If we fall ill, those around us often ask with concern: where does it hurt? In Traditional Chinese Medicine (TCM) terms, any disease, from a symptomatic perspective, is fundamentally about the exterior and interior. We often say: a person lives by a breath of Qi. The maintenance of life and the health of the body depend on the smooth flow of Qi, and when Qi and blood are blocked, it is fundamentally about the upper jiao, middle jiao, and lower jiao. In other words, any disease exists between the upper and lower, exterior and interior.
1. If the middle jiao is blocked, then the upper jiao has heat and the lower jiao has cold.
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What is the San Jiao (Three Jiao)?
Many friends who have seen a TCM practitioner often hear the doctor say: heat rises and cold sinks; your middle jiao is blocked, hence “the upper jiao has heat, and the lower jiao has cold.” This simple statement contains several terms, so what exactly are the upper jiao, middle jiao, and lower jiao?
The upper jiao, middle jiao, and lower jiao collectively referred to as the San Jiao, is a unique term in the organ theory of TCM, representing one of the six fu organs, and is the largest of the fu organs, also known as the external fu or solitary organ.
In overview, the upper jiao is above the diaphragm, including the heart and lungs; the middle jiao is from the diaphragm to the navel, including the spleen and stomach; the lower jiao is from the navel to the two yin (the genital area), including the liver, kidneys, large and small intestines, bladder, and uterus. The liver, based on its location, should belong to the middle jiao, but due to its close relationship with the kidneys, it is classified with the lower jiao. Thus, the function of the San Jiao is essentially a summary of the functions of all the five zang and six fu organs.
We can use a metaphor: the San Jiao is like a large passageway in the human trunk. The meridians mainly run along the limbs, akin to a two-lane road, while the San Jiao runs along the trunk, encompassing the majority of the meridians, like an eight-lane highway. Therefore, unblocking the San Jiao is more important than unblocking any single meridian.
2. Why is there “heat above and cold below”?
TCM summarizes the main functions of the upper, middle, and lower jiao with the phrase: the upper jiao is like mist, the middle jiao is like fermentation, and the lower jiao is like drainage.
The upper jiao is like mist: the upper jiao of the heart and lungs distributes Qi and blood, resembling mist and dew that nourishes and warms all the organs and tissues of the body;
The middle jiao is like fermentation: the middle jiao of the spleen and stomach digests and transforms food and fluids, thereby generating Qi and blood;
The lower jiao is like drainage: the lower jiao transmits waste and excretes urine and feces.
In the circular movement of the body, heat needs to descend from above to warm the kidney water, while water needs to rise from below to nourish the heart fire. Heat naturally rises, and water naturally sinks; therefore, to allow heat to descend and water to rise, a force is needed to drive this process, and this force is the middle Qi, which is key to the rise and fall of Qi. The “middle Qi” is generated by the spleen and stomach; if their function is weak, the middle Qi will be insufficient, leading to blocked Qi pathways, preventing heat from descending, resulting in “heat above,” while kidney water cannot rise due to lack of warmth, resulting in “cold below.” In other words, if the spleen and stomach are strong, then the middle Qi is sufficient, the middle jiao is open, and the upper and lower jiao are connected, allowing Qi and blood to form a complete circuit.
Thus, the spleen’s upward movement and the stomach’s downward movement maintain the energy exchange between the upper jiao (heart and lungs) and the lower jiao (liver and kidneys) — when the spleen Qi rises, the kidney water ascends; when the stomach Qi descends, the heart fire lowers, allowing the heart fire and kidney water to interact in the middle jiao. Simultaneously, when the spleen Qi rises, clear Qi ascends to nourish the heart, lungs, and brain, while when the stomach Qi descends, turbid Qi descends to expel waste.
Clinically, if a person exhibits symptoms of “heat above and cold below,” or if issues arise between the upper and lower jiao due to the middle jiao’s inability to communicate, TCM often suggests treating from the middle jiao, focusing on regulating the spleen and stomach.
3. How to perform moxibustion for a blocked middle jiao?
As mentioned above, the blockage of the middle jiao focuses on regulating the spleen and stomach, with common acupuncture points including Pishu (Spleen Shu), Weishu (Stomach Shu), Zhongwan (Middle Cavity), Zusanli (Leg Three Miles), and Taibai (Great White). If there is spleen Qi deficiency, moxibustion can be added at Qihai (Sea of Qi); if there is heavy spleen dampness, moxibustion can be added at Yinlingquan (Yin Mound Spring), Fenglong (Abundant Dragon), and Jiexi (Stream Divide).
However, it is important to note that individuals with a blocked middle jiao are prone to excessive heat after moxibustion. To address this situation, there are generally two methods:
One: Directing heat downward
This is the method most people tend to choose, primarily using moxibustion on the lower jiao and points on the legs to direct heat downward, commonly used points include Zusanli, Yinlingquan, Sanyinjiao (Three Yin Intersection), and Yongquan (Gushing Spring). Additionally, it is recommended to soak the feet in hot water before moxibustion to direct heat downward; warming the legs opens the meridians, allowing the heat from the upper jiao to descend.
Another: Heavy moxibustion at Guanyuan
This is a method highly recommended by moxibustion expert Wang Zhenglong. He believes that excessive heat after moxibustion indicates that the yin pathogen is about to disperse; at this point, one should take the opportunity to perform heavy moxibustion at Guanyuan.
The human body has self-regulating functions, and the rise and fall of yin and yang within the body follow fixed patterns; when the vital energy is sufficient, yin and yang will operate regularly, rising when they should rise and descending when they should descend, thus there is no need to artificially manipulate it through methods like directing heat downward. Guanyuan is the gateway for the vital yin and yang energies to be stored; moxibustion at Guanyuan can enhance the true fire of the gate, replenish the vital energy, and restore the function of “storing without leaking,” allowing the scattered heat to return, thus the symptoms of excessive heat will disappear on their own, eliminating the need to direct heat downward. He suggests moxibustion at Guanyuan and Zhongwan together to accelerate the expulsion of yin pathogens.
Therefore, if excessive heat after moxibustion is particularly severe, one can pause for a few days or reduce the amount of moxibustion to allow the body to gradually adapt; if tolerable, it is recommended to proceed with heavy moxibustion at Guanyuan and Zhongwan. Although symptoms of excessive heat may still persist in the short term, persistence will lead to their eventual disappearance.
2. If the exterior and interior are disharmonious, the root lies in the Shaoyang and Jueyin.
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What is the exterior and interior?
The exterior and interior are two guiding principles for identifying the location of disease, the severity of the condition, and the trend of the disease.
The exterior and interior are relative concepts; for example, the skin and muscles are considered exterior, while the internal organs are considered interior; conversely, the organs are considered interior, while the fu organs are considered exterior.
In the differentiation of exterior and interior, the exterior primarily represents the external and internal locations of the disease and its depth.When external pathogens invade the exterior, it is often in the early stages of illness and generally mild; when the internal organs are affected, it is often due to the invasion of pathogens into the interior, commonly seen in the later stages of external diseases, and generally more severe.
When seeking treatment from a TCM practitioner, the differentiation of exterior and interior is commonly used,aiming to understand the severity of the condition, clarify the depth of the disease, and predict the development of the illness to gain the initiative in treatment.
2. What is Shaoyang syndrome?
Shaoyang syndrome is one type of syndrome among the “Three Yang” syndromes, which include Taiyang, Yangming, and Shaoyang.
In the “Shang Han Lun” (Treatise on Cold Damage), it is mentioned: “Fever and aversion to cold arise from yang; no fever and aversion to cold arise from yin.” This statement clearly indicates that: fever and aversion to cold are common characteristics of the “Three Yang” syndromes. However, there are distinctions between exterior syndromes, interior syndromes, and half-exterior half-interior syndromes.
Taiyang syndrome: is an exterior syndrome, treated by inducing sweating to release the exterior. Common symptoms include: fever, aversion to cold, stiffness and pain in the head and neck, and floating pulse. Among these, aversion to cold without sweating and a floating tight pulse is termed an exterior excess syndrome; sweating and aversion to wind with a floating relaxed pulse is termed an exterior deficiency syndrome; fever, thirst, desire to drink, and difficulty urinating is termed a water retention syndrome. The unique symptom of Taiyang syndrome is stiffness and pain in the head and neck.Yangming syndrome: is an interior syndrome,divided into two types: fever, aversion to heat, irritability, profuse sweating, great thirst, and a large pulse is termed an interior heat syndrome; tidal fever, delirium, abdominal pain, constipation for several days, and a deep, solid, forceful pulse is termed an interior excess syndrome. The unique symptom of Yangming syndrome is a full stomach, indicating dryness and heat in the stomach and intestines. Shaoyang syndrome: is a half-exterior half-interior syndrome,common symptoms include: alternating chills and fever, bitter taste in the mouth, dry throat, dizziness, fullness and pain in the chest and hypochondria, loss of appetite, irritability, and nausea, with a wiry pulse.The unique symptoms of Shaoyang syndrome are bitter taste in the mouth, dry throat, and dizziness.
Shaoyang disease lacks the exterior symptoms of Taiyang syndrome, and the pathogen is not in the exterior, hence sweating should not be induced (as sweating would deplete fluids and allow the pathogen to penetrate inward); it lacks the interior excess symptoms of Yangming syndrome, and the pathogen is not in the interior, hence purgatives should not be used (as purging would cause yin deficiency and provoke fire); there is no excess pathogen in the chest, hence vomiting should not be induced (as vomiting would harm yang and cause palpitations). Therefore, Shaoyang has three prohibitions (prohibition of sweating, prohibition of purging, prohibition of vomiting), and the treatment principle should focus on harmonizing the exterior and interior (i.e., a method of relieving heat without inducing sweating). However, since Shaoyang disease often combines both exterior and interior symptoms, it can be treated with a combination of Taiyang sweating methods or Yangming purging methods, depending on the symptoms.
3. How to perform moxibustion for disharmony between the exterior and interior?
Shaoyang plays an important role in the relationship between the exterior and interior, because the pathway between the exterior and interior lies in the Shaoyang.
From the perspective of meridians, Shaoyang includes the Hand Shaoyang Sanjiao Meridian and the Foot Shaoyang Gallbladder Meridian, and is interrelated with the Hand Jueyin Pericardium Meridian and the Foot Jueyin Liver Meridian. We can also infer from the symptoms: the Gallbladder Meridian runs along the two sides of the body; if the Gallbladder Meridian is blocked, it will cause fullness and pain in the chest and ribs; the Sanjiao Meridian connects to the Pericardium, and if the heart Qi cannot flow smoothly, it will lead to irritability. Therefore, to address disharmony between the exterior and interior, it is essential to unblock four meridians: the Sanjiao Meridian, Gallbladder Meridian, Pericardium Meridian, and Liver Meridian.
The Qi of the exterior comes from the Qi of the interior; only when the interior Qi is sufficient can the Qi of the exterior and half-exterior half-interior resist external pathogens. The material for moxibustion is mugwort, which has the medicinal property to “travel through the three yin and connect the twelve meridians,” capable of both releasing the exterior and entering the interior — releasing the exterior can expel pathogens outward; entering the interior can generate interior Qi, supplying the interior Qi to the surface, thus assisting the surface in resisting pathogens while also unblocking the middle jiao. If the middle jiao is free of pathogens, then the upper and lower jiao can communicate. In this way, the half-exterior half-interior pathogens can be completely eliminated.
Having read this article, do you understand why I recommend moxibustion? To emphasize again, because: unblocking the upper and lower requires smoothing the Qi mechanism of the middle jiao, which necessitates moxibustion to regulate the spleen and stomach to facilitate the middle Qi; disharmony between the exterior and interior requires sufficient interior Qi; when the interior Qi is sufficient, the evil Qi can be expelled, which requires moxibustion to supplement the Yang Qi to support the righteous Qi. Moxibustion allows the entire body to connect in Qi, naturally unblocking the upper and lower, harmonizing the exterior and interior, leading to a healthy body.
(End of the article, thank you for reading)
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