Introduction Using the Five Elements of generation, overcoming, and mutual restraint, the five internal organs correspond to five colors. The internal conditions must manifest externally as guidance. Coupled with the theory of Qi movement, all diseases can be attributed to abnormal Qi circulation, making it easy to identify the source of dysfunction. At this point, methods such as bian (stone therapy), zhen (acupuncture), jiu (moxibustion), and yao (medication) can be employed to regulate Qi, restoring its upward and downward flow, thus enabling the body to regain health.
Qi Movement Up and Down – The Essence of TCM in Treating Diseases
The theory of TCM is quite simple. The five internal organs and six bowels are distributed vertically, and each organ is in a dynamic state guided by Qi movement.The kidney is at the bottom and is the organ associated with water. TCM states that the kidney contains fire within water; water represents kidney Yin, and fire represents kidney Yang. Fire rises, generating earth; the upward movement of kidney fire warms the spleen earth, allowing the spleen to process the nutrients absorbed by the stomach, refining the coarse into the subtle, distributing the refined substances throughout the body. The nature of the spleen is also upward, with some nutrients needing to be sent to the lungs above, where they combine with the subtle substances in the air, and then the lungs distribute them throughout the body. The spleen Qi rises from the left side.The water in the kidney nourishes wood, and the wood Qi thrives under the nourishment of water, rising upwards, while the liver Qi also ascends from the left. Following the upward movement of spleen earth Qi, there is a saying in TCM: “the liver rises with the spleen, and the gallbladder descends with the stomach.” Therefore, if there is a disease in the left ascending organs, one should consider whether the upward movement of liver and spleen Qi is normal, especially the liver Qi.The liver belongs to wood, and this Qi movement rises to the top, where the lungs and heart are located. Wood generates fire; the heart, belonging to fire, has the characteristic of upward inflammation. However, due to the presence of the lungs, the heart fire is directed downward.The lungs belong to metal and govern descent, causing the Qi movement to begin descending. The heart fire, which originally wants to rise, is pulled down by the lung metal, leading the heart to descend until it reaches the kidneys, warming the kidney water to prevent it from becoming cold. Meanwhile, the kidney water rises with the liver wood, reaching the position of heart fire, preventing the heart fire from becoming too hot, which is referred to as “water and fire in harmony.”If the descending process is disrupted, the heart fire cannot descend, leading to excessive heat above and cold below. The heart is prone to heat, which can cause insomnia, vivid dreams, and sores on the tongue, while the cold below can lead to abdominal cold and coolness in the lower limbs. As the lung metal descends, food enters the stomach, and substances move downward, causing the stomach Qi to descend.The spleen, being Yin earth, and the stomach, being Yang earth, must have Yang descend and Yin ascend. As the stomach Qi descends, the gallbladder Qi also descends, with bile entering the duodenum along with the stomach contents, in accordance with the saying “the gallbladder descends with the stomach.” If the stomach is diseased, it is due to the stomach Qi not descending; if it does not descend, it will rise, causing bile to reflux, which is the result of Qi movement reversing. The descent of stomach and gallbladder Qi occurs on the right side. If the right side organs are diseased, one should consider whether the Qi movement downward is encountering issues.The spleen earth rises on the left, while liver Qi and kidney water also rise; stomach Qi descends on the right, while lung Qi, gallbladder Qi, and heart fire descend. This creates a pattern of Qi movement where the left side rises and the right side descends . The spleen and stomach, one Yin and one Yang, serve as the central axis around which everything revolves.Based on the principles of the Five Elements of generation, overcoming, and mutual restraint, as well as the “diagnostic view” of the five organs corresponding to five colors, and the guidance that internal conditions must manifest externally, one can observe the body, facial features, and complexion, and utilize methods such as smelling, inquiring, listening, and pulse diagnosis to discern diseases through meridian differentiation. Coupled with this theory of Qi movement, it becomes easy to identify the causes.All diseases can be attributed to abnormal movement, pinpointing where the dysfunction lies. At this point, methods such as bian, zhen, jiu, and yao can be employed to regulate Qi, restoring its upward and downward flow, thus enabling the body to regain health.
Discussing the Pathogenesis of Six Meridians Diseases from the Perspective of Qi Movement
The basic forms of Qi movement are Yin rising, Yang descending, Yin exiting, and Yang entering, with the central earth serving as the pivot, and fire, metal, water, and wood representing the coordinated operation. The physiological and pathological states of the human body reflect the normal and abnormal Qi movement. Therefore, the pathogenesis of the Six Meridians diseases in the Shang Han Lun can be explored using this theory as guidance.1. Taiyang Disease is the disorder of the entry and exit of Ying and Wei QiTaiyang disease mainly refers to exterior syndromes. Zhou Xuehai in his Notes on Medicine states: “The external response of the skin and hair, coordinating with Ying and Wei, governs the exterior of the body, which is the Qi of the Taiyang bladder.” Therefore, it is essential to understand the entry and exit of Ying and Wei Qi. Ying is Yin within the pulse, while Wei is Yang outside the pulse. Ying and Wei must coordinate, with Ying exiting and Wei entering. If Ying is internal and does not exit, and Wei is external and does not enter, it leads to disharmony between Ying and Wei, resulting in Taiyang disease.Taiyang Wind occurs when a patient is externally affected by wind-cold, with wind being the predominant evil. Wind is dispersive, causing Wei Qi to move outward, unable to secure Ying Yin, leading to Ying Yin leaking from the external openings, resulting in fever and aversion to wind, necessitating sweating. Taiyang Cold Damage occurs when a patient is externally affected by wind-cold, with cold being the predominant evil. Cold is constrictive, causing Ying and Wei Qi to become stagnant, preventing Wei Qi from entering and Ying Yin from exiting, resulting in fever and aversion to cold without sweating.Both conditions require harmonizing Ying and Wei. For cases where Ying and Wei are separated due to Wei Qi moving outward, one should guide Wei into Ying, treating with Gui Zhi Tang (Cinnamon Twig Decoction). For cases where Ying and Wei are separated due to stagnation, one should release the exterior and disperse cold, treating with Ma Huang Tang (Ephedra Decoction).As for “patients with no other diseases, experiencing fever and spontaneous sweating that does not resolve,” the reason for inducing sweating and “sweating at the right time” is that the Wei Qi is not always floating externally but sometimes floats outward, hence the spontaneous sweating. However, at this time, Ying Yin leaks from the external openings, so even with sweating, Ying and Wei remain uncoordinated. It is necessary to rely on the medicinal power to induce sweating, allowing Ying Yin to reach Wei, enabling Yang to be attracted to Yin and enter, thus preventing Wei Qi from floating externally. The “sweating at the right time” means taking the medicine to induce sweating before sweating occurs, as at this time, Ying and Wei are relatively close , making it easier for Ying Yin to reach Wei and for the two to harmonize, thus achieving the desired medicinal effect without excessive sweating. The principle stated by Xu Lingtai, “spontaneous sweating indicates separation of Ying and Wei, inducing sweating to harmonize Ying and Wei,” is based on this.2. Yangming Disease is the failure of Yang Earth Qi to descend“Stomach fullness” is the pathogenesis of Yangming disease. The stomach Qi should naturally descend; thus, “stomach fullness” indicates that the stomach Qi is obstructed by pathogenic factors and cannot descend. The stomach is Yang Earth, and its Qi not descending often presents as excessive Yang heat rising outward. If stomach heat pervades the Yangming meridian, filling both the interior and exterior, symptoms such as high fever, thirst, profuse sweating, and a rapid pulse are observed, indicating Yangming meridian syndrome. If dryness and heat combine, leading to dry stools obstructing the stomach and intestines, with symptoms such as tidal fever, constipation, delirium, frequent urination, abdominal distension, and a firm pulse, this indicates Yangming organ syndrome. Regardless of whether it is meridian syndrome or organ syndrome, both belong to the failure of Yang Earth Qi to descend.One of the most thought-provoking points in the Yangming chapter is the “spleen constraint” syndrome. The original text states, “The pulse of the foot Yang is floating and rough; floating indicates strong stomach Qi, and rough indicates frequent urination; floating and rough colliding leads to hard stools, indicating spleen constraint, treated with Ma Zi Ren Wan (Hemp Seed Pill).” Many scholars interpret this as the stomach being strong and the spleen being weak, with the spleen being constrained, but this reasoning is not thorough. When explained using the theory of Qi movement, it becomes clear. This syndrome arises after sweating, purging, and promoting urination in Taiyang disease, leading to loss of body fluids and dryness in the stomach. Although there is dryness and heat in the stomach and intestines, the primary issue is still the deficiency of stomach Yin.The failure of Yang Earth Qi to descend is a pathological hyperactivity, hence the statement “floating indicates strong stomach Qi”; the spleen Qi does not rise, and body fluids leak, hence “rough indicates frequent urination.” The root cause is the strong stomach Qi not descending, leading to the weak spleen Qi not rising, hence the statement “floating and rough colliding leads to hard stools, indicating spleen constraint.” It is evident that Zhang Zhongjing’s discussion of spleen constraint in the Yangming chapter aims to help readers understand the intrinsic connection between the spleen and stomach in the context of Qi movement.3. Shaoyang Disease is the obstruction of the pathways of Qi movementZhou Xuehai in his Notes on Medicine states, “The passage between the interior and exterior, governed by the pores, is the Qi of the Shaoyang Sanjiao.” For Shaoyang disease, it should not only be understood as a gallbladder disease but primarily as a Sanjiao disease.The Jin Kui Yao Lue states: “The pores are where the Sanjiao connects with the original Qi, and the pathways are the patterns of the skin and internal organs.” “All internal organs, external skin, flesh, vessels, tendons, and bones, and the spaces between these tissues are where the Sanjiao connects with the original Qi, thus governed by Shaoyang. Therefore, it is clear that “the Qi of the exterior and interior all enters and exits through the Sanjiao.” The Sanjiao serves as the channel for Qi and water; if evil enters the Shaoyang, the pathways of Qi movement become obstructed, leading to abnormal Yin exiting and Yang entering, as well as abnormal Yin rising and Yang descending.The key symptoms of Shaoyang disease are “bitter mouth, dry throat, and dizziness.” This only reflects the upward inflammation of Shaoyang fire and is insufficient to represent the pathogenesis of Shaoyang disease; it should be analyzed in conjunction with the symptoms of Xiao Chai Hu Tang (Minor Bupleurum Decoction). This syndrome presents with symptoms such as “alternating chills and fever, fullness in the chest and hypochondrium, aversion to food, irritability, nausea, or discomfort in the chest without nausea, thirst, abdominal pain, hardness in the hypochondrium, palpitations, difficulty urinating, or no thirst, slight fever, or cough,” with symptoms manifesting throughout the body, both exterior and interior. Alternating chills and fever indicate the subjective experience of alternating cold and heat. The pores are between the skin and flesh, and the evil obstructs the Sanjiao; if it enters the pores, it causes alternating chills and fever; if it enters the interior, it causes heat without cold, thus leading to the alternating appearance of chills and fever.Fullness in the chest and hypochondrium, aversion to food, irritability, nausea, thirst, abdominal pain, and hardness in the hypochondrium are mostly related to gallbladder disease, caused by the Qi of gallbladder wood not being smooth, or due to wood fire rising, or gallbladder wood invading the stomach. Symptoms such as fullness in the chest without nausea, cough, palpitations, difficulty urinating, no thirst, slight fever, indicate that the issue is more related to the Sanjiao Qi pathways being obstructed, leading to disordered Qi and water movement.Therefore, the text points out that “blood weakens and Qi is exhausted, the pores open, and the evil Qi enters and collides with the righteous Qi,” clearly indicating that Shaoyang governs the Sanjiao and the pores.4. Taiyin Disease is the failure of Yin Earth Qi to riseIn terms of the Shang Han Lun, Taiyin disease primarily involves the changes in the spleen.The key points of Taiyin disease state: “Taiyin disease presents with abdominal fullness and vomiting, inability to eat, and frequent diarrhea, with abdominal pain that worsens upon defecation, leading to hardness below the chest.” The most important symptom is frequent diarrhea. “Frequent diarrhea” indicates abdominal fullness and vomiting, inability to eat, and a series of symptoms that worsen with diarrhea, indicating that diarrhea is the key to the overall situation of Taiyin disease and determines the progression of the condition.Thus, the text reiterates: “Frequent diarrhea without thirst belongs to Taiyin, due to the cold in the organ.” This implies that even with abdominal fullness and vomiting, inability to eat, if there is no frequent diarrhea, it should be considered whether it belongs to Taiyin deficiency-cold syndrome.Clinically, abdominal fullness and vomiting, inability to eat, can be attributed to both spleen and stomach issues, as Yangming organ fullness can also present with these symptoms. Besides distinguishing these symptoms based on their characteristics, the key point for differentiation is whether there is accompanying diarrhea, and whether it worsens with diarrhea. This is because the spleen is Yin Earth, and its Qi should rise; if the spleen Qi does not rise, the clear Qi will descend, hence the Su Wen: Treatise on Yin and Yang states: “If the clear Qi is below, it leads to vomiting and diarrhea.” The spleen and stomach reside in the central earth, serving as the pivot for Qi movement. If the spleen earth Qi does not rise from the left, then the stomach earth Qi cannot descend from the right, which is similar to the situation where the stomach earth Qi does not descend, leading to the spleen earth Qi not rising.Therefore, Taiyin deficiency-cold with frequent diarrhea is often accompanied by abdominal fullness and vomiting, and the symptoms of stomach Qi not descending, as stated in the Su Wen: Treatise on Yin and Yang, “If the turbid Qi is above, it leads to abdominal distension.” The Ling Shu: Treatise on Yin and Yang states, “Yin is clear and Yang is turbid,” indicating that the stomach is Yang Earth, and the Yang Earth Qi not descending leads to turbid Qi being above.However, the failure of the stomach turbid Qi to descend in Taiyin disease differs from that in Yangming disease; Taiyin deficiency-cold syndrome is characterized by the failure of clear Qi to rise as the root, while the failure of turbid Qi to descend is a symptom. Therefore, abdominal fullness may sometimes lessen (if warmth and the Yang Qi temporarily circulate, it may lessen); although there is vomiting, it is not that food is immediately vomited; although there is inability to eat, it is merely a lack of appetite, not an inability to ingest food. Additionally, abdominal pain must be intermittent, worsening with pressure, rather than continuous pain that worsens with pressure. It is evident that the key to this syndrome lies not in the stomach, which governs ingestion, but in the spleen, which governs transformation and transportation. Therefore, the text states: “It should be warmed, and it is advisable to take Si Ni San (Frigid Extremities Powder).” Clearly, Si Ni San encompasses all formulas that warm and promote spleen Yang, elevating clear Qi and descending turbid Qi.5. Shaoyin Disease is the disorder of the rise and fall of water and fireThe heart belongs to fire, and the kidney belongs to water; the rise of water and the fall of fire is fundamental to maintaining the balance of Yin and Yang in the body. Shaoyin disease is characterized by the disorder of the rise and fall of heart and kidney water and fire. The causes may stem from the excess or deficiency of water and fire within water and fire, but essentially, it is a matter of the decline of fire and water, with the excess of water or fire occurring on the basis of the deficiency of fire or water, thus Shaoyin disease encompasses both Yang deficiency-cold transformation syndrome and Yin deficiency-heat transformation syndrome.Shaoyin cold transformation syndrome is caused by the decline of heart and kidney Yang, particularly the decline of kidney Yang. “The lower jiao is deficient and cold, unable to control water” is its basic pathogenesis. When kidney Yang is weak, it cannot vaporize kidney water to reach above or outside, leading to diarrhea below and “white urine,” while above, it leads to thirst, hence the statement “the deficiency leads to drawing water for self-rescue; if the urine is white, all symptoms of Shaoyin disease are present.” If this is not treated, the lower jiao will become obstructed and unable to transform, while the upper and external Yin fluids will become even more deficient, leading to the Yang Qi above and outside being unable to descend or enter, instead rising and floating outward, forming the conditions of Da Yang syndrome and Ge Yang syndrome.The upper organs include the heart, lungs, and stomach; if heart Yang does not descend, it leads to agitation; if lung Yang does not descend, it leads to throat pain; if stomach Yang does not descend, it leads to dry retching. The Yang Qi in the upper part cannot descend to the lower; in severe cases, “the complexion turns red.” If the Yang Qi on the surface cannot enter the interior, it leads to fever, sweating, and in severe cases, “the body does not feel aversion to cold.” The treatment should focus on the root, strengthening Yang Qi and vaporizing fluids, hence the use of Sheng Fu Zi (Fresh Aconite) and Gan Jiang (Dried Ginger) as main herbs. For mild cases, Si Ni Tang (Frigid Extremities Decoction) is used. For severe cases of Ge Yang syndrome, Tong Mai Si Ni Tang (Four Reverse Decoction to Open the Pulse) is used, with heavy doses of Sheng Fu Zi and Gan Jiang, along with roasted licorice to transform and generate blood in the middle jiao, allowing the blood vessels to open, and since the spleen is the source of blood, supplementing the spleen to generate blood allows the surface Yang to be nourished by Yin and enter, thus resolving the Ge Yang syndrome.For severe cases of Da Yang syndrome, Bai Tong Tang (White Passage Decoction) is used, combining scallions with Sheng Fu Zi and Gan Jiang, as scallions are white and have a very pungent flavor, which can moisten kidney dryness, open the pores, generate fluids, and facilitate Qi movement. This first guides the fluids upward, allowing the Yang Qi above to be attracted and descend, thus resolving the red complexion of Da Yang syndrome.Shaoyin heat transformation syndrome is caused by kidney water deficiency, unable to nourish heart fire, and insufficient heart blood, unable to carry heart fire downward. Heart fire rises, causing restlessness, and Yang does not enter Yin, hence “the heart is agitated and cannot sleep.” The treatment should focus on nourishing kidney water and heart blood, with adjuncts to clear the heart and descend fire, hence the use of Huang Lian and Ejiao Tang (Coptis and Donkey-hide Gelatin Decoction). In this formula, Ejiao and Bai Shao nourish Yin and blood, while Huang Qin and Huang Lian clear the heart and descend fire, with egg yolk serving as a mediator, thus allowing water to rise and fire to descend, resolving all symptoms.6. Jueyin Disease is the disorder of the rise and fall of Qi and bloodJueyin disease can present with cold syndromes, heat syndromes, and particularly with mixed cold and heat syndromes. Exploring the causes of these syndromes is an important topic in the study of the Shang Han Lun.Jueyin cold-heat mixed syndrome arises from the deficiency of Shaoyin cold syndrome, where Yang is deficient and Yin is also deficient. The reasons for Yin deficiency are twofold: one is the decline of Shaoyin Yang, which cannot vaporize Yin fluids; without Yang, Yin cannot generate; the other is prolonged diarrhea, leading to excessive loss of Yin fluids. The Shaoyin chapter emphasizes symptoms such as “diarrhea stops and dizziness occurs,” “vomiting and diarrhea stop, sweating leads to syncope, and the limbs are stiff and cannot be released,” “diarrhea stops and the pulse is absent,” “frequent changes of clothing, yet still less,” and “diarrhea stops and blood is lost,” indicating symptoms of Yang damage and Yin depletion, which lay the groundwork for the subsequent discussion of Jueyin cold-heat mixed syndrome.Due to Yang deficiency, it inevitably leads to cold below, while Yin deficiency leads to heat above. When it reaches Jueyin, although the fire of the heart is insufficient (if it were sufficient, it could resist Yin evils and prevent disease), the Yin is exhausted, but there is still a chance for Yang to recover, allowing the fire to expand. At this moment, kidney Yin is severely deficient, and liver blood is also insufficient due to kidney Yin deficiency, leading to the inability of Yin to attract Yang, water cannot nourish fire, and water cannot contain wood, resulting in the fire of the heart being excessively strong, causing a reversal of Qi movement. The fire of the heart is the fire of Jueyin, where Qi is Yang and blood is Yin; Qi fire should descend but instead rises, while blood should rise but does not nourish, thus also belonging to the disorder of Qi movement where Yin does not rise and Yang does not descend.This syndrome has cold as the root, with the heat above caused by insufficient blood being a symptom. Therefore, the treatment should primarily focus on warming the cold below. However, since Yin fluids are insufficient, simply warming the cold below may further deplete Yin blood, hence it is necessary to supplement Yin, nourish Yin, and strengthen Yin. At this time, if the heat above is not eliminated, it will further absorb kidney water, thus it is also necessary to clear the heat above. Therefore, the overall treatment principle should be to warm the cold below, clear the heat above, and nourish Yin blood. Wu Mei Wan (Mume Pill) is a formula that combines the three methods of ascending, descending, and nourishing, which can serve as a reference for formulating treatments for these syndromes in clinical practice.Jueyin cold syndrome includes Wu Zhu Yu Tang (Evodia Decoction) for liver Qi deficiency, insufficient liver Yang, and turbid Yin rising, as well as Dang Gui Si Ni Tang (Angelica Decoction for Cold Extremities) for blood deficiency and cold stagnation. One focuses on Qi, while the other focuses on blood: one pertains to the meridians, while the other pertains to the blood vessels. Jueyin cold syndrome also includes “frequent diarrhea of clear grains, internal cold and external heat, sweating and syncope,” treated similarly to Shaoyin Ge Yang syndrome.Jueyin heat syndrome may arise from prolonged liver Qi stagnation transforming into heat, or from excessive Yang recovery, both of which can easily injure Yin blood, leading to throat pain and throat obstruction above, and diarrhea with pus and blood below.It is evident that Jueyin disease, whether cold syndrome, heat syndrome, or mixed cold and heat syndrome, all stem from the disordered rise and fall of Qi and blood, resulting in Qi movement reversal.