Traditional Chinese Medicine (TCM) - Basic Principles

Questions about Taking Chinese Herbs

Q : How does TCM apply the Five Element Theory in tonifying or reducing therapies?

A: According to the Five Elements Theory, all things can be divided into five elements (metal, wood, water, fire and earth). Our body's five yin organs (heart, liver, spleen, lung and kidney) correspond to the five elements based on their biological special natures. 

TCM makes use of these relationships to treat diseases of the organs in tonifying or reducing therapies. 

Figure 1.This cycle shows how the five elements produce one another

Figure 2.This cycle shows how the five organs promote one another

Index:   Generates

In case of deficiency syndromes, besides tonifying the deficient organ, it is necessary to tonify its counter-generation partner in order to speed up the recovery. For example, in treating liver (wood) deficiency, water generates wood, so physicians will also tonify the kidney (water) to reinforce treatment. 

In case of excess syndromes, besides reducing the particular organ, it is also necessary to reduce its generation partner in order to depress the excitatory conditions. For example, in treating excessive fire in the liver (wood), wood generates fire, so physicians will also reduce the heart (fire) so as to relieve the excessive fire indirectly.

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Q : What is the most common form of Chinese medicine?

A: The most common form is liquid decoction. Chinese herbal decoctions are characterized by their quick absorption, favorable therapeutic outcomes and minimal toxic side effects. The ingredients in the decoctions can be modified, increased or decreased on a daily basis, allowing physicians to tailor to the patient's changing conditions and needs. Flexibility is one of the main reasons why this method is still being used after thousands of years.

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Q : What is the proper way to make a herbal decoction?

A: Just like cooking, it is important to follow the proper steps. Incorrect preparation may impact on the intended effects. 

A ceramic clay or crockery pot with a lid works best; however, an enamel or glass pot can also be used. Iron, aluminium and copper pots should be avoided because chemical interaction can occur and affect the original nature of the ingredients.

Uncontaminated cool water is best. Physicians may recommend using rice wine or a combination of water and wine for certain types of decoctions. 

Add water until the herbs are lightly submerged; soak for 20-30 minutes so the effective contents can be easily extracted when boiled. Bring to a boil quickly and then turn the heat down as required for the time given. 

The specific time and heat used in preparing your decoction are determined by the properties and nature of the ingredients. Generally, cold and flu or purgative decoctions are boiled on high heat for 20-30 minutes. Tonic or other decoctions that contain rich sticky substances are decocted for a longer time (approximately one hour) with mild heat and more water. In order to achieve the best results, your physician should clarify what type of decoction you are preparing, the appropriate amount of water that should be used and how long it should be boiled.

The herbal compounds and the liquids are commonly boiled down to one glass or 250ml. Then it should be filtered into a container while straining the dregs. If the decocted herbal ingredients are overheated or burnt, the whole decoction should be discarded because damaged ingredients can produce undesirable effects.

Certain ingredients must be treated differently due to their special properties. If they are in your prescription, the ingredients are usually packed separately. For example, shells and minerals have to be smashed and decocted first; volatile and aromatic substances like peppermint and Amomum fruits are added near the end and are cooked for 5 minutes only. Substances like Biond Magnolia flower and Plantain seed must be wrapped in gauze, because they make the decoction turbid or irritate the throat. Expensive substances such as deer horn and ginseng are sliced and boiled separately, so that their active ingredients are not affected by other herbs. Their decoctions can either be taken together with other decoctions or drunk separately. Some colloid ingredients like honey or malt sugar should be melted into the warm finished decoction directly. Some rare aromatic substances like musk are ground into powder and taken with a decoction or lukewarm water. 

If preparing your own decoction seems like a daunting task, many herbal shops and physicians can provide this service when asked.

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Q : Can Chinese medicine be boiled twice?

A: Sometimes the same set of ingredients can be boiled twice. When decocting for a second time, less water (approximately 500ml) is used or just enough to cover the surface of the ingredients. The two glasses of liquid that are obtained from both procedures are then mixed together; consume one in the morning and the other in the evening.

Medicinal materials that have a strong flavor and those with tonifying effect can usually be re-boiled. In order to extract most of the active ingredients, it is suggested to scoop out the medicinal residues and

wrap them with a piece cloth and squeeze out the liquid, so as to fully utilize the active ingredients and not to let them get to waste. Medicine for treating influenza, for example, is not suitable for re-boiling. This is because the active ingredients of this medicine like peppermint and Amomum fruits can easily evaporate. If you "over cook" your decoction, it is best not to drink it as the chemical nature of the medicine has probably been altered.

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Q : Can you explain what toxicity in Chinese Medicine means?

A: Traditionally, Chinese medicines are divided into three categories: those with heavy toxicity, minor toxicity and no toxicity. According to Chinese medicinal pharmacology, serious toxic effects are coma, nausea, numbness in the mouth and in the limbs, which can be easily induced by drugs such as dried toad venom, unprocessed croton fruits and cinnabar. Medicines with minor toxicity like apricot seeds and ginkgo nuts, if used in high dosages, can cause mild breathing difficulties, abnormal heartbeat and dizziness. Drugs without toxicity, i.e., commonly used ingredients, are mild in nature and are less likely to have side effects. However, most TCMs are safe if applied according to syndrome differentiation and with the correct dosage for the appropriate length of time.

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Q : Can TCM be used incorrectly?

A: The most outstanding characteristic of TCM is diagnosis and treatment based onSyndrome differentiation. When the syndrome of a specific disease is determined, the appropriate medicine will be prescribed. For example, in the treatment of gastroptosis (abnormal drooping of the stomach), drugs that have elevation properties would be used and drugs that have a descending effect would be avoided. If the body's constitution and the nature of disease are not clearly understood and medicine is applied randomly, the disease may be aggravated or lead to other health problems. Some Chinese medicines are extremely strong and contain toxic ingredients. If the dosage is inappropriate or consumed incorrectly by mistake, it could lead to poisoning and even death. The Chinese Medicine Council of Hong Kong declared in 1996 that there are 31 types of potent/toxic Chinese herbal medicines. Always obtain prescriptions from a registered TCM doctor and follow their advice regarding preparation. If poisoning occurs, seek medical help as soon as possible.

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Q : What is the best way to choose a proprietary Chinese medicine?

A: When choosing a proprietary Chinese medicine, it is important that the chosen medicine is suitable for your particular health need, so one should always read thelabel carefully. In addition, although different medicines contain the same herbal ingredients, one should always buy a product made by a reputable manufacturer. As preparation of Chinese herbal products rely on special skills, a difference in manufacturing can have subtle differences in effects. The best way is to seek advice from medical professionals or the manufacturers of the medicine before taking the medicine. (See "The effect of dual modulation")

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Q : Can Chinese medicine and western medicine be taken together?

A: Both TCM doctors and western medical doctors think that western drugs and Chinese medicines should not be taken simultaneously. The reason is that some chemical elements in Chinese medicines may react with western drugs. Using the two together also may affect the efficacy of both medicines and their interaction may produce toxic effects which could endanger health. One should leave around a 4-hour gap between taking these different kinds of medicines. Ideally, the individual should first consult a medical practitioner before taking any medicine.

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Q : Does TCM have standardized dosages?

A: Physicians will generally consider the recommended dosage listed in pharmacopoeia during their consultations. However, due to variations in the quality of herbs as well as a person's individual condition, physicians tend to vary somewhat from the recommended dosage. The Hong Kong Department of Health, in conjunction with The Chinese University of Hong Kong and Hong Kong Baptist University, has developed standards for commonly used herbs.

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References: Chinese PharmaceuticsChinese Pharmaceutics IdentificationPublished by Shanghai Science and Technology Publishing House, 6th edition. 

Written by:CM Promotion Group - School of Chinese Medicine, CUHK.

Translated and Edited by:Jennifer Eagleton, BA, MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd. 

Questions about Chinese Herbs

Q : What are Chinese Medicines made out of?

A: Any type of material can be a Chinese medicine. However, plants (herbs) make up the bulk of prescriptions, followed by animal products and then minerals. Plants cover whole grasses, roots, stems, leaves, flowers, barks and fruits. Animal products consist of insects, fishes, shells, worms and animals, while minerals include gypsum, realgar and sulphur.

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Q : How do you take Chinese medicine?

A: Traditionally, Chinese medicines are placed in water and boiled. When the residue is removed, the end product is called a decoction. Other forms of Chinese medicines include boluses, powders, pastes, pills as well as capsules, tablets, granules, syrups, fluids for injection, etc.; these are used to suit the individual needs of each patient.

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Q : What are the "four natures" and the "five flavors?"

A: The four natures in Chinese medicine are "cold, cool, warm and hot". The five flavors are "sour, bitter, sweet, spicy hot and salty". TCM believes that since Chinese medicines have such different properties they have different effects and can work on specific organs or meridians. For example, hot and spicy medicines like ginger and onion make one sweat; sweet-tasting herbs like red dates and pilose asiabell root have tonifying effects. Clinically, people with a dry throat and bitter taste in their mouth are regarded as having excessive heat inside their bodies; they need to take medicines that are relatively cold and cool. People who tend to suffer from internal coldness need to ingest medicines that are relatively warm and tonifying.

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Q : What are the lifting, descending, floating and sinking effects of TCM medicines?

A: These different "spatial" effects reflect the effects of tendencies of Chinese medicines. A "lifting" effect enables the medicinal properties to move from the lower region towards the upper region; a "descending" effect enables the medicinal properties to descend to the lower parts of the body; a "floating" effect drives the medicinal properties to reach the different parts of the body or to move from upper to the lower region; while a "sinking" effect means consolidating and restricting, enabling the facilitation of urination and defecation. Since different diseases have various developmental tendencies

Gypsum

(moving upwards, downwards, spreading outwards and moving inwards), medicines that can match the conditions of these diseases or improve on or eliminate their symptoms are used. For example, for Influenza (common cold), TCM believes that the position of the disease lies on the upper part and on the exterior, and then it is appropriate to use medicines that have the nature of rising and dispersing, such as ephedra and cassia twig, medicines that have descending and sinking natures should not be used.

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Q : What is meant by medicine being prescribed by meridian?

A: Applying medicine according to the meridians is to demonstrate the position where the medicine will have the most effect on. Medicines are grouped according to their natures. Meridians mean the different internal organs that are linked by energy channels. 

There are some medicines that apply to only one meridian, but others can be applied to several meridians. The matching of medicines with meridians helps raise the efficacy of the medicine. However, since the meridians and the internal organs are interrelated and influence one another biologically, in applying medicines it is necessary to consider the relationship between the meridians and the internal organs. Therefore, most TCM practitioners usually apply medicines that match more than one meridian.

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Q : How do different herbal combinations work together in TCM?

A: Herbal medicines can complement and assist each other in certain combinations:

1. Mutual reinforcement leads to a synergy effect when two drugs of a similar nature are used simultaneously. For example, when Rhizoma Anemarrhenae and gypsum are used together, the effect of heat clearing is enhanced.

2. Mutual assistance means the major ingredient of a prescription is enhanced by other subsidiary drugs, for example when Rhizoma Coptidis is used to treat dysentery, Radix Aucklandiae can assist to smooth bowel movements and arrest abdominal pain.

3. Mutual suppression helps to reduce the toxicity of a drug. For example, the toxicity of Fructus Crotonis can be reduced by mung beans.

4. Mutual restraint occurs when two drugs, when combined together inhibit the toxicity of each other, for example, ginseng and Faeces Trogopterorum.

5. Mutual aversion means when two drugs are used together, the healing effect of one drug is inhibited by another, such as the invigoration effect of ginseng can be inhibited by radish seeds.

6. Mutual incompatibility means that certain drugs in combination can lead to adverse effects; for example, liquorice root will increase the toxicity of Flos Genkwa .

7. Single application refers to a drug used alone in order to exert its own specific action, e.g. using ginseng to replenish primordial qi.

These contraindications are not absolute and are for reference only. However, in actual practice, TCM practitioners base their prescriptions on these principles.

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Q : What is the medicinal guiding effect in herbal prescriptions?

A: In TCM, the medicinal guiding effect means augmenting the overall efficacy of the medicine, enabling it to work on specific meridians, reducing toxicity and improving flavor.

1. Harmonize and reinforce the drug's actions: Example: in wind-heat type influenza when individuals present with a high fever and thirst, bamboo leaf and reed rhizome are used. These two herbs together can strengthen the effect of clearing heat and bringing down the fever.

2. Guiding drugs to work on specific meridians:Example: if the pain is located in the lower limbs and feet, then achyranthes root is said to act as a guide to let other drugs travel to the painful location.

3. Reducing the toxicity of drugs: Mylabris is usually used to treat liver cancer, however since this insect also has severely toxic, mung beans would also be used as the guiding medicine to prevent harmful effects from occurring.

4.Improving flavor: Example: the fishy smell of some animal products can be eliminated by the addition of millet wine. Ingredients like honey, malt sugar and sugar cane juice are generally used to make medicines more palatable.

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Q : Why is Chinese medicine prepared in various ways?

A: Chinese medicines are prepared in such a way to:

Lower / eliminate toxicity and side effects; Alter or ameliorate the nature of the medicine, and to elevate its healing effects:

Alter or reinforce the parts and tendencies of the medicine for their special effect;

To facilitate their mixing with other medicines so that they can be made into different forms;

To maintain the purity of the medicinal materials;

Facilitate storage and aid consumption.

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Q : How can you determine the quality of Chinese medicinal materials?

A: Due to differences in growing environment and the nature of the soil, there are big differences in the effective ingredients of plants used as TCM. There are also differences in quality. Generally speaking,

Achyranthes root

medicinal materials which are grown in the wild and from well known area are considered to be of better quality than those which are cultivated by man. Furthermore, the size, shape, color, texture and flavor of medicinal materials are factors determining the quality of a Chinese medicine. To ensure that you buy high quality herbs, please purchase Chinese medicine from creditable herbal pharmacies.

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Q : How do you store Chinese medicines?

A: If Chinese medicines are not stored properly, their effectiveness could become compromised. This is indicated by certain physical changes, like changes in colour. Worm infestation and mould can also occur if the medicine has been stored in a place with a relatively high room temperature and humidity (>70%) or when the medicines have a relatively higher water content. In such a situation, medicinal materials could also lose their essential oils and become "covered with oil". In order to keep your Chinese medicine from deteriorating, place it in a dry, well-ventilated and dark place. Ideally, storage in a cool place will lessen the likelihood of mould or pest infestation occurring.

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References: Chinese PharmaceuticsChinese Pharmaceutics IdentificationPublished by Shanghai Science and Technology Publishing House, 6th edition. 

Written by:CM Promotion Group - School of Chinese Medicine, CUHK.

Translated and Edited by:Jennifer Eagleton, BA, MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd. 

Common TCM Questions

Q：Does TCM need a longer time to work?

A: While TCM has an advantage in relieving symptoms associated with chronic diseases like diabetes and cancer, it is also good at treating acute conditions. For example, coma from an acute stroke can be treated with acupuncture or a drug made with the gallstone of an ox. Just like western medicine, the period is subject to individual conditions. Chronic diseases need a longer treatment time; for acute diseases or infections, patients can recover in a short period.

Q：Does Chinese medicine always have to have a bitter taste?

A: No. To put it simply, the flavors of Chinese medicine are classified into five types or "five tastes": pungent or hot (ephedra, peppermint and tangerine peel); sweet (liquorice, kudzu root, astragalus root); sour (raspberry fruit, spine date and smoked plum); bitter (dandelion, wild chrysanthemum and motherwort herb); and salty (clam shell, seaweed and cuttlebone). There is a close relationship between the flavor of the herb and its effectiveness.

1  Pungent medicines have the effect of dispersing and enhancing the flow of qi (energy) and blood, such as in the case of digestive or emotional problems.

2 Sweet medicines have a tonification effect and can be used to alleviate acute conditions.

3 Sour medicines possess astringent, consolidating and cessation effects that can be used to arrest conditions like profuse sweating, incontinence and spermatorrhea.

4 Bitter medicines possess cooling and purgative properties. Therefore, most herbal teas prescribed for fever are bitter.

5 Salty medicines have the effect of softening the hard and dispersing knots. It can release congestion downwards. Herbs in this category are used for conditions like tumors, abdominal masses or fluid retention.

Q：Some people after taking tonics experience symptoms such as nasal bleeding; if this occurs, is it the so-called "being deficient, one cannot benefit from tonification"?

A: "When deficient, tonify it" and "when excessive, release/reduce it" are the basic principles of treating diseases in TCM. No matter whether you are treating a disease or keeping your body in balance, it should be noted that tonification methods can only be used in a deficient state. In excess states, e.g. the acute stage of an infection, tonification should be applied with caution. 

TCM tonifying methods are mainly used to treat a particular deficiency in the body. Symptoms vary according to the cause, degree of deficiency, and organs involved. Tonifying medicines can be categorized into 4 types: (1) benefiting qi (vital energy); (2) supplementing blood; (3) nourishing the yin; and (4) replenishing yang. If tonification is not done in the appropriate way, the particular deficiency will not be tonified. Individuals should take sweet, cold, yin-nourishing herbs so as to nourish the yin and clear the heat. Yet if this patient by mistake takes spicy, warm and yang-assisting herbs that flare up the fire, further exhausting the yin, it will aggravate the situation, leading the fire evils to irritate the blood and cause nasal bleeding. 

Q：What is a "sub-health state"?

A: A "sub-health state" means that the body is unhealthy but does not fulfill the criteria of illness. For example, people are always complaining about headache, dizziness or fatigue; however on medical examination, nothing appears abnormal. From a TCM perspective, however, the body is already manifesting an imbalance of yin and yang, qi, blood, and the viscera.

In comparison with healthy people, people in a "sub-health state " have a higher rate of developing a psychological or physiological disease. Therefore, prevention and elimination of the "sub-health state" have become one of the most important tasks in TCM. To prevent and treat a state of "sub-health", in addition to paying attention to the healthy state of one's body and mind, having a proper diet, regular sleep and an appropriate amount of exercise, one should also try to detect the early appearance of problems and deal with them early. The "sub-health state" in TCM is classified according to the following categories:

stagnation of liver-qi;

phlegm and dampness generate internally;

deficiencies in the heart and spleen;

deficiency in the lung's protective qi;

deficiencies in the liver and kidney;

deficiencies in the spleen and kidney.If you want to understand whether you are in any of the "sub-health states" please consult your TCM practitioner. Then they will prescribe a treatment according to your particular type. 

Q：What is acupuncture and moxibustion?

A: Acupuncture and moxibustion are two different methods of treatment. Acupuncture inserts metallic needles into certain designated points on the skin and exerts a healing effect by different manipulation techniques. Moxibustion uses burning moxa or moxa cones (moxa refers to the Chinese mugwort herb) above the skin to warm or heat certain designated points. These designated points are called acu-points in both acupuncture and moxibustion. The chosen points and locations will vary according to the disease. The methods activate the flow of qi (vital energy) and removes blockages in the meridians, so that the body can reach a new balance through its self-healing processes.

Acupuncture can either be used to fortify a weakness or release/reduce an excessive condition. Moxibustion is only suitable for fortifying or removing blockages through its warming effect. Acupuncture works quicker than moxibustion; however, the effect of moxibution lasts longer. Clinically, they are often used together. Sometimes, moxibustion is used to replace acupuncture method, e.g. in cases like umbilical regions that are contraindicated for acupuncture. 

Q：Can you explain about the toxicity and adverse effects of Chinese medicine? 

A: Most people think that Chinese medicine only has a mild action so that no harm will come to you if you take it for a long time. This is absolutely wrong! Improper use of any medicine can lead to adverse effects. For example, when ginseng is used in individuals with fever, skin sores or constipation, the symptoms will become worse. Therefore, it is better to seek professional advice before you take any medicine. 

Some recent reports have shown that a Chinese herb, Caulis Aristolochiae Manshuriensis (Guan mu tong), contains a toxic ingredient called Arisolochic Acid, which can cause kidney failure. It should be noted that a common herb used by TCM is Caulis Clematidis Armandii (Chuan mu tong), the two are different species. Furthermore, TCM will use some toxic herbs in complicated cases, for example, Radix Aconiti Lateralis Preparata (fu zi) and Radix Aconiti (chuan wu) are used to treat rheumatoid arthritis; special attention should be paid to the dosage and preparation procedures for these herbs in order to avoid side effects. Therefore it is important to monitor the quality of Chinese herbs. 

Q：Can TCM practitioners diagnose every illness just by taking the pulse?

A: Pulse-taking has a vital role in disease diagnosis. However, just relying on this will only tell you part of the story. For example, the "rolling pulse" is a usual sign in pregnant women; however it can also be seen in patients who have dampness in their intestines and stomach. 

In order to make an accurate diagnosis, it is necessary to combine the four methodsof diagnosis: (1) inspection – observe anything unusual about the patient's appearance; (2) listening and smelling – listen to the patient's voice and notice how they smell; (3) questioning – asking the patient about their medical history and symptoms; and (4) palpitation – finding out the pulse rate and its nature as

well as by pressing the skin, hands, feet, chest and abdominal areas to check for pathological changes. A comprehensive view of all the body's symptoms and signs has to be undertaken before any diagnosis can be made. 

Q：A TCM practitioner can use various and even totally different prescriptions to treat the same disease. How do you explain that?

A: First of all, TCM stresses the uniqueness of each patient in the treatment of disease, so the amount and contents of formulas used could either increase or decrease according to the individual. 

Secondly, TCM views what we called a disease representing the entire course of pathological changes whereas a syndrome reflects the pathology of a disease at a certain stage. A TCM syndrome is a complex disharmony pattern of signs and symptoms that manifest at a given stage of the disease. The TCM practitioner treats a syndrome instead of a disease. For example, the common cold or flu has different syndromes according to TCM understanding, such as wind-cold syndrome, wind-heat type syndrome or low-resistance syndrome. As a result, various therapeutic strategies are employed and different prescriptions will be used among patients; this is called treatment based on syndrome differentiation. 

Q：Chinese herbs are said to have 4 energies: cold, cool, warm, and hot. So is the food in our daily diet classified in the same way?

A: Medicines and foods share the same origins and they both can be used as medicine. Therefore, foods can also be classified into cold, cool, warm and hot energies. Actually, most foods have a neutral nature; however certain foods have extreme energies, for example, cold foods include bamboo shoot, banana, bitter gourd, clam, crab, grapefruit, kelp, lettuce, muskmelon, persimmon, salt, seaweed, star fruit, sugarcane, water chestnut, watermelon and lotus root; hot foods include peppers, chili, cinnamon, cottonseed, ginger and chives. It is important to know about the energies of food because different energies act upon the human body in different ways and affect the state of health. If a person suffers from cold rheumatism and the pain is particularly severe on a cold winter's day, eating foods with warm or hot energy shall relieve the pain considerably. Or if a person suffers from skin eruptions that worsen when exposed to heat, it is beneficial to eat food with a cold or cool energy to relieve symptoms. 

Q：TCM uses herbs to treat disease but not on the basis of their chemical components. So on what is the principle of disease treatment in Chinese medicine?

A: This is the major difference between Western and Chinese medicine. Generally, TCM treatments focus on the overall state of the body, rather than pinpoint a specific pathogen that may cause the condition. This focus on the overall state of the body is done according to set principles.

Firstly, practitioners definite the nature a disease into yin, yang, exterior, interior, cold, heat, deficiency (xu) and excess (shi) which summarize the location and pathological changes as well as the course of the disease. Then they use certain properties of a particular Chinese medicine, what they call energy, flavor, movement, and therapeutic action on a certain meridian to draft the appropriate formulae. Every type of Chinese medicine has a particular energy: cold, hot, warm, and cool; it also has a particular taste: spicy, sweet, sour, bitter, salty; they also have ascending, descending, floating and sinking properties and their corresponding targeted meridians. Practitioners use these properties of herbs to stimulate the body's self-healing power, and make the body resume its balance. The medicinal nature of substances has been determined through years of accumulated experience. 

Chinese herbs rely on their unique properties to counteract the opposite nature of the disease, and

make the body shift to a new balance. For example, herbs that can treat or eliminate heat or hot syndromes mostly have a cold or cool nature, such as baical skullcap and isatis root. Herbs that can treat or eliminate cold syndromes mostly have a warm or hot nature, such as monkshood and ginger. As the Shennong Bencaojing (Classic of Herbal Medicine) says, "Treat cold disease with hot medicines and treat hot diseases with cold medicines." The Su Wen (Book of Plain Questions)also states: "Treat cold with heat and heat with cold." These are the basic principles in prescribing medicines. 

Q：It is said that traditional Chinese medicines have no side effects and that using them for a long time will not harm our health. Therefore, even if the medicine doesn't match the symptoms, they don't do much harm. Is this true?

A: In treating diseases, Chinese medicines restore the yin-yang balance of the human body through their different natures. All medicines have their own particular nature and some degree of toxicity. Improper use will lead to extreme energy excess inside the body and disturb the yin-yang balance. 

Q：Isn't Chinese medicine mainly just bitter decoctions?

A: Chinese medicine has always taken many different forms. These forms developed because of their different processing methods. The most common forms are: decoction, soft extracts, pastes, granules, boluses, powders, syrups, lotions and tablets. In clinical application, the appropriate forms will be prescribed according to the nature of the disease.

References: TCM Principles

TCM Diagnosis

Internal Medicine of TCM

Chinese Meteria Medica

Formulae of TCMPublished by Shanghai Science and Technology Publishing House, 6th edition. 

Written by:Shirley Yau, Enid Cheung, Ivy Poon, Janie Wong & Ray Chan. CM Promotion Group - School of Chinese Medicine, CUHK.

Translated and Edited by:Jennifer Eagleton, BA, MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd.

Ancient Chinese people were greatly interested in the relationships and patterns that occurred in nature. Instead of studying isolated things, they viewed the world as a harmonious and holistic entity. In their eyes, no single being or form could exist unless it was seen in relation to its surrounding environment. By simplifying these relationships, they tried to explain complicated phenomena in the

universe.

Modern symbol of Yin Yang陰陽符號

What is the Yin Yang Theory?

Yin yang theory is a kind of logic, which views things in relation to its whole. The theory is based on two basic components: yin and yang, which are neither materials nor energy. They combine in a complementary manner and form a method for explaining relationships between objects. Gradually, this logic was developed into a system of thought that was applied to other areas. Traditional Chinese Medicine (TCM) is an example of one area where the yin yang theory is used to understand complicated relationships in the body.

Early Daoism representation of Yin Yang陰陽之卦象形成的表達

The Origin of the Yin Yang Theory

The original concept of yin and yang came from the observation of nature and the environment. "Yin" originally referred to the shady side of a slope while "yang" referred to the sunny side. Later, this thinking was used in understanding other occurrences, which occurred in pairs and had complementary and opposing characteristics in nature. Some examples include: sky and earth, day and night, water and fire, active and passive, male and female and so on. Working with these ideas, ancient people recognized nearly all things could have yin and yang properties. Yin and yang can describe two relative aspects of the same phenomena such as the example of the slope, or they can describe two different objects like sky and earth. 

Usually, yang is associated with energetic qualities. For example, movement, outward and upward direction, heat, brightness, stimulation, activity and excitement are all yang qualities. Yin, on the other hand, is associated with the physical form of an object and has less energetic qualities such as rest, inward and downward direction, cold, darkness, condensation, inhibition, and nourishment. See Table 1 for a description of yin and yang characteristics.

Table 1 Examples of Yin Yang Pairs  Yang Yin

Light Bright Dark

Temperature Hot Cold

Position Upper Lower

Action Movement Rest

Direction Outward Inward

Physiological functions Excitatory Inhibitory 

Properties of Yin and Yang 

By describing how things work in relation to the universe and to each other, the yin yang theory establishes a dynamic thought process that can be applied to everyday life. 

1. Yin and Yang oppose each other.Yin yang theory believes everything has an opposing yin and yang aspect. These aspects are mutually controlled and inhibited by each other, which results in a continuous state of dynamic balance. For example, heat can dispel cold while cold can reduce heat. If there is not enough heat, it will become cold and vice versa. Another example is the physiological functions in our body. Both the excitatory (yang) and the inhibitory (yin) functions are in mutually controlled balance. If the dynamic balance is disturbed, one aspect may become excessive causing serious health problems.

2. Yin and Yang mutually create and depend on each other. Both yin and yang cannot exist without each other or stand alone. They depend on each other for definition and can only be measured by comparing themselves to each other. For example, heat ceases to exist (yang aspect) if there is no such thing as cold (yin aspect). Without an understanding of hot and cold, there would only be one temperature. Height (yang aspect) cannot be measured if there is not a low reference point (yin aspect); otherwise, everything would be at one level. In addition, the comparisons between yin and yang are relative to the objects being compared. For example, when soup is first cooked it is hot but after it a while it becomes cold, but the hot cold distinction is relative to a cold an ice cube and boiling water.

According to the yin yang theory, our physical body is closely related to its

physiological functions. The activity (yang) of our body is nourished by its physical form (yin), and the physical form is created and maintained by the body's activity. They rely on each other to achieve a balanced state of health.

3. Yin and Yang change and grow in a cyclic and balanced manner. Yin and yang achieve a state of balance by mutual control and inhibition. The balance is neither static nor absolute, but is maintained within certain limits. At certain times, yin expands while yang diminishes. At other times, the opposite is true. The change of seasons illustrates this concept. From winter through spring and summer, the weather changes from cold to hot. This is a process where yang (heat) grows and yin (cold) diminishes. On the other hand, the weather will change from hot to cold from summer through autumn and winter. A process where yin expands and yang diminishes. Over time, the proportion of hot (yang) and cold (yin) weather will be balanced and in harmony.

   4. Yin and Yang transform into each other.When one aspect goes to an extreme, it will undergo a reverse transformation into the opposite character. This sudden transformation usually takes place in a particular situation. For example, when summer reaches the hottest day (extreme yang), the weather begins changing in a reverse manner. Instead of becoming hotter, it starts to become cooler. When winter reaches its coldest day (extreme yin), the weather reverses its direction and becomes warmer. This transformation is the source of all changes, which allow both yin and yang to create each other. In the body, the pattern of yin yang transformation happens when excitatory and inhibitory functions transform into one another.

The Application of Yin Yang Theory in Traditional Chinese Medicine

Application in human body structures 

Traditional Chinese Medicine (TCM) believes the human body has organic unity. The sense of unity is based on the opposing and complementary relationships of yin and yang. The body's organs and tissues can be classified according to yin yang theory based on their functions and locations. The upper body belongs to yang while the lower body belongs to yin. Other yin yang pairs in the body include the interior (yin) versus the exterior (yang), the front (Yin) versus the back (yang), the inside (yin) versus the outside (yang) of the limbs and the five yin organs versus the six yang organs. Each organ can also be further divided into yin and yang aspects such as heart yin and heart yang and kidney yin and kidney yang. 

Physiological application 

TCM believes health is achieved when yin and yang are in harmony. As already mentioned, the body's physical form belongs to yin while the body's activities or functions belong to yang. Because both the body's physical form and functions are

dynamically balanced, they mutually restrict and depend on one another. The body cannot function if it doesn't have a physical form in which to perform them. Furthermore, physiological functions can consume certain physical forms (material) and metabolize these materials to obtain energy.

Pathological application 

TCM believes yin yang disharmony is the cause of disease and physiological disorders. Disharmony means the proportions of yin and yang are unequal and unbalanced. When one aspect is deficient, the other is in excess. There are many factors that cause yin and yang disharmony, but they are all related to the "evils" (outside influences that cause disease) and the flow of qi throughout the body. When a person has normal qi flow, their body functions well and has good immunity allowing them to recover easier from illness. Normal qi is composed of yang qi (physiological functions and energy) and yin fluid (physical form and the physiological fluid of body) while the "pernicious evils" are composed of six evils. Cold and dampness belong to yin evils while wind, dryness, summer heat, and fire belong to yang evils. Hence in TCM, disease results from either a deficiency of normal qi (deficiency of yin fluid or a deficiency of yang qi) or an excess of the "pernicious evils" (excess of yin evils or yang evils). The conflict between resuming normal qi and getting rid of the "pernicious evils" is what allows the disease to either progress or transform back to a healthy state. By applying the yin yang theory to treat and diagnose diseases, yin yang harmony can be restored and health maintained.

Diagnostic application 

TCM diagnoses patients according to their disharmony pattern. Preliminarily, all patterns are classified into a system known as the "eight principal patterns." The "eight principal patterns" contain four pattern pairs: interior and exterior, cold and heat, deficiency and excess, and yin and yang. Among the eight patterns, yin and yang are the most fundamental and essential pattern pair. (See Table 2.). Generally speaking, yang signs are associated with excitatory, active, hot, progressing externally and developing upward and improving manifestations. Yin signs, on the other hand, are associated with inhibitory, resting, passive, cold, progressing internally and developing downward and worsening manifestations. Table 3 illustrates the clinical signs of yin and yang patterns. 

Table 2 Eight Principal Disharmony Patterns

  Disharmony Pattern

Yin/Yang Manifestations

1 Exterior Yang An exterior pattern is generated by "external influences" such as wind and cold. (i.e. common cold)

2 Interior Yin An interior pattern is generated by internal disharmony such as a disorder of organ function.

3 Cold Yin

A cold pattern is manifested by the signs such as a pale face, cold limbs, aversion to cold, clear urine, or watery stools. The signs are usually related to non-excitatory physiological functions.

4 Heat YangA heat pattern is manifested by signs of a red face, high fever, dislike of heat, dark urine, or constipation. The signs are usually related to excitatory physiological functions.

5 Deficiency Yin

Signs of frail and weak movements, tiredness, shortness of breath, low voice, or dizziness indicate a deficiency pattern. The signs are usually related to lack of energy of normal functions.

6 Excess Yang

An excess pattern exhibits signs of heavy movements, heavy and coarse respiration, or discomfort when touched with pressure. The signs are usually related to an excess/accumulation of evils/metabolic waste.

7 Yin Yin General pattern groups for Yin manifestations include interior, cold and deficiency patterns.

8 Yang Yang General pattern groups for Yang manifestations include exterior, heat and excess patterns.

Table 3 Yin and Yang signs in the bodyBody signs Yang signs Yin signs

Face Red face, fever, hot feeling, agitated and active manner

Pale face, low spirit, feels cold, cold limbs, tired and weak,

Voice Coarse and strong voice, coarse breath, dry moth, thirst

Low voice, reduced appetite, no taste in mouth, little thirst

Urine Constipation with awkward smell, dark urine

Copious and clear urine

TongueRed and scarlet tongue or yellow and black moss present on tongue

Pale and swollen tongue material

Pulse Rapid and floating, flooded and strong, slippery and full pulse

Slow and sinking, weak, frail pulse

Understanding Kidney Yin and Kidney Yang

The theory of yin-yang is a conceptual framework used for observing and analyzing the material world in ancient China. The theory permeates all aspects of traditional Chinese medicine. It serves to explain the organic structure, physiological functions and pathological changes of the human body, and in addition guides clinical diagnosis and treatment and prevention. 

When The theory of yin and yang is used to explain the organic structure of the human body; the physical form pertains to yin, while activities or functions pertain to yang. The physical forms are the material basis for functions, while functions are the motivating power for physical forms. They are mutually complementary. TCM views the kidneys as the center of the body's yin and yang, the "congenital foundation," or the origin of life. In other words, the kidneys store the primordial yin and primordial yang (also called kidney yin and yang), which is the place where nutrients are stored and physiological functions take place.

Kidney yin, also called primordial yin, true yin or true water, is the foundation of theyin fluid of the whole body; it moistens and nourishes the organs and tissues.

Kidney yang, also called primordial yang, true yang or true fire, is the foundation of the yang qi of the whole body; it warms and promotes the functions of the organs and tissues.

Kidney yin provides energy for physiological functions while kidney yang promotes storage of kidney yin. Kidney yin and yang are mutually dependent, promoting and restraining each other, leading to an internal harmony of yin and

The yin-yang Symbol

TCM kidneys

yang, and healthy functioning of the body's organs. It is the dynamic interaction between the two that maintains the normal life activities. The third chapter of Suwen (The Book of Plain Questions) confirms this by saying, "When yin is stabilized and yang well-conserved, the spirit will be in harmony; separation of yin and yang will cause exhaustion ofessence and qi." This statement implies the mutual relationship of yin and yang.

When imbalance Occurs

When the balance of kidney yin and kidney yang is disrupted, pathological changes take place and illness occurs.

Presentations of kidney yin deficiency include: soreness and weakness of the lumbar regions and knees, dizziness, ringing in the ears, hearing problems, a dry mouth and throat, a hot sensation in the palms, soles and chest, spontaneous sweating, constipation, and seminal emission. The pulse is weak or fine and rapid; the tongue is red and covered with a light coating of fur. Kidney yin deficiency syndrome always produces signs of yin vacuity internal heat. 

Presentations of kidney yang deficiency include: soreness or cold sensation in the knees and lumbar regions, aversion to cold, cold limbs, spiritual fatigue, difficulty in urination, enuresis, incontinence, declining libido, or impotence in severe cases; female sterility, and general edema may also appear. The pulse is fine or fine and deep; the tongue is bulky, moist, and covered with white fur. Kidney yang deficiency syndrome always produces signs of yang vacuity internal cold. 

Kidney yin and kidney yang always influence each other, since they are mutually dependent. Therefore if kidney yin suffers long-term damage, kidney yang will be affected and result in depletion of both yin and yang. This is called "impairment of yin affecting yang" and vice versa. 

This is why in routine TCM therapies, tonifying yin will also support yang and tonifying yang will also support yin, or tonify both yin and yang at the same time, by this means the state of equilibrium are restored. According to the clinical diagnosis, yang and yin are invigorated to different degrees. In the Ming dynasty (1368-1644), a notable physician, Zhang Jiebin (1563-1640) had the celebrated idea that "The body is prone to deficiency rather than excess. It is necessary to warm and tonify kidney yin and kidney yang from time to time, and to use cold-cool and potent drugs with caution. Therefore the kidney, which is the root of all the organs, can be consolidated." He also claimed that "when tonifying the yin, yang should be protected, not suppressed, and vice versa." This concept is generally accepted today, and many of his formulas relating to kidney tonification are still popular. 

In respect to deficiency in kidney qi and kidney yang 

Kidney yang deficiency and kidney qi deficiency have similar presentations; however they can still be differentiated clinically. Manifestation of kidney yang deficiency follows the rules of yang vacuity internal cold; therefore it usually presents cold symptoms, e.g. cold and pain in the lumbar area and cold limbs. Kidney qi deficiency is a common clinical diagnosis and does not usually present with cold symptoms. When the kidney's astringent or storage functions are poor with a kidney qi deficiency, associated symptoms appear, e.g. frequent urination, copious amounts of clear urine, incontinence, enuresis, seminal emission, abortion, or

Kidney deficiency

usually presents as lumbar soreness

Kidney yang deficiency and kidney qi deficiency represent different stages of a process.

miscarriage. 

Kidney yang deficiency and kidney qi deficiency represent different stages of a process; improper management of kidney qi deficiency leads to kidney yang deficiency; in contrast, proper management of kidney yang deficiency leads to less severe symptoms of a kidney qi deficiency and then gradual recovery to the normal state.

In respect to kidney qi and kidney essence

In ancient times, qi belonged to yang and was called yang-qi. Therefore, kidney qi belongs to yang, and represents all the functions of the kidney. On the other hand, the body's essence, blood, and fluidare generally called yin essence in TCM. Yin essence is material basis for the body's physiological functions as well as the kidneys as a whole. Manifestation of kidney yin deficiency follows the rules of yin vacuity internal heat; therefore it usually presents heat symptoms, e.g. a dry mouth and throat, a hot sensation in the palms, soles and chest. However deficiency in kidney essence does not usually present with the heat symptoms. 

Simply speaking, citing the analogy of yin and yang, kidney essence is the material basis, kidney qi is the functional force. Kidney essence and kidney qi are complementary and closely associated. 

Conclusion

Imbalance of kidney yin and kidney yang leads to many diseases, and affects all organs of the body. For accurate diagnosis of a condition, it must be first ascertained whether there is a deficiency of yin or yang, before identifying the organs involved. For example in chronic nephritis, chronic renal failure, or senile kidney deficiency diseases, the usual TCM syndromes are kidney qi deficiency, kidney yang deficiency, qi deficiency in the kidney and spleen, yang deficiency in the kidney andspleen, kidney yin deficiency, yin deficiency in kidney andlung, yin deficiency in kidney and liver. Careful diagnosis can increase the effectives of treatment. 

Written By: 

Prof. Zou Yanquan (鄒燕勤教授)

Affiliated Hospital of Nanjing TCM University National Medical Center of TCM Kidney Disease 

Editors: Angela Collingwood MSN, Integrated Chinese Medicine Holdings Ltd.Jennifer Eagleton, BA & MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd.  

Essence and qi come under different categories.

During TCM consultation, the yin-

yang theory is superordinated to other

theories.

Etiological or Causal Factors in TCM 

TCM holds that there are both opposite and unitary relationships between the organs and the tissues, and between the human body and the natural environment. These things maintain a relative dynamic balance through a process in which contradiction alternately appears and disappears. When this dynamic balance is broken for whatever reason and cannot immediately be restored through self-regulation, certain diseases will occur. 

The five elements and their relationships with the body's organs 

The pathogenic influences that alter the state of relative balance in the body and lead to disease are called etiological or causal factors.

Modern Western medical science attempts to isolate purely physical factors as the cause of disease. Bacteria and viruses, chemical compounds, and other external factors are blamed for most illnesses. The Chinese, however, view many of these "causes" merely as symptoms of the disease; because a certain organ is weak and unable to resist outside invasion, it is therefore prone to attack by an outside agent. Killing the agent eliminates the immediate symptoms of the disease but does nothing to restore the original qi (vital energy) of the diseased organ and tissues. It is only a matter of time before it succumbs to another attack.

TCM, however, attributes the cause of most diseases to external cosmological and internal emotional factors. These factors conform and act according to the principles of yin-yang and the five elements, which both stress balance and interconnectedness.

The external cosmological causes of disease are called the "Six Evils" and are governed by the meteorological conditions of season and climate while the internal emotional factors are called the "Seven Emotions" which are affected by our emotional response to different situations. The Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic) states: "The pathogenic evils either originate in yin or originate in yang; those coming from yang are related to wind, rain, cold, and summer heat; Those coming from yin are related to food and drink, living places, sexual life, and emotions such as joy and anger."

Table 1 The five elements and their relationships with nature and the body  Wood Fire Earth Metal Water

Orientation East South Middle West North

Season Spring Summer Late Summer Autumn Winter

Climate Wind Summer Heat Dampness Dryness Cold

Cultivation Germinate Grow Transform Reap Store

Yin Organ Liver Heart Spleen Lung Kidney

Yang Organ Gall Bladder Small Intestine Stomach Large Intestine Bladder

Orifice Eye Tongue Mouth Nose Ear

Tissues Tendons Vessels Muscles Skin & Hair Bones

Emotions Anger Joy Pensiveness Grief Fear

Colour Blue/ Green Red Yellow White Black

Taste Sour Bitter Sweet Pungent Salty

Voice Shout Laugh Sing Cry Groan

What Are The Six Evils ?

The six climatic evils are:

 Wind   Cold   Summer Heat   Dampness   Dryness   Fire

They have the following pathogenic features:

The pathogenic features of the six TCM evils.

They are related to the seasons or working environmentFor example, generally there are wind diseases in spring, summer-heat diseases in summer, damp diseases in late summer and early autumn, dry diseases in autumn, and cold diseases in winter. In addition, people who live for a long time in a damp environment tend to be easily attacked by the damp evil, and those who work long in an environment of high temperature tend to be easily attacked by the dry-heat evil or fire evil.

All evils can work alone or in combination of two more in attacking the bodySuch syndromes like the common cold of wind-cold type, damp-heat diarrhoea, and wind-cold-damp blockage are examples of medical problems caused by a combination of evils.

In the course of causing disease, any one of the six evils can influence the others and can also transform into another kind of evil under certain conditions. For example, the cold evil that enters the body's interior can be

transformed into the heat evil, and the long-persisting summer-heat with dampness can be transformed into dryness evil.

The six climatic evils enter the body and cause disease mostly through the spaces located between skin and muscle, or the openings like nose and mouth. For this reason they are also termed the "six exogenous or outside evils".

Table 2

Evil Element Season

Wind Wood Spring

Cold Water Winter

Summer-heat Fire Summer

Dampness Earth Late Summer

Dryness Metal Autumn

Special Conditions

The Six Evils do not affect every person in the same way. Indeed, exceptionally healthy persons are not adversely affected by any of them. An "evil-excess" will attack the body only when and where it is weak and only when the protective-qi is deficient somewhere along the surface of the body. One of the purposes of preventive medicine is to keep the body resistant to such outside attacks.

Diseases of the six evils are most likely to occur under abnormal weather conditions, when the body is prepared for the dominant season and suddenly faces an opposite force. Sudden cold spells in mid-summer, for example often causes epidemics of influenza. Similarly, people who travel or move from a cold, dry place to a warm, damp climate are more vulnerable to invasion by local meteorological excesses than natives of the region.

Plague was a major problem during ancient time; therefore TCM learnt about epidemic diseases earlier and pestilential evils are blamed for it. The pestilential evil is a kind of pathogenic factor with intense infectivity. Attacks of pestilential evils are usually related to unusual climates such as droughts, floods, extreme heat as well as pollution. Epidemics occur suddenly with severe symptoms and are highly contagious.

What Are The Seven Emotions?

Suwen (The Book of Plain Questions) says "The five yin-organs of the human body produce five kinds of essential qi, which bring forth joy, anger, grief, worry, and fear." TCM also believes that certain organs are related to emotional activities, i.e. the heart is related to joy, the liver to

anger, the spleen to pensiveness, thelungs to anxiety and the kidneys to fear. 

The emotions are considered the major internal causes of disease in TCM. Emotional activity is seen as a normal, internal, physiological response to stimuli from the external environment. Within normal limits, emotions cause no disease or weakness in the body. However, when emotions become so powerful that they become uncontrollable and overwhelm or possess a person, then they can cause

serious injury to the internal organs and open the door to disease. It is not the intensity as much as the prolonged duration or an extreme emotion, which causes damage. While Western physicians tend to stress the psychological aspects of psychosomatic ailments, the pathological damage to the internal organs is very real indeed and is of primary concern of the TCM practitioner.

Excess emotional activity causes severe yin-yang energy imbalances, wild aberrations in the flow of blood, qi (vital energy) blockages in the meridians and impairment of vital organ functions. Once physical damage has begun, it is insufficient to eliminate the offending emotion to affect a cure; the prolonged emotional stress will require physical action as well. The emotions represent different human reactions to certain stimuli and do not cause disease under normal conditions.

The Pathogenic Features of the Seven Emotions:  Directly impairing organ qi (vital energy)

  Affecting the functions of organ qi (vital energy)

  Deteriorating effects of emotional instability

The seven emotions in TCM are:

Joy   Anger   Anxiety   Pensiveness   Grief   Fear   Fright

喜 Joy 

"When one is excessively joyful, the spirit scatters and can no longer be stored," states the Lingshu (The Vital Axis). However, in TCM, joy refers to a states of agitation or overexcitement, rather than the more passive notion of deep contentment. The organ most affected is the heart. Over-stimulation can lead to problems of heart fire connected with such symptoms as feelings of agitation, insomnia and palpitations.

怒 Anger

Anger, as described by TCM, covers the full range of associated emotions including resentment, irritability, and frustration. An excess of rich blood makes one prone to anger. Anger will thus affect the liver, resulting in stagnation of liver qi (vital energy). This can lead to liver energy rising to the head, resulting in headaches, dizziness, and other symptoms. In the long run it can result in high blood pressure and can cause problems with the stomach and thespleen. It is commonly observed that ruddy, "full-blooded" people with flushed faces are more prone than others to sudden

fits of rage at the slightest provocation.

憂 Anxiety 

"When one feels anxiety, the qi (vital energy) is blocked and does not move." Anxiety injures the lungs, which control qi (vital energy) through breathing. Common symptoms of extreme anxiety are retention of breath, shallow, and irregular breathing. The shortage of breath experienced during

In TCM joy refers to a state of agitation or overexcitement.

Anger could lead to high blood pressure.

Anxiety can block the qi and manifest in rapid, shallow breathing.

periods of anxiety is common to everyone. Anxiety also injures the lungs' coupled organ, the large intestine. For example, over-anxious people are prone to ulcerative colitis. 

思 Pensiveness

In TCM, pensiveness or concentration is considered to be the result of thinking too much or excessive mental and intellectual stimulation. Any activity that involves a lot of mental effort will run the risk of causing disharmony. The organ most directly at risk is the spleen. This can lead to a deficiency of spleen qi (vital energy), in turn causing worry and resulting in fatigue, lethargy, and inability to concentrate. 

悲 Grief

The lungs are more directly involved with this emotion. A normal and healthy expression of grief can be expressed as sobbing that originates in the depths of the lungs - deep breathes and the expulsion of air with the sob. However, grief that remains unresolved and becomes chronic can create disharmony in the lungs, weakening the lung qi (vital energy). This in turn can interfere with the lung's function of circulating qi (vital energy) around the body.

恐 Fear

Fear is a normal and adaptive human emotion. But when it becomes chronic and when the perceived cause of the fear cannot be directly addressed, then this is likely to lead to disharmony. The organs most at risk are the kidneys. In cases of extreme fright, the kidney's ability to hold qi (vital energy) may be impaired leading to involuntary urination. This can be a particular problem with children. 

驚 Fright

Fright is another emotion not specifically related to only one organ. It is distinguished from fear by its sudden, unexpected nature. Fright primarily affects the heart, especially in the initial stages, but if it persists for some time, it becomes conscious fear and moves to the kidneys.

Table 3. Excess of Certain Emotions Affects a Particular Yang-

Too much intellectual stimulation can cause pensiveness.

Grief that remains unresolved can create disharmony in the lungs.

Fear that cannot be directly addressed is likely to lead to disharmony in the kidneys.

Fright can affect the kidneys if left unchecked.

organsJoy Heart

Fear (Fright) Kidney

Grief (Anxiety) Lungs

Pensiveness Spleen

Anger Liver

Constitutional and Lifestyle Factors 

While the main causes of body disharmony are external like the six evils or internal like the seven emotions, there are additional factors that need to be taken into consideration in disease causation. These factors are constitutional factors, lifestyle factor and unforeseen factors.

Constitutional Factors 

TCM maintains that an individual's energy system are comprised of inborn qi andjing produced throughout life. Inborn qi represents our constitution, which depends on our parents. If inborn qi is deficient, the individual is more susceptible to the whole range of external and internal factors, which can possibly cause a disharmony. Therefore, if we believe that we have any constitutional weakness, we need to take particular care to ensure that any other potential causes of disharmony in our lives are avoided if at all possible. 

Lifestyle Factors

TCM has always recognized the importance of "lifestyle factors" in the maintenance of good health and well being. This now has become the focus of Western medicine.

Work

The kind of work we do, or lack of it if unemployed, can profoundly influence our energy system. Too much physical work can impair the qi (vital energy), and with excessive lifting the lungs become deficient. Too much mental activity can damage the spleen and make the yin deficient. Someone who works outdoors, for example, is more liable to be at risk from cold, dampness, wind or heat evils.

 Exercise

Too much physical work can impair the qi.

Exercise, if undertaken to an extreme can cause disharmony. For example, many athletes, who train to an excessive degree, appear very fit, but are often very susceptible to infections and injuries. In the long run they may become chronically qi (vital energy)deficient because of overstressing thekidneys. It will be noted that many Chinese exercise regimes such as qi-gong ortaijichuan are not obviously aerobic in nature like many Western forms of exercise. These practices however, offer a more balanced approach to exercise consistent with the principles of TCM. It is evident that good health and longevity are notable in the practitioners of such activities.

 Diet

Diet is afforded a very important place in Chinese medicine. See Chinese Functional Foods. The stomach and spleen have the responsibility for processing food and extracting the nutrient essence, which is then passed onto the lungs as a central part of the production of qi (vital energy) in the body. If the spleen has to work against poor and damaging foods, then it will suffer (especially from damp) and the body will deplete the qi (vital energy) of the body as a whole.Balance rather than specific dietary instructions represents the Chinese approach to nutrition. If an individual follows a healthy and balanced diet, then the spleen will remain healthy and the qi (vital energy) of the body will be sufficient. The overemphasis on sweet and processed foods in many Western diets does not lend itself to such a balance.

 Sexual Activity

In TCM, excessive sexual activity is considered to be damaging to kidney jing and can lead to long-term deficiency problems. An excessive number of pregnancies can seriously deplete a woman's blood and jing. While there is much debate about what is considered excessive sexual activity, the Chinese system generally emphasizes a natural decline in this activity as part of the ageing process.

 What is the Five Elements Theory? 

Based on observations of the natural world, ancient Chinese people recognized continuous patterns of transformation and change in the universe. Initially, these observations were interpreted using yin yang logic, but later these interpretations were expanded using a new theory called the five elements. 

The five elements theory evolved from the study of various processes, functions, and phenomena of nature. The theory asserts substances can be divided into one of five basic elements: wood, fire, water, metal and earth, which contain their own specific characteristics and properties. Today, the five elements theory is still used as a tool for grouping objects, and as a method for analyzing changes of natural phenomena. 

Exercise is good for us in the right amounts.

Diet is a common factor in disease development.

The Origin of the Five Elements Theory 

The yin yang theory has a close relationship with the five elements theory. They are often used simultaneously to explain natural phenomena. Ancient Chinese medical philosophers integrated the yin yang and five elements theories into their medical practices as early as the Warring States Period (475-221BC). As integration of these theories took place, a more formalized system of medicine was established. Today we refer to this medical system as Traditional Chinese Medicine (TCM).

The Five Elements and their Relationships with Nature and the Body 

The five elements correspond to different aspects of the natural world and the body. Wood, for example, corresponds to spring and wind in the natural world and to the liver, gall bladder, eyes and tendons in the body. (See Table 1 for a summary of these relationships.)

Table 1  Wood Fire Earth Metal Water

Orientation East South Middle West North

Season Spring Summer Late Summer Autumn Winter

Climate Wind Summer Heat Dampness Dryness Cold

Cultivation Germinate Grow Transform Reap Store

Yin Organ Liver Heart Spleen Lung Kidney

Yang Organ Gall Bladder Small Intestine Stomach Large Intestine Bladder

Orifice Eye Tongue Mouth Nose Ear

Tissues Tendons Vessels Muscles Skin & Hair Bones

Emotions Anger Joy Pensiveness Grief Fear

Colour Blue/ Green Red Yellow White Black

Taste Sour Bitter Sweet Pungent Salty

Voice Shout Laugh Sing Cry Groan

As shown in the above table, there are organized relationships between the elements, nature and the body. The different vertical characteristics belong to the same element, and horizontally, each characteristic interacts with another according to a specific order and element. Working within this system of thought, everything has a correlation in nature.

The Relationship between the Five Elements 

The five elements of wood, fire, earth, metal, and water are not isolated; rather they work closely together and have their own internal orders and patterns. The

rules that govern the five elements include a mutual generation cycle, a mutual restriction cycle, over restriction, reverse restriction and balance between generation and restriction. 

Mutual generation cycle

This cycle refers to the manner in which the elements create one another. Wood easily burns and makes a fire. Fire produces ash, creating earth. The earth contains mineral from which metal is mined and extracted. When metal is heated and cooled, water droplets will be found over the metal as a result of condensation. Thus, metal creates water. Water promotes the growth of trees, which are wood. The cycle is cyclic and continually gives rise to change and transformation. (See figure 1.)

Figure 1.This cycle shows how the five elements produce one another

Figure 2.This cycle shows how the five organs promote one another

Index:   Generates

The Chinese word "sheng" for "generate" incorporates several other meanings such as create, promote, nurture, support and enhance. The "generation" of the five elements in nature can also be applied to the body. This relationship is sometimes referred to as a mother-child relationship because only a mother can give birth to a baby. For example, fire is the mother of earth since fire creates earth. Correspondingly in the body, the heart (which has a fire element) is the mother of the spleen (earth element) because the heart supports and promotes spleen function. (See Table 1.) If heart function is deficient, the spleen will be affected. According to TCM thinking, a heart deficiency cannot sufficiently rule the blood. Therefore, the spleen cannot perform its normal transformation of qi and blood and disharmony results. This disharmony may be mild, but in severe cases, it can lead to disease. 

Mutual restriction cycle 

This cycle refers to the manner in which the elements restrict and control one another. Wood breaks up the soil and depletes the earth's nutrients, thus controlling earth. Earth contains water in many places, and as dam prevents flooding, earth controls water. Water extinguishes fire, and therefore, controls its spread. Fire

controls metal by its ability to melt it. Metal can be made into an axe that cuts wood into pieces, thus controlling wood. The control repeats in a cyclic fashion and provides an opposite force to balance the generative power. The generation and restriction properties of the five elements hold each other in check, preventing over-functioning. (See figure 3. and figure 4.)

Figure 3.This cycle shows how the five elements restrict one another

Figure 4.This cycle shows how the

fiveorgans restrict one another

Index:   restricts

Over-restriction

The Chinese word for restriction, "ke" means "inhibition" or "winning over". In nature, wood controls the earth. (See figure 3.) In the body, the liver (a wood element) controls the spleen (an earth element) and inhibits its functions in a balanced manner. If the liver's function becomes excessive, there will be over-restriction of spleen function causing an imbalance in the body. This happens because excessive liver function produces fire, which in turns affects the smooth flow of qi. Without good qi flow to start, the spleen cannot successfully transform food into more qi. 

Reverse restriction (insufficient original restriction) 

If the enemy is too strong, the controlling element itself becomes controlled in a reverse manner (i.e. the original restriction is insufficient). When wood is too strong and its controlling metal axe is too blunt, the axe cannot cut the wood and may even break as a result of the rebound force if an attempt is made to chop it. This illustrates reverse restriction because the wood is able to restrict metal, which is not usually the case. In our body, if the spleen functions excessively, its controlling liver will also be restricted in a reverse manner. The excessive spleen function will produce heat and dampness, which doesn't have a sufficient release in the body. The constrained damp heat will heat up the liver and the gall bladder. When this occurs, the gall bladder can no longer properly regulate bile secretion, and disease occurs. 

Balance between generation and restriction

A famous TCM physician Zhang JingYue (1563-1640 AD) said, "The mechanism of creation cannot do without promotion. Neither can it do without control. If there is no promotion, there will be no development and growth. If there is no control, the unbalanced excitement will be harmful. It is necessary to have control inside promotion and to have promotion inside control, so that everything can operate continuously, in both a complementary and opposite manner."

Balance between generation and restriction is important for normal transformation of the five elements. Each element is under the influence of the other four in some way. Wood generates fire and water generates wood. On the other hand, wood inhibits earth, but itself is inhibited by metal. In this way, all five elements establish an intricate homeostasis in nature. This wisdom has also been applied to TCM by incorporating the theory of the five elements into health maintenance strategies, which have been successful for thousands of years. (See figure 5.)

Figure 5.Combined generation & restriction cycle

Index:   Generates Index:   restricts

Correlations within the Five Elements 

Phenomena in the natural world are grouped into one of the five elements according to their properties, functions and appearance, but other correlations can be made among them. By using wood as an example, we can illustrate its many relationships with nature and the body. In spring, wood is in season, and the climate is warm and windy. Young grass and trees start to germinate and grow. A green colour covers the grasslands and forests forming a refreshing picture. Spring, wind, germination and the colour green all belong to the wood element and relate to each other in a synergistic way.

In the body, the liver, which is also part of the wood element, is responsible for spreading and ensuring the smooth flow of qi like the wind spreads around air. In

  Wood

Orientation East

Season Spring

Climate Wind

Cultivation Germinate

Yin Organ Liver

Yang Organ Gall Bladder

Orifice Eye

Tissues Tendons

Emotions Anger

Colour Blue/ Green

Taste Sour

Voice Shout

Chinese terms, the function is described as "sprinkling". Similar to germinating grass, the liver needs to be soft, light and gentle for a desirable healthy state. In addition, the liver is also physiologically and functionally related to the eyes and gall bladder. We can understand their connections better with the example of jaundice. People who have jaundice caused by gall bladder obstruction or liver malfunction will have yellow eyes.

Diagnostic and Therapeutic Applications of Selected Organs

Kidneys 

The kidneys belong to the water element. Just as water supports the growth and development of plants, the kidneys support the birth, development and maturation of humans. Storage of "jing" is the main function of the kidneys. "Jing" is a substance essential for reproduction, development and maturation, and additionally it provides vitality for performing daily life activities. Therefore, in TCM the kidneys are known as the root of life.

Being from the water element, the kidneys also control water, so disharmony of water in the body can also be a sign of kidney disharmony. For example, urinary incontinence (the inability to control proper urination) indicates a kidney deficiency. Hearing disorders or even deafness can also occur in elderly people who are kidney deficient. This is because the kidneys are connected with the ears, which belong to the water element under the orifice classification.

Colour is another indication of kidney disharmony. Renal (kidney) failure patients often have a darker skin complexion than their normal colouring. From a western medicine perspective, this is due to the kidneys being unable to excrete uremic toxins that build up in the blood and body. Since ancient times, TCM practitioners have also been able to diagnose renal failure because they associated the "blackening" of the skin with kidney disharmony. This is due to the fact both the colour black and the kidneys are grouped under the water element. Another example of this type of correlation is the emotion of fear. A person who is fearful in a particular situation may experience urinary incontinence. Again, the relationship of fear to the kidneys and bladder under the water element is what causes urinary incontinence to occur and not something else.

Water

Orientation North

Season Winter

Climate Cold

Cultivation Store

Yin Organ Kidney

Yang Organ Bladder

Orifice Ear

Tissues Bones

Emotions Fear

Colour Black

Taste Salty

Voice Groan

Liver  

As previously mentioned, the liver belongs to the wood element and controls the flow of qi. If a person has angry emotions, the liver will be adversely affected and liver

  Wood

Orientation East

Season Spring

Climate Wind

disharmony can manifest as a shady green colour on the face. Since the liver is connected to the eyes, some types of dizziness and eye disorders are related to liver dysfunction from a TCM point of view. By restoring normal liver function, the eye problem will automatically be cured. 

Cultivation Germinate

Yin Organ Liver

Yang Organ Gall Bladder

Orifice Eye

Tissues Tendons

Emotions Anger

Colour Blue/ Green

Taste Sour

Voice Shout

How Generation and Restriction Works 

The story of a clever doctor

There once was a newly elected mayor who came to a village to help the people. Being new, he met many challenges in governing the village and was overwhelmed by his tasks. Soon, he experienced profound pensiveness and felt very sick. One day, he invited a renowned village doctor to his house to help cure him. The doctor felt his pulse and then thought for a while. Suddenly, he had a crazy idea and said, "Congratulations, mayor! Your symptoms are signs of pregnancy. Don't worry too much. You will get better soon." No sooner had the doctor spoken, the mayor shouted angrily, "Get out! I am male. How can I be pregnant? How ridiculous you are!" A short time later, the mayor's illness disappeared, just as the doctor had predicted.

How was the mayor cured? The answer lies in the generation and restriction abilities of the five elements. According to TCM, the mayor's sickness belonged to earth disharmony, because pensiveness is part of the element earth. Excessive pensiveness harms the spleen, which is also part of the element earth, but wood restricts earth. While anger is the emotion of liver and wood element, sudden and excessive anger can easily inhibit the excessive earth. Therefore, the renowned doctor deliberately made the mayor angry and effectively neutralized his pensiveness. By controlling the mayor's excessive earth element, his body's harmony was restored and he was cured. 

The Five Elements and a Healthy Lifestyle

The relationships of the five elements play an important role in maintaining a balanced lifestyle. This is illustrated in season changes. During the spring season, which belongs to the wood element, we should avoid excessive anger in order to stay healthy. In the winter season, which belongs to the water element, our bodies prefer to store energy so rest is important. Storage is an important function of the water element; therefore, in winter it is advisable for people to go to bed early. Even today, the application of the five elements theory remains relevant in promoting health. Understanding the relationships between the elements is the first step to achieve a harmonious balance in nature and life. 

References: 

1. 南京中醫學院：《中醫學概論》，人民衛生出版社。 

2. 周超凡主編：《歷代中醫治則精華》，中醫中藥出版社。 

3. 廣州中醫學院：《中醫學新編》，上海人民出版社。 

4. 北京中醫學院：《中醫臨證基礎》，人民教育出版社。 

Written By:Yue Feng Xian Researcher, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medicine 

Edited By:Angela Collingwood, MSN, Chief Editor, Integrated Chinese Medicine Holdings Ltd. Angelo Chung, B Pharm, Editor, Integrated Chinese Medicine Holdings Ltd. 

Translated By:Michael Yang

How TCM Kidneys Affect Other Organs

In traditional Chinese medicine (TCM), the kidneys are the most important organs of the body; they are viewed as the root of life activities and the origin of our congenital (inherited) foundation. The TCM understanding of the kidneys is more extensive than the Western anatomical kidneys. They perform reproductive, urinary, endocrine, skeletal, blood, and central nervous functions as well as store primordial yin and primordial yang (known as the inherited kidney yin and kidney yang). The kidneys work closely with the other "zang or fu organs" to carry out physiological functions. The kidneys' relationships with the other organs are ones of mutual generation and restriction with states of constant motion and change. TCM uses the five elements theory as a tool for analyzing the phenomena, to explain the physiology and pathology of the organs and to guide clinical diagnosis and treatment.

The cycle shows how the five elements restrict and generate one another.

The cycle shows how the five zang organs restrict and generate one another.

  Generates Restricts  

I. The kidneys' relationship with the lungs

According to the five elements theory, the relationship between the kidneys and the lungs is like a bond between a mother and child. The kidneys belong to water and the lungs belong to metal; the metal and water elements mutually generate each other. They depend on each other physiologically, and influence each other pathologically. 

The lungs are the respiratory organs. By inhaling clear qi from natural air and exhaling turbid qi out of the body, it exchanges the qi between the interior and the exterior of the body. Depending on the regulation of lungs, the qi (vital energy) can circulate smoothly throughout the body, and therefore, a normal state of internal metabolism is ensured. However, respiration does not merely depend on the lungs functioning; the kidneys also coordinate it. In order to keep the qi exchange effective, the inhaled and refined qi must flow down and be absorbed by the kidneys properly. The astringent or grasping and holding function of the kidneys ensures the lungs to receive and circulate downward the qi. In this way, the former helps coordinate respiration while the latter controls respiration. 

Normal respiration depends on mutual regulation by the kidneys and the lungs. The relationship is clearly stated in Leizheng Zhicai (Differential Diagnosis and Treatment of Diseases): "the lungs are the master of qi and the kidneys are the root of qi; the lungs exhale qi and the kidneys absorb refined qi; smooth respiration is the result of the harmony between yin and yang." In order to have smooth respiration and a clear airway, the kidney-qi must be strong and their astringent grasping and holding functions must be intact. When a kidney deficiency develops and fails to grasp the qi, the qi does not flow down to the kidney. It can lead to respiratory problems like difficulty inhaling with longer exhalation times. Conditions worsen during exercise. In TCM, this is called failure to retain the breathing qi in the kidney. Clinically, diseases like severe chronic bronchitis, emphysema and pulmonary heart problems that affect the right side of the heart are all due to the result of kidney deficiency and areversed flow of qi. 

II. The kidneys' relationship with the spleen

While the kidneys are regarded as the "congenital foundation" and origin of life, the spleen is regarded as the "acquired foundation" and source of blood and qi production. The two organs mutually nourish and promote each other.

The spleen rules transformation and transportation. That

Normal respiration from a TCM perspective

The kidneys are regarded as the congenital foundation and the spleen is regarded as the acquired foundation of life.

means it is the primary organ for digestion, absorption and distribution of nutrient essences to the entire body. The nutrient essences are the material basis for fundamental substances like blood, qi and body fluids. That is why the spleen is regarded as the "acquired foundation" and source of blood and qi production. In order to work properly, the spleen depends on the warming and propelling activities of kidney-yang. Yimen Banghe (Medical Alarms) states: "The transformation and transportation functions of the spleen and stomach are actually motivated by the kidney yang's warming and propelling energy." The statement implies that the congenital foundation supports the acquired foundation, which enables the spleen and stomach to work properly. As a result, food and drink are digested and nutrient essences are produced, ensuring the replenishment and nourishment of the body. 

Formation of acquired jing (essence) that is used to support life functions.

Once the kidney yang is deficient and fails to warm and propel the spleen, the transformation and transportation processes become abnormal, and problems such as diarrhea may occur. In the Chinese medicine classic Jingyue Quanshu (Jingyue's Complete Works), it notes: "The kidneys act as the gate of the stomach; they open into the anterior and posterior orifices; therefore, urination and defecation processes are controlled by them. If a kidney yang deficiency is present, then the fire of thevital gate is diminished...... the body's yin energy will be in extreme, which leads to uncontrollable diarrhea." Clinically, in cases of senile degeneration or long-term illness, individuals usually suffer from a kidney yang-qi deficiency and the spleen loses warmth. Diarrhea is a common symptom among them. For those people who present with constant diarrhea before daybreak, a common TCM therapeutic approach is to warm the kidneys and spleen. 

III. The kidneys' relationship with the heart

According to the five elements theory, the heart belongs to fire and the kidneys belong to water. They are categorized as possessingyang and yin properties respectively. The heart and the kidneys are closely related, with a mutually dependent and

restrictive correlation within each other. If this functional relationship is abnormal, that is to say, if a dynamic equilibrium is disrupted between the body's yin and yang or water and fire properties, the morbid condition is termed as "non-coordination between the heart and the kidney". 

The following concrete presentations describe their relationship:

1. Water and fire coordinate with each other mutually.

From a TCM viewpoint, the heart is located in the upper part of the body. It is categorized as yang and presides over water, which has a quiet property. While the kidneys are situated in the lower part of the body, they are categorized as yin and preside over fire, which has a dynamic property. Under normal physiological conditions, the heart fire descends to the kidney and joins with the kidney-yang to warm and propel kidney-yin. On the other hand, kidney water ascends together with heart-yin to nourish heart-yang and prevent it from becoming hyperactive. There are Chinese medicine sayings such as "when the kidneys lack heart fire, then water is cold; when the heart lacks kidney water, its fire becomes hyperactive." When water and fire are in harmony, a relative balance between the yang above and the yin below is maintained ensuring a healthly condition. 

Coordination between the heart and the kidneys is necessary for each organ to work properly.

Once there is disruption between heart fire and kidney water with yin ascending and yang descending, pathological conditions will occur. For example, when kidney yin is exhausted, the kidney water fails to restrict the heart fire and leads to a hyperactive heart fire. Meanwhile, the hyperactive heart fire cannot be directed downwards to warm the kidney water. Therefore, the upper part of body is suffering from hyperactive heart fire, whereas the lower part of body is suffering from coldness and coagulation of kidney water, leading to problems like insomnia, night involuntary

semen emissions and in severe cases, mental confusion such as delirium.

2. Essence and blood transform each other mutually.

The physiological function of the heart is to govern the blood, and the physiological function of the kidney is to store essence. Blood and essence are important elements inside the body; they form the essential substances in maintaining life activities. The kidney essence can transform into blood, and the blood can transform into essence. The mutually transforming and breeding actions provide the material basis for the functional correlations of the heart and the kidney. 

3. Essence (jing) and spirit (shen) employ each other mutually 

According to TCM, the heart houses the spirit (shen). It dominates all life activities and replenishes the essence. The kidneys store theessence (jing), which transforms into bone marrow and the sea of marrow. The marrow gathers and fills up the brain. That is why TCM believes essence also shelters emotions or sentiments. Accumulating essence can make the spirit full and complete so that it can be on guard internally. Our spirit, which defines our individuality, is the manifestation of essence. That is to say, our mental activities are not only controlled by the heart, but also are influenced by the kidneys intensively. A well-established close relationship between the kidneys and the heart ensures that the kidney essence (categorized as yin) ascends and consoles the heart's spirit. In contrast, it also ensures that the heart qi (categorized as yang) descends and consoles the kidneys' emotions. There are Chinese sayings such as: "essence is the material basis of the spirit; spirit is the outer manifestation of essence." Spirit arises from essence and will power arises from the heart. These activities are also influenced by interactions between the heart and the kidney. When there is a yin deficiency in the lower part of body and yang hyperactivity in the upper part of body, the heart cannot contain the spirit and essence fails to house our emotions. Under these conditions, diseases such as mania, depression and dementia can occur. 

IV. The kidneys' relationship with the liver

The liver stores blood and the kidneys store essence. The liver promotes flowing and releasing movements, while the kidney promotes storing and sealing up actions. The two organs both belong to the lower burner (part of the triple burner), which is said to be from the same origin. They are correlated with each other both in physiology and pathology.

Accumulating essence can make the spirit full and complete, which ensures emotion and / or sentiment.

1. Water can nourish wood.

According to the five elements theory, the liver belongs to wood and kidneys belong to water. The liver promotes flowing and releasing qi movements, and its other function is to store the blood and regulate the supply, which ensures proper blood circulation and bodily adjustment. The water element generates the wood element in the five elements theory. This is sometimes referred to as a mother-child relationship because only a mother 

can give birth to a baby. The kidneys enhance and nourish the liver so it can function normally. One of the related illustrations is the relationship between kidney-yin and liver-yin. Kidney-yin nourishes liver-yin so it makes the liver-yang unlikely to be hyperactive, and therefore, creates unrestrained conditions for flowing and releasing movements. On the other hand, liver-yin contributes to the regeneration of kidney-yin. Among them, kidney-yin is predominant. Abundance in kidney-yin is crucial in retaining the dynamic balance between them. If kidney-yin is deficient, then the water element fails to nourish the wood element and leads to a yin deficiency in both of the liver and the kidneys and also hyperactivity of liver-yang. Then, excessivefire evils accumulate inside the body. Symptoms like headaches and pain on the sides of the ribs will occur. 

2. Essence and blood transform each other mutually.

Acquired essence and blood come from the same source. They are transformed from the nutrient essence that is produced during digestion and absorption by the stomach and the spleen. The blood is then stored in the liver and the essence is stored in the kidneys. Under normal biological conditions, blood stored in the liver relies on the nourishment of kidney essence; on the contrary, kidney essence also depends on persistent complement from the liver blood. They mutually transform and nourish each other. 

3. Both of them possess prime minister-fire.

The prime minister-fire has its origin from the vital gate, which is located in the liver and kidneys. It is relative to the monarch-fire(heart fire) and the two work together to coordinate functioning of all the organs like a kingdom that promotes healthy functioning of the whole body.

4. Their functions are opposite but complementary. 

The kidneys can nourish the liver.

The liver promotes the flowing and releasing movements while the kidneys promote storing and sealing up actions. Proper flowing and releasing in liver-qi movement ensures that kidney-qi works within its normal capacity so it does not become hyperactive. On the other hand, proper storing and sealing up actions of kidney-qi restrict the liver so it does not hyper or under function. Those actions are opposite but complementary. This special relationship is illustrated when looking at male ejaculation. For example, if the liver fails to regulate flowing and releasing movements and the kidneys cannot store essence, the liver-yang will become hyperactive and the fire elements cannot be contained. When the excessive fire overwhelms the leaked out essence, it will give rise to nocturnal emission or spermatorrhea (involuntary discharge of semen without orgasm). 

The liver promotes the flowing and releasing movements while the kidneys promote storing and sealing up actions.

V. How TCM kidneys affect the "fu-organs"

Among the "fu-organs", the kidneys are most intimate with the bladder. The kidney meridian communicates with the bladder creating an exterior and interior relationship. Moreover, according to the five elements theory, both of them belong to the water element, so not surprisingly they play an important role in water movement of the whole body. 

The kidneys rule water by regulating its distribution and excretion, traditionally described as vaporization by the kidney. The bladder stores and excretes urine, which is also part of the vaporizing process. From a TCM understanding, they do this through processes similar to opening and closing of different water gates. The propelling function of the kidney-qi is crucial for normal bladder function. When the kidney-qi is sufficient and its astringent function is proper, the bladder opens and closes regularly so as to maintain normal storage and excretion of urine. When there is a kidney-qi deficiency, it leads to an irregular opening and closing of the bladder. Problems like general swelling (edema), incontinence and frequent urination will occur. Pathological changes in the storage and discharge of urine, therefore, are often related to both the bladder and the kidney.

Similarly, the propelling and warming functions of the kidney ensure the normal actions of the following "fu-organs": 

Receiving and ripening of food and fluids in the stomach.

Containing and transforming food in the small intestine. It refers to receiving the semi-digested materials from the stomach that are further differentiated into nutrients and wastes.

Transmitting the impure materials and stool excretion in the large intestine.

Generally speaking, the kidneys are the most important organs of the human body from a TCM viewpoint. They should be viewed as the congenital foundation and root of life. As we grow older, kidney function naturally declines. On a daily basis, it is crucial to pay attention to the protection and nourishment of the kidneys as they are fundamental to our long term health.

Written By: Prof. Zhou Yanqin Affiliated Hospital of Nanjing TCM University National Medical Center of TCM Kidney Disease

Editors: Angela Collingwood, MSN, Integrated Chinese Medicine Holdings Ltd.Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd.  Special thanks to Elpidio Talens Juan for helping with article graphics.  

TCM representation of "fu" organs, kidneys and orifices.

What is the Meridian System?

Chinese medicine believes there is a distribution network for the fundamental substances of Qi (pronounced chee), Blood andBody Fluids  throughout the body. (These fundamental substances are different from the common western understandings of these terms, and their concepts are important for maintaining health using Chinese medicine.) This distribution network called the Meridian System looks like a giant web, linking different areas of our body together. Its pathways make up a comprehensive yet complex body map that supplies vital energy to every part of the body. Philosophically, the Meridian System explains how we live, and why we become sick. 

The Chinese meaning of the word Meridian 

"Jing luo", the Chinese term for meridian has two interesting concepts which make up the basic structural components of the Meridian System. These concepts date back several thousand years and are reflected in the ancient Chinese medical text,Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine), which says: Jing meridians act as the interior. Those which branch off horizontally are luo meridians. Jing means to pass through or pathway and refers to the vertical channels. Luo means network and refers to the networks that branch off from the vertical channels (Jing). Both Jing and Luo mean link or connection, and they are bound closely together to form channels.

Meridians are not blood vessels 

Although meridians work as a channel system which carries and distributes qi and blood, they are not blood vessels and have no anatomical channel structure. Many meridian research projects have been carried out over the years testing different hypotheses of how this system works. Physiological hypotheses such as nervous reflex models have been put forward, but researchers have not yet come up with a definitive model that can give a complete anatomical description of the Meridian System. 

Development of the Meridian Theory 

According to the ancient literature of Traditional Chinese Medicine (TCM), it is hypothesized the meridian theory developed in the following ways: 

1. Observation of a "needle" feeling projected elsewhere in the body When certain specific points on the skin were pierced by fine needles, feelings like soreness, numbness, heaviness and swelling would occur-a reaction known as the "needle" feeling. It was found these "needle' feelings were always felt on a particular skin area,

following a certain direction and pathway. Ancient Chinese medicine philosophers worked out the patterns of the needle points (acupuncture points) in the body, which later formed the basis of the meridian theory. 

2. Observation of the effects of acupuncture points In ancient times, Chinese people would experiment and stimulate different acupuncture points to get symptomatic relief from a particular ailment. As they practiced these acupuncture trials, they found points with similar effects were always distributed in an organized pattern. After classification and analysis, a meridian map was created. 

3. Correlation of certain illnesses with acupuncture points From every day experiences, Chinese people gradually recognized when a particular disease or organ disorder occurred, they would feel pain in a particular part of their skin, which was often associated with a rash or skin color changes. These correlations were analyzed according to the ancient philosophies such as the yin-yang and the five elements theories and further developed into an integrated scientific and artistic model for maintaining health in TCM. 

Meridians are a collection of acupuncture points 

By connecting and uniting different parts of our body, meridians provide the transport service for the fundamental substances of qi, blood, and body fluids. The flow of qi in the Meridian System concentrates or "injects" in certain areas of the skin's surface. These areas are very small points, otherwise known as "acupuncture points". Although acupuncture points are located externally and superficially, they can affect the internal functions of our body. There are 365 acupuncture points, and each point belongs to a particular meridian channel that connects to specific organs. 

Classification of Meridians 

The Meridian System has 12 principal meridians that correspond to the yin and yang organs and the pericardium. (Yin organs are usually those without an empty cavity, and include the liver, heart, spleen, lungs, and kidneys. Yang organs are organs with an empty cavity such as the gall bladder, small intestine, stomach, large intestine and bladder. In TCM, yin and yang organs are physiological functional units that incorporate a much broader meaning then common western thinking.) Meridians linked with yin organs are known as yin meridians; if they are linked to yang organs, they are known as yang meridians. In addition to the12 principal meridians, there are eight extra meridians and smaller network-like luo meridians. Among the eight extra meridians, the Governing Vessel and the Conception Vessel are considered the most important channels, because they contain acupuncture points which are independent of the twelve principal meridians. 

Understanding the Meridian System by water flow analogy 

Since qi and blood are mobile, it is easier to understand the concept of meridians by comparing it to water flow. When water flows down a mountain or a slope, it flows from a high to low ground. It will also follow the geographical terrain and collect in the most stable area which is a river. Rivers maintain the natural laminar flow and kinetic energy of the water. By avoiding turbulent flow, it provides the most efficient way of transporting water downstream. As a result, the land surrounding the river is lush with vegetation and life because of the steady supply of fresh water.

Qi works in a similar way to the flow of water in nature. By flowing from a high to a low concentration, it follows the body's landscape and gathers in a meridian. Thus, meridians provide a natural pathway for the flow of Qi and supply a constant source of energy to different parts of the body in the same way a river supplies water to its surrounding banks.

If a river is blocked, all areas relying on the water downstream will be affected. Due to a lack of water, the ecosystem's balance and harmony are disturbed, and plants and animals cannot survive. Similarly, if the Meridian System is blocked, the supply of qi to different parts of the body will be interrupted, leading to organ disharmony and disease even if the affected area is far away from the original blockage.

In order to restore balance and harmony, it is necessary to resume the optimal flow of the river or qi. In the case of a river, the debris causing the blockage is removed and the riverbed is strengthened. The harmony of the Meridian System is restored in our bodies by stimulating particular acupuncture points. In this way, the flow of qi is regulated, and qi energy is distributed efficiently throughout the body again.  

Application of the Meridian Theory 

The Huang Di Nei Jing (The Yellow Emperor's Classic of internal Medicine)says, "The twelve Meridian System is: the process through which our body grows; the explanation how disease continues and develops; the methods by which our body is treated; the place where disease occurs; the concept where philosophy begins, the target where successful outcome should be achieved." This saying illustrates the importance of the meridian theory in human physiology, pathology, diagnosis and therapeutics in TCM. 

Physiological application 

The Huang Di Nei Jing (The Yellow Emperor's Classic of internal Medicine) also says, "The Meridians move the Qi and Blood. As a result, Yin and Yang get regulated. Tendons and bones get nourished. Joints get facilitated." 

Meridians work like a network system, transporting and distributing qi and blood. They link up organs, limbs, joints, bones, tendons, tissues and skin, and provide communication between the body's interior and exterior. Through a healthy Meridian System, Qi and Blood successfully warm and nourish different organs and tissues, and maintain normal metabolic activities. Meridians are essential in supporting the flow of nutritive Qi inside the blood vessels and the flow of protective Qi around them. In addition, they strengthen the body's immunity, protect against external pernicious influences (anything evil that causes disease) and assist in regulating yin and yang, 

Pathological application In Chinese Medicine, the "evils" (pathogenic influences) transform and progress along the meridians to attack the body and cause disease or illness. They are classified in TCM as wind, fire, dampness, dryness, cold and summer heat. Sometimes, the evil travels from one organ to other, but it can proceeds from the exterior to the interior of the body.

A common example is the development of influenza, which TCM believes is caused by external influences. Initially, the person with influenza presents with fever, dislike of cold,

headaches, and body pains. The evil may subsequently progress along the closest Lung Meridian and launch an attack on the lungs. When this occurs, the person may suffer from common complications of influenza such as a cough, wheezing and chest pain.

Disharmony of one organ can also affect other organs because of their interconnections through the Meridian System. For instance, liver disharmony can influence the stomach, and stomach disharmony can influence the spleen. Moreover, organ disharmony inside the body will show pathological changes along the Meridian channel with which it is associated. For example, liver disharmony can cause lower chest pain, because the liver meridian passes through lower chest region. Kidney disharmony can cause groin pain, because the kidney meridian crosses the groin area. Ulcers on the tip of tongue can suggest heart disharmony since the heart meridian has branches at the tip of tongue.

Diagnostic Application Because of the special properties of meridians, disharmony and imbalance in the body can be diagnosed according to the meridian and its corresponding organ. Headaches, for example, are classified according to their affected painful spots and the distribution of the meridians in that area. Pain in the forehead indicates a Yang Ming Meridian type headache, while pain in both sides of head indicates a Shao Yang Meridian type headache. Back and neck pain is a Tai Yang Meridian type headache, and pain in the top of head indicates the Jue Yin Meridian type headache. Such specific diagnoses help tailor individual treatment plans allowing for the best outcome for relief of the headache.

Another common example is the presentation of liver disharmony. Because the liver meridian passes through the lower chest and lower abdomen, pain in those areas

may indicate problems in the liver and not other organs. When organ disharmony occurs, usually the corresponding meridian and acupuncture points demonstrate morphological changes, and it can feel painful when these points are pressed. All these Meridian-related presentations and symptoms assist in TCM diagnosis. The Meridian System is the basis of the well-known Six Meridian differential diagnostic method, which was conceived by a famous and distinguished Chinese Medicine physician in the Han dynasty named Zhang Zhongjing (2nd to 3rd century AD). His diagnostic method had a significant impact on the future development of TCM.

Application in herbal treatment and acupuncture therapy Understanding the Meridian System and its relationship with the body's organs is essential in guiding herbal treatment and acupuncture therapy. Chinese medicine always aims to resume the harmony of yin and yang and maintain the flow of qi and blood. Acupuncture exerts its therapeutic effects by replenishing, balancing and moving the flow of qi throughout the body so normal organ functions and harmony can be resumed.

Meridian differential diagnosis is essential for both herbal treatment and acupuncture therapy. In TCM, herbal medicines are chosen specifically for treating certain meridians and their corresponding organs. Moreover, some herbs have meridian guiding properties, which help potentiate the therapeutic effects of specific organs and meridians. In this way, meridians allow for an individually tailor-made herbal treatment plan according to a patient's disharmony pattern.

Similarly, understanding meridian selectivity is important for optimal therapeutic outcomes with acupuncture. For example, a headache in the forehead region is diagnosed as Yang Ming Meridian disharmony. Acupuncture points in Arm Yang Ming Meridian such as Hegu (the depression on the dorsum of the hand between the first and second metacarpal bones, at the level of the middle of the second metacarpal bone) can be selected to treat this type of headache. Another common example is a stomach ache (indigestion, dyspepsia). Since the stomach belongs to the Leg Yang Ming Meridian, the corresponding acupuncture point of Zusanli(located: one finger-breadth lateral to the anterior crest of tibia) can be chosen to relieve this pain. 

In conclusion, the Meridian System remains an important and integral part of Traditional Chinese Medicine, and the application of herbal therapies and acupuncture continues to be essential in restoring the balance of health in our bodies. 

References

1.Kaptchuk Ted J.,Chinese Medicine : The Web That Has No Weaver, London: Rider, (2000).

2.Williams Tom, Complete Chinese Medicine, Bath, Mustard, (1999).

3.張恩勤主編：《中醫基礎理論‧上冊》，上海 上海中醫學院出版社， 1988。

4.邱茂良主編：《針灸學》，上海 上海科學技術出版社，1983。

Written by: Angelo Chung, B Pharm, Integrated Chinese Medicine Holdings Ltd.

Edited By: Angela Collingwood, MSN, Integrated Chinese Medicine Holdings Ltd.     

The twelve meridians are named according to their corresponding organs, limb positions and yin and yang properties. They include three arm yin meridians (lung, pericardium, heart), three arm yang meridians (large intestine, triple burner, small intestine), three leg yang meridians (stomach, gall bladder, bladder), and three leg yin meridians (spleen, liver, kidney). The triple burner and the pericardium do not refer to anatomical structures. They are functional units in Traditional Chinese Medicine (TCM). It should also be noted, the organs mentioned here have a much broader meaning in TCM then what is typically thought of their functions in western medicine. Since the twelve meridians make up the majority of the Meridian System, they are known as the regular or principal channels.

Name of the twelve MeridiansArm/ Leg Yin/ Yang Three Yang/ Three Yin The Twelve Meridians

Arm

YinTai Yin Lung Meridian

Shao Yin Heart Meridian

Jue Yin Pericardium Meridian

YangYang Ming Large Intestine Meridian

Tai Yang Small Intestine Meridian

Shao Yang Triple Burner Meridian

Leg

YinTai Yin Spleen Meridian

Shao Yin Kidney Meridian

Jue Yin Liver Meridian

YangYang Ming Stomach Meridian

Tai Yang Bladder Meridian

Shao Yang Gall Bladder Meridian

Distribution of the twelve meridians in the body

The twelve Meridians have lateral and symmetrical distribution on the head, face, trunk and limbs. The six yin meridians are distributed on the inner side of the limbs and on the chest and abdomen. The six yang Meridians are distributed on the outer side of the limbs and on the head, face and trunk. 

As shown in the diagram, the order and arrangement of the three yang meridians for both arms and legs are as follows: a) Yang Ming (meaning sunlight yang) has an anterior position. b) Shao Yang (meaning lesser yang) has a middle position. c) Tai Yang (meaning greater yang) has a posterior position. The three names have described the variation of yang qi (pronounced chee). They can also be interpreted as describing the variation of sunlight received. Since most animals' backs receive the greatest amount of sunlight, the back or posterior region is usually named as the Tai Yang position. Similarly, the position of Shao Yang and Yang Ming are located at more anterior regions where less sunlight is received.

The order and arrangement of the three yin meridians are as follows: a) Tai Yin (meaning greater yin) has an anterior position. b) Jue Yin (meaning absolute yin) has a middle position. c) Shao Yin (meaning lesser yin) has a posterior position. Again, the three names have described the variation of yin Qi and the degree of darkness at that position. The following figure has illustrated the general distribution of Meridians on the limbs. 

The twelve meridians follow specific time schedules and pathways. The Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine) says, " The three yins of the arm go from the organs to the hands. The three yangs of the arm go from the hands to the head. The three yangs of the legs go from the head to the feet. The three yins of the legs go from the feet to the abdomen." Qi is continuously circulating through the meridians in a daily cycle. At certain times, both qi and blood have maximum flow in particular meridians which are outlined below.

Meridian Flow Chart (The Daily Qi Current of the 12-hour Division) 

Arm Leg

Yin/Interior Yang/Exterior   Yang/Exterior Yin/Interior

Arm Tai YinLung Meridian(3am - 5am)

Arm Yang Ming Large Intestine Meridian(5am - 7am )

Leg Yang Ming Stomach Meridian (7am-9am)

Leg Tai Yin Spleen Meridian(9am-11am)

Arm Shao Yin Heart Meridian(11am-1pm)

Arm Tai YangSmall Intestine Meridian(1pm-3pm)

Leg Tai Yang Bladder Meridian(3pm-5pm)

Leg Shao Yin Kidney Meridian(5pm-7pm)

Arm Jue Yin Pericardium Meridian(7pm-9pm)

Arm Shao Yang Triple Burner Meridian(9pm-11pm)

Leg Shao Yang Gall Bladder Meridian(11pm-1am)

Leg Jue Yin Liver Meridian(1am-3am)

As shown in the above chart, qi is more prevalent in different meridians at different times. For example, from 3am to 5am, meridian qi mainly flows through the Lung Meridian and enters the Large Intestine Meridian at 5am-7am, and then the Stomach Meridian from 7am-9am. In this way, the meridian cycle is continuous as the qi flows through the body. 

Exterior-Interior relationship in the meridian 

As mentioned before, meridians are classified into yin meridians and yang meridians according to the yin or yang organs with which they are connected. TCM believes the interior belongs to yin and the exterior belongs to yang. Hence, yin organs are thought to have more internal functions and are called interior organs. The yang organs, on the other hand, are believed to have more external functions and are considered exterior organs. TCM analyzes the physiological function of the body based on the harmonious relationships between yin and yang organs. From these relationships, the interior and exterior relationship theory was developed. 

Characteristics of Meridian flow 

Looking closely at the meridian chart, one can see a beautiful pattern with laws governing the meridian flow of Qi in the body. The pattern includes exterior towards interior, interior towards exterior, arm towards leg, and leg towards arm, etc. 

Exterior towards Interior, Interior towards Exterior.

For example, the Lung Meridian (Tai Yin) flows towards the Large Intestine Meridian (Yang Ming). The Lung and Large Intestine Meridians are yin and yang organs and have an interior-exterior relationship. Both of them belong to metal of thefive elements. TCM believes the interior belongs to yin and the exterior to yang,

because this meridian flow can be considered as: "the internal metal yin running towards the external metal yang." In this way, the flow obeys the yin yang theory and has shown its mobile development and harmonious balance.

Arm towards Leg, Leg towards Arm.

Another example is the Arm Large Intestine Meridian (Yang Ming) flowing towards the Leg Stomach Meridian (Yang Ming). This illustrates the arm and leg relationship.

Pattern of the Meridian flow 

The meridian flow chart illustrates an interesting flow pattern which is organized to follow both vertical and horizontal orders. Horizontally, the six meridians on the left side of the chart are all arm meridians, while those on the right side are all leg meridians. Therefore, the meridian flow intrinsically has arm-to-leg and leg-to-arm patterns, which means there is a balance between the upper and lower parts of the body. All meridians communicate with the body in a balanced manner. 

Among the six arm meridians, the three on the left-hand are interior meridians while those on the right are exterior meridians. Of the six leg meridians, the three on the left are exterior meridians, while the three on the right are interior. This beautiful symmetry shows meridians go from the interior of the arm towards the exterior of the arm. Then, they proceed from the exterior of the arm towards the exterior of the leg to the interior of the leg and so on. 

Meridians in the chart also have a vertical order. All yang meridians follow a downward order: a) Yang Ming; b) Tai Yang; c) Shao Yang. For yin meridians, the order is : a)Tai Yin; b)Shao Yin; c)Jue Yin. For example, Leg Tai Yin Spleen Meridian flows towards Arm Shao Yin Heart Meridian. The Leg Shao Yin Kidney Meridian flows towards the Arm Jue Yin Pericardium Meridian. Generally speaking, the meridian flow follows the order of Tai Yin, Shao Yin and Jue Yin. The yin yang theory governs the flow of meridians and their symmetrical and organized connections throughout the whole body.

1. Arm Tai Yin Lung Meridian

Pathway: 

The Lung Meridian originates in the middle portion of the body, and runs downwards connecting with the large intestine. It then turns and passes through the diaphragm to connect with the lungs. This meridian branches out from the axilla (armpit) and runs down the medial aspect of the upper arm where it crosses the elbow crease. It continues until it passes above the major artery of the wrist, and emerges at the tip of the thumb. Another branch emerges from the back of the wrist and ends at the radial side of the tip of the index finger to connect with the Large Intestine Meridian. 

Symptoms: 

Disorders of the Lung Meridian lead to diseases related to TCM lung dysfunction. According to TCM, the lung rules and regulates qi throughout the body and administers respiration (breathing). In addition, the lung moves and adjusts the water channels, so disorders of this meridian may be related to disharmony of lung fluid or "water" and respiratory disorders. Symptoms like chest discomfort with a fullness sensation, dyspnea (shortness of breath), cough, and wheezing indicate Lung Meridian disharmony. This disharmony can also lead to pain along the meridian position. For example, a person may feel pain in the shoulder and back or along the anterior border of the medial aspect of the arm. 

Main indications: 

Acupuncture points in the Lung Meridian are indicated for throat, chest and lung ailments and for other symptoms that are presented along the meridian's pathway. 

2. Arm Yang Ming Large Intestine Meridian 

Pathway: 

The Large Intestine Meridian starts from the tip of the index finger and runs between the thumb and the index finger. It then proceeds along the lateral side of the forearm and the anterior side of the upper arm, until it reaches the highest point of the shoulder. From there, it has two branches. One goes internally towards the lungs, diaphragm and large intestine. The other travels externally upwards where it passes the neck and cheek, and enters the lower teeth and gums. It then curves around the upper lip and crosses to the opposite side of the nose. 

Symptoms: 

Disharmony of the Large Intestine Meridian can lead to symptoms of abdominal pain, intestinal cramping, diarrhea, constipation and dysentery. Since it passes through the oral cavity and the nose, symptoms like toothache, a runny nose, nosebleeds, and pain or heat along the meridian pathway can also indicate a disorder in this meridian. 

Main indications: 

Acupuncture points in this meridian are indicated for diseases affecting the head, face, pharynx (throat), febrile conditions and other symptoms along the meridian pathway. 

3. Leg Yang Ming Stomach Meridian

Pathway: 

The Stomach Meridian starts from the end of the Large Intestine Meridian at the side of the nose, and passes through the inner corner of the eye to emerge from the lower part of the eye. Going downwards, it enters the upper gum and curves around the lips and lower jaw. It then turns upwards, passing in front of the ear, until it reaches the corner of the forehead where it splits into an internal and external branch. The internal branch emerges from the lower jaw, running downwards until it reaches its pertaining organ, the stomach. The external branch crosses the neck, chest, abdomen and groin where it goes further downward along the front of the thigh and the lower leg, until it reaches the top of the foot. Finally, it terminates at the lateral side of the tip of second toe. Another branch emerges from the top of the foot and ends at the big toe to connect with the Spleen Meridian. 

Symptoms: 

Stomach Meridian disorders have symptoms of stomachache, rapid digestion, hunger, nausea and vomiting, or thirst. Other symptoms that relate to disorders along the meridian pathway include abdominal distension, ascites (a fluid build up in the abdomen), sore throat, nosebleeds, or pain in the chest or knee. 

Main indications: 

Acupuncture points in this meridian are indicated for certain gastro enteric diseases, toothaches and mental illnesses. Conditions that affect areas through which the meridian passes such as the head, face, eyes, nose and mouth can also benefit from stimulation of the acupuncture points along this meridian. 

4. Leg Tai Yin Spleen Meridian

Pathway: 

The Spleen Meridian begins at the big toe and runs along the inside of the foot crossing the inner ankle. It then travels along the inner side of the lower leg and thigh. Once it enters the abdominal cavity, it internally connects with the spleen and continues upward to reach the Heart Meridian. Externally, the Spleen Meridian continues moving toward the chest and branches out to reach the throat and the root of the tongue.

Symptoms: 

Disharmony of the Spleen Meridian is related to spleen dysfunction. According to TCM, the spleen is responsible for the transformation and transportation of different substances, and is the foundation of our after-birth existence. Spleen function is essential in maintaining the digestive power of the body and transforming food into qi and blood. If the Spleen Meridian does not function properly, qi cannot be efficiently transported to the spleen. As a result, symptoms like abdominal distention, loose stools, diarrhea, epigastric pain, flatulence and a heavy sensation in the body occur. In addition, symptoms such as pain at the root of the tongue, swelling of the inner side of the lower limb may also indicate disharmony of the Spleen Meridian.

Main indications: 

Acupuncture points in this meridian are indicated for peptic, gynecological and genital diseases. They are also indicated for symptoms along the meridian.

5. Arm Shao Yin Heart Meridian

Pathway: 

The Heart Meridian starts from the heart, and divides into three branches. One goes towards the small intestine. The second runs upwards along the throat towards the eyes, and the third branch emerges under the arm and runs along the inner side of the forearm, elbow and upper arm. It then crosses the inner side of the wrist and palm and ends at the inside tip of the little finger, where it connects with the Small Intestine Meridian.

Symptoms: 

Disharmony of the Heart Meridian leads to pain at the heart position (precordial pain or pain at the sternum). In TCM, the heart rules the blood and the pulse. Without sufficient nourishment, an individual may feel thirsty and have a dry throat. Pain in the inner side of the forearm and heat in the palm may also indicate problems in this meridian.

Main indications: 

Acupuncture points in this meridian are indicated for heart, chest and mental problems. They are also indicated for symptoms along the meridian.

6. Arm Tai Yang Small Intestine Meridian

Pathway: 

The Small Intestine Meridian starts from the tip of the little finger and crosses the palm and wrist. It runs upwards along the posterior side of the forearm until it reaches the back of shoulder where it ends at the uppermost part of the back (the bottom of the neck). At this position, it first branches off and moves internally through the heart and stomach to reach the small intestine. The second branch travels externally across the neck and cheek until it reaches the outer corner of the eye and then enters the ear. A short branch in the cheek moves upward to the inner corner of the eye where it connects with the Bladder

Meridian. 

Symptoms: 

Disharmony of the Small Intestine Meridian presents mainly as symptoms along its pathway such as a swollen chin, stiff neck, sore throat, hearing problems, yellow eyes, and pain along the shoulder, upper arm, elbow and forearm.

Main indications: 

Acupuncture points in this meridian are indicated for diseases of the head, neck, ear, eyes and pharynx (throat), as well as certain febrile conditions and mental illnesses. These acupuncture points are also recommended for symptoms associated with the meridian's pathway.

7. Leg Tai Yang Bladder Meridian

Pathway: 

The Bladder Meridian starts at the inner side of the eye and goes across the forehead to reach the top of the head where it branches into the brain. The main channel then goes across the back of the head and divides into two branches. One branch crosses the center of the base of the neck and extends downwards parallel to the spine. Once in the lumbar region (bottom of the spine), it branches out to reach the bladder. The other branch crosses the back of the shoulder and runs downward on the outside, which is adjacent and parallel to the inner branch. It continues down until it reaches the buttocks where two branches run across the back of thigh along different pathways that join at the back of the knee. The joint meridian then continues along the back of the lower leg, circles behind the outer ankle, runs along the outside of the foot and terminates on the lateral side of the tip of the small toe, where it connects with the Kidney Meridian. 

Symptoms: 

Disharmony of the Bladder Meridian can lead to problems of TCM bladder dysfunction. It is often related to symptoms caused by external pernicious influences (outside influences that cause disease such as cold, wind, fire, dampness, dryness and summer heat). Because the Tai Yang Meridian is considered the most exterior, it is the first meridian to be invaded if there is any external attack. Therefore, its disharmony can cause symptoms such as difficult urination, incontinence, painful eyes, runny nose, nose bleeding and nasal congestion. Pain in the head, neck, back, groin and buttock areas indicate disharmony in the Bladder Meridian pathway.

Main indications: 

Acupuncture points in this meridian are indicated for diseases in the head, neck, eyes, back, groin and lower limbs as well as certain and mental illnesses. They are also recommended for symptoms along the meridian pathway. 

8. Leg Shao Yin Kidney MeridianPathway: 

The Kidney Meridian starts from the inferior side of the small toe. Crossing the middle of the sole and the arch of the foot, it circles behind the inner ankle and travels along the innermost side of the lower leg and thigh, until it enters the body near the base of the backbone. After connecting with the kidney, it comes out at the pubic bone. Over the abdomen, it runs externally upwards until it reaches the upper part of the chest (the inner side of clavicle). A second branch emerges from the kidney and moves internally upwards and passes through the liver, diaphragm, lungs and throat, finally terminating at the root of the tongue. Another small branch divides from the lung to connect with the heart and the pericardium.

Symptoms: 

Disharmony of Kidney Meridian can manifest as wheezing or coughing because the kidneys "grasp the qi". They also are the "mansion of fire and water," and the "residence of yin and yang". If there is insufficient nourishment and warming of the kidney, symptoms like edema (swelling), constipation, and diarrhea can indicate an imbalance in this meridian. Pain in the groin and pharynx (throat), which are located along the meridian's pathway, also can indicate a problem with the Kidney Meridian.

Main indications: 

Acupuncture points in this meridian are used for gynecological, genital, kidney, lung, and pharynx (throat) diseases. They are also indicated for symptoms associated with the pathway of the meridian. 

9. Arm Jue Yin Pericardium MeridianPathway: 

The Pericardium Meridian starts from the chest, leaves the pericardium organ and runs downwards through the diaphragm to connect with the triple burner. A branch rising from the chest emerges from the lower chest region and travels upwards to the axilla (armpit). From the medial aspect of the upper arm, it makes its way down between the lung and heart channels, until it reaches the elbow crease. It then runs down the forearm and enters the palm ending at the tip of the middle finger. Another short branch splits off from the palm to connect with the Triple Burner Meridian at the end of the ring finger.

Symptoms: 

Disharmony of the Pericardium Meridian is related to the imbalance of the TCM heart and blood functions. The manifestation includes heart pain (precordial pain), chest discomfort, palpitations and an oppressed feeling in the chest. Since the Heart stores the "shen" or mental activities, Pericardium Meridian disorders are related to mania. In addition, swelling of the axilla and spasms of the elbow and arm can indicate a problem in this meridian, since it passes through these areas. 

Main indications: 

Acupuncture points in this meridian are used for heart, chest, and peptic diseases as well as mental illness. They are also indicated for symptoms manifested along the meridian's pathway.

10. Arm Shao Yang Triple Burner Meridian

Pathway: 

The Triple Burner Meridian begins at the outer tip of the ring finger and goes along the back of the hand, wrist, forearm and upper arm, until it reaches the shoulder region where it branches off. One branch travels internally into the chest and passes through the pericardium and diaphragm uniting the upper, middle and lower burner (triple burner). The other branch runs externally up the side of the neck, circles the ear and face, and finally ends at the outer end of the eyebrow where it connects with the Gall Bladder Meridian. 

Symptoms: 

Disharmony of the Triple Burner Meridian leads to symptoms like abdominal distention, edema (swelling), urinary incontinence, difficulty urinating, loss of hearing, and ringing in the ears (tinnitus). Pain in the pharynx (throat), eyes, cheek, back of the ear, shoulder and the upper arm can occur as these structures are located along this meridian's pathway.

Main indications: 

Acupuncture points in this meridian are recommended for ailments of the ears, eyes, chest, pharynx (throat), and the side of the head as well as certain febrile conditions. They are also indicated for symptoms along this meridian's pathway.

11. Leg Shao Yang Gall Bladder Meridian

Pathway: 

The Gall Bladder Meridian starts from the outer corner of the eye and divides into two branches. One branch runs externally and weaves back and forth at the lateral side of the head. After curving behind the ear, it reaches the top of the shoulder and crosses the lateral side of rib cage and abdomen, until it ends up at the side of the hip. The other branch enters the cheek and runs internally downward, through the neck and chest to connect with thegall bladder. It continues moving downwards and comes out in the lower abdomen, where it connects with the other branch at the hip. The hip branch then runs toward the lateral side of the thigh and lower leg. After crossing the ankle, it goes over the foot to reach to the tip of the fourth toe. Another small branch leaves the meridian and terminates at the big toe to connect with the Liver Meridian.

Symptoms: 

In TCM, the gall bladder is closely related to the liver. Hence, the disharmony of the Gall Bladder Meridian causes symptoms such as a bitter taste in the mouth, dizziness, headache, and pain at the outer angle of the eyelids. Pain along the meridian pathway such as in the axilla (armpit), chest, lower chest, buttocks and the lateral side of the lower limbs can also indicate a disorder of the Gall Bladder Meridian.

Main indications: 

Acupuncture points in this meridian are indicated for ailments of the eyes, ears, pharynx (throat), and lateral side of the head in addition to mental illness and fever. They are also recommended for symptoms along the meridian's pathway.

12. Leg Jue Yin Liver Meridian

Pathway: 

The Liver Meridian starts from the top of the big toe and goes across the top of the foot. After crossing the inner ankle, it continues to go upwards along the inner side of the lower leg and the thigh, until it reaches the pubic region. It then circulates around the external genitalia and enters the lower abdomen. Afterwards, it goes up the abdomen and reaches the lower chest to connect with theliver and gall bladder. The meridian further travels upwards along the throat and connects with the eyes. Finally it emerges from the forehead to reach the vertex of the head. One of its internal branches originates internally from the eye and moves downwards to the cheek where it curves around the inner surface of the lips. Another branch starts from the liver and passes through the diaphragm to reach the lung where it connects with the Lung Meridian and completes the cycle of the twelve meridians.

Symptoms: 

Disharmony of the Liver Meridian leads to groin pain, chest fullness, urinary incontinence, difficulty urinating, swelling of the lower abdomen and hernias. 

Main indications: 

Acupuncture points in this meridian are indicated for liver, gynecological and genital diseases. They are also recommended for symptoms along the meridian's pathway. 

References:

1.Kaptchuk Ted J., Chinese Medicine :The Web That Has No Weaver, London: Rider, (2000).2.Williams Tom, Complete Chinese Medicine, Bath: Mustard, (1999).3.張恩勤主編：《中醫基礎理論‧上冊》，上海 上海中醫學院出版

社，1988。4.邱茂良主編：《針灸學》，上海 上海科學技術出版社，1983。Written By: Angelo Chung, B Pharm, Integrated Chinese Medicine Holdings Ltd. 

Edited By: Angela Collingwood, MSN, Integrated Chinese Medicine Holdings Ltd.

Qi (vital Energy) from a TCM Perspective

Western medicine places strong emphasis on the physical structures of the body, which are made up of different organic and inorganic substances, proteins, tissues and cells. These substances form the physiological basis of humans. Traditional Chinese medicine (TCM), on the other hand, views life a little differently. Instead of emphasizing discrete body components with cells being the basic building blocks, the body is seen as a whole entity with connecting parts that work together to sustain life. Some parts have more energetic properties while others have more material characteristics. The interaction between the different parts is vital to the individual's being so they are often referred to as fundamental substances. Qi (pronounced chee), blood and body fluids are the most important fundamental substances necessary for life.

The ancient Chinese people believed qi was the most fundamental entity making up the world. They thought everything in the universe resulted from the movement and change of qi. The Chinese character for "qi" is the same word used for air or gas, and it is thought to have the same properties as these substances. Qi can be interpreted as the "life energy" or "life force," which flows within us. Sometimes, it is known as the "vital energy" of the body. 

In TCM theory, qi is the vital substance constituting the human body. It also refers to the physiological functions of organs and meridians. In fact, it may be difficult to find one equivalent English word or phrase that completely describes the nature of qi. Most often, qi is best defined according to its functions and properties. 

The origin of qi

Human qi comes from two main sources. The first source of qi is inherited from our parents at conception. It is known as the "innate vital substance". The second source is derived from essential substances in nature such as the air we breathe, food and water. Both the inherited and the acquired vital energies are further processed and transformed by the organs.

The kidney first sends the innate vital substance upwards where it combines with food essence derived from the spleen. It further mixes with the fresh air from the lungs where it finally forms into qi of the body.

By understanding how qi is formed, TCM has identified two important factors necessary for maintaining health. By eating a healthy diet and breathing fresh air, the body extracts their most valuable essences and uses them to help form the vital energy. Following these simple principles are the first steps towards creating a healthy balance in the body. 

Functions of Qi

1. Promoting function of qi Just as wind (highly active air) provides energy to push the sails of a boat or turn the turbine of a windmill, qi provides the active, vital energy necessary for the growth and development of the human body and to perform the physiological functions of the organs, meridians and tissues. In addition, qi promotes the formation and circulation of blood and supports the metabolism of body fluid. If there is a deficiency of qi, its promoting functions are weakened. As a result, growth and development can be affected or delayed, the organs and meridians cannot function properly and blood formation is hampered, leading to a series of

The Chinese character "qi"is the same word for air or gas

health problems. 

2. Warming function In a gaseous state, air contains more kinetic heat energy than in its liquid state. Like air, qi also contains heat energy for the body. Being a heat source, qi warms the body and keeps it at a constant temperature so normal physiological functions can take place. Deficiency of qi can lead to a lowered body temperature, intolerance of cold and cold hands and feet. 

3. Defending function In TCM, one of the main causes of disease is the invasion of "Evils"."Evils" are environmental factors that lead to illness. They are classified as wind, summer heat, dampness, dryness, cold and fire. By resisting the entry of ' illness evils" into the body, qi defends against their attack and maintains healthy physiological functions. In western terms, this qi defending function acts like the immune system.

4. Consolidation and retention function Qi consolidates and retains the body's substances and organs by holding everything in its proper place. First, qi keeps the blood flowing within the vessels and prevents it leaking out into the tissues. Secondly, qi controls and adjusts the secretion and excretion of sweat, urine and saliva, and keeps body fluids from escaping the body. Thirdly, qi consolidates and stores sperm to prevent premature ejaculation. Lastly, qi consolidates the organs and stops them from descending into a position where they cannot function properly. If qi is deficient, the consolidating function is weakened, leading to various kinds of health problems such as haemorrhage; frequent urination, premature ejaculation and stomach or kidney prolapses (where the organ sinks). 

The promoting and consolidating functions work in a complementary manner. For example, qi promotes blood circulation and the distribution of body fluids, but it also controls and adjusts the secretion of fluid substances. The balance between these two functions is essential for maintaining a healthy blood circulation and water metabolism.

5. Transforming functions Qi also possesses vaporization or " transformation" functions, which are important for the metabolism of fundamental substances. As suggested by these words, qi may "vaporize" substances in the body and transform them into essence or vital energy. For example, certain actions of qi allow food to be changed into food essence, which is in turn transformed into different types of qi and blood. Indigestible food and waste are also transformed by qi into urine and stools for excretion. 

Movement of Qi

The four directions of qi movement are up, down, outward and inward. These movements are so important that once qi can no longer travel in these directions, life will come to an end.

Each organ has different specialized movements. For example, spleen qi ascends the pure part of digested food from the stomach for transformation into nutritional essence. Stomach qi, on the other hand, pushes food downwards in order to remove its impurities. Some organs, like the lungs, perform movements in all four directions. Lung qi moves in and out during breathing. However, when disseminating nutritional essence to the body, lung qi ascends and then descends when liquefying waste to be sent to the kidneys.

The different movements of qi work in a coordinated manner to maintain a harmonious balance. The ascending balances the descending movement while the outward balances the inward movement. Balanced movement is important for promoting the physiological functions of different tissues, organs and meridians. Disharmonious movement of qi leads to health problems. For example, insufficient downward movement of lung qi causes a cough. When stomach qi cannot descend nausea and vomiting occurs. 

Types of Qi 

Qi is further classified according to its type. The four types are inborn qi, pectoral qi, nutritive qi and protective qi. 

1. Inborn qi Inborn qi is the most original, essential and vital type found in the human body. It possesses prenatal and congenital properties. After conception, "congenital essence" (an essential vital substance inherited from parents) is stored in the kidney, the place from which inborn qi originates. Inborn qi is further nourished by "acquired essence" (food essence derived from digestion) of the spleen and stomach. After this process is complete, inborn qi is ready to travel to the entire body to exert its effects. Starting from the portion between the two kidneys, known as the "vital gate", the qi moves through the triple burner and circulates through the organs, muscles, skin and meridians providing the power source for all of life's activities. 

2. Pectoral qi Pectoral qi is stored in the chest. It is formed by combining fresh air inhaled by the lungs and food essence derived from the spleen and the stomach. Because pectoral qi concentrates in the chest, it can penetrate the blood vessels of the heart and lungs and move outward during expiration and inward during inspiration. By flowing through the respiratory tract, pectoral qi supports the breathing function of the lungs and affects how loud the voice can be. Its ability to flow through the blood vessels and the heart is important in regulating the heartbeat and supporting the circulation of other types of qi and blood. Pectoral qi also plays a role in keeping the body warm and influences the activities of the limbs. 

3. Nutritive qi Nutritive qi, as its name suggests, supplies nourishment to the body. It mainly circulates through the blood vessels with the blood. Sometimes this combination of nutritive qi and blood is referred to collectively as "nutritive blood". Nutritive qi

mainly comes from food essence derived by the spleen and stomach's transformation and transportation properties. Starting from the middle burner, nutritive qi goes to the lungs where it enters the main circulation. Nutritive qi hasyin properties so it can form into materials needed by other parts of the body. For example, its close relationship with blood allows it to provide some of the necessary substances needed to produce new blood. Nutritive qi also provides the needed nutrients to support the physiological functions of the organs. 

4. Protective qi Protective qi protects against evils. As previously mentioned, evils are environmental factors that lead to illness. In western terms, protective qi functions like the immune system, which helps prevent disease from occurring or spreading. Unlike nutritive qi, protective qi has yang properties, because it has more functional characteristics.

Protective qi also comes from the food essence derived by the spleen andstomach. It moves outside the blood vessels and circulates in different areas from nutritive qi. Internally, it will be distributed to the diaphragm and scattered around the chest and abdominal cavities. Externally, it moves between the skin and muscles providing protection. Protective qi not only guards against illness and disease but also regulates the sweat glands and pores and provides nourishment for the skin, hair and muscles.

Although nutritive and protective qi share the same origin, their flow directions, as previously described, are opposite to one another. By balancing their nutritive (yin) and protective (yang) functions, healthy sweating, temperature control and defence functions are maintained. 

Flow chart for formation of qi

Blood from a TCM Perspective

In western medicine, blood is composed of red blood cells, white blood cells, platelets, nutrients, other proteins, electrolytes and water. Its functions are based on the characteristics of these individual components. Some of these functions include distributing hormones, carrying oxygen and energy (glucose) and supporting the immune system.

Instead of studying things at a cellular level, TCM focuses on the body as a whole. Blood is viewed simply as the red fluid inside the blood vessels that provides nutrition for the body. The nutrients transported by blood are not restricted to physical materials. Its meaning can be extended to anything that provides nourishment to the body. 

The origin of blood

Blood mainly originates from food essence and Jing (the essence of life associated with the growth and development of the body). First, digested food is turned into food essence by the stomach and spleen's transforming functions. It is then transported upwards by the spleen to the lungs where it turns into blood with the help of the heart and lungs. Eating a balanced and healthy diet is extremely important, because of the spleen's role in the production of qi and blood.

A second source of blood comes from Jing, which is stored in the kidneys. Jing travels to the bones where its turns into healthy and strong marrow. The marrow in turn produces the blood. Jing also goes to the liver to be transformed into clear blood. 

The Functions of Blood

Blood is mainly responsible for nourishing and keeping the body moist. Internally, it circulates to the organs, and externally, it flows to skin, flesh, bones and muscles. Its detailed functions are as follows: 

1. Providing nutrients for organs, tissues and meridians With sufficient nourishment from the blood, organs and tissues can function normally resulting in a healthy glow in the skin, cheeks, and hair. Nails, muscles and bones also rely on blood nourishment to remain strong and healthy. 

2. Maintaining healthy body movement and sensation The Huang Di Nei Jing, a famous Chinese medicine text from the Han dynasty, says, "Having received sufficient blood, the liver can support healthy eyesight. Having received sufficient blood, feet can walk. Having received sufficient blood, the palm can grasp hold of things. Having received sufficient blood, the fingers can pick up things." This illustrates blood's importance in healthy muscle movement and sensation. If blood is deficient, dizziness, vertigo, ringing in the ears (tinnitus) or limb weakness can occur.

3. Aiding the mind and mental activities A good blood supply is also important for mental health. With sufficient blood nourishment, a clear mind, good spirit, fast thought processes and swift reaction times are possible. On the other hand, deficiency of blood leads to poor memory and insomnia and in serious cases causes mental disorders and psychiatric diseases. 

Flow chart for formation of Blood

Body Fluids from a TCM Perspective

Body fluids refer to the different kinds of physiological fluids found in the body, including fluids in the organs and tissues, gastric fluid, intestinal fluid, semen and tears. Classified as one of the fundamental substances, body fluids are essential to life's activities. 

The Origin, Distribution and Excretion of Body Fluids

According to TCM theory, body fluids originate from food and water. They are formed during digestion in the stomach and by transformation in the spleen. The small intestine extracts body fluids by further separating the pure fluids from the impure fluids contained in the food, and the large intestine contributes to the formation of body fluids by absorbing water from the stool. 

Body fluids are distributed and excreted via different pathways. First, they are distributed through the spleen's transportation function to the lungs. In the lungs they are disseminated to the rest of the body. The lungs descend fluids that become impure while circulating through the body to the kidneys. The kidneys "vaporize" the body fluids and regulate their metabolism by sending the impure wastes to the bladder to be excreted. The triple burner also acts as a distribution pathway for body fluids. 

Body fluids help excrete metabolic waste and toxins produced through the metabolic functions of various organs. These fluids are usually excreted as sweat and urine. In this way, body fluids maintain a clean and healthy environment for organs, meridians and tissues. 

Functions of Body Fluids

Body fluids are mainly responsible for providing moisture and nourishment to the tissues. When distributed to the surface of the body, body fluids moisten the skin and hair and maintain the smooth and elastic texture of the skin. Body fluids also moisten, nourish and protect different orifices in the body. For example, body fluids allow the eyes to blink smoothly, the nasal cavity to maintain an open airway without blockage and the lips and mouth to remain moist without becoming dry. Internal body fluids also penetrate different organs, tissues and even bone marrow to provide moisture and nourishment. The spinal cord and brain are examples of organs surrounded by body fluid that protects and nourishes them. 

Disharmony of body fluids is manifested in two ways. When body fluids can no longer nourish and provide moisture to the body, symptoms such as dry skin,

flaccid muscles, brittle hair, dry eyes, parched lips and a dry nose or throat occur. When there is dysfunction of distribution or excretion of body fluids symptoms can present as swollen eyelids, edema (retention of fluid in the tissues), obesity or other conditions.

Flow chart for formation of body fluids

References :

1. 張恩勤：《中醫基礎理論》〈上冊〉，上海 上海中醫藥大學出版社，1990。2. 劉家義等：《中醫診斷學》，上海 上海中醫藥大學出版社，1990。3. 北京中醫學院：《中醫學基礎》〈第一版〉，上海 上海科學技術出版社，1978。4. 印會河：《中醫基礎理論》，上海 上海科學技術出版社，1985。 

5. 《黃帝內經素問》，北京 人民衛生出版社，1978。6. 劉燕池：《中醫基礎理論問答》〈第一版〉，上海 上海科學技術出版社，1982。7. Kaptchuk Ted J.,Chinese Medicine :The Web That Has No Weaver, London: Rider, (2000).8. Williams Tom, Complete Chinese Medicine, Bath: Mustard, (1999). 

Written By:Dang YiProfessor, Beijing University of Chinese Medicine Ph.D. Beijing Union Medical CollegeVice Director, Gourmet Food Institute of Health Care and Nutrition of Beijing 

Edited By:Angelo Chung, B Pharrm., Integrated Chinese Medicine Holdings Ltd.Angela Collingwood, MSN, Integrated Chinese Medicine Holdings Ltd.Margaret Harris, MD, Integrated Chinese Medicine Holdings Ltd. 

Translated By:Michael Yang

In western medicine, the body's organs are explained in terms of their anatomical structure and physiological functions. However, in Traditional Chinese Medicine (TCM), the approach is quite different. Organs are considered functional units of the body. Therefore, what is typically thought of as an organ (i.e. heart, liver, stomach etc.) has a much broader meaning and application in TCM. An organ's anatomical structure is not as important as its yin yang properties or relationships with other organs. Chinese medicine recognizes five yin organs and six yang organs, also known as "zang" and "fu" organs respectively. 

What are the yin yang organs? 

The yin organs include the liver, heart, spleen, lungs and kidneys. The pericardium is sometimes considered a sixth yin organ. The function of the yin organs is to produce, transform, regulate and store fundamental substances such as qi, blood, and body fluids. In general, yin organs do not have empty cavities.

The six yang organs are made up of the gall bladder, stomach, small intestine, large intestine, bladder and triple burner. The triple burner does not have a physical structure and is considered a functional unit. The yang organs are mainly responsible for digesting food and transmitting nutrients to the body. Usually, yang organs are organs with empty cavities. 

In TCM, the physiological functions of the body are based on harmonious

relationships between yin and yang organs. Central to these relationships is the interior and exterior relationship theory, which states the interior belongs to yin and the exterior belongs to yang. Hence, yin organs are thought to have more internal functions and are called interior organs. They tend to play a more important role in TCM medical theory and practice. The yang organs, on the other hand, are believed to have more external functions and are considered exterior organs. (See table.) 

Interior-exterior relationship between yin and yang organsYin organs (interior organs) Yang organs (exterior organs)

Liver Gall bladder

Heart Small intestine

Spleen Stomach

Lung Large intestine

Kidney Bladder

Liver from a TCM Perspective 

In western physiology, the liver is responsible for a number of important body functions, including the production and excretion of bile, which is used to break down fat and the detoxification of blood. However, according to TCM, the liver's functions are different. They include control of the central nervous system, the autonomic nervous system (the part of the nervous system over which a person does not have voluntary control), and the circulatory system. In addition, the liver is responsible for vision. "The liver rules flowing and spreading." In TCM, the liver promotes flowing and spreading movements. By stimulating flow, the liver adjusts and ensures the smooth movement of qi, blood and body fluids, and spreads these substances to the entire body. There are three functional aspects of the liver's "flowing and spreading" activity: regulating qi, regulating emotions and enhancing the digestive properties of the spleen. 

Regulating qi movement 

The activities of the organs and meridians are dependent on qi movement. The flow and spread of qi throughout the body are in turn dependent on the regulatory functions of the liver. If the liver is not functioning properly, qi flow is interrupted, which can lead to disharmony and imbalance. When this becomes marked,, disease and other health problems ensue. 

Regulating emotions 

The liver balances emotions. Normal emotional health depends on the harmony of qi and blood.

When the liver keeps qi flowing smoothly, a relaxed internal, emotional environment is created. If liver disharmony results in stagnant liver qi, emotional disturbances like depression and anger can occur.

Enhancing the digestive power of spleen 

The liver's flowing and spreading functions also adjust the digestive functions of spleen. If the liver is not functioning properly, the movement of spleen qi is not smooth. Consequently, the transformation and transportation of digested food will be affected, leading to abdominal pain, nausea, belching, diarrhea and other complications. 

"The liver stores the blood."The liver is also responsible for storing and regulating blood flow. When a person moves or exercises, the blood leaves the liver and goes to the part of body that needs it. The blood returns to the liver to be stored, when a person rests. If a person has insufficient blood available for storage in the liver, their eyes will not be adequately nourished and will become rough and dry. Dizziness can also occur. 

"The liver opens into the eyes." The eyes have a close relationship with the liver; because, they are connected to the liver meridian. The ability to see depends on the nourishment of the eyes from blood stored in the liver, and many liver disorders are reflected in the eyes. For example, insufficient liver blood can lead to blurred vision. "Dampness and heat" of the liver and gall bladder, a condition known in western medicine as jaundice, manifests as yellow eyes. 

"The liver rules the tendons and is manifested in the nails." The proper movement of tendons, which attach muscle to bone, is closely related to liver function. If the blood stored in the liver is insufficient and incapable of nourishing the tendons, symptoms like spasms, numbness of limbs and difficulty bending or stretching occur. Fingernail and toenail health is also dependent on the nourishment of blood from the liver. If the liver blood is sufficient, nails will appear pink and moist. If it is insufficient, the nails will become thin, brittle and pale. 

Heart from a TCM Perspective 

In TCM, the functions of the heart are different from those of the anatomical heart, as it is understood in western medicine. The heart organ represents a group of physiological functions. In addition to regulating the cardiovascular system, it is responsible for maintaining the nervous system's functions.

"The heart rules the blood and blood vessels"The heart is the functional unit for regulating blood flow. Blood is transported

inside the blood vessels around the entire body when the heart pumps. The heart, blood and blood vessels are united by their common activities. In TCM, this functional relationship is known as the "ruling" of the heart. 

Heart qi refers to the pumping actions of the heart. If heart qi is abundant and sufficient, the heart pumps at a normal pace, transporting blood smoothly inside the blood vessels, the pulse is regular and strong, and the face will look brilliant. As a result, the body is able to obtain from blood the nutrients needed to sustain life. On the other hand, if heart qi is deficient, blood cannot maintain an efficient flow in the blood vessels, and the pulse is weak. The individual looks pale, and the tongue also appears pale and white. Without healthy ruling of the heart, individuals will experience palpitations, chest discomfort and pain.

"The heart rules the spirit" In TCM, the heart stores the "spirit". In general, the "spirit" refers to an individual's vitality, which is reflected in the eyes, speech, reactions and overall appearance. Specifically, the "spirit" refers to a person's mental, cognitive and intellectual abilities. The heart takes charge of mental activities by mastering other organs and their physiological functions. If the "spirit ruling" is good, the individual will be wise and have a clear and fast mind. If there is heart disharmony, signs like forgetfulness, poor self esteem, and slow thought processes or reactions occur.

"Sweat is the fluid of the heart." Sweat comes from body fluids, which are an essential and integral part of blood. Blood is ruled by the heart and is the main fluid of this organ. Because sweat comes from the same origin as blood, in TCM over-sweating is considered an exploitation of qi and heart blood, leading to symptoms such as palpitations. As a result, people who sweat abnormally usually have a heart deficiency. If such sweating is spontaneous, the disharmony belongs to a deficiency of heart yang. If it takes place at night, the disharmony belongs to a deficiency of heart yin. 

"The heart opens into the tongue. The heart's brilliance is manifested in the face." In TCM, both the tongue and face are windows for the heart and blood. The heart "opens into the tongue" because they are connected. By observing the tongue and looking for the "heart's brilliance to be manifested in the face," a lot can be learned about how the heart is functioning. For example, if heart function is normal, individuals will have bright, healthy red cheeks and the tongue will appear pink. If there is blood stasis (where blood is not able to flow smoothly through the blood vessels), the face and tongue will appear purple. A healthy blood supply is also essential for providing nutrients for hair growth, because in TCM, hair is thought to be the "remains of blood." If hair growth is affected, it may indicate a problem with the heart and blood. 

Spleen from a TCM Perspective 

In western physiology, the spleen is a large, vascular, lymphatic organ. It acts as a reservoir and filters the blood. It also plays a role in making blood

early on in life. In TCM, the spleen does not perform these functions. It assists with digestion, blood coagulation and fluid metabolism in the body. 

"The spleen rules transformation and transportation." Since the spleen is the primary organ responsible for digestion, its main function is to transform food into essence used for qi and blood transformation. Once the ingested food and liquids get into the body, the spleen extracts a pure nutritive essence from them. This pure nutritive essence is used for the production of qi, blood and body fluids, which the spleen then transports throughout the body. Liquids extracted as pure nutritive essence are sent upwards to the lung for dissemination and redistribution. However, some will descend to the kidney and bladder to be excreted as urine.

If the transformation and transportation functions of the spleen are harmonious, there will be abundant nutritive essence for qi and blood, but if the spleen is in disharmony, its digestive powers will be affected. As a result, abdominal distention, pain, diarrhea or malaise occurs. 

"The spleen rules ascending pure essence." After transforming food into nutritive essence, the spleen sends it upwards to the heart and lungs where it is transformed into qi and blood for nourishment of the whole body. Food not transformed into nutritive essence becomes an impure substance. While the spleen ascends pure essence, the stomach, (the spleen's corresponding exterior organ), will descend the impure substances inside the digestive tract. By ascending the pure nutritive essence and descending the impure substances, a balance in the digestive system is created.

"The spleen governs the blood." Not only does the spleen transform food essence, it also governs the movement of blood by keeping it flowing in its proper pathways in the blood vessels. When spleen qi is sufficient, there is adequate production of qi and blood, and blood is, therefore, kept inside the blood vessels. If the spleen's functions are in disharmony, the blood escapes from its normal pathways, leading to symptoms such as bloody vomit, blood in the stool, blood under the skin, blood in urine, or menorrhagia (excessive menstrual bleeding). 

"The spleen rules the muscles and flesh. It opens into the mouth and its brilliance is manifested in the lips."In TCM, the movements of the muscles and the four limbs depend on the power of the spleen. When spleen qi is sufficient, the limbs and muscles are healthy and strong because they are nourished by the blood and qi. If spleen qi is deficient, however, the muscles become weak and an individual may feel tired and have general malaise. 

The lips and mouth are also affected by the spleen's health. If spleen function is harmonious, the mouth can distinguish the five tastes (sweet, salty, sour, bitter and pungent (spicy)), and the lips appear red and moist. If the spleen is weak, the mouth cannot distinguish the different tastes and the lips will be pale. 

Lungs from a TCM Perspective 

In western physiology, the lungs are responsible for air exchange. In addition to performing respiration in TCM, the lungs' regulate fluid metabolism, blood circulation, the autonomic nervous system and the immune system. 

"The lungs rule qi and administer respiration. "The lungs are where qi exchange and regulation occurs. During inhalation, the lungs take in natural air qi (one type of qi referring to the atmospheric air), propelling it downward where it meets other types of qi. The different types of qi combine to produce normal qi (qi present in the body). During exhalation, the lung expels the "impure" air not useful to the body. If the lungs are healthy, qi will enter the body smoothly and respiration will be even and regular. If there is lung disharmony, respiration is weakened and normal qi production is affected, leading to qi deficiency. 

"The lungs direct movement in a disseminating, descending and liquefying manner." The lungs disseminate substances in an ascending and outward direction. For example, impure air is expelled in this manner, and body fluids and food nutritive essence are directed towards the skin and hair. By regulating sweat secretion, the lungs disseminate protective qi (qi mainly responsible for immunity) to the skin and the pores.

The lungs also demonstrate descending and liquefying properties. They take in natural air qi during respiration and liquefy the fluids in the airway. The lungs then descend these substances downwards along with food essence transformed by the spleen. The descending function is necessary to maintain a normal respiratory tract. 

The disseminating, descending and liquefying properties of the lungs are essential for good health. If disharmony occurs, individuals may suffer from coughing, wheezing, chest discomfort, abnormal sweating or congestion from phlegm.

"The lungs move and adjust the water channels"The lungs are responsible for the transformation and movement of water in the body. They move water in the same directions as qi. The lungs' disseminating properties enable water vapor to ascend and scatter to the skin pores. This is the process of normal sweating. The lungs also liquefy and cause water vapor to descend to the kidneys, where the liquefied waste is excreted as urine. 

"The lungs collect blood vessels and rule regulation."As mentioned before, the lungs rule qi. By regulating qi movement, which is necessary for blood circulation to occur, the lungs intercept all blood and blood vessels. After qi exchange occurs during breathing, the qi moves the blood throughout the body. Qi movement also regulates the distribution of body fluids. Since qi is essential for all physiological functions in the body, the lungs' ability to 'rule

and regulate qi" is an important function. 

"The lungs open into the nose and their brilliance is manifested in the body hair. The lungs also connect to the throat."The skin and body hair share a close relationship with the lungs. Together with the sweat glands, they are often referred to as the "exterior" of the body in TCM. The lungs are the interior organs that rule this exterior. By controlling the skin, sweat glands and body hair, the lungs regulate the sweating process. In addition, they maintain healthy movement and dissemination of protective qi over the skin. Protective qi is important for guarding the body against "illness evils" (factors causing illness including wind, fire, dampness, dryness, cold and summer heat). If these particular lung functions are weakened, too much spontaneous sweating occurs, and the protective qi will become weak as well. As a result, the body will have lower resistance to illness and may easily get colds, influenza, or other respiratory problems. 

The nose is considered the opening of the lungs and the exit for qi in the body. If lung dysfunction occurs, the nose is affected. For example, disordered flow of lung qi leads to a watery nasal discharge, congestion, a loss of sense of smell and sneezing. The throat and vocal cords are also connected to the lungs. Sometimes lung deficiency produces a coarse or low voice. 

Kidneys from a TCM Perspective 

In western physiology, the kidneys are a vital excretory organ whose main function is to create urine to help the body get rid of toxins and unwanted water. TCM practitioners view the kidneys as a very important organ that not only regulates the urinary system but also exercises control over the reproductive, endocrine and nervous systems. 

"The kidneys store Jing"In TCM, Jing is an essential substance, closely associated with life. It is the substance needed for reproduction, growth development and maturation. The kidneys are the organs responsible for human development, because they store Jing. For example, conception is made possible by the power of Jing, growth to maturity is the blossoming of Jing, and aging reflects the weakening of Jing. As time passes, Jing decreases, causing both vitality and kidney qi to decline. This decline is the normal aging process. 

"The kidneys rule water."The kidneys rule water by regulating its distribution and excretion, traditionally described as the vaporizing power of the kidneys. The kidneys can differentiate between clean water, which is recycled and used by the body, from turbid water that is turned into urine. The separation of these two is the vaporization process. 

The kidneys play an important role in water movement and balance of the whole body. Fluids and food are received by the stomach where separation begins. The unusable portions of food and fluid are sent to the intestines as waste where pure fluids (mainly water) are extracted from them. The pure fluids go to the spleen, which then sends them in a vaporized state upward to the lungs. The lungs circulate and disseminate the clear part of the fluids throughout the body. Whatever has become impure through use is liquefied by the lungs and sent downward to the kidneys. In the kidneys, the impure fluids are further separated into "clean" and "turbid" parts. The clean part is vaporized into a mist and sent upwards to the lungs, where it rejoins the cycle. The final impure portion goes to the bladder, where it is stored and finally excreted as urine. 

"The kidneys rule the grasping of qi." Although respiratory functions mainly depend on the lungs, deep and normal breathing is controlled by the "grasping" function of the kidneys. By grasping qi, the kidneys enable the "natural air qi" of the lungs to penetrate deeply during the inhalation process. If there is kidney disharmony, respiratory problems such as shallow breathing or wheezing on exertion can occur. Some types of asthma are related to disordered grasping of qi by the kidneys. "The kidneys rule the bones and produce bone marrow.

The kidneys manifest in the head hair." Stored in the kidneys, Jing is the substance responsible for producing bone marrow, which in turn, creates and supports bone growth. Therefore, bone development and repair depends on the nourishment of kidney Jing. Deficiency of Jing in children can lead to soft bones or incomplete closure of the skull bones. Teeth are made up of bone so dental problems can also indicate a kidney deficiency.

Head hair depends on blood for its nourishment. The kidneys play a role in transforming stored Jing into blood. If Jing and blood are abundant, the hair will appear bright, shiny and healthy. On the other hand, hair loss or other hair disorders can indicate a kidney deficiency or blood deficiency. 

"The kidneys open into the ears and genital organs."Good hearing comes with abundant kidney Jing, while a deficiency causes hearing problems like deafness or ringing in the ears (tinnitus). Genital and urinary tract disorders such as urinary frequency or dripping urine (incontinence) are also signs of kidney disharmony.

Gall Bladder

Similar to western medicine, in TCM the gall bladder stores and secretes bile produced by the liver. The liver's flowing and spreading properties allow bile to be secreted into the small intestines where it aids the digestive process. Liver harmony is essential for the healthy functioning of the gall bladder. The secretion of bile also supports the spleen in its transformation functions. If liver disharmony occurs, bile secretion is affected, which can

have a negative impact on other digestive functions. Disharmony of gall bladder function leads to jaundice where an individual develops yellow eyes and yellow skin colour as a result of a build up of bile in the body.

In TCM, the gall bladder rules decision and is related to bravery. Mental disorders involving anxiety and fear are treated by resuming gall bladder harmony.

Stomach

The stomach, known as "the sea of food and fluid", is responsible for "receiving" and "ripening" ingested food and fluids. When food is ingested, it passes down into the stomach where stomach qi and fluid decompose it into materials to be further digested in the small intestine. 

Food is divided into two parts in the stomach. The "pure" part is sent upwards to the spleen for transformation into nutrient materials for the body. The "impure" part is sent downwards to the small intestine. This function is called the "descending the impure" in TCM. While the spleen rules "ascending" functions, the stomach rules "descending" functions. If the stomach loses its descending properties, disharmony occurs, leading to symptoms such as nausea and vomiting. Being a yang organ, the stomach prefers a moist rather than dry environment. Excess of yang may sometimes cause "dryness fire" which leads to stomach disharmony as well. This condition presents as a dry mouth and thirst. 

Small intestine

The small intestine rules "containing and transforming." It receives what the stomach has not completely digested and this material is further digested into nutrients. The small intestine also separates the "pure" from the "impure." Like the stomach, the small intestine sends the "pure" (useful) part to the spleen where the nutrients will be distributed, and the "impure" (waste) part is directed down into the large intestine. Any useless water produced in the digestion process will be sent to the bladder and stored as urine. Healthy small intestine functions are essential for normal urination and defecation. If disharmony is present, an individual may experience dysuria (difficulty or pain on urination) or loose stools. 

Large intestine

The large intestine receives the "impure" parts of the digested food from the small intestine and continues to absorb water from these materials. At the end of the process, stools are formed and excreted through the anus. Large intestine disharmony presents with symptoms of abdominal pain, intestinal rumblings and diarrhea. Sometimes, if there is excessive "heat", intestinal fluids will dry up, and constipation will occur. 

Bladder

The bladder is responsible for storing and excreting urine. As previously discussed, the lungs, spleen and kidneys all have roles in fluid metabolism and regulating the water distribution in the body. The "turbid' water collected by the kidneys that cannot be reused by the body is sent to the bladder for excretion as urine. TCM describes this function as "vaporization" of urine in the bladder. Disharmony of the bladder can lead to urinary problems such as incontinence or difficult urination. Kidney function complements bladder function so a problem with the bladder often indicates kidney problems as well.

Triple Burner

The triple burner is a special concept in TCM, and there is no corresponding organ in western medicine. Suggestions have been made that the triple burner's function may be related to the pancreas and metabolism in the body, but no clear conclusion has been reached as to the nature of this organ. The triple burner is actually a collective term for the upper, middle and lower burner. The Chinese word "triple burner" actually means "three parts which burn or scorch." 

The upper burner is located above the diaphragm and includes the heart and lungs. The middle burner is located in the region above the belly button and below the diaphragm and includes the spleen and stomach. The lower burner is located below the belly button, and it includes the liver, kidneys, large intestine, small intestine and bladder. (This description of location is used for the functional classification of the TCM triple burner. The above locations do not refer to the anatomical location of organs.)

The triple burner's functions relate to the activities of qi and the movement of water. The functions of the three burners were summarized in the Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine) as follows: "The upper burner acts like a mist. The middle burner acts like foam. The lower burner acts like a swamp." 

"Mist" refers to the disseminating functions of the upper burner. With this function, qi, blood and body fluids are distributed throughout the body just as mist disperses in the environment. "Foam" means the digestive churning of the middle burner. When the spleen and stomach transform and ripen food, the food decomposes in a similar way to foaming. "Swamp" relates to the excretion of impure substances. The lower burner separates the "clear" from the "turbid" substances and excretes these impurities as wastes- like a swamp breaks down certain vegetation. 

The triple burner is the passage through which water, food and fluid are transported. The Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine) also says, "The triple burner is the controller of the entire circulation of body fluid". Therefore, disharmony of the triple burner can lead to edema ( fluid collection in the tissues) or difficult urination. Treatment of these conditions is aimed at resuming the harmony of the affected organs such as the lungs, spleen or kidneys.

Click here to read more about the Triple Burner Meridian. 

References:

1. 張恩勤：《中醫基礎理論》〈上冊〉，上海 上海中醫藥大學出版社，1990。2. 劉家義等：《中醫診斷學》，上海 上海中醫藥大學出版社，1990。3. 北京中醫學院：《中醫學基礎》〈第一版〉，上海 上海科學技術出版社，1978。4. 印會河：《中醫基礎理論》，上海 上海科學技術出版社，1985。5. 《黃帝內經素問》，北京 人民衛生出版社，1978。6. 劉燕池：《中醫基礎理論問答》〈第一版〉，上海 上海科學技術出版社，1982。7. Kaptchuk Ted J., Chinese Medicine :The Web That Has No Weaver, London: Rider, (2000).8. Williams Tom, Complete Chinese Medicine, Bath: Mustard, (1999). 9. Stedman's Medical Dictionary, 27th Ed., Lippincott Williams & Wilkins, (2000) 

Written By:Dang Yi Professor, Beijing University of Chinese Medicine Ph.D. Beijing Union Medical College Vice Director, Gourmet Food Institute of Health Care and Nutrition of Beijing

Edited By:Angelo Chung, B Pharm., Integrated Chinese Medicine Holdings Ltd. Angela Collingwood, MSN, Integrated Chinese Medicine Holdings Ltd. Margaret Harris, MD, Integrated Chinese Medicine Holdings Ltd. 

Translated By:Michael Yang 

An Overview of TCM Kidney

The TCM understanding of the kidney is more extensive than the Western understanding of the anatomical kidney, regarding it as the root of life and the origin of our individuality as human beings. It is no wonder that the kidneys are considered to be one of the most important organs in the body in TCM. They perform genital, urinary, endocrine, skeletal, blood, and central nervous system functions as well as store primordial yin and primordial yang (known as inherited or kidney yin and yang) which are attributive to the water and fire elements of the body respectively.

The major physiological functions of the TCM kidneys include:

1. Storing essence for reproduction, blood production, growth and development, and preventing evils or pathogens from invading the body.

2. Controlling water/fluid balance in the body.3. Helping to control respiration through the grasping of qi.4. Producing strong healthy bones and bone marrow.5. Producing healthy hair.6. Connecting with the ears to control hearing.7. Opening into the urethra and anus.

The Western Urological

System

TCM Kidneys

1. Kidneys store essence (jing) 

Essence, which is also called "essential qi" or jing is considered to be the underpinning of all aspects of organic life. Stored in the kidneys, it is the material basis for all kinds of functional activities and is responsible for human growth and development. In effect, kidney essence is what makes up our human vitality. The stored essence is comprised of congenital jing (also called congenital essence) and acquired jing (also called acquired essence).

Congenital jing: Congenital jing originates from the kidney itself and is made from the sexual energies of the parents when they procreate. Thus, "congenital jing" forms the basis for prenatal growth in the womb and nourishes the developing embryo and fetus. It also determines the constitution and characteristics a person will have throughout their life. After birth, congenital jing is stored in the kidneys and is nourished by acquired jing. It gradually becomes the material for our development and reproduction. Thus it also sometimes referred to as "reproductive jing."

Acquired jing: Acquired jing is often called the "jing of the organs" because this jing originates from them. It is obtained from ingested foods and fluids through the action of the stomach and spleen. The digested food and fluids are first transformed into nutrient substances in the stomach, and then further transformed into nutrient essence by the spleen. This nutrient essence or acquired jing is mainly responsible for irrigating and nourishing the organs so they can maintain their daily functions. Extra-acquired jing that is not being used is stored in the kidneys and can be used for nourishing the organs on demand. This process results in acquired jing being repeatedly replaced in the kidney; the extra jing is stored, sent out as required, and then replaced by new jing.

Click here to understand the physiological functions of kidney essence (jing)

Although the above two jings are from different sources, both are mutually dependent on the other in order to function properly. Because congenital jing forms the essence of us as humans it is needed initially to produce acquired jing. This is sometimes referred to as "congenital jing creating acquired jing." At the same time, acquired jing is needed to nourish and support the congenital jing, which is

referred to as "acquired jing providing congenital jing". Often these two types of jing are collectively referred to as "kidney essence" since their functions and origins depend on one another and cannot exist independently.

Formation of Acquired Jing

2. Kidneys rule water 

The kidneys play an important role in water movement and balance of the whole body. They do this through a kidney yang process called vaporization. Vaporization is the process by which fluids are separated into clean and turbid (unclean) portions. Clean fluid is "vaporized" by the kidneys and sent back to thelungs for redistribution throughout the body while turbid fluid is sent to the bladder by the kidneys for excretion as urine. This type of regulation of body fluids is also called the "opening and closing of the water gate." 

Having a balance between kidney yin and yang functions are necessary for normal functioning of the opening and closing of the water gate and the regulation of fluid   movement which both control urination. However, when kidney-yin and kidney-yang are unbalanced, the opening and closing of the water gate is abnormal, disturbing normal fluid movement. For example, in the case of a yang-deficiency and yin-excess, there is more closing than opening of the water gate, which leads to problems of urine production and excretion. This gives rise to symptoms of scanty urine and edema (generalized swelling). In the case of a yin-deficiency and yang-excess, there are many more incidences of opening the water gate, and problems like polyuria (excess urine production) will appear. Other organs, like as the lungs,spleen and bladder, are also dependent on the vaporization function of the kidney to regulate fluid movement. Therefore, the kidneys' vaporization control on the opening and closing of the water gate is crucial in balancing the fluid movement throughout the body.

Vaporization Function of the Kidneys

The kidney's "water gate"

regulates fluid distribution in the

body.

3. Kidneys rule the grasping of qi 

One way that qi enters and leaves the body is through normal respiration. The kidneys grasp the qi that is inhaled through the lungs to help regulate respiration. Although respiratory functions mainly depend on the lungs, inhaled qi must flow down and be grasped by kidneys for smooth respiratory movements to occur. Since normal respiration depends on mutual regulation by the kidneys and lungs, sayings such as "the lungs are the master of qi, the kidneys are the root of qi, the lungs exhale qi and the kidneys inhale qi" are commonly used to describe this relationship.

In order for the kidneys to be able to grasp the qi, they must have an abundance of stored kidney essence and their astringent or grasping and holding functions must be intact. When a kidney deficiency develops and there is a failure to grasp the qi, the qi does not flow down to the kidney and leads to symptoms such as difficulty inhaling with longer exhalation times, shortness of breath, wheezing, spontaneous perspiration, and fatigue. 

4. Kidneys rule the bones 

Kidney essence is needed for healthy bones. Essence stored in the kidneys is transformed into bone marrow, which provides the nutrients for bone development and blood formation. When kidney essence is abundant, the bone cavities can be fully occupied with marrow and the bones become strong. Through this process the kidneys contribute to bone growth and reconstruction. 

Kidney Essence and Bone Growth

Normal respiration from a TCM perspective

When depletion of kidney essence occurs, the bone cavity empties, as marrow is no longer able to fully occupy the space. This results in bone weakness or growth retardation. Clinical presentations include delayed closing of the fontanels (delayed fusing of the skull bones) in babies, difficulty walking, osteoporosis, and fractures related to bone weakness or brittleness. 

Teeth are considered to be remnants of bone in TCM and therefore are also dependent on kidney essence for their health. One particular TCM saying that illustrates this concept is: "Teeth are the manifestation of the kidneys, but their root is the bones." Teeth problems associated with a kidney deficiency include delayed growth of teeth in children or teeth falling out in early adulthood. 

5. Kidneys manifest in the hair

Head hair depends on blood for its nourishment and TCM believes hair is the remnant of blood. Since the kidneys play a role in transforming stored essence into blood, they are thought to be the origin of hair. If the stored kidney essence and blood are abundant, hair will appear bright, shiny, and healthy. On the other hand, hair loss or other hair disorders can indicate a kidney or blood deficiency. For example the elderly or those with chronic diseases, who have a depletion of kidney essence, may have hair that appears withered and falls out easily. In these cases, the TCM physician will replenish the kidney essence and nourish the blood to amend the problem. 

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6. Kidneys open into the ears

In traditional Chinese medicine (TCM), the ears are considered to be the openings of the kidney on the body surface. It is no surprise then that hearing relies

on nourishment from essence stored in the kidneys. A famous TCM classic Yilin Gaicuo (Errors Corrected from the Forest of Physicians)published in 1830 said, "The two ears communicate with the brain, and all the sound they perceived will be conveyed to the brain." When kidney essence is transformed into the marrow, part of the marrow collects to form the "sea of marrow" which makes up the brain and spinal column, which are responsible for neurological functions as well as intelligence. If the kidney essence is abundant then so will be the sea of marrow resulting in acute hearing. However, if there is inadequate kidney essence to nourish the sea of marrow then hearing disorders like tinnitus (ringing in the ears) or deafness appear. In the elderly, increasing deafness coincides with the age-related depletion of kidney essence. 

7. Kidneys dominate anterior and posterior orifices 

"Anterior orifice" refers to the urethra (the tube that urine passes through from the bladder to the outside of the body) and male/female genitalia, which provide urination and reproduction functions. Although the storage and excretion of urine is related to the bladder, it is dependent on the kidney's vaporization function for the production of urine. Therefore, disorders in urination such as enuresis (involuntary leakage of urine), incontinence, frequent urination, scanty urine and inability to make urine, are the result of the kidney's inability to carry out the vaporization function properly.

"Posterior orifice" refers to the anus, which excretes stool or feces. Although stool is mainly transmitted by the large intestine to the anus for excretion, the spleenplays an important part in digestion and stool production through its transformation and transportation functions. These functions need the support of the kidney to perform normally. Kidney yang provides a warm force while kidney yin provides nourishment for the spleen. In this way, the kidneys indirectly affect stool excretion. When a kidney yang deficiency is present, the spleen loses warmth and the large intestine becomes cold and under performs, leading to problems such as diarrhea. On the other hand, when kidney yin is deficient, the large intestine does not have adequate fluid for nourishment and constipation results. 

Kidney Properties 

The Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic) states: "Kidneys control the storage of essence, so they are also the root for sealing up substances and storing them." The kidneys possess sealing and astringent (consolidating) properties. These properties allow them to gather and hold on to substances such as essence. If the essence leaked out freely, there would not be sufficient amounts for all the bodily functions that rely on it. Inherent fire (part of inherited or primordial kidney yang) that is kept in the kidney should also be hidden and not be over exposed. The simultaneous storing of the primordial fire and

primordial water (part of primordial or inherited kidney yin) means the kidneys provide a place for the essence (yin) to motivate the power of our human vitality (yang). Only the kidneys' sealing and astringent properties can prevent them form escaping and extinguishing their existence. Therefore, the kidneys are not suitable to carry out dispersing and expelling functions.

Clinically, most kidney diseases are due to a deficiency of some sort and present as an asthenia syndrome. Tonification is the usual method of treatment for deficiencies because it tries to replace the missing elements in the body. However this is not absolute, sometimes a sthenia syndrome can be the cause of a kidney problem. Sthenia syndrome, which is the opposite of asthenia syndrome, occurs when there is a strong body resistance to fight off exogenous evils. Fever is a common symptom with a sthenia syndrome. In this case, a reducing method is applied to help decrease the body's resistance. It is not uncommon to have sthenia symptoms in a deficiency state. Remedies for replenishing vital energy (qi) and expelling the pathogens or evils are generally used in these instances. It is important to weigh the predominant symptoms carefully when generating a diagnosis and apply the correct treatment method to avoid further deterioration. 

Conclusion

Since the kidneys affect so many vital bodily functions, maintaining their health is an essential part of disease prevention in Chinese medicine. Retaining youth and vitality is also closely linked with good kidney functioning. This is why the kidneys' importance in health maintenance cannot be overlooked.   

Written By: Prof. Zou Yanquan (鄒燕勤教授)Affiliated Hospital of Nanjing TCM University National Medical Center of TCM Kidney Disease 

Editors: Angela Collingwood MSN, Integrated Chinese Medicine Holdings Ltd.Jennifer Eagleton, BA & MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd. 

Modern Immunology

Immunology is a study of about how the body identifies foreign bodies and reacts to them. In essence it is the study about the body's self defense mechanisms. The word "immunology" came from Latin "immunis", which was originally a law concept, and means "not subject to an obligation imposed on others"; e.g. immune from taxation. At first, immunology concentrated on studying anti-infection aspects only, which belonged to a branch of microbiology. In the 1960's, the rapid advancement of immunology expanded to include non-infectious aspects, such as autoimmune, allergy and immunodeficiency, consequently it became an individual science.

According to modern theory, the body depends on the immune system to fight against various infections from bacteria, microbes, viruses, toxins and parasites. It also clears up harmful materials inside our own body. The whole process can be understood as self-discrimination and elimination of foreign bodies in an attempt to create an internal equilibrium and provide physiological protection for the body. Thus, when the immune system is normal, health can be maintained. On the other hand, when the immune system is malfunctioning, disharmony will occur and give rise to illness. The above functions are carried out by an integrated body system, which includes organs (thymus, spleen and lymph nodes), tissues (skin and mucosal layers), cells (lymph cells and macrophages) and cell products (immunoglobulin, antibodies and complement).

To sum it up, the human immune system has three basic functions: defense, surveillance and homeostasis. 

The Immune Organs of the Body

Traditional Chinese Medicine Theory and Immunity

In the history of traditional Chinese medicine (TCM), the documentary records for the Chinese word "immune" was first seen in the 18th century in the book Mian Yi Lei Fang (Formulas for the Immunity from Plague). "Plague" had been a common term used by ancient Chinese to refer to infectious diseases that affected a large population. Although the terminology came later than Western medicine, their concrete context was different. However, TCM already knew about the theory and practice of immunology and infectious diseases from earlier dynasties. In chapter 72 of the Suwen (The Book of Plain Questions), when the Yellow Emperor asked about the seasonal epidemic diseases, his chief advisor Qi Bo answered that in order to defend against those diseases, one should always keep his healthy energy abundant, and the evils will not invade. The dialogue clearly shows that TCM regards "healthy energy" as the general defense mechanism against infectious diseases. Since then, it has abundant experience in various related aspects, with studies concentrating

The variolation method in ancient times: the patient inhales the vaccine powder through the nose with the aid

of a silver tube.

on wenbing, shanghan, liqi (pestilential evils) and measures of variolation (inoculation against smallpox) in the 16th century which was very progressive for the time.

TCM immunology has its own unique characteristics listed below:

The concept of holism is a main characteristic of TCM immunology.

From the beginning, TCM has employed holistic approaches; because, it sees the human body as an organic whole. The correlations between the organs and tissues, as well as the human person and the living environments, are organized according to specific orders, which give rise to mutual balance between each physiological function. This integral stability and harmony is the root of disease defense and health maintenance. Any disturbances in this equilibrium will cause disease. Every part of the body such as qi (vital energy), blood, body fluids, organs and themeridians has its own particular function. They combine to build up the body's defense system and bring out their protective strength mutually. According to TCM concepts, the body's natural resistance against diseases and its repair ability are described as a flow of energy that circulates throughout the body, which is called thehealthy energy (zheng qi).

Healthy energy (zheng qi) is the integral manifestation of the human body's immune functions.

Under normal circumstances, the body depends on the immune system to fight against various infections and to clear up harmful materials in order to keep a clean internal environment. When the immune system functions normally, health can be maintained; otherwise disharmony will occur and give rise to illness.

Similar to Western medicine, TCM also holds that the body has its own disease defense ability due to the existence of healthy energy (zheng qi). In chapter 72 ofSuwen (The Book of Plain Questions), it states: "When healthy energy is well stored inside the body, no evils can cause interference." In chapter 33 it states: "Whenever the evils are gathered inside, a deficiency of healthy energy must be present." These statements imply that healthy energy is the body's natural resistance against disease, and disease is seen as the result of the disharmonious healthy energy within us. Occasionally, other TCM terms such as primordial qi, genuine qi orprotective qi also refer to this kind of resistance. All of these embody the body's comprehensive immune

functioning.

Immune modulation effects are an important part of immune functioning.

TCM holds that when healthy energy (zheng qi) is abundant, evil forces cannot prevail. According to the yin yang theory, the body's yin and yang are regulated and adjusted continuously. Keeping yin and yang in equilibrium is an essential factor to carry on normal life activities. Once this equilibrium is disturbed, disease will result.

Resuming yin and yang harmony is the universal treatment goal of TCM. The overall therapeutic strategy is to replenish deficiencies and remove excesses of yin or yang. The approaches are usually focused on holistic regulation and possession of dual modulation effects, which as stated above, are to remove excesses and replenish deficiencies. These characteristics are similar to Western medicine's understanding of our body's immune modulation effects. The dual modulation (or immune modulation) effects of TCM have the following characteristics.

TCM focuses on mobilizing our own innate healing power; most of its remedies work on the whole being, not just on specific systems. Their healing power is far beyong the physical level; they can also work on the level of qi (vital energy) that empowers us. Even when the body seems healthy and there are no outward symptoms, immune function can be affected with symptoms present internally. Herbal remedies can find and fix these imbalances even when they are not obvious to us.To support the balancing process, TCM uses different modulation methods, for example adjusting the body's yin and yang, qi (vital energy), blood or organ functions. They can rehabilitate the body to go from a hyper-functioning state to a normal state or from an under-functioning level back to a normal state. TCM has unique theories about this, categorizing the regulating properties into four actions; "to depress when stimulated", "to rise when collapsed", "to subdue when overwhelming" and "to nourish when deficient."In some ways, normal immune functions are enhanced and the internal pathogenic factors are eliminated with dual modulation effects. A complementary relationship is formed that reinforces healthy energy and repels evils.

TCM therapeutic methods are usually focused on holistic regulation and possession of dual modulation effects.

The Material Basis of TCM Immunology: Zang Organs

The zang organs of TCM, which include the lungs, spleen, kidneys, liver and heart (also named as the five solid organs) are at the core of the immune activities. They combine with the tissues, viscera (organs), meridians, qi (vital energy), bloodand body fluids, and form a unity. Unlike Western medicine, their physiological and pathological meanings are not entirely the same. Rather than a single anatomical structure, a zang organ is part of the overall dynamic energy process of the body. Healthy energy is closely associated with their physiology activities. They are the center of the whole immune process. Their collaborative jobs are to act as messengers, be responsible for transportation and storage, deal with excesses and wastes, control internal communication, make decisions and activate body functions.

In TCM, healthy energy (zheng qi) refers to the body's natural resistance against diseases and its repair ability, which is closely associated with the physiological activities of the five zang

organs.

Details for individual organs are outlined in the following:

1. The lungs are an immuno-barrier.

The lungs preside over qi (vital energy). They connect externally with the skin and hair and disseminate protective qi over the body's surface. The lungs' protective qi belongs to part of the healthy energy (zheng qi); because it forms the first barrier against the invasion of exogenous pathogens. The protective qi provides warmth and nourishment to the skin, subcutaneous tissues and muscles; it also controls the opening and closing of skin pores. When protective qi is abundant, muscles are smooth, skin is tender and subcutaneous tissues are firm. Therefore, the ability to resist external pathogens is ensured. 

In this way, the lungs maintain the integrity of the body's outer barriers. Their actions are similar to the anatomical skin and mucosa linings such as that found in the mouth, which act like a natural immune barrier.

2. The spleen promotes immune functions.

In western physiology, the spleen is a large, vascular, lymphatic organ. However, in TCM, the spleen is regarded as the "acquired foundation of life", the source of blood and qi (vital energy) production. Actually, the spleen is a multi- functioning unit, which covers functions of the western anatomical spleen and pancreas and promotes activities of the digestive, endocrine, nervous and blood systems.

The spleen governs transportation and transformation of body fluids and nutrient essences and also controls blood flow. Although to a certain degree, the power of healthy energy is determined by

congenital (inherited) factors, it is mostly dependent upon the nourishment of the spleen to keep it in regular supply. Therefore, the spleen determines the abundance and depletion of healthy energy. In turn, it assures bodily protection against diseases.

3. The kidneys are the basis of immune functions.

TCM views the kidneys as the "congenital foundation of life", the root of healthy energy. It governs congenital constitution and prosperity of the healthy energy. The stored kidney essence (jing) is the material basis for the entire body's yin and yang forces, which make the body's physical form and functions mutually restrict and depend on one another. Therefore, the kidneys play an important role in safeguarding the internal equilibrium. Moreover, abundance in kidney essence (jing) promotes vitality and functioning of protective-qi, thereby strengthening the body's resistance.

According to modern understanding, the TCM kidneys not only regulate the urinary system, they also exercise control over the reproductive, hematological, endocrine and nervous systems. They work closely with the neural-endocrine immune regulating network.

4. The liver helps to maintain normal immune activity.

From a TCM viewpoint, the liver is responsible for part of the functions of the endocrine, digestive, circulatory and immune systems. The liver promotes flowing and spreading movements. By stimulating flow, the liver adjusts and ensures the smooth movement of qi, blood and body fluids, and spreads these substances to the entire body. TCM believes that emotional activity is an outer manifestation of the physiological status of the internal organ system, which is considered the major internal cause for diseases (regarded as endogenous evils in extreme conditions). Normal emotional health depends on the harmony of qi and blood flow, and the liver is mainly in charge of this aspect. When the liver keeps everything flowing smoothly, a regulated internal environment is created keeping diseases out.

5. The heart regulates the immune activities.

The heart controls and regulates the flow of blood through the vessels of the body. It also rules the spirit, which in TCM, is the chief administrator of all the physiological and mental activities. Normally, the heart exerts its influence over other organs through the monarch-fire (heart fire) which cooperates with the prime-minister fire to promote the functional activities of other organs. When the heart's "ruling" is good, then the other organ systems work in harmony, and the body can fight against diseases effectively.

In addition to pumping blood, the heart possesses our Western understanding of the brain's role in regulating the nervous, cardiovascular and endocrine functions, because, the heart houses the spirit (shen). Since the heart plays a role in regulating nervous and endocrine functions, it naturally also plays a part in immune regulation.

Furthermore, the meridians are the pathways of qi and blood circulation as well as the channels where the immune functions take effect. The triple burner directs the various types of qi, and they

act as the channel stations for the body fluids to circulate. They have an important effect on immune activities.

The Modulation Effect of Chinese Medicines

According to the concept of immunology, no matter if the immune reaction belongs to physiological or pathological factors, all the developing factors are crucial to disease formation. The basic rule for curing immune diseases is to shift the pathological immune reaction to a normal physiological immune reaction. In TCM, it is expressed by regulating the yin and yang balance, by applying holistic approaches to enhance the system's harmony, a method called dual modulation. Certainly, the immune modulation effect of Chinese medicine is extremely complicated, only a preliminary understanding has been revealed at this moment. Below are a few areas of discovery.

Modern research shows that the majority of individuals suffer from syndromes of deficiency, various degrees of under-functioning or a disturbance of their immune system.(2) Correspondingly, most of the tonifying herbs applied to these conditions can enhance immune function. For example, herbs like Lingzhi, ginseng, Tang shen, milk vetch root (huang qi), large head artactylodes rhizome (bai zhu), deer antler and Chinese caterpillar fungus, Chinese angelica (dang gui) and Barbary wolfberry fruit (gou qi zi) enhance the engulfing activities of monocytes, promote T- lymph cells' activation, increase the NK cells' activation and specific antibody productions and induce interferon reactions.(2) Tonifying herbs that are blood builders like Barbary wolfberry fruit (qi zi), fleece flower root (shou wu), donkey hide glue, rehmannia root (di huang), Chinese angelica (dang gui) and deer antler enhance blood production in the bone marrow (immune organ) significantly. They can be used as adjuvant therapy in leucopenia (low level of white blood cells) conditions caused by radio or chemotherapies, or some autoimmune blood diseases.(2)

Large head artactylodes rhizome (bai zhu) enhances the engulfing

activities of monocytes and promotes T- lymph cells' activation.

Chinese angelica (dang gui) promotes the NK cells' activation and specific antibody production.

Fleece flower root (shou gui) enhances blood production in the

bone marrow.

In the herbal category for heat clearing, many herbs promote immune function or the body resistance. Meanwhile, they also inhibit certain adverse immune reactions that are harmful to the body. For example, herbs like Baical skullcap root (huang qin), honeysuckle flower (jin yin hua), wormwood (qing hao) and Trichosanthes root (tian hua fen) inhibit hypersensitivity significantly.(2) Some of them also induce the production of interferon or tumor necrosis factor.(2) Enhancement of the pituitary- adrenal cortex can also be done with this category of herbs such as Spreading hydyotis (bai hua she she cao), Ningpo fogwort (xuan shen), Andrographis (chuan xin lian) and Northern ash bark (qin pi).

Baical skullcap root (huang qin) inhibits hypersensitivity significantly.

Honeysuckle flower (jin yin hua) induces the production of interferon.

Spreading hydyotis (bai hua she she cao) enhances the functions of the

pituitary- adrenal cortex.

Besides the benefit of improving the cardiovascular system and dynamic blood activities, some herbs used for blood and circulation also possess important effects on immune regulation. Herbs like notoginseng, achyranthes (niu xi), Dan shen, Szechuan Lovage (Chuan xiong), peach kernel (tao ren) and Argy wormwood leaf (ai ye) increase T-lymph cells and promote specific antibody production.(2) Some other herbs like notoginseng and madder (qian cao) promote blood production in the bone marrow too.(2)

Dan shen increases T-lymph cells. Szechuan Lovage (chuan xiong) promotes specific antibody

production.

Peach kernel (tao ren) is commonly used for blood and circulation in

TCM.

Main effect of herbs in the category for expelling wind and relieving syndromes of exterior type, are on the body's immune barriers, such as skin, respiratory mucosa, or localized body fluids and cell immune functioning. For example, some of them enhance the engulfing actions of phagocytes, like Divaricate Saposhnikovia root (fangfeng), cassia twig, Perilla leaf (su ye), fresh ginger and Chinese tororwax root (chai hu).(2) However, some herbs also act directly on the immune organs.

Fangfeng enhances the engulfing actions of phagocytes.

The main effect of cassia twig is on the body's immune barriers.

Chinese tororwax root (chai hu) is commonly used for relieving

syndromes of exterior type in TCM.

It is well known that Chinese drugs used for rheumatism possess significant immune inhibiting effects. Herbs used to treat this condition include Oriental vine stem (qing feng teng), Tripterygium (lei gong teng) and Northern fangji (Radix Stephaniae Tetrandrae). Other herbs that inhibit multiple hypersensitivity reactions are Paniculate Swallowwort root (xu chang qing), Slenderstyle Acanthopanax bark (wu jia pi) and Largeleaf gentian root (qin jiao).(2)

Northern fangji has immune inhibiting effects.

Slenderstyle Acanthopanax bark (wu jia pi) inhibits multiple

hypersensitivity reactions

Largeleaf geatian root (qin jian) is commonly used for rheumatism in

TCM.

Chinese herbs that possess anti-cancer effects can depress or kill cancer cells by inducing certain immune actions. Such herbs are natural indigo, Java Brucea fruit (ya dan zi), sweet melon pedicel and Chinese fir.(2) Some of these herbs even boost the overall immune functions, such as toad venom, Java Brucea fruit (ya dan zi), blister beetle (ban mao), natural indigo and sweet melon pedicel.(2) Also, some herbs like garlic can help reduce carcinogenic factors.(2)

Most Chinese medicines are natural substances that remain in their natural form when used for treatment. After being tested and verified for thousand years by Chinese medicine practitioners, those left behind have proven their effects. Scientists have noted multiple efficacies of these prescriptions which have dual modulation and adaptive capabilities. However, even in the study of immune modulation, projects for Chinese medicine are huge and complex, and the current overall research work has not been systematic. Among those single herbs or formulas, it is necessary to carry out more in depth investigations for further explanation about the mechanism of how these herbal ingredients work.

References1. He Huai-xin & Xi Xiao-xian, TCM Immunology, Beijing: Publishing House of People's Military Hospital, May 2000.2. Luo He-sheng, Luo Ding-hui & others, TCM Immunology: Chinese Medicine Pharmacology and Clinical Practice, Beijing:

Joint Publishing House of Beijing Medical College and Beijing Union Medical College, April 1999.3. Yu chuan-lin, Ye Tian-xing & others, Modern Medical Immunology, Publishing House of Shanghai Medical University,

October 1998.4. Kou Hua-sheng & Lin Jian-yu, TCM Immunology, Wuhan: Hubei Publishing House of Science and Technology, June 1990.

Written By: Wang LiProfessor, Beijing University of Chinese Medicine

Editors: Angela Collingwood, MSN, Integrated Chinese Medicine Holdings Ltd.Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd.

Special thanks to Elpidio Talens Juan for helping with article graphics.

What is Dual Modulation?

The central tenet of Chinese medical thought is that the whole body should be kept in harmony. The theory of Yin Yang and the Five Elements are two ways of expressing this system harmony. This means that each organ of the body not only must perform well, but also must keep in balance with the rest. When one organ is not functioning, as it should, it will affect the overall performance of the others. TCM seeks to restore the body to a condition of balance using a method called dual modulation.

In pharmacological terms, dual modulation is when a drug (which commonly are herbal prescriptions in TCM) possesses a dual character. This means that when the body is in an unbalanced state, the same drug can be used to cause the body to go from a hyper-functioning to a normal state, or from an under-functioning to a normal state, with no adverse effects. Many Chinese medicines have dual modulation characteristics. TCM has unique theories about this, categorizing the regulating properties of the medicinal substance into eight actions; "ascend and descend", "cold and heat production", "yin and yang", "reinforce and reduce", "excrete/drain and astringent", "dry and moisture", "activate and stop or slow down circulation", and "dissolve and gather". These actions relate to the drug's character and taste, quality, combination, processing methods and administration method. 

Four Important Concepts of Dual Modulation

Dual modulation of particular herbs and medicinal substances is possible because of four important concepts. These are:

1. Herbs contain multiple active ingredients, which can have opposite effects on the body.

2. Different amounts of the same herb or medicinal substances can have opposite effects on the body.

3. The body's adaptation ability can allow herbs to work differently in times of stress or illness.

4. Different processing or preparation methods can bring about different healing effects of the same herb or medicinal substance.

1. Herbs contain multiple active ingredients, which can have opposite effects on the body.A single herb, containing reverse-acting ingredients, forms the elemental basis for dual modulation. Complex formulas consisting of several herbs create a much more complicated mechanism because different active ingredients can work together to

The five elements and organs diagram

produce a more desired health effect, or a particular herbal combination can cancel out the negative effects associated with a single herbal ingredient thereby minimizing side effects and retaining only the desired effect. These complex herbal prescriptions are combined in such a way to make them more flexible in the conditions that they treat. Western medicine simply cannot match the range and scope of Chinese herbal medicine.

Some examples of this concept include: Huang qi (黃) or astragalus's traditional functions are to invigorate qi (vital energy)), benefit yang and increase body resistance. The main active ingredients identified in this herb are astragaloside and huang chi polysaccharide. Modern research shows that its dual modulation capabilities allow it to regulate the immune system by increasing the immune response when it is suppressed, and depressing the immune response when it is too high or over functioning. Therefore, the action of invigorating qi and benefiting yang can be interpreted in modern medicine as promoting and regulating the body's immune functions; thereby, maintaining the balance of the internal environment.

The root of pseudo-ginseng (san qi 三七), according to TCM application, is a drug used to stop bleeding and promote blood flow. The ancient classic the Bencao Gangmu (Compendium of Materia Medica) claims that it can "stop bleeding, dissolve blood stasis, and relieve pain." Pharmacological research has shown that it has a double action on the blood clotting system; active ingredients of pseudo-ginseng like saponin activate blood circulation and dissolve stasis, while san-qi-su stops bleeding. Other psuedo-ginseng active compounds, dencichine and ginseng propanol, also possess opposite blood clotting effects. Dencichine increases the production of certain clotting factors in the liver, and activates them, helping to stop bleeding. Ginseng proponal, on the other hand, increases the cAMP content in platelets, declines the production of TXA2, and prevents thrombosis (a fixed blood clot in the body). Although the body can modulate its own coagulation-anticoagulation system, pseudo-ginseng improves this action by its ability to both stimulate and prevent blood clotting with its active ingredients.

2. Different amounts of the same herb or medicinal substances can have opposite effects on the body.

When using single herbs or complex formulas, different quantities will produce different health effects. For example: 

Huang qi (astragalus)

pseudo-ginseng

Ginseng (人參) is a well-known tonic for invigoratingprimordial energy, and its main ingredient is ginsenoside. Studies show that small dosages causes high blood pressure in dogs and increase the strength of heart contractions. Large dosages cause transitional hypotension (low blood pressure), decrease the strength of heart contractions and lower the heart rate.

The usual dosage of rhubarb (da huang 大黃) is 9g-15g; its main effect is diarrhea, which is caused by the active ingredient, quinone. However, when rhubarb is used in small dosages (e.g. around 1g), it will benefit the stomach and stop diarrhea. This illustrates that, by using different dosages, the ratio of active ingredients that work for dual modulation may change, resulting in different effects.

According to some studies, dosages of astragalus (huang chi 黃) below 20g can lead to noticeable diuresis (excessive urination). However when dosages over 30g are used, it inhibits urination.

3. The body's adaptation mechanism can be enhanced with TCM medicinal substances 

Recent studies show that certain Chinese herbs such as ginseng (人參), acanthopanax (刺五加), rhodiolae root (紅景天) and Ganoderma lucidum (靈芝), can improve non-specific resistance to negative influences when the body encounters harmful stimulation. This is due to the drug's enhancement of the body's own "adaptation" mechanism. This kind of non-specific resistance only works in special circumstances, such as when the body's immune resistance is low, under stress or when it has to do extra work. When the body is in normal health, therapeutic dosages of these herbs do not interfere with physiological functions or cause any adverse effects. Russian cosmonauts carried these kinds of Chinese medicines with them as health supplements during their voyage into space. 

Acanthopanax Barbary wolfberry fruit Ganoderma lucidum

4. Different processing or preparation methods can bring about different healing effects of the same herb or medicinal substance.

Different therapeutic effects are achieved with different processing methods. For

Ginseng

Rhubarb

example:

Rhubarb (da huang 大黃): leads to severe diarrhea when used fresh, moderate diarrhea when processed; it can also stop bleeding after being fried. This is due to the heat that decomposes the active ingredient, quinone.

Fleece flower root (he shou wu 何首烏): possesses lubricant and diarrhea effects when it is used fresh. When processed, it benefits the liver and kidneys, replenishing the essence (jing) and the marrow. This is also due to the decomposition of the active ingredient, quinone.

Conclusion

By understanding the dual modulation effects of single herbs on the body, you can see how it becomes even more difficult to predict how the complex interactions of several herbs in one formula will affect the body. The interactions between active ingredients contained in the herbs, dosages of each ingredient and processing methods, all contribute to make a unique product that can have completely different effects from a similar formula if any of these things are altered. Furthermore, these formulas may react differently from person to person or on a body that is healthy, stressed or ill. This is why the empirical knowledge passed down through the TCM practitioners and various TCM classics is invaluable. The practitioner's skill in knowing what herbs can be combined, in what amounts, and how they should be prepared cannot be overlooked. This knowledge, combined with today's new scientific methods, help us to identify new active ingredients and understand how best to prepare and combine herbal ingredients to make even better TCM formulations for health maintenance.

By understanding the concept of dual modulation, you can understand why there is such variety in the efficacies of similar products. It is also essential to understand this concept in order that TCM formulas can be applied appropriately for maximum health benefits. 

References

Tao Yufeng, What is Chinese Medicine? - A Home Companion to Chinese Medicine,Shanghai Education Publishing House 1997:102-105.陶御風，中藥是什麼-家庭中藥保健顧問，上海教育出版社，1997:102-105. .

 Written By:Prof. Jiang Shufa (江樹發教授)Senior Engineer, Shanghai Institute of Materia Medica

Formula Prescription

Fleece flower root

 Editors:Angela Collingwood MSN, Integrated Chinese Medicine Holdings Ltd.Jennifer Eagleton, BA & MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.Rose Tse, Integrated Chinese Medicine Holdings Ltd.

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