path that a disease is
most likely to follow (Yanchi, 1995; Jingfeng et al, 1995).
In Chapter 22 of the Suwen: 2 Huang Di asked " There is a concept of taking the principles that govern
the 5 zang organs and applying them to the seasons and the five elements in diagnosis and treatment."
Qi Bo answered "When we talk about the 5 elements, we are discussing the dynamics of the creative control
cycles, the changes of excess and deficiency, and so forth. By understanding the principles underlying these
changes, we can apply them to disease progression. We can determine the severity of a problem and its changes
on an hourly basis, to the very time of death. We can analyse the success or failure of a treatment method."
(Maoshing, 1995).

After the Neijing

The zang-fu theory was developed after the Neijing by many famous Chinese doctors, one
who perhaps stands out is Zhang Zhongjing who wrote the Shanghan Lun (Treatise on Febrile
Diseases caused by Cold) and the Jinkui-Yaolue (Synopsis of Prescriptions from the Golden Chamber)
(Maciocia 1980). Zhang Zhongjing integrated the basic theory of the Neijing with his own
personal experiences and established the therapeutic principle of rendering treatment
according to overall symptoms and signs. He borrowed from the idea that the cause of
febrile diseases (Diseases with fever as a main symptom) were caused by Shanghun - cold.
Using his experience he formulated new approaches to therapeutic methods (Maciocia
1980).
He concluded that diseases are caused by:
1. Pathogenic factors invading the zang-fu via the meridians, arising from outside the body.
2. Obstruction of the vessels that connect the 4 limbs and 9 orifices of the body, caused by
invasion from the outside the body through the skin
3. Injuries due to intemperance in sexual life, trauma, wounds inflicted by insects or wild
animals (Yanchi, 1995; Jingfeng et al, 1995).
Other Chinese doctors influenced by the Neijing are mentioned below:
● Hua Tuo was born in Qiao in the State of Pei. He lived in the second century AD and
was considered to be an outstanding medical scientist. He studied the Neijing and the
other classics in great depth and was known widely for his skill in surgery. (Yanchi, 1995;
Jingfeng et al, 1995)
● Liu Wansu was born in Hebei province. He was said to have studied the Neijing from the
age of 25 to the age of 60. He observed the high frequency of fever and inflammation
in serious diseases and promoted the idea of using herbs of cooling nature to heal these
conditions. This was contrary to what many of his ancestors who focused on using warm
herbs. This work had profound influence on the later concept of "wen bing" or contagious
diseases (Yanchi, 1995; Jingfeng et al, 1995)

.
"The skillful doctor knows by observation, the mediocre doctor by interrogation, the ordinary doctor by
palpation"
Zhang Zhongjing

Zhang Zhongjing lived in the district of Nan yang. He studied under Zhang Ji a fellow
villager during the Eastern Han dynasty. A time of great conflict and suppression among
the peasants and war among different warlords ravaged the land. It was also a time of great
disease and sickness as epidemic after epidemic attacked the people. Epidemics posed a
grave threat to people as there was no effective cure for such disease. Many people died
from illness or at the hands of incompetent doctors. Zhang Zhongjing wrote that 200
of his family died in less than 10 years. 70 died from febrile diseases. Following this he
concentrated on working on the theory of and methods of treating exogenous febrile
diseases. He studied the Neijing and coupled with his clinical experience wrote the Treatise
on Febrile diseases caused by cold (Shanghun Lun).
The Shanghan Lun may have been lost only for a doctor called Wang Shuhe who was
Commissioner of the Imperial Academy of Medicine during the Jin Dynasty (265-420). He
put together the fragmentary record of the Shaghan Lun and arranged it in a logical order.
Figure 2. The Life of Zhang Zhongjing (Maciocia 1980 ; Jingfeng et al,1995)

Conclusion- TCM in the modern world

Within this assignment I have concentrated on looking at the zang-fu and yin-yang theories in
relation to their significance within the Neijing and beyond. I have also touched on the theory
of the Five elements because of its importance in explaining the relationship between the zang-
fu and the yin-yang theories. The Neijing has not just influence Chinese society but has had a
profound influence around the world. It has been translated into many languages and still
remains core reading for students and practitioners of TCM alike.
It has laid the grounding for the scientific study for TCM moving away from witchcraft
and the supernatural which existed at that time. Throughout the ages it has been critically
tried and tested by many doctors; the theories within developed and changed (Jingfeng et al,
1995).
As Maoshing (1995) suggests “The Neijing offers a framework by which modern science, technology,
and medicine can integrate with the natural principles of TCM. This is the Integral way”. As science
technology and industry race forward with detrimental effects on the external environment
of humankind and the ecological balance of the planet; will the people of the world take
heed?

Bibliography and References

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