Traditional Chinese Medicine (TCM) posits that the organs and tissues of the human body, including the five zang organs, six fu organs, five senses, limbs, skin, muscles, and bones, while each having distinct physiological functions, are interconnected. This connection forms an organic whole, with the meridian system serving as the primary means of communication and coordination within the body.
The meridians are akin to rivers on the ground, crisscrossing and interweaving, with main channels and tributaries. The main channels are called jing (经), also known as meridians, while the tributaries are called luo (络), which refers to networks or connections.
The term “pulse” (脉) appeared earlier, followed by the concepts of jing and luo. The pulse refers to the heartbeat, which relies on blood, the constriction of blood vessels, and the propulsion of qi (气). These activities are governed by the heart, hence TCM states that “the heart governs blood and pulse”.
The larger blood vessels are referred to as jing, while the smaller vessels are called luo. There are twelve primary meridians in the human body, six on the hands and six on the feet, known as the Taiyang, Shaoyang, Yangming, Taiyin, Shaoyin, and Jueyin meridians. They are systematically arranged to form a closed network that connects the surface of the body with the internal organs.
The meridian system is primarily composed of the twelve primary meridians, which branch out into 365 luo, distributed throughout the body, interconnecting and facilitating the flow of qi and blood, thus linking all parts of the body closely. The smaller branches of the meridians are called sun luo (孙络), which are associated with numerous acupuncture points, akin to deep pools in rivers.
In addition to the twelve meridians distributed in the limbs, there are also the eight extraordinary meridians primarily located in the trunk of the body. Among these, the Ren meridian (任脉) along the front midline, the Du meridian (督脉) along the back midline, and the Dai meridian (带脉) around the waist have significant impacts on the body. Additionally, there are the Chong meridians (冲脉) located on both sides of the front midline.
Under normal circumstances, the meridian system plays a crucial role in the circulation of qi and blood, as well as in coordinating the yin and yang of the body. The “Huangdi Neijing” states: “The meridians are responsible for the circulation of blood and qi, nourishing the yin and yang, moistening the muscles and bones, and facilitating the joints.”
The circulation of blood and qi in the meridians primarily relies on the propulsion of heart qi and the zong qi (宗气) in the chest. Specifically, as qi flows along the meridians, it divides into ying qi (营气) and wei qi (卫气). Ying qi circulates within the meridians, nourishing the entire body and transforming into blood; wei qi, on the other hand, disperses outside the meridians, protecting the body from pathogenic invasions, regulating body temperature, managing sweat secretion, and nourishing the skin and warming the muscles.
The meridians facilitate the flow of qi and blood, “internally nourishing the organs and externally moistening the skin and muscles,” ensuring that the internal organs and the external features of the body are interconnected. The internal and external, upper and lower, left and right, as well as the organs and the surface of the body, maintain relative balance and coordination due to the connections provided by the meridians.
When the body is afflicted by illness, the meridian system plays a role in resisting pathogens and reflecting symptoms. However, the meridians also serve as pathways for pathogenic qi to penetrate the body. The acupuncture points on the surface of the body (including reflex points) are where the small sun luo are distributed, and they are also the sites where wei qi resides and where pathogenic qi can invade. When pathogenic factors invade the body, the sun luo and wei qi can exert significant defensive effects.
When the righteous and the evil contend, abnormal phenomena may appear on the surface of the body. If the disease progresses, it can move from the surface to the interior, starting from the sun luo, then to the luo, and further into the jing, gradually penetrating the internal organs and manifesting corresponding symptoms. The meridians reflect symptoms that can be categorized as local, one meridian, multiple meridians, or systemic.
Generally speaking, when the qi and blood in the meridians are obstructed and not flowing smoothly, it can lead to pain or swelling in the affected areas; when qi and blood stagnate and transform into heat, symptoms such as redness, swelling, heat, and pain may occur. These are classified as excess conditions of the meridians.
If there is insufficient circulation of qi and blood, it can lead to numbness, weakness of the skin, and functional decline in the affected areas. These are classified as deficiency conditions of the meridians.
If the yang qi (including wei qi and yuan qi) in the meridians is insufficient, symptoms such as localized coldness or a general aversion to cold may occur, which is termed “yang deficiency leads to cold”; if the yin qi (including ying qi and blood) is insufficient while yang qi is excessive, symptoms such as five hearts heat (indicating yin deficiency and internal heat) or general heat may occur, which is termed “yin deficiency and yang excess, yang excess leads to heat”.
The meridian system plays a role in the prevention and treatment of diseases by conducting responses and regulating deficiency and excess. Treatment methods such as acupuncture, massage, and qigong stimulate the acupuncture points on the surface of the body, conducting responses and activating the meridians to circulate qi and blood, and adjust the balance of yin and yang.
When using acupuncture and other treatment methods, it is essential to focus on “regulating qi”. The phenomena of “obtaining qi” during acupuncture and “conducting qi” are manifestations of the meridian’s conduction and response.
The function of the meridians in regulating deficiency and excess is based on their normal function of coordinating yin and yang, and treatment methods such as acupuncture stimulate the meridian’s inherent functions through appropriate acupuncture points and suitable stimulation methods, thereby achieving the goal of “draining the excess and replenishing the deficiency, restoring balance between yin and yang”.
The application of meridian theory in clinical practice can be divided into diagnosis and treatment. In terms of diagnosis, it involves pulse diagnosis based on the meridians, examining the surface of the body, and differentiating symptoms, known as meridian diagnostic methods and meridian differentiation; in terms of treatment, it involves selecting acupuncture points based on the meridians and applying different treatment methods and medications, known as meridian-based point selection and meridian-based medication.
Meridian-based pulse diagnosis is a major component of meridian diagnostic methods. The “Lingshu” states that the pulse at the cun (寸) position can diagnose the deficiency and excess of yin meridian diseases, while the renying pulse can diagnose the deficiency and excess of yang meridian diseases. The Yangming pulse is the most robust, and its lower part can diagnose the Chongyang (趺阳) pulse, while the condition of the kidney can be diagnosed through the Taixi (太溪) pulse.
Meridian-based examination refers to examining the color of the blood vessels on the skin to differentiate pain, numbness, cold, heat, etc. Modern practitioners also use skin rashes for differentiation, which falls under meridian diagnostic methods.
Palpation for tenderness is particularly important for clinical point selection. “Pressing the area, if it is in the middle and painful, it should be relaxed” (as seen in “Lingshu: Back Acupuncture Points”). This is both a method of point selection and one of the meridian diagnostic methods.
Each meridian has its corresponding acupuncture points. Acupuncture points are organized by meridians, and meridians are categorized by acupuncture points. The distribution of meridians has both longitudinal (branching) relationships and transverse (segmental) relationships, and this relationship becomes more significant when combined with relevant acupuncture points.
The significance of meridian-based point selection should be comprehensively understood from this relationship; thus, selecting points from distant meridians is meridian-based, and selecting points from adjacent meridians is also meridian-based.
The “Neijing” states that “the points that treat the disease” refer to the acupuncture points that can treat the corresponding symptoms. The meridians’ “specific diseases” refer to the symptoms treated by the acupuncture points associated with that meridian. This is primarily based on the acupuncture points of the limbs.
Specific categories of acupuncture points in the limbs include jing (井), ying (荥), shu (输), yuan (原), jing (经), he (合), luo (络), and xie (郄). In the head and trunk, there are the corresponding acupuncture points related to the organs and numerous meeting points.
For the organs, using acupuncture points from the head and trunk is considered close selection, while using acupuncture points from the limbs is considered distant selection. The combination of distant selection and close selection has special significance in clinical treatment.
Medications are categorized according to their therapeutic properties into specific meridians, referred to as “medications belonging to certain meridians”. This concept has developed based on meridian differentiation. Since diseases can be categorized by meridians, medications that treat certain diseases also become medications of specific meridians.
Since the Song and Jin dynasties, practitioners like Zhang Yuanshu (字洁古) have promoted this concept, providing convenience for understanding the therapeutic properties of medications. In the Qing dynasty, Xu Lingtai in “Medical Source Theory” stated: “Chai Hu treats alternating chills and fever, capable of curing Shaoyang diseases; Gui Zhi treats aversion to cold and fever, capable of curing Taiyang diseases; Ge Gen treats great heat in the limbs, capable of curing Yangming diseases. The ability to stop chills and fever, alleviate aversion to cold, and eliminate great heat is the specialty of Chai Hu, Gui Zhi, and Ge Gen. Therefore, medications that can treat diseases of certain meridians are referred to as medications of those meridians.” Modern pharmacological texts often include records of meridian categorization.
Traditional Chinese Medicine’s understanding of the ecological human body—The Theory of Zang and Xiang
People unfamiliar with TCM often question: How can TCM understand the condition of a patient without relying on instruments?
In fact, TCM has a unique method that allows practitioners to assess internal health conditions through external manifestations. This is known as the “Theory of Zang and Xiang” in TCM.
The term “Zang” refers to the organs that are hidden deep within the body, while “Xiang” refers to the phenomena that manifest externally.
In ancient times, TCM practitioners could not directly observe internal conditions and had to rely on external manifestations for diagnosis. Is this inference reliable?
Ancient people recognized the unity of content and form early on, firmly believing that “what exists internally must manifest externally, and what appears externally must have internal roots.” This means that any internal changes will inevitably be reflected in external appearances, and external differences stem from internal distinctions.
For example, various fruits, despite ancient people lacking testing equipment and not understanding their internal chemical compositions, can still distinguish between pears and apples, peaches and apricots, cucumbers and loofahs, and watermelons and winter melons. Therefore, a housewife, even without knowledge of chemical analysis, can buy delicious vegetables and fruits based on their external appearances, while a student who attempts to select vegetables and fruits based on chemical analysis may end up with inferior produce.
This is because the “Neijing” states: “Qi combines to form shape, and changes give rise to proper names.”
Form and name are unified, not separated. Grasping the external form means grasping the internal essence. What is brought back from the market is not only content but also not just appearance; it is the entirety of the whole. The differences in the external appearances of pears and apples determine that their internal contents will also differ.
“Internal and external are one” lays the foundation for TCM’s Theory of Zang and Xiang.
The internal organs and the external features such as color, pulse, five senses, and skin are closely related. The normal function of internal organs determines the normal expression of external colors, pulses, and symptoms.
TCM believes that the organs are the “abode of essence and qi” and the “universe of transformation.” If the essence and qi within this universe are abundant, and the functions between the organs are balanced and coordinated, with smooth and moderate flow of essence and qi, the body will not feel discomfort. Because “if there is imbalance, there will be sound,” any microscopic changes within the body that are not coordinated will inevitably be reflected externally, manifesting various symptoms. Grasping the external symptoms also means grasping the internal pathological changes.
So, what does TCM’s Theory of Zang and Xiang specifically include?
The Theory of Zang and Xiang in TCM is a widely connected system centered around the five zang organs.
TCM holds that the heart is fundamental to life, as it governs the spirit. The normal function of the heart can be observed through the complexion of the person, as the complexion is nourished by blood, and the heart governs blood flow and pulse. The heart is as important as the sun; heart qi is connected to the summer’s yang qi and is closely related to fire and bitterness. When a person’s heart qi is abundant, they are often joyful; when heart qi is insufficient, their spirit is low.
TCM believes that the lungs govern the movement of qi and are the source of vitality. When lung qi is sufficient, a person’s voice is loud. Lung qi connects to the skin, and the opening and closing of every pore are related to lung qi, so those with lung qi deficiency are prone to spontaneous sweating. Lung qi connects to autumn and is closely related to dryness and pungent flavors. Therefore, when lung qi is not functioning well, it can lead to edema and cough. Sadness is related to the lungs, which also correlates with lung qi’s connection to autumn.
TCM believes that the kidneys govern the metabolism of fluids, store essence, and control reproductive functions and the excretion of urine and feces. These functions of the kidneys are related to kidney qi’s connection to winter. The kidneys correspond to the north and are closely related to cold and salty flavors. The sufficiency of kidney essence can be reflected in hair. Children with congenital kidney essence deficiency often have sparse and dull hair. The kidneys govern the strength of bones; elderly individuals or children with kidney essence deficiency are prone to osteoporosis and weakness. The bones can produce bone marrow. TCM believes that the spinal cord is similar to bone marrow and is also governed by the kidneys. The spinal cord connects to the brain, thus the kidneys store will and govern memory. Those with sufficient kidney essence have good memory.
TCM believes that the liver stores blood, which is fundamental to human labor. Blood is also where the soul resides. The sufficiency of blood can be observed through the color of the nails and the strength of tendons. Liver qi connects to spring and corresponds to the east, closely related to wind and sour flavors. Those with excessive liver fire are prone to anger. Tremors, spasms, and convulsions are closely related to the liver.
TCM believes that the spleen stores nutrients and, along with the stomach, large intestine, small intestine, san jiao, and bladder, completes the digestion, absorption, transportation, and distribution of food and water, much like a granary transporting grain, with both input and output, storing essence and eliminating waste. The normal function of the spleen can be observed through the color of the lips and the fullness of the muscles. The spleen corresponds to earth and is closely related to sweet flavors and yellow color.
TCM believes that the heart opens to the tongue; when the heart’s function is impaired, a person’s speech becomes incoherent, or they may even become speechless.
TCM believes that the lungs open to the nose; when external pathogens invade the lung meridian, not only do the sweat pores on the skin easily close, preventing sweating and causing fever and chills, but the nose, as a lung orifice, may also become blocked, leading to runny nose and loss of smell.
TCM believes that the liver opens to the eyes; when liver blood is insufficient, the eyes may become dry and vision may blur; when liver fire is excessive, symptoms such as eye pain, redness, and tearing may occur.
TCM believes that the kidneys open to the ears and the front and back yin; when kidney essence is deficient, symptoms such as deafness, tinnitus, male impotence, female infertility, or urinary incontinence may occur.
Since TCM observes these relationships and states dynamically in living bodies, it does not adopt anatomical methods. It does not open the body to observe structure for function but infers through phenomena and relationships to assess whether the functions of the organs are normal.
If one always uses anatomical methods to dynamically observe the state of essence and qi and the relationships of the organs, not only will they not see what they wish to see, but they also cannot maintain a “live broadcast” state to observe the internal organs.
Therefore, TCM states, “Observe where it begins, and the path will emerge.” As long as there are external manifestations, there must be internal laws that can be grasped. The “symbolic research method” of “observing the external to infer the internal” is irreplaceable. It is like choosing a watermelon; although one can cut it open to check, in most cases, through repeated verification, one can accurately judge the quality of the watermelon based on external phenomena without opening it.
In diagnosing diseases, assessing conditions, and evaluating treatment effects after medication, TCM practitioners not only rely on the characteristics of color and pulse but also inquire about the patient’s subjective feelings, such as how they eat, sleep, bowel movements, energy levels, and whether discomfort has improved, aiming to assess internal conditions through external manifestations and the patient’s self-perception.
Thus, TCM is characterized by its human-centered approach, which inevitably concerns the patient’s subjective feelings, as TCM believes that the human body has the ability to make overall self-assessments of its health status. This is akin to a computer performing a self-check when powered on; only when all programs are functioning normally can it operate correctly. Otherwise, it is in an unhealthy state, requiring early intervention, adjustment, and treatment to achieve better outcomes.
TCM’s understanding of the ecological human body—”Ascending and Descending”
TCM believes that the human body is an organic whole that continuously exchanges substances with the external environment, which aligns completely with modern biological understanding. Modern biology posits that the most fundamental characteristic of all life is metabolism.
Metabolism involves continuously acquiring beneficial substances from the external environment while simultaneously expelling outdated substances that are no longer needed from the body. Absorption and excretion occur continuously to maintain internal balance within the organism.
In other words, despite the rapid development of human society, humans still need to continuously inhale oxygen from nature and exhale carbon dioxide; they must also timely absorb water and excrete urine; they must eat food, as although one can fast for several days or even weeks, prolonged fasting can lead to illness or even death.
Even in outer space, astronauts must simulate the living environment of Earth, performing these essential functions just as they do on the ground; the Shenzhou VI spacecraft astronauts expressed gratitude for the role of TCM.
The Chinese Astronaut Research and Training Center believes that the integration of traditional medicine with modern medicine is a unique advantage in developing aerospace medicine, which not only plays a crucial role in ensuring the health of astronauts and maintaining their work capacity but also lays the foundation for establishing a Chinese characteristic aerospace medicine system.
Not only do astronauts need to simulate the Earth environment in space, but divers must also carry oxygen tanks when submerged; otherwise, they risk suffocation and death.
It is important to note that even scientific achievers must rely on various foods for sustenance and cannot live solely on “chemically synthesized pills”.
If any link in the absorption and excretion process encounters issues, it will disrupt the body’s balance and lead to disease. If problems in the absorption and excretion process are not resolved over time, life will ultimately cease. Therefore, the classic TCM text “Neijing” states: “Ascending and descending, there is no organ that does not exist. If ascending and descending cease, life will be extinguished. If entry and exit are obstructed, qi will become isolated and endangered.”
This means that while the forms of life metabolism are diverse, the most fundamental form is the process of ascending and descending, or the process of expelling from the body and absorbing from the outside. This is a fundamental characteristic of all life, without exception.
For instance, the process of human respiration involves inhaling external gases, which is an upward process, while exhaling involves expelling turbid air from within the body, which is a downward process. TCM believes that while gas exchange is primarily a function of the lungs, it also requires the close cooperation of other organs. In other words, the inhalation of air into the body, moving inward and downward, is an activity associated with “yin”.
Gas is light and tends to move upward and outward; so why does it move inward and downward into the body? This is mainly due to the attraction of the yin qi from the liver and kidneys. Therefore, TCM believes that the inhalation of air involves the participation of the liver and kidneys, with the kidneys being the root of qi.
We often observe that elderly individuals with kidney qi deficiency experience shortness of breath upon exertion, as if the air is thin; this is due to kidney deficiency, which leads to “the kidneys not retaining qi”.
After gas exchange, the outdated gases must be expelled from the body. This is the process of gas moving from the lower and internal parts of the body to the external and upper parts. The upward and outward movement is associated with “yang”. Among the five organs, the heart and lungs are positioned highest, representing yang. Therefore, TCM believes that the process of exhaling gas is primarily governed by the heart and lungs, termed “exhaling through the heart and lungs, inhaling through the liver and kidneys”.
This describes the metabolic process of gas exchange between the human body and the natural environment. Ancient people effectively explained the principles of gas ascending and descending using the concepts of yin and yang. This is a description of systemic relationships rather than a description of specific structures or pathways. Only by understanding the ancient thoughts in this way can we truly grasp the fundamental principles of TCM. Here, we can see that TCM’s description of respiratory physiology differs completely from Western medicine’s structural description of the respiratory system.
TCM’s description aligns with its understanding of disease patterns and the treatment of diseases through herbal medicine or qigong exercises.
We often see qigong practitioners emphasizing the need for qi to sink to the dantian. The so-called dantian refers to the qi sea located below the navel. If a person’s qi only floats in the upper body and cannot sink to the dantian, the qi lacks roots, making it impossible to practice qigong effectively, and thus they cannot utilize qigong for health and disease prevention.
The TCM breathing techniques and qigong practices have existed since the pre-Qin era, and not only are they rich in content, but they have also been continuously validated and improved over thousands of years, proving to be effective methods for strengthening the body. Modern TCM masters, such as Professor Deng Tietao from Guangzhou University of Chinese Medicine, who is over ninety years old, attribute his longevity to regularly practicing “Ba Duan Jin”, benefiting from TCM’s qigong exercises.
TCM believes that the substances exchanged between the human body and the natural environment, in addition to gases, include food and liquids. The five grains are one of the sources of beneficial substances for the human body. The metabolism of the five grains is primarily related to the spleen and stomach, as well as the large and small intestines.
When the five grains enter the human body, the stomach must first accept them, hence the saying: “The stomach is the sea of water and grains.” The stomach not only accepts water and grains but also must ferment and digest them, allowing the water and grains to undergo digestion within the stomach.
Ancient people believed that the fermentation process of the stomach is akin to the process of soaking hemp, referred to as “the middle jiao is like soaking”. TCM holds that “the stomach is the sea of water and grains”; if a person has stomach qi, they have vitality; if a person loses stomach qi, they lose vitality. Therefore, TCM states: “A person with stomach qi lives; a person without stomach qi dies.”
The “fermentation changes” represent qualitative changes, just as grains transform into wine or vinegar, indicating a qualitative transformation. The five grains undergo a fermentation process that results in qualitative changes.
The contents of the stomach are then transmitted downward to the small intestine, where “separation and distinction” occur, meaning the essence is separated from the waste. The essence is then transported upward to the spleen, which transmits it to the lungs, nourishing the entire body through the relationship between the lungs and the blood vessels. This is what TCM refers to as “the lungs govern the hundred vessels”. The lungs distribute the water essence throughout the body, delivering the essence of the grains to nourish the body, thus fulfilling the nutritional role that the essence of the grains should have.
The yang function of the heart acts on the essence of the grains, generating heart blood, which can nourish the entire body.
The essence of the grains can also transform into various bodily fluids, such as tears, sweat, saliva, semen, cerebrospinal fluid, joint lubricating fluid, and breast milk. All these bodily fluids, like blood, originate from the essence of the grains. Therefore, TCM has a famous saying: “Blood and sweat share the same source.”
When blood is lost, the body will produce less sweat; excessive sweating, or conditions such as burns or heatstroke, can affect blood circulation, and excessive blood loss can lead to shock or even death.
TCM believes that “essence and blood transform into each other”.
The kidneys govern the storage of essence, and the essence of the five zang and six fu organs can overflow into the kidneys when abundant, thus TCM states, “The kidneys receive the essence of the five zang and six fu organs and store it”; “The kidneys are the root of storage”.
Among the kidney essence, there is both the “congenital essence” inherited from parents and the “acquired essence” transformed from the essence of the grains, hence TCM believes that “the kidneys govern water, store essence, and govern reproduction”.
The liver stores blood; “When a person rests, blood returns to the liver,” meaning that when a person is at rest or asleep, the blood that nourishes the body during activity returns to the liver for storage. When a person wakes up, the blood flows out from the liver to supply the body’s needs. “The eyes receive blood to see, the feet receive blood to walk, and the hands receive blood to grasp.” “Blood governs moistening,” which reflects this function.
Since both “essence” and “blood” are transformed from the body’s subtle substances, they are closely related and mutually beneficial. Therefore, TCM also states, “Yin and yang share the same source, essence and blood transform into each other.” “Yin and yang share the same source” refers to the common origin of liver blood and kidney essence.
Why is it called “Yin and yang share the same source”? In ancient China, the method of using the ten heavenly stems and twelve earthly branches to describe things was invented. The ten stems are the main stems, which include Jia, Yi, Bing, Ding, Wu, Ji, Geng, Xin, Ren, and Gui. The twelve branches are the side branches, which include Zi, Chou, Yin, Mao, Chen, Si, Wu, Wei, Shen, You, Xu, and Hai. Some emperors in ancient times were named Di Yi, Di Tai Jia, Di Xin, etc., using the heavenly stems for record-keeping.
In oracle bone inscriptions, there are already records of using heavenly stems and earthly branches to document each day. Only through careful observation can one distinguish the differences between today and yesterday; only by recording the differences of each day can one form the division of seasons. The oracle bone inscriptions also contain concepts of years and months, and each day is recorded with different heavenly stems and earthly branches, indicating that Chinese civilization has a history of five thousand years.
Before the invention of the heavenly stems and earthly branches, ancient people recorded history using symbols and knots. Recording various events with numbers is an excellent method. The ancient people put considerable thought into what numbers represented what events, which is called “the study of symbols and numbers”.
All substances and phenomena possess certain images, whether concrete or abstract, and through convention, certain images are replaced by specific numbers, forming the study of “symbols and numbers”.
For example, the liver is believed to store blood, which is the foundation of all activities, so it is likened to spring, full of vitality, and represented by the numbers Jia and Yi; the heart governs fire and spirit, akin to the summer climate, thus assigned the numbers Bing and Ding; the spleen governs transformation and the muscles of the limbs, resembling the vitality of late summer and early autumn, hence assigned the numbers Wu and Ji; the lungs govern qi, respiration, and sound, akin to the refreshing autumn, thus assigned the numbers Geng and Xin; the kidneys govern water, receiving the essence of the five zang and six fu organs and storing it, symbolizing the winter when all things return to storage, thus assigned the numbers Ren and Gui.
Through the comparative analysis of the relationships between the five zang organs and the four seasons of nature, ancient people established a model of harmonious unity between humans and nature. The theory of the five zang organs in TCM originates from human anatomy, but it is not merely the anatomical structures; it is a relational model.
The liver has yin and yang; the yang of the liver is represented by Jia, while the yin of the liver is represented by Yi. The kidneys also have yin and yang; the yang of the kidneys is represented by Ren, while the yin of the kidneys is represented by Gui. The blood of the liver is the liver yin, hence called Yi; the essence of the kidneys is the kidney yin, hence called Gui. “Yin and yang share the same source” means that blood and essence share the same origin.
These seemingly complex concepts can be understood and integrated once one grasps their principles and delves into their essence. Otherwise, one may only wander on the surface, echoing others, lost in confusion, and never truly enter the realm of TCM, let alone attain mastery.
TCM’s understanding of the ecological human body—The Theory of Five Elements
The so-called Five Elements is a theory summarized by ancient people to explain the interconnections, mutual generation, and mutual restraint of all things, thereby achieving ecological balance. The Theory of Five Elements is a discipline adept at resolving multi-factorial balance, harmony, and coexistence, representing a valuable theoretical approach.
The specific content of the Five Elements is simple: earth generates metal, metal generates water, water generates wood, wood generates fire, and fire generates earth; as well as the relationships of mutual restraint: earth restrains water, water restrains fire, fire restrains metal, metal restrains wood, and wood restrains earth. This describes the complex relationships of generation and restraint among the five elements: metal, wood, water, fire, and earth.
Mutual generation means that there is a “generating” and a “generated” relationship among the five elements. For example, earth generates metal, meaning that the earth contains minerals that can be refined into metals; metal generates water, meaning that metal tools can dig wells and channels to access water; water generates wood, meaning that plants rely on water for growth; wood generates fire, meaning that plants can burn to create fire, which is a natural force that humans have conquered; fire generates earth, meaning that the warmth of the sun can invigorate the soil, allowing it to be fertile. In winter, the land does not grow plants because it lacks warmth, hence it lacks vitality.
“Generating” refers to the “child” of the generating element, while “generated” refers to the “mother” of the generating element. Each element in the Five Elements has both a generating “mother” and a generated “child”. The Five Elements form a continuous biological cycle, an interdependent ecological system. The five elements are all “relatives” in a loving system, mutually supportive. However, the world also requires the restraining forces of “mutual restraint” to establish an equal and harmonious system.
Mutual restraint refers to the restraining relationships among the elements. For example, earth restrains water, meaning that soil can direct the flow of water, as in “water comes and earth blocks”; water restrains fire, meaning that water can extinguish fire; fire restrains metal, meaning that intense heat can refine metals from ores, which was discovered after ancient people mastered pottery techniques; of course, using fire to forge metals and create various tools is a significant achievement; metal restrains wood, meaning that metal tools can cut down trees, harvest crops, and create wooden furniture; wood restrains earth, meaning that the growth of plants can alter the structure of the soil, making it loose and fertile.
The dynamic changes among the Five Elements involve human labor, depicting a beautiful picture of harmonious development between humans and nature.
Each element in the Five Elements is indispensable; if one element is missing, the system cannot exist. No element can be excessive; if one becomes excessive, it will affect the other elements, leading to corresponding changes through the actions of mutual restraint and mutual generation to restore balance in the system.
It is particularly noteworthy that among the Five Elements, water, fire, wood, and earth can be natural substances, while metal is not. Metal is a product of human labor. The generation and restraint among the Five Elements require human labor to participate; without human activity, the Five Elements cannot be established and can only be categorized as “five substances” or “five elements”. The term “Five Elements” refers to the five material elements that move, change, and interact through human labor.
The Theory of Five Elements is widely applied in TCM. For example, the five qi of heaven and the five flavors of earth are closely related to the five zang organs of the human body.
The spring qi corresponds to the liver, which belongs to wood; the summer qi corresponds to the heart, which belongs to fire; the long summer qi corresponds to the spleen, which belongs to earth; the autumn qi corresponds to the lungs, which belong to metal; and the winter qi corresponds to the kidneys, which belong to water.
In spring, the wind promotes the growth of plants. The growth of plants is characterized by upward extension and downward rooting, and the initial growth of plants often has a sour taste. The liver’s function is to regulate and promote growth, similar to how trees extend. When liver qi is smooth, blood circulation is also smooth, and digestive and absorptive functions are vigorous. Trees depend on water and soil, which also affect water and soil. Therefore, the normal function of the liver is first determined by the sufficiency of kidney water and the healthy operation of spleen earth. Of course, wood can generate fire, and fire can restrain metal, so excessive liver fire can affect the lung qi’s dispersal and the flow of heart blood, leading to anxiety in the heart and spirit.
Other zang organs are similar to the liver; their normal functions not only relate to themselves but also affect other organs. This is a characteristic of TCM. It does not simply look at one organ but seeks balance within the entire system, striving to restore balance among the five zang organs, between the organs and qi, blood, body fluids, five senses, skin, muscles, and bones.
In the system of the Theory of Five Elements, each element is equal, reflecting harmony, balance, and dynamism. No element can be excessive; if one is excessive, it will lead to a series of changes, causing disharmony and affecting other material factors, resulting in disease. Similarly, no element is allowed to be “too weak”; because if one element is too weak, it will also affect the other elements, leading to disharmony, imbalance, and a series of changes that can result in disease.
The Theory of Five Elements emphasizes the whole, harmony, dynamism, and balance. The emergence of this “ideal state” requires mutual restraint among diverse worlds and great wisdom. What is great wisdom? It is to “follow the natural way”, which is the movement of heaven and earth, sun, moon, and stars, forming the four seasons and the Five Elements.
It can be said that the Theory of Five Elements is a philosophical thought that emerged at a certain stage of human society’s development, adept at solving complex problems, constructing harmonious societies, and advocating a human-centered philosophy. It is the crystallization of Eastern wisdom, an excellent thought of Chinese culture, and a theoretical treasure for solving complex problems in the world.
Time and space are the forms of existence of matter. In past philosophies, time and space were measured separately, as if they were two lines that could intersect at will. However, once time and space are combined, different substances will emerge. Therefore, in the Theory of Five Elements, through human involvement, time and space merge into one.
The five qi of heaven and the five flavors of earth were originally unrelated substances, isolated from each other, each possessing their own “inclusion standards” and “exclusion standards”. However, through the five zang and six fu organs of humans, the five qi of heaven and the five flavors of earth unify, forming a complete system that nourishes humans.
Of course, the separation of the five qi of heaven and the five flavors of earth can also lead to human death.
The five directions of east, west, south, north, and center, as well as the four seasons of spring, summer, autumn, and winter, are integrated under the guidance of the Theory of Five Elements. For example, the east corresponds to spring and belongs to wood; the south corresponds to summer and belongs to fire; the west corresponds to autumn and belongs to metal; the north corresponds to winter and belongs to water; the center corresponds to earth, primarily associated with the long summer of late summer and early autumn. This correspondence forms a continuous, undivided whole in time and space.
The five sounds, five colors, five bodies, five tastes, seven emotions, and nine orifices of the human body can all be integrated through the Theory of Five Elements, forming a complete system. In other words, the philosophical foundation related to the five zang organs of the human body is the Theory of Five Elements.
People often mention the relationship between the “I Ching” and TCM, mostly believing that the two are closely related, but they do not see the references to the “I Ching” in TCM texts.
In fact, the medical content in the “I Ching” is minimal, primarily in methodology, aimed at inspiring people’s thinking. Additionally, in methodology, the concepts of yin and yang and the Theory of Five Elements have already conveyed the essence of the “I Ching” to TCM. Therefore, it is difficult to find the text of the “I Ching” in TCM classics.
When people interpret the eight trigrams of the “I Ching”, they often believe that the Qian trigram represents heaven, the Kun trigram represents earth, the Kan trigram represents water, the Li trigram represents fire, the Gen trigram represents mountain, the Dui trigram represents marsh, the Zhen trigram represents thunder, and the Xun trigram represents wind. These eight types of natural substances, which are essential for human survival, do not include human influence.
However, the earth, mountain, and marsh in the eight trigrams can be combined into earth; heaven, thunder, and fire can be combined into fire; wind can transform into wood; while water remains water. Although the substances in the eight trigrams are abundant, they do not encompass metal from the Theory of Five Elements. This means that while the eight trigrams claim to encompass all things, they lack the element of metal from the Theory of Five Elements.
Why does this phenomenon occur? Because metal is not an inherent substance of nature; it is a product of human labor.
The eight trigrams were formed before metals were smelted, indicating that they emerged earlier. The Theory of Five Elements could not have developed before the widespread use of metal tools.
In the system of the Theory of Five Elements, fire, as the first natural force mastered by humans, has a history of over a million years and holds a more significant position than in the eight trigrams; wood, representing life, also has a different significance than merely representing wind in the eight trigrams; earth, as the representative of the essence of earth, mountains, and marshes, has a more prominent status; water, being the most abundant substance on this planet and essential for life, cannot be underestimated.
In the eight trigrams, “Xun” is sometimes interpreted as symbolizing wind and sometimes as symbolizing wood. The “Xiang Zhuan” explains the fifteen combinations containing the three-stroke Xun trigram, using wind to explain Xun ten times and wood five times; the Kan trigram is mostly said to symbolize water, but sometimes it is also interpreted as a spring, cloud, or rain; the Li trigram is often interpreted as a symbol of fire, with fewer instances of it being interpreted as brightness or electricity.
The “Shuo Gua Zhuan” connects the eight trigrams with the eight directions and correlates them with the body’s head, abdomen, feet, thighs, ears, eyes, hands, mouth, and other limbs, associating the eight trigrams with animals such as horses, cattle, dragons, chickens, pigs, pheasants, dogs, and sheep, thus gradually expanding the associations of the eight trigrams.
According to legend, the eight trigrams originated in the time of Fuxi, which is relatively early; while the Theory of Five Elements was formed before the Shang dynasty, later than the eight trigrams, thus borrowing from and selectively adopting elements from it.
The Theory of Five Elements not only simplifies the “basic units” of the eight trigrams from eight elements to five elements but also removes the complex calculations involving “tools” and the mysterious outer layer, making the connections among metal, wood, water, fire, and earth more extensive, universal, and tight-knit.
The Theory of Five Elements eliminates the “randomness” of the eight trigrams’ results (i.e., each divination yields different results), forming a theoretical system that is consistently present and universally guiding.
The Theory of Five Elements also addresses certain shortcomings of the yin-yang theory, providing complex forms of relationships among the myriad things in the world, including mutual generation and restraint, as well as cause and effect.
For example, while men and women are opposites in terms of yin and yang, the relationship between a mother and child involves not only the different properties of yin and yang but also the nurturing relationship; water and fire, cold and heat, while opposites in terms of yin and yang, also differ based on regions and seasons; the same excess or deficiency of water and fire can lead to entirely different outcomes depending on the season and region. Such complex relationships are more appropriately handled using the Theory of Five Elements than the yin-yang theory.
In the foundational texts of TCM, such as “Suwen”, “Lingshu”, and “Nanjing”, we find rich content related to the Theory of Five Elements, but we do not find the text of the eight trigrams.
The “I Ching” theory, as the foremost of the six classics and the source of Chinese culture, has been replaced by the yin-yang and Five Elements theories, which have intertwined and integrated with primitive medical knowledge, completely shedding the influence of “shamans” and “sorcery”, moving towards science, forming a complete and systematic medical theory that guides the continuous development, progress, and perfection of TCM, leading into the twenty-first century.
In the exchanges and impacts with modern science, the yin-yang and Five Elements theories continue to lead TCM in safely and effectively treating diseases and promoting health, gradually moving towards the world and a brilliant future.
TCM’s understanding of the ecological human body—The Theory of Yin and Yang
Many people unfamiliar with TCM often say that yin and yang are mystical, akin to the tricks of fortune tellers. In fact, this is a misunderstanding.
The Theory of Yin and Yang is not mystical at all; it is a universal law proposed by ancient people based on their observations and summaries of the natural world.
How did ancient people come to understand yin and yang? It is not complicated.
When ancient people began to observe nature, what did they feel most deeply? First, it was the alternation of day and night. After years of experience, intelligent ancient people would ponder how the stark contrast between day and night was formed. An “easy” answer emerged: it is due to the sunlight. Thus, ancient people worshipped the sun.
Another profound feeling for ancient people was the contrast between heat and cold, water and fire.
In the hot summer, after a long and gradual period, it inevitably transitions into the cold winter; similarly, the cold winter, after a long and gradual change, inevitably transitions into summer. Such experiences occur repeatedly, and through continuous accumulation and reflection, ancient people discovered the underlying laws. This means that behind the changes of heat and cold, there must be some governing law or force driving the movements of the sun, moon, and stars.
With the sun comes brightness and warmth; without the sun, there is darkness and cold. Fire, like the sun, has properties of brightness and warmth, and it also has characteristics of upward, outward, lightness, and mobility. Water, in contrast to fire, is cold, downward, still, and heavy.
Ancient people, having experience with fire and having measured the sundial to observe changes in temperature, gradually formed a systematic understanding of these principles.
Through long-term observation and summarization, ancient people gradually formed the concept of yin and yang.
Ancient people believed that all substances with warm, upward, outward, bright, active, and clear properties belong to the category of yang; conversely, all substances with cold, downward, inward, dark, still, and turbid properties belong to the category of yin.
For example, among the four seasons, spring and summer are warm and hot, thus classified as yang, while autumn and winter are cold and cool, thus classified as yin.
Throughout the day, daytime is bright and warm, thus classified as yang, while nighttime is dark and cold, thus classified as yin. Therefore, the classic TCM text “Neijing” states: “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, and the abode of spirit; thus, in treating diseases, one must seek the root.”
This means that “yin” and “yang” are the most fundamental laws between heaven and earth, the highest principles for categorizing and classifying all things, the source of all quantitative and qualitative changes, and the fundamental cause of the birth and death of all things. The significant changes and subtle variations in the universe are all caused by the changes in yin and yang. Therefore, in treating diseases, one must seek the root cause, which is fundamentally yin and yang. Why is this the case?
The “Neijing” states that the formation of heaven and earth occurs when yang qi accumulates to form heaven and yin qi accumulates to form earth. The celestial bodies in the sky are constantly changing, so the nature of heaven is yang; the earth, being relatively still, is classified as yin. In spring, yang qi gradually strengthens, and all things revive, so yang qi governs life; in autumn and winter, yin qi gradually strengthens, and all things wither, so yin qi governs storage.
Within yin and yang, further divisions can be made. For example, although spring and summer are generally classified as yang, each day within spring and summer also has yin and yang; within a day, yin and yang can be further divided based on the amount of yin and yang qi, into yang within yang, yang within yin, and yin within yang, yin within yin. For instance, the morning is generally yang and represents a process of increasing yang qi, thus it is yang within yang; the afternoon, while overall yang, is in a process of decreasing yang qi, thus it is yang within yin.
Yin and yang are constantly changing and do not remain at a fixed level. This forms the basis of ancient Chinese dialectics, which is a method of understanding that aligns with the true nature of things.
The mutual transformation between yin and yang often occurs as yin diminishes and yang increases, or vice versa, and gradual accumulation of quantitative changes can lead to qualitative changes. Ancient people referred to this as “when yang is abundant, yin must follow; when yin is abundant, yang must follow.” For example, at sunrise, yang qi gradually increases, reaching its peak at noon, then gradually declines, transitioning to yin by evening. At night, it is classified as yin, and yin qi gradually increases, peaking at midnight, then gradually declines, transitioning to yang at dawn. This illustrates the principle of “when yang is abundant, yin must follow; when yin is abundant, yang must follow” as a governing law.
Yin and yang are interdependent and mutually opposing, and they continuously grow and transform into each other.
From this, it is clear that the Theory of Yin and Yang is proposed by ancient people based on their observations of the laws governing the movements of the sun and moon and the changes of the four seasons, and it is not abstract or difficult to understand. As long as one opens their eyes to the world, they cannot escape the existence of yin and yang in all things. In other words, all things possess yin and yang properties, and one can see yin and yang as soon as they open their eyes.
Since the human body is a product of the changes in the qi of yin and yang in nature, it must also possess yin and yang properties.
Based on this understanding, the fundamental issue in TCM treatment of diseases is proposed: “In treating diseases, one must seek the root.” The root is the foundation. Ancient people said: “A gentleman focuses on the root; when the root is established, the path emerges.”
What is the root of the human body? The “Neijing” states: “The root of life is based on yin and yang.” This means that the essence of life must be established on the natural changes of yin and yang. Specifically, the surface of the body is yang, while the interior is yin. The abdomen is often flexed, thus classified as yin; the back is often extended, thus classified as yang. The upper part of the body is yang, while the lower part is yin.
The ancient standard body position is to sit facing south, with the sun rising on the left and setting on the right, hence ancient people said, “Left and right are the pathways of yin and yang.” Therefore, the left side of the body is yang, while the right side is yin.
The internal organs of the body are also classified as yin and yang based on their physiological characteristics. The heart, liver, spleen, lungs, and kidneys are primarily responsible for storing essence and qi, thus classified as yin; the stomach, small intestine, large intestine, gallbladder, and bladder primarily function to transport the metabolic products of food and water, thus classified as yang.
The relationship between yin and yang within the body determines the health status of the individual.
The activities of the body are yang, while the material foundation is yin. All activities must be based on material; the basic material must function through active processes. TCM states: “Yang is external, serving yin; yin is internal, guarding yang,” which describes the interdependent relationship between the two.
If a person engages in excessive activity, it will deplete the basic material, leading to severe deficiency of the foundational material, resulting in disease. If the foundational material is exhausted, life will cease. Conversely, if a person has only foundational material without active life, the foundational material will stagnate. Stagnant material cannot function and will hinder life activities, leading to disease. If the material that sustains life is completely stagnant and loses vitality, life will also end. Therefore, the classic TCM text “Neijing” states: “When yin is balanced and yang is secret, the spirit is treated; when yin and yang are separated, essence and qi are extinguished.”
TCM’s understanding of the ecological human body—How do humans live?
Currently, there are two medical systems in China: TCM and Western medicine. Due to their differing understandings of human physiology and pathology, their concepts and methods for treating diseases are also different, resulting in completely distinct academic systems. We must recognize the issues according to their respective characteristics to correctly handle the relationship between the two. There is no question of who is right or wrong between TCM and Western medicine; thus, one cannot use one to evaluate the other.
Both TCM and Western medicine must undergo practical testing. Safety, effectiveness, and the ability to promote long-term health are the standards by which we choose TCM or Western medicine. Of course, achieving the quickest results with the least expenditure is our further pursuit.
How do humans live between heaven and earth?
Where do humans come from? This question has sparked exploration worldwide, leading to many different explanations.
Those who believe in the Bible think that humans were created by God, first Adam, and later Eve was formed from Adam’s rib, producing human descendants in the Garden of Eden.
In China, there was a legend of Nuwa creating humans from clay, believing that Nuwa breathed life into the clay figures, turning them into real people.
So, how does TCM, which has existed for thousands of years, understand this?
TCM, as the earliest human medical science, does not attribute human creation to God or deities but explains the reasons for human birth according to the natural development of the world.
In the ancient classic text “Neijing”, it is clearly stated: “Humans are born of the earth and their fate is suspended in the heavens; the union of heaven and earth’s qi gives rise to humans.” This means that although humans live on earth, their life is inseparable from the air of the heavens. If a person does not breathe, they will die immediately, hence the ancient term for death is “to stop breathing”. It is also said that a person’s death is due to “running out of qi”. When a dynasty is about to perish, it can also be described as “the qi has run out”, indicating that it is beyond saving.
Life is sustained by a breath, which illustrates this principle.
TCM places great importance on human respiration and qi, while the understanding of heartbeat is relatively secondary; this is a difference between TCM and Western medicine. In the relationship between qi and blood, qi is the active driving force, while blood is the relatively quiet component. TCM believes that the flow of blood relies on the propulsion of qi. When qi flows, blood flows; when qi stagnates, blood clots; when qi is deficient, it cannot effectively propel blood, leading to stagnation.
The qi in the natural world is not fixed; it is dynamic and subject to temperature changes. The fundamental reason for these changes is the rotation of the sun, moon, and stars. Therefore, when the sun is present, the temperature is high; when the sun is absent, the temperature drops. The temperature is warm in spring, hot in summer, cool in autumn, and cold in winter; qi is constantly changing.
Ancient Chinese people were keen observers and summarizers. They established the division of the four seasons early on and further refined it into five days for a period, three periods for a qi, and fifteen days for a solar term; six qi for a season, dividing the year into twenty-four solar terms. Before the Spring and Autumn period, people emphasized the importance of establishing a calendar. “Providing the people with time” was an important responsibility of rulers throughout history; violating agricultural timing would lead to a loss of trust from the people and an unstable regime.
The Chinese lunar calendar is significant; the timing of the twenty-four solar terms is not only related to the growth of crops but also closely linked to the occurrence of diseases in the human body and the types of diseases that may arise.
Remarkably, the Chinese lunar calendar emphasizes long-term predictions. During the summer solstice, before the onset of the dog days, when the heat is unbearable, ancient people already knew that “when the summer solstice arrives, yin is born”, as the shadow of the sundial has reached its shortest point, indicating an imminent transformation, thus issuing the first forecast of the increase of yin qi: “Summer solstice brings forth the first yin.”
During the winter solstice, as the first nine days begin, the coldest period is approaching, yet yang qi is already stirring, as the shadow of the sundial has reached its longest point, indicating that it will gradually shorten day by day, thus issuing the first forecast of the increase of yang qi: “Winter solstice brings forth the first yang.”
Ancient people derived the laws of changes in yin and yang through years of objective observation, and this has proven to be accurate year after year.
Since humans are a product of the natural world’s development, the human body must also change its rhythms according to the yin and yang changes in nature. Understanding these changing laws and actively adapting to them can maintain health and prevent disease. Otherwise, acting against the natural order may lead to illness and shortened lifespan.
The “Neijing” states: “Humans are born from the qi of heaven and earth, and their formation follows the laws of the four seasons,” highlighting the close relationship between the human body and the changes of yin and yang in nature.
After birth, humans rely on the continuous supplementation and nourishment from natural substances. Humans must constantly exchange substances with the natural world to maintain life. Ancient people referred to this as “Heaven nourishes humans with the five qi, and Earth nourishes humans with the five flavors.”
The five qi of heaven are wind, fire, dampness, dryness, and cold; these five qi are the main factors constituting the natural climate of the four seasons.
The five flavors of earth are sour, bitter, sweet, pungent, and salty; these five flavors are the basic elements of all foods.
The five qi enter through the nose and are stored in the heart and lungs; the five flavors enter through the mouth and first reach the stomach. The five qi and five flavors represent all beneficial substances for the human body.
Human survival is inseparable from the five qi and five flavors; without them, life ceases. Therefore, ancient people had an innate reverence for nature, known as “those who follow it prosper, while those who go against it perish.” This means that humanity can only thrive and live well by conforming to the changes of nature. If one cannot adapt to nature and cannot continuously obtain substances from the natural world, life will end.
Ancient people placed great importance on qi, believing that “when qi gathers, life is born; when qi disperses, death occurs.” Specifically, within the body, the content of qi becomes further enriched. For instance, the human body can be divided into tangible matter and intangible functions, and the relationship between the two is called the relationship between form and qi. A person can only be healthy when there is a relative balance between form and qi. If a person is overweight, they may experience shortness of breath upon movement, lacking energy and agility, which TCM refers to as “form is excessive, qi is deficient”; if a person is excessively thin, although they may have strength and agility, they lack fullness, even appearing bony, which is termed “qi is excessive, form is deficient”.
In the relationship between qi and form, qi represents yang, while form represents yin.
Within the body, qi is further refined based on its distribution and functions, leading to different names such as lung qi, heart qi, liver qi, spleen qi, kidney qi, stomach qi, zong qi, ying qi, and wei qi.
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