Understanding the Five Elements in Traditional Chinese Medicine

The Five Elements are revealed through the research method of “observing the heavens and examining the earth, understanding human affairs,” which uncovers the laws of the movement and change of Qi in nature throughout the year.

The Neijing places the Five Elements alongside Yin and Yang, considering both as the source of life.The theory of the Five Elements is an ancient natural science that studies the movement and change of Qi in nature, as well as the origins and laws of life. Understanding the Five Elements through the lens of Traditional Chinese Medicine (TCM)Understanding the Five Elements in Traditional Chinese MedicineThe Five Elements are one of the important contents of TCM theory. Based on the records in the Huangdi Neijing and other ancient texts, the author discusses the basic concepts of the Five Elements from the perspective of Qi’s movement.1. The Five Elements are not merely five materialsWhat is known as the Five Elements refers to Wood, Fire, Earth, Metal, and Water. However, if understood literally as five specific materials, they can only be called five materials, not the Five Elements.The concept of “five materials” has existed since ancient times. In the Zuo Zhuan, it states, “Heaven produces five materials, which the people use together; one cannot be discarded.” The Shangshu Dazhuan also records, “Water and Fire are what the people consume; Metal and Wood are what the people use for work; Earth is what nourishes all things, which is for human use,” referring to five materials, the five specific substances. Even if referred to as five elements, it still falls under the category of five materials.The character “行” (xing) in Five Elements, as explained in the Shuowen Jiezi, means “the steps of a person,” which implies walking, and can be extended to mean action, movement, or operation.In modern Chinese, terms like sidewalk, pedestrian street, and the character “行” in bicycle all carry this meaning. The so-called “Five Elements” should refer to the five modes of Qi’s operation in nature, or five forms of movement. The Baihu Tong from the Han Dynasty states, “The term ‘行’ refers to the movement of Qi in the heavens.” This means that the character “行” is used to describe the movement and operation of Qi in nature. Dong Zhongshu from the Han Dynasty elaborated in the Chunqiu Fanlu: “The Qi of heaven and earth combines into one, divides into Yin and Yang, distinguishes into four seasons, and categorizes into five elements. The different movements of Qi result in the Five Elements. They mutually generate and restrain each other.” It is clear that the Five Elements refer to the movement of Qi in heaven and earth; with Yin and Yang, there are four seasons, and with the four seasons, there are the Five Elements. The use of the character “行” is because the movement of Qi in heaven and earth is different.Between the Five Elements, they generate each other in the order of adjacent seasons and restrain each other in the order of alternating seasons, which is known as mutual restraint. The Suwen states, “Heaven has four seasons and five elements, for growth, storage, cold, heat, humidity, dryness, and wind,” linking the four seasons with the Five Elements. Therefore, in the Huangdi Neijing, the Five Elements are also referred to as “Five Movements,” as stated in the Suwen: Tianyuan Ji Dalu: “Heaven has five elements governing five positions, for growth, storage, cold, heat, humidity, dryness, and wind; humans have five organs transforming five Qi, generating joy, anger, thought, worry, and fear. Discussing the Five Movements and their interactions, at the end of the year, they cycle and repeat. The Five Movements of Yin and Yang are the way of heaven and earth… can they not be interconnected!”These all illustrate that the Five Elements reveal the laws of the movement and change of Qi between heaven and earth across the four seasons, reveal the intrinsic connection between humans and nature, and reveal the characteristics and interconnections of Qi in various organs of the human body.Thus, in the theory of the Five Elements, the five characters of Wood, Fire, Earth, Metal, and Water have transcended their original meanings as five specific materials or substances, rising to the level of five forms of Qi’s movement, from the material level to the metaphysical level of studying universal laws, that is, from the level of “tools” to the level of “Dao.”Understanding the Five Elements in Traditional Chinese Medicine2. Attributes and Classification of the Five ElementsWhat are the movement forms and characteristics represented by the Five Elements? What is the basis for classifying all things in nature using the Five Elements? The ancients used the method of “observing the heavens and examining the earth, understanding human affairs” to study this. Due to the Earth’s rotation and revolution, the ancestors living in the Northern Hemisphere could easily observe the daily and annual movements of the Big Dipper when looking at the night sky in the evening. Regarding the annual movement, when the handle of the Big Dipper points east in the evening, it corresponds to spring; when it points south, it corresponds to summer; when it points west, it corresponds to autumn; and when it points north, it corresponds to winter. This is the origin of the correspondence between directions and seasons.In the Shanghan Lun, Zhang Zhongjing wrote about the “Four Seasons, Eight Festivals, Twenty-Four Qi, and Seventy-Two Phenomena” to describe the relationship between the direction of the Big Dipper’s handle and the four seasons, eight major festivals (Beginning of Spring, Beginning of Summer, Beginning of Autumn, Beginning of Winter, Winter Solstice, Summer Solstice, Spring Equinox, Autumn Equinox), twenty-four Qi, and seventy-two phenomena.It is evident that using the direction of the Big Dipper’s handle to determine the seasons and solar terms is a long-standing and precise method, referred to as “Dipper Calendar” in the Shanghan Lun.Observing the heavens, the Dipper points east; examining the earth, it is spring. In this season, the gentle breeze warms, the ice and snow melt, seeds take root and sprout, and the roots and branches of plants extend. Bears, curled up in hibernation, emerge from their dens at the call of spring, stretching their bodies; snakes, coiled in hibernation, awaken to the spring breeze, stretching out and slowly crawling out of their caves, beginning a new year of life… From the observation of phenology to the ancient discussions about the dispersal and emergence of Yang Qi in spring, it is suggested that in spring, the movement of Qi’s expansion and release controls or dominates all biological activities in nature. Since the roots and branches of trees prefer to spread and extend, the ancients named the form of Qi’s expansion and release as “Wood.” Therefore, “Wood” in the Five Elements does not refer to specific trees or timber but represents the movement of Qi’s expansion and release in nature during spring. Heaven has five elements, and humans have five organs; in TCM, the liver corresponds to spring Qi, meaning that the physiological characteristics of the liver correspond to the dispersive and expansive Qi of Wood. Clinically, by regulating and soothing the liver, it can treat heart and lung diseases above, and promote bowel movements and diuresis below, as well as treat gynecological diseases, all utilizing the liver’s function of dispersing and releasing. However, some texts state that the liver governs “ascending,” while spring Qi governs “emergence,” which is debatable. The liver governs growth, and spring Qi governs emergence and expansion, which is the original meaning of the Huangdi Neijing.The Dipper points south, and the earth is in summer, with hot weather. The growth of roots underground slows significantly, while the branches and leaves above ground flourish, and animals become more active, creating a scene of vitality and prosperity in nature. From the observation of phenology to the ancient discussions about the flourishing of Yang Qi in summer, the rise of summer Qi, and the thriving of all things, it is suggested that in summer, the movement of Qi’s ascent controls or dominates all biological activities in nature. Due to the fiery nature of fire, it is named “Fire.” Therefore, the one that rises is Fire Qi, not Wood Qi. Once the movement of Wood Qi changes from “growth” to “ascent,” it becomes Wood stagnating into Fire, leading to pathological conditions.The Dipper points west, and the earth is in autumn, with cool and dry weather. The branches and leaves of plants wither, and the tips of the roots dry out, as nutrients are stored within the main trunk, into the fruits and seeds; hibernating animals accumulate a large amount of fat, appearing bloated, to prepare for the harsh winter ahead, entering a state of hibernation and slowly utilizing this energy. From the observation of phenology to the ancient discussions about the need to conserve spirit and energy in autumn, the path of nourishment and the command of autumn Qi to gather, it is clear that in autumn, the movement of Qi’s inward gathering controls or dominates all biological activities in nature. Due to the high density of metals, symbolizing gathering and concentration, it is named “Metal.”The Dipper points north, and the earth is in winter, with severe cold. All things are hidden. Seeds are buried deep in the soil, life is dormant, and hibernating animals stay deep in their dens, with their basic metabolism at the lowest level. From the observation of phenology to the ancient discussions about the closure of the earth’s doors in winter, the concealment of Yang Qi, the descent of Yang Qi, the descent of earth Qi, and the command of winter Qi to nourish and store, it is suggested that in winter, the movement of Qi’s descent and concealment controls or dominates all biological activities in nature. Due to the downward nature of water, symbolizing descent and concealment, it is named “Water.”From spring to summer, it transitions from the expansion of Wood Qi to the ascent of Fire Qi, representing the Yang movement of Qi; from autumn to winter, it transitions from the inward gathering of Metal Qi to the descent of Water Qi, representing the Yin movement of Qi. The transition from Yang to Yin requires a transitional phase at the turn of summer and autumn, which TCM refers to as “Long Summer.” In Long Summer, the heat of summer has not dissipated, and continuous rain makes the climate hot and humid. At this time, the growth of branches and tips slows down, having already flowered and fruited, and is now nurturing seeds and fruits; animals are nurturing their young, and reproduction is not as active as in spring and summer. Thus, it can be inferred that this time is dominated by the stable movement of Qi, balancing the movements of expansion and inward gathering, and the movements of ascent and descent, maintaining a dynamic stability, and since the nature of Earth is the most stable and solid, it is named “Earth.”In fact, from the expansion of Wood Qi in spring to the ascent of Fire Qi in summer; from the inward gathering of Metal Qi in autumn to the descent of Water Qi in winter; from the descent of Water Qi in winter to the expansion of Wood Qi in spring, there exists a period of smooth transition.Thus, the Huangdi Neijing mentions the saying “Earth flourishes in all four seasons.” The so-called flourishing of Earth in all four seasons refers to the last 18 days of each season, where the stable movement of Earth Qi predominates.Accompanied by the shifting of the stars in the sky and the changing of the seasons on the ground—spring, summer, Long Summer, autumn, and winter—the Qi of nature undergoes orderly movements and changes of expansion, ascent, stability, inward gathering, and descent, which the ancients represented with Wood, Fire, Earth, Metal, and Water to signify their movement characteristics. This is called the Five Elements. Of course, the determining factors for seasonal changes are related to the periodic changes in the distance of the Earth from the Sun during its revolution around the Sun, and are not dependent on the direction of the Big Dipper’s handle; the direction of the Dipper is merely a reference for observing celestial phenomena, yet it is one of the contents of the classification of the Five Elements.Understanding the Five Elements in Traditional Chinese Medicine3. The Generating and Restraining of the Five ElementsBetween the Five Elements, in the order of the seasons, they mutually generate, nourish, assist, and promote each other, which is called the mutual generation of the Five Elements, as stated in the Chunqiu Fanlu: “They mutually generate each other.” The expansion of Wood Qi in spring creates conditions for the ascent of Fire Qi in summer, called Wood generating Fire; the inward gathering of Metal Qi in autumn provides the premise for the descent of Water Qi in winter, called Metal generating Water; when Fire Qi rises to its peak, it must stop rising and stabilize, called Fire generating Earth; the stability of Earth Qi in Long Summer transitions to the inward gathering of Metal Qi in autumn, called Earth generating Metal; and the descent of Water Qi in winter, with life concealed, preserves energy for the emergence and expansion of Wood Qi in the following spring, which is Water generating Wood.Between the Five Elements, in the order of alternating seasons, they restrict, suppress, and restrain each other, which is called the mutual restraint of the Five Elements, as stated in the Chunqiu Fanlu: “They mutually restrain each other.”For example, the expansion of Wood Qi restrains the excessive stability of Earth Qi to prevent its tendency to become overly solid and inward gathering, called Wood restraining Earth; the stability of Earth Qi can restrain the excessive descent of Water Qi, called Earth restraining Water; the descent of Water Qi restrains the excessive ascent of Fire Qi, called Water restraining Fire; the ascent of Fire Qi restrains the excessive inward gathering of Metal Qi to prevent its premature descent, called Fire restraining Metal; and the inward gathering of Metal Qi restrains the excessive expansion of Wood Qi, called Metal restraining Wood.Indeed, the explanation of the generating and restraining of the Five Elements can also be discussed from the relationships between the five materials. For instance, the Suwen: Baoming Quansheng Lun states: “Wood is felled by Metal, Water is extinguished by Fire, Earth is reached by Wood, Metal is deficient by Fire, Water is exhausted by Earth; all things are thus, and cannot be exhausted.” Similarly, the Wuxing Dayi states: “Wood generates Fire because of its warm nature; Fire lies within it, burning and emerging, hence Wood generates Fire. Fire generates Earth because it is hot enough to burn Wood, and the ashes become Earth, thus Fire generates Earth…” At first glance, this seems mechanical and even somewhat forced, but from the perspective of the Suwen stating “all things are thus, and cannot be exhausted,” it should represent the generating and restraining laws of the Five Elements through the relationships between the five materials.Qing Dynasty physician Huang Yuanyu clearly stated in the Si Sheng Xinyuan: “The mutual generation and restraint are all based on Qi, not on quality; once it becomes quality, it cannot generate or restrain.” The “Qi” referred to by Huang is the movement of Qi, while “quality” refers to specific materials or substances.Thus, Huang further stated: “Mutual restraint is to control excess. The dispersive nature of Wood is restrained by Metal Qi, so Wood does not disperse excessively; the ascending nature of Fire is restrained by Water Qi, so Fire does not excessively rise; the moistening nature of Earth is restrained by Wood Qi, so Earth does not become excessively moist; the inward gathering of Metal Qi is warmed by Fire Qi, so Metal does not excessively gather; the descending nature of Water is restrained by Earth Qi, so Water does not excessively moisten. All are the marvelous transformations of Qi.” Although there are some differences in details from the previous explanations, the essence is consistent, all recognizing the nature of the mutual generation and restraint of the Five Elements from the perspective of the movement forms of Qi.Between the Five Elements, there is mutual generation to prevent any element from being deficient, and mutual restraint to prevent any element from being excessive. Within generation, there is restraint; within restraint, there is generation, leading to the stability of Qi’s changes throughout the year. Only with such stability, after billions of years of evolution, has a vibrant world of life emerged, thus all life bears the imprint of the Five Elements. Plants have growth and storage rhythms, and animals have life processes of growth, aging, and death. The teeth of trees, horses, cattle, sheep, the scales of fish, the growth rings on turtle shells, and even the ice layers in Antarctica all reflect the wonders of the Five Elements.The Suwen: Tianyuan Ji Dalu states: “The Five Movements of Yin and Yang are the way of heaven and earth, the framework of all things, the parents of change, the origin of life and death, the abode of the divine and mysterious; can they not be interconnected!” It places the Five Movements, that is, the Five Elements, alongside Yin and Yang, considering both as the source of life.The Shanghan Zhubing Lunji states: “Heaven distributes the Five Elements to operate all kinds of things; humans inherit the five constants to have five organs, meridians, and the meeting of Yin and Yang, the mysterious and subtle, the changes are difficult to exhaust…” Although some believe this passage may be a later addition and not necessarily the original words of Zhang Zhongjing, it is certainly not modern language. It is evident that the ancients did not regard the Five Elements as five specific materials or substances on Earth, but as the laws of Qi’s movement that nurture and govern all things, even referring to them as the “Five Constants.”Since the theory of the Five Elements gradually formed over a long historical process, different viewpoints emerged during its formation, and even different understandings arose in applying the Five Elements to classify the natural world and human organs. This is entirely possible and objectively exists, and is understandable.Moreover, Daoists, alchemists, military strategists, Confucians, and geomancers have all adapted and transformed the theory of the Five Elements according to their respective needs, which is also a historical fact. However, the theory of the Five Elements in TCM, like the theory of Yin and Yang, originally stems from the ancient human study of the movement and change of Qi in nature, as well as the origins and laws of life. TCM is based on natural laws and life principles to prevent and treat diseases.· The End · Warm Reminder:This platform shares health-related graphic information for reference and learning purposes only, and should not be used as a basis for medical diagnosis. If needed, please consult a physician for guidance.⊙ Copyright Statement: The article is sourced from the internet; if there is any infringement, please contact us for removal.

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Understanding the Five Elements in Traditional Chinese Medicine

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