Click the blue text to follow us
Editor’s Note: The Five Elements Theory is an important component of the theoretical system of Traditional Chinese Medicine (TCM), encompassing the concepts of “generating” and “overcoming” relationships. The so-called generating relationship refers to mutual promotion, while the overcoming relationship indicates mutual restriction. In clinical practice, this principle can be applied to determine treatment strategies and predict disease outcomes, thereby enhancing the efficacy of syndrome differentiation and treatment.
In the “Neijing: Six Yuan Zheng Ji Da Lun,” it states: “Wood promotes the flow of Qi,” “Fire promotes the development of Qi,” “Earth restricts Qi,” “Metal drains Qi,” and “Water restrains Qi.” This provides significant guidance for the treatment of the Five Elements corresponding to the Five Zang organs. The “Jinkui Yaolue” states: “To treat diseases before they manifest, one must recognize liver diseases and understand that the liver transmits to the spleen; one should first tonify the spleen. If the spleen is strong in all four seasons, it will not be invaded by pathogens. If one does not understand the transmission, seeing liver disease and not tonifying the spleen will only treat the liver.” Zhang Zhongjing was adept at applying the Five Elements Theory, deducing from liver diseases transmitted to the spleen to other organs, guiding clinical practice based on the interdependent and mutually restrictive theories of the Five Elements.
Today, let’s explore the application of the “generating and overcoming” relationships of the Five Elements in clinical practice.
Application of the Generating Theory of the Five Elements
Tonifying the Liver and Nourishing the Heart Method
This method is suitable for symptoms such as heart deficiency, palpitations, insomnia, and forgetfulness.
The heart houses the spirit and governs fire. Insufficient blood nourishment leads to excessive fire, causing unrest in the spirit. Since wood is the mother of fire, if liver blood is not nourished, it results in blood deficiency that cannot nourish the spirit. Therefore, it is advisable to tonify the liver to nourish the spirit, with the main formula being Yangxin Decoction (Ren Shen, Huang Qi, Bai Zhu, Fu Ling, Gan Cao, Dang Gui, Shu Di, Wu Wei Zi, Bai Shao, Yuan Zhi, He Huan, Jiu Xiang Chong) with the addition of jujube seeds.
Benefiting Fire to Generate Earth Method
This method is suitable for symptoms of kidney yang deficiency and spleen weakness, leading to diarrhea of clear fluids. Symptoms include early morning diarrhea, abdominal pain relieved by pressure and warmth, along with a series of symptoms of spleen and kidney yang deficiency.
Due to kidney yang deficiency, the body cannot properly digest food, leading to early morning diarrhea. As Ming dynasty physician Li Shicai stated: “The kidney governs urination and is the foundation of storage. Although it belongs to water, true yang resides within it. Without sufficient fire, it cannot promote the transformation of food.” The kidney contains true yang, referring to the Mingmen (Gate of Life), which is the root of vital energy and the residence of water and fire.
The spleen and stomach govern the central earth; without fire, it cannot generate. Therefore, the Mingmen is the source of transformation, and the spleen and stomach are its mother. Under normal circumstances, nourishment comes from food and drink, and a strong appetite leads to a robust body. If the Mingmen fire is deficient, it cannot stimulate the yang energy of the spleen and stomach, leading to poor digestion and clear fluid diarrhea. Treatment involves tonifying the kidney and strengthening the spleen using formulas like the Four Gods Pill (Bu Guo Zhi, Wu Yu, Rou Dou Kou, Wu Wei Zi) or the Five Flavors Pill (Ren Shen, Bai Zhu, Wu Wei Zi, Bu Guo Zhi, Fu Ling, Wu Yu, Ba Jiao, Rou Cong Rong, Long Gu). In clinical practice, for persistent diarrhea, one may use the Fu Gui Li Zhong Decoction to warm the kidney and tonify the spleen, “benefiting the source of fire to dispel dampness.”
Strengthening Earth to Generate Metal Method
This method is suitable for chronic lung diseases with weak spleen earth, leading to symptoms of insufficient metal generation. Symptoms include thin body, poor appetite, loose stools, pale tongue, and thin rapid pulse.
For lung tuberculosis with hemoptysis, it is essential to clear lung heat to nourish the upper source and nourish kidney yin to control excessive yang. Due to prolonged illness, simply clearing metal and nourishing water will not yield good results; it is necessary to combine methods to tonify and supplement spleen earth to support the source of transformation. Therefore, in the past, when treating lung diseases, additional herbs that also support the spleen and stomach were often included, such as Fu Ling, Bian Dou, Shan Yao, Bai Zhu, and Shi Hu.
In cases of yin deficiency with excessive fire, such as bone steaming, night sweats, hemoptysis, thin body, rapid pulse, red lips, and poor appetite, one should combine nourishing spleen yin with clearing metal and nourishing kidney. In summary, for deficiency syndromes, one should not solely emphasize tonification to avoid hindering the spleen; it is essential to incorporate methods to strengthen earth to achieve efficacy.
Clearing Metal and Nourishing Water Method
This method is used for symptoms of lung heat damaging metal, leading to depletion of water and yin deficiency. Symptoms include cough with little phlegm, blood-streaked phlegm, thin body, tidal fever, night sweats, lower back soreness, sore throat, and hoarseness, with a red tongue and thin rapid pulse.
The relationship between growth and storage in the human body must be balanced. When yang energy is excessively exuberant, it will deplete yin blood. Therefore, the function of clearing metal primarily involves restraining excessive yang energy to preserve the depleting yin fluids. When applying the clearing metal and nourishing water method clinically, one must distinguish between the deficiency and excess of both the pathogenic and righteous qi. For example, in the late stage of a warm disease, if the pathogenic qi has retreated but the righteous qi is weak, one should use formulas like Sheng Mai San or Zhu Ye Shi Gao Decoction to support the righteous qi; if the pathogenic heat is severe, and the water fluids are about to deplete, with symptoms of high fever, shortness of breath, extreme thirst, profuse sweating, confusion, dry tongue, and a large pulse, one should use a large dose of Bai Hu Decoction or Bai Hu Decoction with Ren Shen to support the righteous qi, dispel the pathogenic qi, clear metal, and nourish water.
Additionally, due to excessive sexual activity or alcohol consumption, true yin in the kidney may be depleted, leading to water and fire imbalance, causing upward heat in the lungs, resulting in cough with blood-streaked phlegm, lower back soreness, thin body, tidal fever, red tongue with little coating, and thin rapid pulse. It is necessary to use clearing metal formulas to nourish the source of water, allowing metal and water to generate each other, thus gradually replenishing yin fluids. Main formulas include Bai He Guo Jin Decoction (Bai He, Sheng Di, Shu Di, Xuan Shen, Bei Mu, Jie Geng, Mai Dong, Bai Shao, Dang Gui, Gan Cao) or Qing Zao Jiu Fei Decoction (Ren Shen, Gan Cao, Pi Pa Ye, Sang Pi, Xing Ren, E Jiao, Shi Gao, Mai Dong, Ma Ren).
Nourishing Water and Supporting Wood Method
This method is suitable for kidney water deficiency and internal movement of liver yang, with symptoms of headache, dizziness, tinnitus, palpitations, and muscle spasms, with a red tongue and thin wiry pulse.
When kidney water is deficient, it cannot nourish wood, leading to liver yang rising and causing the aforementioned symptoms. The nourishing water and supporting wood method focuses on tonifying kidney yin and nourishing liver wood, with formulas like Zuo Gui Decoction (Di Huang, Shan Yao, Gou Qi, Shan Yao, Fu Ling, Gan Cao) or with the addition of Gui Ban, Mu Li, Xuan Shen, and Mai Dong. Clinically, conditions of yin deficiency and yang hyperactivity, where liver yang does not subside, and water is depleted, leading to hypertension, eclampsia, and stroke, can be treated with Yun Mu Decoction with modifications (Yun Mu, Mu Dan Pi, Shi Jue Ming, Gou Teng, Huang Qin, Mu Li, Dai Zhe Shi, Xia Ku Cao, Di Huang, Gou Qi Zi, Xuan Shen, Gui Ban), nourishing yin, subduing yang, calming the liver, and nourishing wood, allowing water and wood to assist each other, thus subduing excessive yang and alleviating all symptoms.
The application of the Five Elements Theory in clinical practice is extensive. As long as one grasps the generating and overcoming relationships and their connection to the human organs, and applies appropriate formulas based on the Five Elements Theory, good results can be achieved.
Application of the Overcoming Theory of the Five Elements
Suppressing Wood and Supporting Earth Method
This method involves draining the liver and stomach, suitable for liver diseases transmitted to the spleen, where wood is excessive and earth is weak, leading to abdominal pain and diarrhea that comes and goes, with a wiry pulse and lack of appetite.
The liver is the organ of wind and wood, with a strong and vigorous nature, easily attacking the stomach and restraining the spleen. If the spleen is weak, the liver wood can easily overcome it, resulting in abdominal pain and diarrhea that persists over time. Treatment should focus on the Pain-Draining Formula. If the spleen has been weak for a long time and liver wood is excessive, one may choose the Six Gentlemen Decoction with Bai Shao, Wu Zhu Yu, and Mu Xiang.
The method of draining the liver and stomach is suitable for symptoms of epigastric pain radiating to the ribs, nausea, frequent vomiting of sour fluids, with a wiry and slippery pulse. One can use Jin Ling Zi San to drain the liver and relieve pain, Er Chen Decoction to harmonize the stomach and descend rebellious qi, or Zuo Jin Wan to open the liver and descend bitterness, which can also stop vomiting and relieve nausea. This method is widely applied in the “Wood Overcomes Earth” section of the “Clinical Guidelines,” for example, “Pain is not tangible, and relief is not traceable,” occurring at night, with a desire to vomit but unable to, indicating liver qi attacking the stomach due to anger and overeating, leading to disharmony of qi. During an attack, one can use He Jian Jin Ling Zi San, along with methods to promote Yangming. Common herbs include Chuan Lian Zi, Yuan Hu, Fa Ban Xia, Chen Pi, Gua Lou Pi, and Shan Zhi Zi.
Draining Fire and Clearing Metal Method
This method is suitable for heart fire rising, leading to lung dysfunction, with symptoms of cough, shortness of breath, and possibly hemoptysis or epistaxis.
The lung belongs to metal and is the organ of clearing and regulating. If metal is burned by fire, the lung loses its ability to clear, resulting in cough and shortness of breath, and if the lung channels are damaged, hemoptysis may occur. All these symptoms require draining fire to clear metal, with main formulas like Xie Xin Decoction (Da Huang, Huang Lian, Huang Qin), primarily used for hemoptysis; Huang Qin Zhi Mu Decoction (Huang Qin, Zhi Mu, Sang Pi, Xing Ren, Zhi Zi, Tian Hua Fen, Bei Mu, Jie Geng, Gan Cao), used for heat-induced cough with phlegm and facial redness; and Xie Bai San (Sang Bai Pi, Di Guo Pi, Gan Cao, Jing Mi, Zhu Ye), used for irritability and lung heat with cough. In clinical practice, common herbs used for cough include Sang Ye, Sang Pi, Tian Hua Fen, Chuan Bei Mu, Quan Gua Lou, Xing Ren, Gan Cao, Jie Geng, and Pi Pa Ye. These herbs that clear fire and transform phlegm, from a broad perspective, also belong to the category of draining fire and clearing metal.
Fire can be classified into deficiency fire and excess fire. The draining fire and clearing metal method is generally used for excess conditions, with a pulse that is often large and forceful or slippery and rapid, and a tongue that is red with a yellow coating. If there is yin deficiency with excessive fire, then one should strengthen water to control fire, and this method is not suitable for treatment.
Strengthening Earth to Control Water Method
This method is suitable for earth not controlling water, leading to flooding of water pathogens, with symptoms of abdominal distension, facial swelling, and generalized edema.
The spleen belongs to earth and is the mother of all things. Zhang Jingyue stated: “Water is the most yin, thus its root is in the kidney; water transforms in qi, thus its manifestation is in the lung; water fears earth, thus its control is in the spleen.” According to this reasoning, the occurrence of edema is closely related to the relationship between the lung, spleen, and kidney, especially with the spleen being crucial, as it has the function of controlling water. Therefore, the application of the strengthening earth to control water method is quite extensive. Symptoms include fatigue, lethargy, lack of appetite, chest and abdominal fullness, facial swelling, pale tongue, and weak pulse, with main formulas like Shi Pi Yin (Bai Zhu, Fu Ling, Gan Jiang, Zhi Gan Cao, Hou Po, Mu Xiang, Fu Zi, Dou Kou, Lai Fu Zi, Mu Guo, Sheng Jiang, Da Zao).
Clearing Metal to Control Wood Method
This method is suitable for excessive wood fire, burning the lung metal, where metal does not control wood, and wood counteracts metal. Symptoms include pain in the ribs, cough with blood, and a wiry rapid pulse.
The lung metal has a clearing function, while the liver wood has the ability to disperse and regulate. Wood embodies the energy of spring, nurturing all things, while metal embodies the command of autumn, causing plants to wither. In the human organs, wood contains fire, also known as relative fire. When the physiological functions of the body are healthy, both wood energy and relative fire can move in moderation, becoming the driving force of transformation. As Zhu Danxi stated: “Relative fire can only be supplemented by tonifying the spleen to create transformation, thus sustaining life.”
Conversely, if the lung metal fails to clear and leads to wood fire rising, burning true yin, treatment must employ the method of clearing metal to control wood, commonly using herbs like Sha Shen, Mai Dong, Shi Hu, Tian Dong, Pi Pa Ye, Yu Zhu, Shi Jue Ming, Zhi Zi, and Gua Lou Ren. Additionally, the commonly used formula Chi Yun Decoction (Yun Mu, Sheng Di, Yuan Shen, Mai Dong, Niu Bang Zi, Chi Shao, Huang Qin, Chi Xiao Dou, Ou Jie, Gan Cao) is also a formula for clearing metal to control wood, suitable for hemoptysis, coughing blood, and epistaxis.
Strengthening Water to Control Fire Method
This method is suitable for water deficiency and excessive fire, leading to symptoms of dizziness, tinnitus, spontaneous sweating, night sweats, tidal fever, and nocturnal emissions.
The kidney is the water organ, and when it communicates with heart fire, water and fire are in harmony, leading to abundant spirit. Conversely, if water and fire are not in harmony, and water does not nourish wood, yin and yang become imbalanced, resulting in disease. Liu Hejian stated: “Thus, those with wind stroke and paralysis are not due to the wind of liver wood, but rather due to excessive and sudden onset, not from external wind, but from improper rest, leading to excessive heart fire, kidney water deficiency, which cannot control it, resulting in yin deficiency and yang excess, causing heat to accumulate, leading to confusion of the spirit, and inability to move the muscles and bones, resulting in sudden collapse without awareness.” The formula Di Huang Yin Zi (Di Huang, Sang Pi, Shi Hu, Mai Dong, Wu Wei, Shi Chang Pu, Yuan Zhi, Fu Shen, Rou Cong Rong, Ba Jiao, Fu Zi, Rou Gui) is primarily used for treating heat stroke. By removing Ba Jiao, Fu Zi, and Rou Gui, and adding Huang Lian, Zhi Mu, and Huang Bai, it can treat conditions of excessive internal fire.
In clinical practice, we often encounter symptoms of kidney water deficiency and excessive heart fire, where the heart and kidney do not communicate. Using Tian Wang Bu Xin Dan, Zhu Sha An Shen Wan, and similar formulas often yields good results. Additionally, if kidney yin is deficient, fire may become excessive, disturbing the essence and leading to nocturnal emissions, the main formulas include Zhi Bai Di Huang Decoction with Mu Li, or San Cai Feng Sui Dan. As Zhang Jingyue stated: “Deficiency fire arises from lack of water; one should only supplement water to extinguish fire, thus achieving balance between yin and yang, and the disease will naturally heal. If one wishes to eliminate fire to restore water, the already deficient water may not be replenished, and removing fire will lead to the defeat of both yin and yang.”
For symptoms such as lower back soreness, dizziness, tinnitus, dry tongue, sore throat, and even thirst, one can use Liu Wei Di Huang Decoction with Shi Hu, black sesame, or Da Bu Yin Wan to tonify the kidney, benefit essence, nourish yin, and cool the blood, “strengthening the master of water to control excessive yang.”
In summary, the application of the strengthening water to control fire method involves using large doses to strengthen water to control fire, while simultaneously using methods to clear fire, paying attention to the different conditions of deficiency and excess.
New Media Editor | Xu Jing
