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Course A: Basic Theories of Traditional Chinese Medicine
Brief Introduction
Chapter 1 The Theory of Yin-Yang and Five Elements
General Descriptions
Section 1. The Theory of Yin-Yang

1. The Concept of the Theory of Yin-Yang
2. Basic Contents of the Theory of Yin-yang
3. Application of the theory of Yin-Yang in Traditional Chinese Medicine
Section 2. The theory of the Five Elements

1. Basic Concepts of the Five Elements
2. Basic Contents of the theory of the Five Elements
3. Application of the Theory of the Five Elements in Traditional Chinese Medicine
Chapter 2 The Theory of Zang-Fu System
General Descriptions
Section 1. Five Zang Organs

1. Heart Appendix: the Pericardium
2. Lung
3. Spleen
4. Liver
5. Kidney
Section 2 Six Fu Organs

1. Gallbladder
2. Stomach
3. Small Intestine
4. Large Intestine
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5. Bladder
6. San Jiao (Triple Energizer)
Section 3. The Extraordinary Fu Organs

1. Brain
2. Uterus
Chapter 3 The Theory of Essence, Qi, Blood and Body Fluids
Section 1. Essence
Section 2. Qi
1. The Classification and Generation of Qi
2. Function of Qi
Section 3. Blood
1. Formation and Circulation of Blood
2. Functions of Blood
Section 4. Body fluids

1. Formation, Transportation and Dissemination of Body Fluids
2. Functions of Body Fluids
Chapter 4 Meridians and Collaterals
Section 1. Concept and Formation of the Meridian System

1. The Concept of Meridians
2. The Composition of the Meridian System
Section 2. The twelve principal meridians

1. The courses, connections and distributions of the twelve principal meridians
2. The relationships between the twelve principal meridians and cyclical flow of Qi
and blood in them
3. The routes of the principal meridians
Section 3 The eight extra meridians

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Section 4 The functions of meridians and their Application

1. Functions of meridians
2. Clinical Significance of the theory of meridians
Chapter 5 Etiology and Pathogenesis
Section 1. Etiology
1. The six exogenous factors
2. Internal injury by emotional frustration
3. Irregular diet
4. Excessive physical exertion and lack of physical work and exercise
5. Phlegm and fluid retention, and blood stagnation
6.Traumatic injuries
Section 2. Pathogenesis
1. Disharmony of yin and yang
2. Conflict between anti-pathogenic qi and pathogenic qi
3. Abnormal descending and ascending qi

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Brief Introduction
Traditional Chinese medicine (TCM) studies human physiology and pathology, it is

indicated as well to the theory and practice of diagnosis, prevention and treatment of
diseases. It views the human body not only as an integrated whole, but also
inseparable from nature. Therefore, it studies, through synthesis and analysis, the
interaction between the dynamic activities of various parts of the human body and
their relationship to the external environment. Traditional Chinese medicine
elucidates the fundamental laws of life processes from a macrocosmic perspective and
thus serves medical care and the prevention of diseases.
Through clinical study and practice over thousands of years, Chinese medicine
eventually turned into an efficient and unique medical system. It is characterized by
the concept of holism and the concept of basing treatment on the differentiation of
syndrome which closely unites principle with method, prescriptions with drugs,
internal medication with a variety of modified therapies. Besides its wealth of clinical
experiences and unique therapeutic principles, however, the vitality of traditional
Chinese medicine should be attributed mainly to the influence of ancient China' s
dialectical concepts. The theories of Yinyang and five elements are at the core of this
relatively comprehensive theoretical system of medicine. Practice has proven that
these dialectical materialist ideas, though imperfect in some respects, are nonetheless
guiding scientific principles that conform to certain objective laws of physical
evolution. Adherence to these principles has ensured the continuous development of
traditional Chinese medicine as a branch of natural science.
1. Foundation of the Basic Theoretical System of Traditional Chinese Medicine

The basic theory of Chinese medicine covers studies of various fundamental concepts
of traditional Chinese medicine, such as concepts of yin and yang, five elements,
Zang-Fu organs, and the meridian system, as well as the etiology, pathogenesis,
prevention and treatment of diseases.
Understanding the fundamental theory is necessary for learning about the various
branches of traditional Chinese medicine and the medical system at large. The basic
theory of traditional Chinese medicine was initially developed during the Warring
States Period (475-221 B. C.) and the Qin and Han dynasties (221 B.C.-24 A. D.). It
was a time of radical social change, with fairly rapid developments in the political,
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economic, scientific, and cultural spheres. Various schools of thought and doctrines
were born, among them the dialectical philosophical concepts of yin and yang, and
the five elements. They laid the foundation from which the relatively comprehensive
theoretical system of traditional Chinese medicine arose.
But why should the theoretical system of traditional Chinese medicine have taken
shape then? There are several reasons. First, ancient medical practice substantiate a
massive accumulation of clinical experience from which a deep understanding of
diseases was gradually acquired, adequate clinical information is the foremost
precondition for the systematization of medical laws. Second, the system was greatly
influenced by the philosophical thought of the intelligentsia in ancient China.
Historical records also show that ancient practitioners conscientiously applied
dialectical materialism, such as the theories of essence and qi, yin and yang, and the
five elements, to the analysis of random medical experiences, developing these
experiences into a systematic medical theory. Clearly, then, the theoretical system of
traditional Chinese medicine has a profound historical and philosophical origin. The
appearance of The Inner Canon of the Yellow Emperor, a monumental work of
medicine, marked the initial formation of the theoretical system of traditional Chinese
medicine. It summarized the medical achievements before the Warring States Period,
and included in its text the multiple variegated achievements of astronomy, biology,
geography, anthropology, psychology, and philosophy of the Qin and Han Dynasties.
Even now, The Inner Canon of the Yellow Emperor is considered as the foundation
and source of the theoretical system of traditional Chinese medicine and
pharmacology. Later generations added many important contributions. The Classic of
Questions, for instance, written before the Eastern Han Dynasty (25-220), further
explained the physiology, pathology, diagnosis, and the guiding principles of
treatment. It, too, is considered part of the theoretical foundation of traditional
Chinese medicine, as it balances out the inadequate aspects of The Inner Canon of the
Yellow Emperor. In the last years of the Han Dynasty, Zhang Zhongjing (150-219), a
distinguished physician, described the development of a wide range of diseases
relating to the internal (Zang-Fu) organs in his Synopsis of the Golden Cabinet. These
descriptions advanced the etiology and pathogenesis described in The Inner Canon of
the Yellow Emperor, and in consequence exerted a significant influence on the
development of etiology and pathogenesis of traditional Chinese medicine. The AB
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Classic of Acupuncture and Moxibustion, by Huangfu Mi (215-282) of the Jin

Dynasty (265-420), developed the theory of meridians further.
The Pathogenesis and Manifestations of Diseases by Chao Yuanfang, a practitioner in
the Sui Dynasty (581-618), recorded the causes and symptoms of different kinds of
diseases in detail, enriching the theory of etiology and pathogenesis.
Physicians of later generations, basing themselves on The inner Canon of the Yellow
Emperor, The Classic of Questions, Treatise on Cold Diseases, and Synopsis of the
Golden Cabinet, developed the basic theory of Chinese medicine from various angles.
2. Distinguishing Features of Traditional Chinese Medicine

Traditional Chinese medicine has its own unique understandings about the
physiological activities of and pathological changes in the human body, it has, as well,
many distinguishing features in terms of the diagnosis and treatment of diseases. For
example, it views the body as an organic whole. At the center of this organic integrity
are the Zang-Fu organs which are linked through an elaborate system of meridians.
Traditional Chinese medicine also views the relationship between the human being
and nature as an integrated one. And though it recognizes the importance of the six
climatic factors and the seven emotions in the pathogenesis of diseases, it emphasizes
the importance of the endogenous pathogenic factors even more. A diagnostic system
of syndrome differentiation has been created based on the "four diagnostic methods",
"eight principal syndromes" and "the differentiation according to the theory of the
Zang-Fu organs." Traditional Chinese medicine also places the first priority to
prevention, while considering treatment as secondary. It suggests treating a disease by
looking first into the root cause, taking into consideration, at the same time, the
climatic and seasonal conditions, geographic location, and the patient's constitution.
This unique theoretical system has two basic characteristics, i.e., the concept of
integrity and treatment on the basis of differentiation of syndromes.
2.1 The Concept of Integrity

Integrity infers a state of completeness and unity. Chinese medicine views the human
body as an organic whole, and the relationship between the human being and nature
as on integrated unity. As an organic whole, the various parts of the body are
inseparable in structure, the organs and their physiological functions are interrelated
and mutually influenced by any disorder or pathology. Meanwhile, traditional Chinese
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medicine holds that a close relationship also exists between the human body and the
environment. Human bodies dynamically adapt to the universe and alter while
pursuing normal life activities. The unity of the human body with the external
environment is known as the concept of integrity, a term which, in its expression of
the dialectical thinking in Chinese medicine, penetrates all aspects of physiology,
pathology, diagnostics, syndrome differentiation and treatment.
2.1.1.Taking the Human Body as an Organic Whole

The human body is composed of various organs and tissues, each of which has its
own distinct physiological function, which, in turn, is a part of the total life activity.
Because they are part of a unified whole, these organs and their physiological
functions are bound to be interrelated in order to maintain a balance, thus all are
mutually affected by any disorder or pathology. At the center of this organic integrity
are the five Zang organs and their related fu organs of which there are six. All of them
are internally and externally linked through an elaborate system of meridians. The
five Zang organs represent the five systems of the human body, which includes all the
organs and tissues. As the center, the five organs link all other parts of the body, such
as the six fu organs, the five body constituents (the skin, flesh, blood vessels, tendons,
bones), the five sense organs, the nine body openings, the four limbs and the skeleton.
Joining all into an organic whole through the network of meridians, these five Zang
organs, in collaboration with essence, Qi, blood, and body fluids, accomplish the
harmonizing function of the human body.
Guided by the concept of integrity, TCM holds that normal physiological activity
relies on the functions of the individual organs and tissues, and the harmonious
function of the various organs and tissues, their interaction, mutual promotion or
mutual restraint, is what maintains the physiological equilibrium on the other. Each
zang-fu organ has its own function, yet each only works as a part of the whole. This
reflects the idea of the unity of the individual part with the whole.
Traditional Chinese medicine believes that the function of the human body as a whole
never ceases when the heart leads property. The yin and yang of the human body
counteract each other, consume and support each other and transform into one another,
the five elements also promote and counteract one another in order to keep the
dynamic balance which is at the root of all normal life processes.
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Chinese medicine not only explores the laws of life processes but also analyzes
pathological changes, such as those aroused through localized lesion through holism.
On the one hand, it attaches great importance to the localized lesion as well as the
Zang-Fu organs and meridians they directly related to, on the other, it pays attention
to the influence exerted by the diseased Zang-Fu organs and meridians on other
related organs. This double awareness reflects the concept of integrity in pathogenesis
in Chinese medicine.
Generally, a localized lesion tends to have some kind of relations with the condition
of the Zang-Fu organs, Qi and blood, and yin and yang of the body. Because of the
interconnection between the Zang-Fu organs and tissues, correct diagnosis and
treatment can be given through observing the manifestations of the five sense organs,
the constitution and complexion, as well as the pulse conditions, all of which reflect
pathological changes of the internal organs. For example, the tongue is connected
directly or indirectly with five Zang organs through the meridians.
Because the human body is an organic whole, it is necessary to treat localized lesions
on the basis of the conception of integrity, this means applying corresponding
principles when giving treatment. For example, ulcers of the tongue and mouth may
be cured by dispelling pathogenic heat from the heart and small intestine because the
tongue is the body opening of the heart, which, with the small intestine, forms a
Zang-Fu pair.
2.1.2. Integrity between Human Body and Nature

As long as human beings live in nature, the natural environment will supply the
necessities for their existence. Any change in the natural environment will directly or
indirectly influence the human body, which will, in turn, respond. In terms of
physiology, this is a kind of physiological adaptation, in terms of pathology, it is a
kind of pathological reaction.
In the four seasonal climatic changes, spring corresponds to wood and its Qi is warm.
Summer corresponds to fire and its Qi is hot, late summer corresponds to earth and its
Qi is damp, autumn corresponds to metal and its Qi is dry, winter corresponds to
water and its Qi is cold. All of these represent the general law of yearly climatic
changes. Generation occurs in spring, growth in summer, transformation at the end of
summer, harvest in autumn, and storage in winter. Living organisms respond to

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climatic changes, so do humans.

From the above we can see that because of the yearly climatic changes, the human
body must constantly adjust its physiological activities in terms of yin, yang, qi, and
blood.
Similar changes occur in the pulse conditions during the four seasons. The taut,
bounding, superficial, and deep pulses are usually found respectively in spring,
summer, autumn and winter. This indicates the normal seasonal adjustment of the
pulse.
TCM contends that changes in the time of the day also affect the physiological
functions of the human body, and the balance between yin and yang and the behavior
of Qi and blood correspond to changes between day and night, as well as dawn and
dusk. In Chinese medicine, it is said that "One falls asleep when yang enters into yin.''
It is true that the changes in the time of the day in terms of heat and cold are not as
obvious as that in the four seasons, nevertheless, they affect the human body to some
extent. Therefore, it is certain that physiological changes take place in the human
body, corresponding to changes between day and night, dawn and dusk.
Another effect on the human body is geographic location. In general, weather varies
in different localities. People of different places usually have different habits; this
influences the body' s physiological activities.
Climatic change is one of the preconditions for generation, growth, harvesting, and,
storage. Sometimes, however, it becomes disadvantageous to existence. Human being'
s capacity to adapt to nature cannot go beyond a certain limit. Disorders often result
from violent climatic changes or bad weather to which humans have failed to adapt.
Climate changes of every season have their own features. Consequently, besides
common diseases, special seasonal or epidemic diseases often occur.
The fluctuations of yin and yang during the day also affect, to some extent, the onset
and development of diseases. Most conditions are less serious during the day, but
deteriorate at night.
Some endemic diseases are closely related to geographic location. Endemic diseases
found among people living in the east, west, central and north, are also closely related
to differences in weather and habits.
In short, because humans and nature form a relationship of unity of the opposites,
rendering treatment to diseases according to different individuals, geographic
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locations, and seasons has become an important therapeutic principle of traditional

Chinese medicine. In terms of differentiation of syndromes, it is necessary to have a
profound understanding of the relationship between external and internal conditions in
order to give effective treatment.
Generally speaking, along with climatic changes, corresponding variations in
physiology and pathology occur. In treatment, one must pay attention to the "climatic
conditions of the year'' and "not go against them.'' As it is dry and cold in the
highlands of northwestern China, and damp and hot in the lowlands of southeastern
China, medication should accord with the features of the different locations.
2.2. Treatment on the Basis of Differentiation of Syndromes

2.2.1.The Concept of Differentiation of Syndromes
Rendering treatment on the basis of differentiation of syndromes is the fundamental
principle of TCM in understanding and treating any disease, and it is also one of the
basic characteristics of Chinese medicine. "Syndrome'' infers an overall summary of
pathology at a certain stage in the course of a disease. In other words, it reflects the
totality of pathological changes at that stage: the location, cause, nature of the
disorder, and the relationship between pathogenic and anti-pathogenic factors. Thus,
the term "syndrome" implies a more comprehensive assessment of a disease, with
regard to its process and nature, than a mere description of symptoms does.
Differentiation of syndromes defines the procedure for identifying a patient's
condition. Through the synthesis of relevant information provided by the four
methods of diagnosis, the cause, nature, location, and relationship between the
pathogenic and anti-pathogenic factors can be identified. All guide the decision
concerning treatment, for which the differentiation of syndromes is the necessary
prerequisite. Hence, treatment based on the differentiation of syndromes is nothing
but the procedure through which one, s understanding of a disease is expressed.
2.2.2. Relations between Differentiation of Diseases and Differentiation of

Syndromes
A disease is thought to be a response to pathogenic factors, which have acted on the
human body under particular circumstances, and a response which reflects the failure
of the human body to adapt to the changing external environment. The "syndrome''
expresses the typical manifestations of the disease as it progresses. Pathogenic factors
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are bound to act on individuals, and invariably find expression in the human body.
Pathological information is collected through the reactions of the sense organs, and a
particular syndrome is eventually identified after analysis of all the evidence.
In the identification and treatment of a disease, it is necessary to employ techniques
for both differentiation of diseases and differentiation of syndromes, though the latter
approach is most often used to determine the nature of a disease. For example, the
common cold is a disease, its symptoms are an aversion to cold, fever, headaches, and
general aching. The symptoms suggest that the superficial parts of the body have been
affected. But a case of common cold may correspond to syndromes of either wind
cold or wind heat, each linked to different pathogenic factors and body response.
Appropriate treatment can never be selected unless the proper syndrome is identified.
For a case of common cold due to wind-cold, the method is to dispel pathogenic
factors from the exterior of the body through herbs of acrid flavor and warm
properties. For that of the wind-heat type, the method is to dispel pathogenic factors
from the exterior of the body through herbs of acrid flavor but cool properties.
2.2.3. Different Methods of Treatment for Same Diseases, and Same Method of
Treatment for Different Diseases
When the principle of differentiation of syndromes is used to guide clinical practice,
several different syndromes may be found in the same disease; by extension, the same
syndrome may appear in a variety of diseases in their course of development. This
observation leads to two maxims of clinical practice: "applying different methods of
treatment to the same disease," and "treating different diseases with the same
method."
In the first case, different methods of treatment are necessary for the same disease
because the syndromes may vary according to certain factors, such as the season and
location at the time of the onset of the disease. And different individuals may also
respond differently to the pathogenic factors, or to different stages of the disease.
Again, take the common cold for example. Treatment for cold occurring in different
seasons is not the same. Treatment for common cold which occurs in summer is not
the same for that which occurs in other seasons because its root cause is pathogenic
heat and damp. Consequently, its treatment relies on aromatic drugs which dispel the
heat and damp.

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In other cases, it may be appropriate to apply the principle of "same method of

treatment for different diseases", since, at a particular stage, different diseases can
have the same syndromes. For instance, prolapse of the rectum due to protracted
diarrhea and, prolapse of the uterus are two different disorders.
In conclusion, treatment in Chinese medicine is based not on differences of diseases,
but on distinctions of syndromes and pathogenesis, because in Chinese medicine
syndromes and pathogenesis are identical. Diseases of the same pathogenesis can be
treated with basically the same methods. Using different methods to treat different
syndromes during the progress of a disease is exactly the core of the principle of
rendering treatment on the basis of differentiation of syndromes.
Chapter 1. The Theory of Yin-Yang and Five Elements
General descriptions
The Concept of the Yin and Yang and the five elements represent the ancient naive
Chinese materialism and dialectics, reflecting world outlook and methodology of the
ancient Chinese people in understanding and explaining natural phenomena. The
theory of Yin-Yang holds that the world is material and that this material world
evolves constantly as the result of the mutual action of two opposing material forces.
The theory of the five elements assumes that the world is made up of five basic
elements: wood, fire, earth, metal and water. The existence of the material world
depends on the mutual promotion and mutual restraint among the five elements. This
concept had exerted a profound influence on the early Chinese materialistic
philosophy and became the theoretical basis on the materialistic world outlook and
methodology of natural science in ancient China.
Early Chinese practitioners used the theory of Yin-Yang and the five elements to
explain the physiological functions of and pathological changes in the human body,
and to guide medical diagnosis and treatment. This theory constitutes an important
part of the theoretical system of traditional Chinese medicine (TCM), very significant
to its formation and development. However, the elements of materialism and
dialectics contained in the theory of Yin-Yang and the five elements can never be on a

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par with modern scientific materialist dialectics. Therefore, in studying them, we must
proceed from the views of dialectical and historical materialism to discard the
superficial and preserve the essential, so as to make it better serve the needs in
medical practice.
Section 1. The Theory of Yin-Yang
1. The concept of the theory of Yin-Yang
What is Yin-Yang? The terms of Yin and Yang first appeared in Yi Jing" (the Book
of Changes in Zhou Dynasty). At its origin, the terms were used to designate the two
slopes of a mountain. The sunny side was Yang and the shady side was Yin. Later,
their meaning broadened to include all opposites. Yin and Yang then were used to
denote cold or warm weather; downward or upward direction; left or right; exterior or
interior; and quiescence or dynamic. All natural events and states of being are rooted
in Yin and Yang, and can be analyzed by the theory of Yin-Yang. The theory of
Yin-Yang, however, does not itself refer to any concrete objective phenomena. It is a
theoretical method for observing and analyzing phenomena. Generally speaking, Yin
and Yang are a philosophical conceptualization, a means to generalize the two
opposite principles that may be observed in all related phenomena within the natural
world.
They may represent two separate phenomena with opposing natures, as well as
different and opposite aspects within the same phenomenon. Thus the ancient Chinese
people came to understand that all aspects of the natural world could be seen as
having a dual aspect, for example, day and night, brightness and darkness, movement
and stillness, heat and cold, etc. It was said: "Water and fire are symbols of Yin and
Yang". This means that water and fire represent the two primary opposite aspects of a
contradiction. Based on the properties of water and fire, everything in the nature may
be classified as Yin and Yang. Those with the basic properties of fire, such as heat,
movement, brightness, upward and outward direction, excitement, and potency
pertain to Yang; while those with the basic properties of water, such as coldness,
stillness, dimness, downward and inward direction, inhibition, and weakness pertain
to Yin. Accordingly, within the field of medicine different parts of the body are

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classified as either Yin or Yang. For example, the upper and exterior parts of the body
belong to Yang and the lower and interior parts to Yin; the hands belong to Yang;
while the feet to Yin; the five Zang organs pertain to Yin; the six Fu organs to Yang.
The Yin-Yang nature of a phenomenon is not absolute but relative. This relativity is
reflected in two ways. On one hand, under certain conditions Yin may change into
Yang and vice versa (the inter-transforming nature of Yin and Yang), and on the other,
any phenomenon may be infinitely divided into its Yin and Yang aspects, reflecting
its own inner Yin-Yang relationship. Day, for example, is Yang, while night is Yin.
However, each can be further classified as follows: morning is Yang within Yang,
afternoon is Yin within Yang, the first half of the night Yin within Yin, and the
second half of the night Yang with Yin. This differentiation of the natural world into
its opposite parts can be carried out infinitely.
Therefore it can be seen that Yin and Yang are at the same time opposite in nature and
yet interdependent. They both oppose and complement each other, and exist within all
natural phenomena. Traditional Chinese medicine applies the Yin-Yang principles of
interconnection and continuous transformation to the human body to explain its
physiology and pathology and to guide clinical diagnosis and treatment.
2. Basic contents of the theory of Yin-Yang
2.1. The opposition and interaction of Yin-Yang

The theory of Yin-Yang holds that everything in nature has two opposite aspects
which are generalized as Yin and Yang, such as upper and lower, left and right,
heaven and earth, quiescence and dynamism, entry and exit, ascending and
descending, day and night, bright and dark, cold and heat, water and fire, etc. Yin and
Yang are opposites yet form a unity. The opposition of Yin and Yang is mainly
reflected in their interaction and mutual wax and wane through which their unity or
dynamic balance is reached, being called "equilibrium of Yin and Yang". For example,
in spring, summer, autumn and winter, the weather varies from warm, hot and cool to
freezing cold. Warm and hot weather in spring and summer results from a rise of
Yang Qi which inhibits the cold of autumn and winter. Cool and cold weather in
autumn and winter is due to the rise of Yin Qi which inhibits the heat of spring and
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summer. Such is the result of the interaction as well as mutual wax and wane in nature.
The process of interaction between Yin and Yang is also the process of their mutual
wax and wane. Normal human life is the result of such interaction between Yin and
Yang, which helps maintain a kind of dynamic equilibrium. Only in this dynamic
equilibrium can development and change occur, and the natural world perpetually
flourishes.
2.2. The interdependence between Yin and Yang

"Without Yang there would be no generation of Yin, without Yin there would be no
production of Yang".
Yin and Yang oppose each other and yet, at the same time, also have a mutually
dependent relationship. Neither can exist in isolation: without Yin there can be no
Yang, without Yang no Yin. Without cold there would be no heat. Both Yin and Yang
are the prerequisite for the existence of the other, and this relationship is known as the
interdependence of Yin and Yang. When the concept of the interdependence is
applied to the physiology of the human body, Yin corresponds to nutrient substances,
and Yang to functional activities. The nutrient substances remain in the interior,
therefore, "Yin remains inside"; while the function activities manifest on the exterior,
so "Yang remains outside." The Yang on the exterior is the manifestation of the
substantial movement in the interior, so it is know as "the envoy of Yin". The Yin in
the interior is the material basis for functional activities and is therefore called the
"backing of Yang".
2.3. Dynamic equilibrium (inter-consumption-support) of Yin and Yang

Yin and Yang within an object are not fixed, but instead are in a state of constant
motion and ever changing. Under normal conditions, the interactive and mutual wax
and wane relationship between Yin and Yang is in a state of relative equilibrium
rather than in a state of absolute stillness and balance.
The equilibrium what stems from the mutual wax and wane of Yin and Yang,
conforms to the law that motion, and growth and decline are absolute, while
quiescence and balance are relative. In other words, the relative stillness involves in
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the absolute motion, or the absolute wax and wane, while the absolute wax and wane
exist in the relative balance. Everything grows and develops in the dynamic
equilibrium between the absolute motion and the relative stillness, and between the
absolute growth and development on one hand and the relative balance in the other.
For example, in terms of physiological activity, the human body tends to excite during
the day because Yang dominates at that time but tends to inhibit at night because Yin
dominates then. Just as Yang starts to rise at midnight and peaks at noon, so do human
physiological activities turn gradually from inhibition to excitation, this is the process
known "waning of Yin and waxing of Yang". But from noon to evening, Yang
gradually falls, while Yin grows, it follows that physiological activity gradually turns
from excitation to inhibition. This process is known as " waning of Yang and waxing
of Yin". Thus under normal physiological conditions, Yin and Yang do not reside
peacefully in a unified object. They are in a dynamic state of mutual restriction in
which they consume and support each other. This is known as the harmony between
Yin and Yang. We can never ignore the importance and necessity of the relative
equilibrium of Yin and Yang though the growth and decline of Yin and Yang are
absolute, and the equilibrium is relative, because it is the continuous growth and
decline of Yin and Yang and the constant balancing of the two that promote the
normal development of things and maintain the normal life activities. If there is only
"waning of Yang and waxing of Yin," or "waning of Yin and waxing of Yang," a
breakdown in the relative balance will occur, resulting in either the excess or the
deficiency of Yin or Yang. In physiological terms, a state of morbidity occurs, just as
Plain Questions points out " The excess of Yin leads to disorders of Yang, and the
excess of Yang leads disorders of Yin."
2.4. Mutual transformation of Yin and Yang

Under certain circumstances, either Yin or Yang may transform into its opposite, i.e.
Yin may transform into Yang and Yang into Yin. The stage at which the
transformation occurs is described as the "extreme". If the mutual wax and wane of
Yin and Yang represents a process of quantitative change, then the mutual
transformation of Yin and Yang denotes a qualitative change which is based on the
quantitative change. The mutual transformation is ordinarily a slow conversion from
one to the other, though abrupt transformation is also possible.

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The mutual transformation of Yin and Yang depends on certain factors. Plain
Questions says, "Yin in extreme will give rise to Yang, and Yang in extreme will
give rise to Yin," and "Extreme cold may bring about heat, and extreme heat may
induce cold." Extreme Yin cold may change to Yang heat under certain conditions
and vice versa. The decisive factors are the conditions, without which such a
transformation is impossible.
Physiologically, the mutual conversion between excitation and inhibition is the same.
During the courses of a disease, Yang may turn into Yin and Yin into Yang. For
example, a sudden collapse of Yang may happen in some cases of persistent pyrexia
that occurs in acute febrile diseases associated with virulent heat; this massive loss of
Yang is manifested by subnormal body temperature, pallor, cold limbs and faint pulse.
This condition exemplifies the change of a Yang syndrome to a Yin syndrome. If
timely and appropriate measures are taken, warmth returns to the limbs and Yang is
restored; a healthier complexion and pulse return and the condition turns for the better.
Here is another example, obstruction of the stomach by cold fluid is a Yin syndrome,
but due to certain factors the cold fluid turns to the pathogenic heat, thus the Yin
syndrome becomes a Yang syndrome.
In general, the transformation from Yin to Yang vice versa relies on certain conditions,
otherwise the transformation is impossible.
3. Application of the theory of Yin-Yang in traditional Chinese medicine
In traditional Chinese medicine Yin and Yang is embodied in every aspect of the
theoretical system. It is used to explain the tissues and structures, physiology and
pathology of the human body, and to direct the clinical diagnosis and treatment.
3.1. Explaining the tissues and structure of the human body

According to the theory of Yin and Yang, it is considered that there are opposite but
unitive phenomena between rostral and caudal, inside and outside, exterior and
interior, dorsal and ventral aspects of every tissue and structure of the human body.
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When speaking of Yin and Yang in the human body, the upper part is Yang, the lower
part Yin; the exterior is Yang, the interior Yin; the back is Yang, the abdomen Yin;
the lateral aspect of the extremities is Yang; the medial aspect Yin. When speaking of
Yin and Yang of the internal organs in the body, the five Zang organs, i.e. heart, lung,
liver, spleen and kidney are Yin, because their functions of preserving vital substance
tend to be stable. The six Fu organs, i.e. the gallbladder, stomach, large intestine,
small intestine, bladder and San Jiao (triple energizer), are Yang, because their
functions of transmitting and digesting water and food tend to be active. The
relationship between Yin and Yang also remains constant among the five Zang organs.
The heart and lung are Yang, because of being higher, while the liver, spleen and
kidney are Yin, because of being lower. To compare the heart and lung, the heart is
Yang and the lung is Yin. When speaking of Yin and Yang of every organ, the
function is Yang, the substance (or organ proper) Yin. When speaking of Yin and
Yang of the meridians and collaterals, the meridians are divided into Yin meridians
and Yang meridians. There are three Yang meridians of the hand and three Yin
meridians of the hand, three Yang meridians of the foot and three Yin meridians of
the foot.
3.2. Explaining the physiological activities

TCM believes that the normal physiological activities of the human body result from
the opposite, unitive and coordinate relations between Yang (function) and Yin
(substance). Yin and Yang always maintain their dynamic equilibrium. It is known as
"Yin is even and well while Yang is firm, hence a relative equilibrium is maintained,
and the essence and spirit will be in normal state." Physiological functions are based
on the substance. Without substance, including the vital essence, blood and body
fluids, there would be no source for functions. But the metabolism of substance must
depend on the performance of function. If Yin and Yang of the human body separate
from each other and can not aid each other, life will come to an end. This is what is
called, in TCM, " the divorce of Yin and Yang means the end of one's life."
3.3. Explaining the pathological changes

In TCM, it is thought that the imbalance of Yin and Yang is one of the basic
pathogeneses of a disease. For example, preponderance of Yang leads to the
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hyperfunction of the organism or the endogenous heat manifestations, while

preponderance of Yin results in the hypofunction of the organism or the endogenous
cold. Deficiency of Yin as the result of exhausted vital essence may lead to the
endogenous heat. Yang in excess makes Yin suffer, while Yin in excess makes Yang
suffer. In severe damage of Yang, Yin is involved; in severe damage of Yin, Yang is
involved likewise, thus, both are damaged. A case of Yin nature (hypofunction) in its
extreme may show Yang (hyperfunction) symptoms and signs, while a case of Yang
nature (hyperfunction) in its extreme will give rise to Yin (hypofunction) symptoms
and signs.
3.4. Serving as a guide to clinical diagnosis and treatment

The root cause for the occurrence and development of diseases is the imbalance
between Yin and Yang. For this reason, however complicated and changeable the
clinical manifestations may be, with a good command of the principle of Yin-Yang,
the key linking elements could be grasped and analyzed effectively. Generally
speaking, the nature of any diseases does not exceed the scope of analysis by
Yin-Yang.
Yin-Yang is the basis for the differentiation of syndromes by the eight principles,
namely, Yin, Yang, interior, exterior, heat, cold, deficiency and excess. Exterior, heat
and excess are Yang, whilst interior, cold and deficiency are Yin. In this way,
complicated clinical situations can be simplified, and a correct diagnosis given.
Since the root cause for the occurrence and development of disease is the imbalance
of Yin and Yang, the basic principle in the treatment of traditional Chinese medicine
is to adjust Yin and Yang, making "Yin stabilized and Yang well conserved" and
restoring the harmony between them. Therefore, in acupuncture the essential
technique of needling consists of striking a balance between Yin and Yang.
Now it can be seen that the basic function of acupuncture needling is to adjust the Qi
of Yin and Yang.
In the clinical application of acupuncture, the theory of Yin-Yang is applied to
determine not only the principles of treatment, but also the selection of points and the
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techniques of needling and moxibustion to be used. For instance, combining points

from externally-internally related meridians, as well as combining Yuan-Primary and
Luo-Connecting points, is used extensively in clinical practice, both of which are the
methods of selecting points from related Yin and Yang meridians. In addition,
Back-Shu and Front-Mu points are often selected to treat diseases of the Zang-Fu
organs. The related Back-Shu points are mostly selected for diseases of the Zang
organs, and the related Front-Mu points for those of the Fu organs. Alternatively, a
combination of Back-Shu and Front-Mu points is applied to "select Front-Mu points
for Yang diseases and Back-Shu points for Yin diseases," in order to adjust Yin and
Yang in either excess or deficiency. Where acupuncture and moxibustion are used
together, apply moxa to the upper part of the body first and the lower part second, and
"insert needles deeply with retention for Yang diseases." From this view, it is
apparent that in acupuncture and moxibustion therapy, the meridians, acupoints, and
acupuncture-moxibustion techniques are all closely related to the theory of Yin and
Yang, emphasizing the vital role that Yin and Yang play in both theory and practice.
Section 2. The Theory of the Five Elements
1. Basic concepts of the theory of five elements

The five elements refer to five categories in the natural world, namely wood, fire,
earth, metal and water. The theory of the five elements was first formed in China at
about the times of the Yin and Zhou dynasties (16th century-221 B. C.). Although the
Chinese theory of the five elements and Greek theory of the four elements are
different in history of formation, yet both of them belong to the earliest atomic theory
in essence. At first, the Chinese only knew that the five kinds of substances (wood,
fire, earth, metal and water) were indispensable things in the daily life of mankind,
subsequently they made a generalization and deduction of the respective properties of
the five kinds of substances and their relationship, so as to explain the whole material
world. According to the theory wood, fire, earth, metal and water are the basic
substances that constitute the material world. These substances are not only of the
relations with generation and restriction but set in a state of constant motion and
change. That is why it is know as the theory of the five elements or the doctrine of
five evolutive phases.

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2. Basic contents of the theory of the five elements

2.1.Characteristics of the five elements
In early times, the Chinese people recognized that wood, fire, earth, metal and water
were the indispensable in their daily lives as well as having different natures. As said
in A Collection of Ancient Works, Food relies on water and fire. Production
relies on metal and wood. Earth gives birth to everything. They are used by the
people The character of wood is to grow and flourish, that of fire is to be hot and
flare up, that of earth is to give birth to all the other things, that of metal is to descend
and to be clean, and that of water is to be cold and to flow downwards.
2.2.Categorization of things according to the five elements

In light of the theory of five elements, traditional Chinese medicine has made a
comprehensive comparison and study of all kinds of things and phenomena in nature
as well as in the Zang-Fu organs, tissues, physiology and pathology of the human
body, classified them respectively to one of the five elements, i.e., wood, fire, earth,
metal and water, in accordance with their different properties, functions and forms,
thus expounding the physiology, pathology of the human body and the correlation
between man and his natural surrounding. The following is a table showing the
classification of things according to the theory of the five elements.
The Classification of things according to the theory of five elements
Table 1: Human Body
Five Five Zang Six Five sense Five Emotional

elements organs Fu-organs organs tissues activity
wood liver gall bladder eye tendon anger
small
fire heart tongue vessel joy
intestine

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earth spleen stomach mouth muscle over-thinking
large
metal lung nose skin & hair grief
intestine
water kidney bladder ear bone fear and fright
Table 2: Nature
Five Environme Growth & Orienta

Color Taste Season
elements ntal factor development tion
wood wind germination green sour spring east
fire heat growth red bitter summer south
late
earth dampness transformation yellow sweet middle
summer
pungen
metal dryness reaping white autumn west
t
water cold storing black salty winter north
2.3. Mutual promotion and restriction, subjugation and reverse restriction

relationships of the five elements
Among the five elements, there exist the relations of promotion, restriction,
subjugation and reverse restriction.
Promotion implies promoting the growth. The order of promotion is as follows: wood
promotes fire, fire promotes earth, earth promotes metal, metal promotes water, and
water, in turn, promotes wood. As far as the relationship of generation of each of the
five elements is concerned, it is composed of two aspects--promoting and being
promoted. The element that promotes is called the mother, while the element that is
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promoted is called the child. Hence, the relation of promoting and being promoted
among the five elements is also known as that of mother and child. Take fire for
example, since fire produces earth, it is called the mother of earth; on the other hand it
is produced by wood, so it is called the child of wood.
Restriction (also known as interacting connotes bringing under control or restraint.
So far as the relationship of restriction that the five elements possess is concerned, it
works in the following order: wood restricts earth, earth water, water fire, fire mental,
and metal wood. Each of the five elements has the chance of restricting and being
restricted. Take fire for example, the element restricting fire is water, and element that
is restricted by fire is metal.
In view of the correlations among things, neither promotion nor restriction is
dispensable. Without promotion, there would be no birth and development; without
restriction, excessive growth would result in harm and damage. For instance, on one
hand, fire promotes earth, and on the other, it restricts metal; while metal, in return,
promotes water and restricts wood. Thus in promotion there resides restriction, and in
restriction there exists promotion. They oppose each other and at the same time
cooperate with each other, thus a relative balance is maintained between promotion
and restriction, and the normal growth and development of things is ensured.
Should one of the five elements be excessive or insufficient, there would appear the
phenomena of abnormal restrictions, known as subjugation (also known as
overacting and reverse restriction (also known as counteracting. By subjugation is
meant that one element subdues the other when the latter is weak or when element is
extraordinarily excessive, it will subjugate its restricted element. It is the
manifestation of abnormal coordination among things. For example, if wood is in
excess and metal can not exercise normal restriction on it, then the excessive wood
will subjugate earth in such a way that earth will become weaker; or on the other hand
when the earth is insufficient wood will subjugate it even wood is not really excessive.
Reverse restriction means preying upon others. That is, when any one of the five
elements is in excess, the one originally restricting it will be restricted by it instead.
That is why we call it reverse restriction. For, instance, the normal order of restriction
is that metal restricts wood; but if wood is in excess or metal is insufficient, wood will
restricts metal in the reverse direction. It is clear that the order of reverse restriction is
just opposite to that of restriction and that reverse restriction is undoubtedly a very
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harmful one.
3. Application of the theory of five elements in traditional Chinese medicine

In traditional Chinese medicine, the theory of five elements is mainly used to explain
the physiology and pathology of the human body and to guide the clinical diagnosis
and treatment.
3.1.Explaining the physiological functions of the Zang-Fu organs and their

mutual relationships
The promotion of the five elements can be used to expound the interdependent
relations between the five Zang organs. For instance, the vital essence of the kidney
(water) nourishes the liver (wood), which is known as water generating wood. The
liver (wood) stores blood to nourish the heart (fire), which is termed as wood
generating fire. The heat of the heart (fire) warms the spleen (earth), which is called
fire generating earth. The spleen (earth) transforms and distributes food essence to
replenish the lung (metal), which is referred to as earth generating metal. The lung
(metal) dredges the water passages to help the kidney (water), which is taken as metal
generating water.
The restriction of the five elements can be used to explain the inter-restraining
relations between the five Zang organs. For example, the lung (metal) purifies and
descends so as to restrain the exuberance of the liver (wood), which is known as metal
restricting wood. The liver (wood) that functions well smoothes and regulates the
stagnation of the spleen (earth) Qi, which is called as wood restricting earth. The
function of the spleen (earth) plays in transforming nutrients and promoting water
metabolism and may prevent the overflow of the water of the kidney (water), which is
referred to as earth restricting water. The ascending of the kidney (water) can prevent
the heart (fire) from hyperactivity, which is understood as water restricting fire.
3.2. Showing the pathological relationships between the Zang-Fu organs

As it is well known, the theories of subjugation, reverse restriction, "illness of
mother-organ involving child-organ", and "illness of child-organ involving
mother-organ" in regard of the five elements are usually used to expound the
pathological impacts between the five Zang organs. Take lung disease for example, if
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it results from the disorders of heart, that is regarded as "fire subjugating metal"; if it
is caused by the disorders of liver (wood), that is referred to as "wood reversely
restricting metal"; if it is developed from the disorders of spleen (earth), that is looked
upon as "illness of mother-organ involving child-organ"; and if it is due to disorders
of kidney (water), that is taken as "illness of child-organ involving mother-organ".
3.3. Application in diagnosis and treatment of diseases

Because, in accordance with the categorization of things and phenomena to the five
elements, the five Zang organs have specific connections with the five colors
(green/blue, red, yellow, white and black,) the five voices (shouting, laughing, singing,
crying and moaning), the five kinds of flavors (sour, bitter, sweet, acrid/pungent and
salty) as well as the relevant pulse conditions, one, when diagnosing, should take the
steps as: first, to generalize the materials obtained through the four diagnostic
methods (inspection, auscultation & olfaction, inquiring and palpation), and then, to
deduce what the disease is according to the theory of five elements. For example, a
condition of a bluish face associated with the string-taut pulse may indicate liver
disease; while the manifestations of red face, bitter taste in the mouth, and surging
pulse may suggest the hyperactivity of heart fire. The patient whose spleen Qi is
deficient might look bluish because of "wood having subjugated earth"; and the
patient who has heart trouble might look dark-purplish because of "water having
restricted fire", to mention but a few.
In acupuncture and moxibustion treatment, there is a use of a type of specific point
named as Five-Shu points which correspond to the five elements. The Jing-Well,
Ying-Spring, Shu-Stream, Jing-River and He-Sea points of the Yin meridians
correspond to wood, fire, earth, metal and water respectively, whilst those of the Yang
meridians correspond to metal, water, wood, fire and earth respectively. Clinically
they are selected for treatment according to the principle of "reinforcing the mother"
and "reducing the child." In addition, it is common in clinical practice to determine
the principle of treatment and selection of points according to the pathological
influences among the Zang-Fu organs which follow the cycle of the five elements. For
instance, in case of a disharmony between the liver and stomach, "wood overacting on
earth," the principle of treatment should be to reinforce the earth and to restrain the

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wood and such points as Zhongwan (RN 12), Zusanli ( S 36) and Taichong ( Liv3)
could be selected.
Chapter 2. The Theory of Zang-Fu System
General descriptions
In traditional Chinese medicine (TCM), the internal organs of the human body are
divided into three groups: "Five Zang organs", "Six Fu organs" and "extraordinary
organs." The five Zang organs include the heart, the liver, the spleen, the lung and the
kidney. Preserving vital substances is their characteristic common . The six Fu-organs
consist of the gallbladder, the stomach, the large intestine, the small intestine, the
bladder and the triple energizer (San Jiao) of which the characteristic in common is
transmitting and digesting water and food. The extraordinary organs refer to the brain,
the marrow, the bone, the blood vessel, the gallbladder and the uterus---six organs or
tissues in all.
The theory of Zang-Fu organs is the one concerning the studies of the physiological
functions and pathological changes of every organ in the human body, as well as the
interrelationships in between them. The formation of the theory is closely related to
the following three factors. The first one is Chinese ancient anatomical knowledge.
The second one is the observation of physiological and pathological phenomena, for
example, if one catches cold because his skin has affected by cold, he will have the
signs and symptoms of a disorder of the respiratory system such as nasal obstruction,
rhinorrhea and cough. That is why TCM believes that the skin and hair have
correlations with the nose and lung, i.e. the respiratory system. The third factor is the
summarization of long-term medical experiences. For example, quite a few herbals,
which have the function of reinforcing the vital energy or essence of the kidney, can
accelerate the healing of the bone. This brings about the saying that kidney dominates
the conditions of the bone.
It is especially necessary to point out that the names of the internal organs of the
human body in TCM are basically the same as those used in western medicine, but
they do not mean exactly the same. For example, the functions of one specific organ

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in TCM may include the functions of several organs in terms of western medicine.
Meanwhile, the functions of a specific organ in western medicine may be contained in
the functions of several Zang-Fu organs in TCM. This is because Zang-Fu in TCM is
not only an anatomic unit, but also a concept of physiology and pathology, and the
latter is more important. For instance, the heart in TCM does refer to the same
anatomic entity as western medicine. However, apart from that, it also refers to some
of the functions of the nervous system, especially some of those of the brain. The
difference in concepts between TCM and western medicine is mainly due to the
difference in the way of viewing things. TCM has generalized its knowledge of the
internal organs mainly from the repeated clinical practice and observation and only
little autopsies in very ancient time, whereas western medicine is based its knowledge
mainly on the repeated autopsies, experiments and summarization. Therefore, it is
very important for the learners to have a clear idea of each Zang or Fu organ, and the
distinction with the relevant internal organ in western medicine when studying the
theory of TCM in concerns with the Zang-Fu organs.
Section 1. Five Zang Organs
1. Heart
The heart is situated in the thorax and its meridian connects with the small intestine
with which it is internally-externally related. The main physiological functions of
heart are: dominating the blood and vessels, manifesting on the face, housing the
mind, and opening into the tongue.
1.1. Dominating the blood and vessels and manifesting on the face
Dominating the blood and vessels means that the heart is the motive force for blood
circulation, whilst the vessels are the physical structures which contain and circulate
the blood. The blood circulation relies on the cooperation between the heart and the
vessels, with the heart being of primary importance. The physiological function of the
heart in propelling the blood relies on the heart Qi. When the heart Qi is vigorous, the
blood will circulate normally in the vessels to supply the whole body. Since the heart,
blood and vessels are interconnected, and there are many vessels on the face, the

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prosperity or decline of the heart-Qi and the quantity of blood circulating will be
reflected in changes in both the pulse and complexion. If the heart-Qi is vigorous and
the blood ample, the pulse will be regular and strong and the complexion lustrous and
rosy. When the heart-Qi and blood are insufficient, the pulse of the patient will be
thready and weak, and the complexion pale.
1.2. Housing the mind
The word "mind" has the broad meaning of the outward appearance of the vital
activities of the whole body, and the narrow meaning of consciousness, e.g. spirit and
thinking. The theory of Zang-Fu organs holds that thinking is related to the five Zang
organs and principally to the physiological functions of the heart.
it is apparent that mental activities and thinking have their foundation in the functions
of the heart. Spirit, consciousness, thinking, memory and sleep are therefore all
related to the function of the heart in housing the mind. Blood is the major material
basis for the mental activities. It is controlled as well as dominated and regulated by
the heart. So the function of the heart in housing the mind is closely related to that of
the heart in dominating the blood and vessels.
1.3. Opening into the tongue
"Opening" refers to the close structural, physiological and even pathological

relationship between a particular Zang organ and one of the sensory organs. The
tongue is connected to the Heart Meridian internally, and via this connection the heart
dominates the sense of taste and the speech. When there is a normal function of the
heart, the tongue will be rosy, moist and lustrous, the sense of taste will be normal,
and the tongue will move freely. On the other hand, disorders of the heart will reflect
on the tongue. For example, deficiency of heart blood may give rise to a pale tongue;
flaring up of heart fire may result in the redness of the tongue tip and ulceration in the
tongue body; and stagnation of heart-blood may lead to a dark, purplish tongue body
or the purplish spots on the tongue. The sayings: "the heart opens into the tongue,"
and "the tongue is the mirror of the heart reflect this close physiological and
pathological relationship.

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Appendix:
The pericardium is a membrane surrounding the heart. Its meridian connects with the
triple Energizer (San Jiao) with which it is externally-internally related. Its main
function is to protect the heart. When pathogenic Qi invades the heart, the
pericardium is always the first to be attacked, and no doubt invasion of the
pericardium by pathogenic Qi will often affect the normal function of the heart. For
example, invasion of the interior by pathogenic mild heat (Wen Xie), would gives rise
to symptoms of mental derangement such as coma and delirium by pathogenic heat,
though the clinical manifestations are the same as those of the heart. For this reason,
the pericardium is not generally regarded as an independent organ, but as an
attachment to the heart.
Note: From the physiology and pathology of the heart stated above, it is easy to see
that the term "heart" in TCM basically suggests many functions of the nervous system
in western medicine.
2. Lung
The lung, situated in the thorax, communicates with the throat and opens into the nose.
It occupies the uppermost position among the Zang-Fu organs, and is known as the
"canopy" of all the Zang-Fu organs. Its meridian connects with the large intestine with
which it is internally-externally related. Its main physiological functions are:
dominating Qi, controlling respiration, dominating dispersing and descending,
dominating skin and hair, and regulating the water passages.
2.1. Domination Qi and controlling respiration
When dominating Qi is concerned there are two aspects indicated: dominating the (Qi
of) respiration and dominating the Qi of the whole body.
Dominating the Qi of respiration means that the lung is a respiratory organ through
which the clean Qi (the air) from the exterior and the Qi from the interior can be
mingled. Via the lung, the human body inhales the clean Qi from the natural
environment, the atmosphere on one hand and also exhales waste Qi from the interior
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of the body on the other. This is known as "getting rid of the stale and taking in the
fresh." Or it is also known that the Qi of the heaven is in communication with the
lung.
Whereas dominating the Qi of the whole body means that the function of lung in
respiration greatly influences the functional activities of the whole body and is closely
related to the formation of pectoral Qi, which is formed from the combination of the
refined essential substance of water and food, and the clean Qi inhaled by the lung. It
accumulates in the chest, ascends to the throat to dominate respiration, and is
distributed to the whole body in order to maintain the normal functions of the tissues
and organs.
When the function of the lung in dominating Qi is normal, the passage of Qi will not
obstructed and the respiration will be normal and smooth. While the deficiency of
lung Qi may lead to general lassitude, feeble speech, weak respiration and shortness
of breath.
2.2. Dominating dispersing, skin and hair
Dispersing here means to distribute the defensive Qi and the body fluid to the whole
body to warm and moisten the muscles, skin and hair. The skin and hair, located on
the surface of the body and including the sweat glands, serve as a protective screen to
defend the body from exogenous pathogenic factors. The skin and hair are warmed
and nourished by defensive Qi and body fluid distributed by the lung, which is in
charge of respiration. The pores of the skin also have the function of dispersing Qi
and regulating respiration. For this reason, it is known in traditional Chinese medicine
that: "the lung dominates skin and hair" and "the pores are the gate of Qi."
The close physiological relationship between the lung, skin and hair implies that they
often affect each other pathologically. For example, exogenous pathogenic factors
often invade the lung through the skin and hair, giving rise to symptoms such as
aversion to cold, fever, nasal obstruction and cough, which reflect the failure of lung
in dispersing. If lung Qi is deficient, the failure of lung in dispersing the Qi of water
and food can cause the skin to become wan and sallow and lead to the deficiency of

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the anti-pathogenic Qi and hence the susceptibility to catching cold. When the lung
fails to protect the surface of the body, there may be frequent spontaneous respiration.
2.3. Dominating the descending and regulating the water passages
As a general rule, the upper Zang-Fu organs have the function of descending, and the
lower Zang-Fu organs that of ascending. Since the lung is the uppermost Zang organ,
its Qi descends to promote the spreading of Qi and body fluid through the whole body
and to conduct them downwards. Dysfunction of the lung in descending may lead to
the upward reversal of lung Qi bringing on the symptoms such as cough and shortness
of breath.
Regulating the water passages means to regulate the passages for the circulation and
excretion of water in the body. The role of the lung in promoting and maintaining
water metabolism depends on the descending function of lung Qi. Dysfunction may
result in dysuria, oliguria and edema.
2.4. Opening into the nose
The nose is the pathway for respiration. The respiratory and olfactory functions of the
nose depend on lung Qi. When lung Qi is normal, the respiration will be free.
Dysfunction of the lung in dispersing, for example, due to invasion by wind-cold, will
lead to nasal obstruction, runny nose, and anosmia. Excessive pathogenic heat in the
lung will lead to shortness of breath and vibration of the alanasi.
Since the throat is also a gateway of respiration and an organ of speech, through
which the lung Meridian passes, the flow of Qi and the speech are directly affected by
the state of the lung Qi. When the lung is diseased, it could cause pathological
changes in the throat, such as hoarse voice and aphonia.
Note: The lung organ in TCM basically plays the same part as the respiratory system
in western medicine, and are related to water metabolism, blood circulation and
functions of the vegetative nervous system and the immune system.
3. Spleen

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The spleen is situated in the Middle Energizer. Its meridian connects with the stomach,
with which it is internally-externally related. Its main physiological functions are
governing transportation and transformation, controlling blood, dominating the
muscles and limbs, opening into the mouth and manifesting on the lips.
3.1. Governing transportation and transformation
Transportation implies transmission; and transformation implies digestion and

absorption. This function of spleen involves the transportation and transformation of
water and food on one hand, and of dampness on the other.
The function of the spleen in transporting and transforming essential substances refers
to the digestion, absorption and transmission of nutrient substance. It is universally
acknowledged that water and food are the main source of the nutrient substance
required by the body after birth, as well as being the main material base for the
manufacture of Qi and blood. When spleen Qi is vigorous, digestion, absorption and
transmission of food and drink are normal while the deficiency of spleen Qi and
dysfunction of the spleen in the transportation and transformation may lead to poor
appetite, abdominal distention, loose stools, lassitude, emaciation and malnutrition. So
spleen is the chief Zang organ for manufacturing Qi and blood and is also known in
traditional Chinese medicine as the foundation of postnatal existence.
The function of spleen in transporting and transforming dampness refers to the

spleen's role in water metabolism. The spleen transports the excess fluid of the
meridians, tissues and organs and helps discharge it from the body. So spleen ensures
that the various tissues of the body are both properly moistened and at the same time
free from retention of dampness. Dysfunction of the spleen in transportation and
transformation may lead to retention of dampness, with such clinical manifestations as
edema, diarrhea, phlegm and retained fluid.
The spleen's function of transporting and transforming water and food on one hand,
and dampness/surplus-water on the other are interconnected, and failure of the
transportation and transformation function may give rise to clinical manifestations of
either aspect or both.

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The transportation and transformation function of spleen relies on spleen Qi, which is
characterized by the tendency of ascending. If the spleen Qi does not ascend, or
indeed descends instead, there may appear such manifestations as vertigo, blurred
vision, prolapse of the rectum after prolonged diarrhea, or prolapse of various other
internal organs. Treatment is aimed at strengthening the ascending function of spleen
Qi.
3.2. Controlling blood circulating within the vessels
The spleen has the function of controlling all the blood of the body and keeping it
circulating normally within the vessels. If it loses this function because of a deficiency
of its Qi, the blood will not flow normally within the vessels but will extravasate from
them. In this case, besides some signs and symptoms due to the deficiency of spleen
Qi, certain kinds of chronic hemorrhages such as tarry stool or other types of
bloodstained stool, purpura, uterine bleeding and others may occur. In treating these
disorders, the spleen should be invigorated, the Qi should be replenished and bleeding
should be checked.
3.3. Dominating the muscles and four limbs
The spleen transports and transforms the essence of food and drink to nourish the
muscles and the four limbs. Adequate nourishment ensures well-developed muscles
and proper function of the limbs. If the nourishment is inadequate, the muscles of four
limbs will be weak or flaccid.
3.4. Opening into the mouth and manifesting on the lips
The spleen's function of transportation and transformation is closely related to the

food intake and the sense of taste, so the sticky, sweetish sensation in the mouth due
to the retention of pathogenic dampness in the spleen.
The spleen dominates muscles, and the mouth is the aperture of the spleen. For this
reason, the lips reflect the condition of the spleen's function of transporting and
transforming water and food. When the spleen is healthy, there will be ample Qi and
blood and the lips will be red and lustrous.
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Note: From the physiology and pathology of the spleen stated above, it can be seen
that the theory of spleen in TCM is concerned with most of the functions of the
digestive system that western medicine deals with, but is also related to the blood
coagulation and the metabolism of body fluid. It is also necessary to point out that in
TCM literatures, the pancreas has not been mentioned. Some scholars believe that the
spleen in TCM should include the pancreas.
4.Liver
The liver is situated in the right hypochondriac region. Its meridian connects with the
gallbladder with which it is internally-externally related. Its main physiological
functions are storing and regulating blood, maintaining the free flow of Qi, controlling
the tendons, manifesting in the nails and opening into the eyes.
4.1. Storing and regulating blood
The liver has the function of storing blood and regulating its amount in circulation.
When the human body is in the state of rest or sleep, it needs less blood, and most
blood is stored in the liver. But when the body is under the exertion for performing
physical labor or working, more blood needs to be supplied in circulation., so the liver
will release more blood to increase the flow in circulation. Modern physiology also
believes that while a human body is lying calmly, his/her whole liver system can store
55 percent of the total blood in his body. In the case of emergency a normal adult's
liver can provide, at least, 1000--2000 milliliters of blood so as to keep enough blood
for the heart to pump out. So it is apparent that the understanding of this function of
the liver in both TCM and western medicine is almost coincidental.
4.2. Maintaining the free flow of Qi
The liver is responsible for the unrestrained, free going, and harmonious functional
activity of all the Zang-Fu organs including itself, which is known as maintaining the
free flow of Qi. The normal character of liver is to "flourish" and liver dislikes being
depressed. Stagnation of liver Qi due to emotional changes may affect the function of
liver, manifesting in the following three ways:

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4.2.1. The liver and emotional activity
In addition to the heart, emotional activity is closely related to the liver Qi. Only when
the function of the liver in maintaining the free flow of Qi is normal can the Qi and
blood be harmonious and the mind at ease. Dysfunction of the liver, therefore, is often
accompanied by emotional changes such as mental depression or over-excitement.
When liver-Qi stagnates, for example, there may be mental depression, paranoia, or
even weeping; when liver Qi is hyperactive, there may be irascibility, insomnia,
dream disturbed sleep, dizziness and vertigo. Whilst dysfunction of the liver often
leads to emotional changes, at the same time prolonged excessive mental irritation
often leads to the dysfunction of liver in maintaining the free flow of Qi.
4.2.2. The liver function and digestion
The liver function of maintaining the free flow of Qi is related not only to the
ascending and descending function of the stomach and spleen, but also to the
secretion of bile. The liver therefore has an important influence on the digestion.
Dysfunction of the liver may affect the secretion and excretion of bile, and the
digestive function of the spleen and stomach, resulting in dyspepsia. When the liver
fails to maintain the free flow of Qi, there may be symptoms of stagnation of liver Qi
such as distending pain in the chest and hypochondrium, mental depression or
irascibility. If the descending function of the stomach is affected, there may also be
belching, nausea and vomiting, and if the spleen's function of transportation and
transformation is affected, there may be abdominal distention and diarrhea. The
former is called "the attack of stomach by liver-Qi" while the latter is known as "the
disharmony of between liver and spleen."
4.2.3. The liver function and Qi and blood
The blood circulation relies upon the propelling function of Qi. Although the heart
and lung play the main role in the circulation of Qi and blood, the function of the liver
in maintaining the free flow of Qi is also required to prevent the stagnation of Qi and
blood. Stagnation of Qi and blood due to the failure of liver in maintaining the free

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flow of Qi may lead to stuffiness and pressure in the chest, distending or pricking pain
in the hypochondriac region, dysmenorrhea, and even the formation of palpable mass.
4.3. Controlling the tendons and manifesting in the nails
The tendons are the main tissues linking the joints and muscles and dominating the
movement of the limbs. Since the liver stores blood, it can nourish the tendons of the
whole body to maintain their normal physiological activities. So, when liver blood is
consumed, it may deprive the tendons of nourishment and give rise to weakness of the
tendons, numbness of the limbs, and dysfunction of the joints in contraction and
relaxation. When the tendons are invaded by pathogenic heat of the liver, there may
be convulsion of the four extremities, opisthotonos and clenching of the teeth.
Manifesting in the nails means that the state of the Yin and blood of the liver reflects
not only the movement of the tendons but also the condition of the nails. When liver
blood is ample, the tendons and nails are strong; and when liver blood is deficient, the
tendons will be weak and the nails soft and thin, withered, or even deformed.
4.4. Opening into the eye
"The liver has its specific body opening into the eyes." This means that whether the
eyes visual sense functions well or not is mainly dependent on the nourishment by
the blood stored in the liver. The Liver Meridian goes upward to the eye system.
Therefore, it is reflected also in the eyes whether the liver's function is normal. For
instance, the deficiency of the liver blood may lead to the blurred vision and night
blindness; the flaming up of excessive heat of liver to the red, sore, and swollen eyes;
bilirubinemia due to the dampness and heat in the liver and gallbladder to the icteric
sclera.
In addition, because the liver meridian goes through the areas of hypochondrium,
lower abdomen and external genitals, the diseases occurring therein may be treated on
the basis of the overall analysis of signs and symptoms in relations with liver.
Note: From the physiology and pathology of the liver stated above, it can be seen the
liver in TCM basically contains the functions of the liver that western medicine
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performs, part of the central nervous system, autonomous nervous system, blood and
visual organ.
5. Kidney
The kidneys are located at both sides of the lumbus, which is therefore described as
"the home of the kidney." The Kidney Meridian connects with the bladder with which
it is internally-externally related. Its main functions are: to store essence and dominate
human reproduction and development, dominate water metabolism and the reception
of Qi, produce marrow to fill up the brain, opening into the ears and dominate anterior
and posterior orifices.
5.1. Storing essence and dominating development and reproduction
"Essence" is the substantial basis of the human body and of all its functional activities
as well. Kidney essence consists of two parts: congenital and acquired. Congenital
essence is inherited from the parents, and acquired essence is transformed from the
refined essential substances of food and drink by means of the functions of spleen and
stomach. The congenital and acquired essences rely on and promote each other.
Before birth, the congenital essence has prepared the substantial basis for the acquired
essence; and after birth the acquired essence constantly replenishes the congenital
essence. Of the two, the acquired essence is more important. The function of the
kidney in reproduction and development relies entirely on kidney Qi. In other word,
the ability to reproduce, grow and develop is related to the prosperity or decline of the
essential Qi of the kidney.
The essential Qi of the kidney includes kidney essence and the kidney Qi transformed
from kidney essence. The transformation of kidney Qi from kidney essence relied on
the evaporating function of kidney Yang upon kidney Yin. Both kidney Yin and
kidney Yang take the essential Qi stored in the kidney as their material basis. The
essential Qi of the kidney therefore involves both kidney Yin and kidney Yang.
Kidney Yin is the foundation of the Yin fluid of the whole body, which moistens and
nourishes the Zang-Fu organs and tissues. Kidney Yang is the foundation of Yang Qi
of the whole body, which warms and promotes the functions of the Zang-Fu organs
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and tissues. Yin and Yang are both lodged in the kidney, which was therefore said to
be "the house of water and fire" by the ancients. According to their nature, essence is
Yin, and Qi is Yang, so kidney essence is sometimes called "kidney Yin" and kidney
Qi is sometimes called "kidney Yang." Kidney Yin and kidney Yang both restrict and
promote each other in the human body so as to maintain a dynamic physiological
equilibrium. Once this equilibrium is disrupted, pathological changes due to
imbalance of Yin and Yang in the kidney will manifest. If kidney Yin is deficient
through exhaustion, it will fail to control Yang which then becomes hyperactive.
Typical symptoms are heat sensations in the chest, palms and soles, afternoon fever,
night sweats, and seminal emission in males or sexual dreams in females. If kidney
Yang is deficient, leading to the failure in warming and promoting, there maybe
symptoms such as lack of spirit, coldness and pain in the lumbar region and knees,
aversion to cold, cold extremities, and impotence in men and frigidity and infertility
in women. If kidney deficiency is not accompanied by obvious cold symptoms, it is
usually called "deficiency of kidney Qi" or "deficiency of kidney essence."
5.2. Dominating water metabolism
Dominating water metabolism is the function of the kidney, which regulates the
distribution of water and helps maintain fluid balance in the body. Water metabolism
of the human body has two aspects: one is to disseminate the body fluid which is
derived from the essence of food and drink and has nutritive and nourishing functions
to the tissues and Zang-Fu organs throughout the body; while the other is to discharge
from the body the turbid fluid produced by all the Zang-Fu organs after metabolism.
Both of them rely mainly on the kidney's function of regulating water metabolism.
The kidney has the function of controlling the opening and closing of the gate of
water. Opening the gate makes the water excreted, while closing the gate helps retain
the water needed by the organ. If the function of regulating water metabolism is
normal, opening or closing the gate of water will be properly fulfilled, resulting in a
normal urination. If this function is abnormal it can lead to the inappropriate opening
or closing of the gate of water, causing a breakdown in the water metabolism. When
closing occurs more often than opening, oliguria and edema may occur; while on
contrary, when the reverse occurs, polyuria and frequent urination may present.

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5.3. Receiving Qi
Receiving Qi means that the kidney assists the lung in its function of receiving and
descending the Qi. In other words, respiration depends not only on the descending
function of the lung, but also on the kidney's function of reception and control. Only
when the kidney Qi is strong can the passage of Qi in the lung be free, and the
respiration smooth and even. If kidney Qi is weak, the root of the Qi is not firm, and
kidney will fail to receive Qi, resulting in the symptoms shortness of breath and
difficult inhalation that are worse with exertion.
5.4. Dominating bone, manufacturing marrow to fill up the brain and

manifesting in the hair
The kidney stores essence which produces marrow. The marrow develops in the
bone cavities and nourishes the growth and development of bones. When kidney
essence is sufficient, the bone marrow has a rich source of production and the bones
are well nourished, firm and hard. If the kidney essence is insufficient, it will fail to
nourish the bones, leading to the weakness and soreness of the lumbar region and
knees, weakness or atrophy of the feet, and maldevelopment. Since the kidney
dominates bone, and the teeth are considered as the extending part of bone, ample
kidney essence will result in strong and healthy teeth, while the deficiency of kidney
essence will lead to the loose or even falling teeth.
The marrow consists of two parts: spinal marrow and bone marrow. The spinal
marrow ascends to connect with the brain, which is considered to be formed by the
collection of marrow.
Essence and blood promote each other. When the essence is sufficient, then blood will
be rich and vigorous. The nourishment of the hair is dependent on a sufficient supply
of blood, but its vitality is rooted in the kidney Qi. The hair, therefore, is both the
surplus extension of blood on one hand, and the outward manifestation of the kidney
on the other. The growth or loss of hair, its being lustrous or withering, are all related
to the waxing or waning of the kidney Qi. During the prime of life, the kidney Qi is in

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a flourishing state and the hair is lustrous; in older age the kidney Qi declines and the
hair turns gray and white and eventually falls.
5.5. Opening into the ear and dominating anterior and posterior orifices
The hearing function of ears relies on the nourishment by the essential Qi of the
kidney. The ears therefore pertain to the kidney. When the essential Qi of the kidney
is sufficient, the ears are well nourished and the hearing is acute. When the essential
Qi of the kidney is deficient, it will fail to ascend to the ear leading to the tinnitus and
deafness.
"Anterior orifice" refers to the urethra and genitalia which have the function of
urination and reproduction. "Posterior orifice" refers to the anus which has the
function of excreting the feces. Although the discharge of urine is a function of the
bladder it also relies on the activity of Qi of the kidney, so do the reproductive
function and the excretion of feces. Decline or deficiency of kidney Qi, therefore, may
give rise to frequency of micturition, enuresis, oliguria and anuria, seminal emission,
impotence, premature ejaculation and infertility in reproduction, and prolonged
diarrhea with prolapse of rectum or constipation.
Note: From the kidney's physiology and pathology stated above it is clear that the
kidney in TCM basically includes the functions of the urinary system, reproductive
system, and part of the endocrine system and nervous system.
Section 2 Six Fu Organs
1. The Gallbladder
The gallbladder is attached to the liver with which it is externally-internally related.

Its main function is to store bile and continuously excrete it to the intestines to aid the
digestion. When the function of the gallbladder is normal, its Qi descends. Since the
bile is bitter fluid, and yellow in color, upward reversal of gallbladder Qi may give
rise to a bitter taste in the mouth, vomiting of bitter fluid, and failure to aid the
stomach and spleen in digestion, resulting in abdominal distention and loose stools.
Since this function of the gallbladder is closely related to the liver's function of
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maintaining the free flow of Qi, it is said that the liver and gallbladder together have
the function of maintaining the free flow of Qi. Similarly, the relation of the liver to
emotional changes is shared by the gallbladder, and this is taken into account in clinic
when treating symptoms such as fear and palpitations, insomnia and dream-disturbed
sleep.
Although the gallbladder is one of the six Fu organs, unlike the other five it stores bile
and does not receive water or food. For this reason it is also classified as one of the
"extraordinary Fu organ".
Note: From the physiology and pathology of the gallbladder stated above, it can be
seen that in TCM the gallbladder is understood basically in the same way as in
western medicine except that gallbladder shares some of the functions of the nervous
system.
2. Stomach
The stomach is located in the epigastrium. Its upper opening connects with the
esophagus and its lower opening is the pylorus which connects with the small
intestine. Its meridian connects with spleen with which it is interiorly-exteriorly
related. The main physiological function of stomach is to receive, digest and
transform the food and drink. Diet enters the mouth, passes through the esophagus,
reaches the stomach and remains there. This is why the stomach is called "the
reservoir of food and drink". The food and drink held in the stomach is reduced to
chyme by the fermenting and grinding action of the stomach. Then the chyme is
pushed downward into the small intestine. A disturbance of this function of the
stomach will cause poor appetite, a capacity for only small amount of food,
indigestion and distension and pain in the epigastric region. Of course, only in
cooperation with the spleen's function of transportation and transformation can the
stomach's function of receiving, digesting and transforming food and drink be
performed successfully.
TCM attaches great importance to the Qi of the stomach, and believes " A human
body's essence is the Qi of the stomach." Sufficient stomach Qi make all the five Zang

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organs to be full of vigor, while the deficiency of stomach Qi leads to their weakness.
While the Qi of the stomach exists, life continues; without it, life comes to an end. It
is meant by the stomach Qi that, on one hand, the physiological functions of the
stomach, and on the other hand, how the spleen and stomach work on the pulse,
securing a pulse condition of being gentle but strong, not too fast and not too slow.
It is normal for the stomach Qi to descend. After being digested and transformed by
the stomach, the food content follows the stomach Qi move down to the small
intestine so as to undergo further digestion and absorption. If the Qi of the stomach
cannot descend but ascends instead, the symptoms of belching, hiccups, nausea or
even vomiting will occur.
The stomach belongs to Yang and has the characteristic of liking to be moistened but
hating to be dried. Too excessive an amount of Yang often brings on dryness and fire,
of which the manifestations are feeling dry in the mouth and thirst, dry and yellow
coated tongue or gingival swelling and pain.
Note: From the stomach's physiology and pathology stated above, it can be seen that
TCM has almost the same understanding of the stomach as that of western medicine.
3. Small Intestine
The small intestine is located in the abdomen. Its upper end connects with the
stomach, and its lower end with the large intestine. The Small Intestine Meridian
communicates with the heart with which it is externally-externally related. Its main
physiological functions are reception and digestion. It receives and further digests the
food from the stomach separates clear from the turbid, and absorbs essential substance
and part of the water from the food, transmitting the residue of the food to the large
intestine and of the water to the bladder. Since the small intestine has the function of
separating the clear from the turbid, dysfunction may not only influence digestion, but
also give rise to an abnormal bowel movement and disturbance of urination.
4. The large Intestine

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The large intestine is located in the abdomen. Its upper end connects with the small
intestine via the ileocecum, and its lower end is the anus. The Large Intestine
Meridian communicates with the lung with which it is externally-internally related.
The main function of the large intestine is to receive the waste material sent down
from the small intestine, absorb its fluid content, and form the remainder into feces to
be excreted. Pathological changes of the large intestine will lead to dysfunction in this
transportation function, resulting in loose stools or constipation.
5. The Bladder
The bladder is located in the lower abdomen. Its meridian connects with the kidney
with which it is externally-internally related. The main function of the bladder is the
temporary storage of urine, which is discharged from the body through Qi activity
when a sufficient quantity has been accumulated. This function of the bladder is
fulfilled with the assistance of the kidney Qi. Dysfunction of the bladder will lead to
symptoms such as anuria, urgency of micturition and dysuria; and the failure of the
bladder to control urine may lead to frequency of micturition, incontinence of urine
and enuresis.
6. San Jiao (Triple Energizer)
The term, Sanjiao (triple energizer), is peculiar to traditional Chinese medicine. It is a

collective name of the upper, middle and lower Jiao (energizer) and one of the six Fu
organs. In the field of TCM, no unanimous conclusion has been drawn about the form
ad crux of the triple energizer. It is generally recommended that "Sanjiao" is a large
Fu organ containing all the internal organs, and also used to locate the body parts. The
upper Jiao is that the portion of the body cavity above the diaphragm which houses
the heart and the lung. The middle Jiao is the portion between the diaphragm and
umbilicus which houses the spleen and the stomach. The lower Jiao is the portion
below the umbilicus which houses the liver, the kidney, the bladder, the intestines and
the uterus. From its location, it can be clearly seen that the liver is an organ within the
middle energizer. Why is it classified to the lower Jiao? That is because TCM
believes the liver and the kidney share the same source so they are closely related to
each other. This puts the liver into the lower energizer.

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Generally speaking, the physiological functions of Sanjiao control the activities of the
Qi of the human body. The upper energizer controls respiration, and activates the flow
of vital energy, blood and body fluid (referring to in fact, the functions of the heart
and lung), i.e., it disperses pectoral Qi accumulated in the chest to all parts of the body
just as fog and dew moisten the earth. This is why TCM says that "The upper
energizer is like a sprinkler for distributing nutrients and Qi". The middle energizer
functions in transportation and transformation (refers to the functions of the spleen
and the stomach), i.e., it ferments food and drink and transports and transforms
refined essence of the food and drink in order to produce vital Qi (energy) and blood.
Therefore, it is likened to a fermentation tun, where food is digested. The lower
energizer separates clear fluids from turbid ones and discharges urine and stool (refers
to the functions of the kidney, the small intestine, the large intestine and the bladder).
The physiological functions mentioned above present the characterization of excreting
wastes downwards and outwards. It is said that the lower energizer works like gutters,
to filter and drain off waste and superfluous water. In fact, all these physiological
functions of the triple energizer are the sum total of the activities of all the Zang-Fu
organs in the body. Pathologically, diseases due to an abnormality of upper, or middle,
or lower Jiao are manifestations of dysfunctions of the Zang-Fu organs within it. It is
also believed in TCM that the triple energizer is the passage through which water,
food and fluid are transported.
Section 3. The Extraordinary Fu Organs
The extraordinary Fu organs include the brain, marrow, bones, vessels, gallbladder
and uterus. Since they are different from five Zang and six Fu organs, they are called
the "extraordinary Fu". The bones, marrow, vessels and gallbladder have been
discussed in the section on the Zang-Fu organs, so only the brain and uterus will be
stressed here in below.
1. The Brain
The brain is located in the skull and connects with the spinal marrow. The main
functions of the brain are as follows:

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1.1. Controlling mental and thinking activities
TCM has long understood the relationship between the brain and mental and
reasoning activities. For example, The Plain Questions says, " The head is the source
of mental activities." In the Qing dynasty, Wang Ang, a medical practitioner, wrote a
book entitled "Essentials of Materia Medica", in which there is a clear-cut sentence
that " A person's memory is wholly stored in the brain." Later, Wang Qingren, a
medical man also in the Qing dynasty, stated clearly, "The spirit and memory are not
stored in the heart but in the brain." This shows that the brain operates mental
activities.
1.2. Guiding sensuous and language activities
As early as the time when the "Canon of Medicine" was written, TCM associated the
audio and visual senses with the brain. In the Qing dynasty, Wang Qingren pointed
out, "The two ears are linked to the brain and the sound that the ears receive are
transmitted into it. The eyes are connected by lineal things to the brain which receive
an image the eyes catch. The nose is linked to the brain, to which goes the sweet or
foul flour the nose smells. A one-year old baby can say one word or two, because its
brain has been growing gradually." In his book, he attributed the functions of seeing,
hearing, smelling and speaking to the brain. Of all the books on TCM, his deals most
comprehensively with the functions of the brain. Although TCM has had certain
knowledge of the brain's physiology and pathology, it is still believed that most
mental, conscious and reasoning activities result respectively from the five Zang
organs and gallbladder. The theory of Zang-Fu organs says that the heart houses the
mind and ensures the soul and its disorder may cause anger. The kidney stores the
memory and its disorder may cause fright. The gallbladder is associated with one's
courage in making decisions. Among these, the heart, the liver and the kidney play the
major role in controlling the mental activities. Therefore, in TCM, either syndromes
established by an overall differentiation of the signs and symptoms of diseases, such
as as " the heart misted by phlegm", or their corresponding therapies, such as
"resolving phlegm so as to open the aperture of the heart", are, in fact, included in
western medicine.

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Note: From the foregoing physiology and pathology of the brain, it can be seen that
although TCM is similar to western medicine in understanding the brain in some
aspects, there are different ways and depths in doing so.
2. The Uterus
The uterus, a reproductive organ of the females, is located in the lower abdomen of
the females behind the bladder and in front of the rectum. Its main functions are
presiding over menstruation and nourishing the fetus.
2.1. Presiding over menstruation
The uterus is the organ by which a woman forms menstruation. Generally speaking, a
girl's kidney Qi is increasing and her womb is fully developed when she reaches the
age of 14 or so. Under the action of a substance named "Tian Gui", her Ren meridian
begins to flow and her Chong meridian begins to flourish; her sea of blood becomes
fuller, and she begin to have regular menses. Up to the age of 49, her Qi of the Ren
meridian declines and her Qi of the Chong meridian becomes weak and scanty. The
"Tian Gui" in her body is used up and her menstruation stops, with the result that her
body becomes old and she can no longer become pregnant. During this period of time,
she begins to have menstrual disorders until menopause occurs.
2.2. Nourishing the fetus
Once a woman's uterus is fully developed and her menses are regular an egg from her
ovary can be fertilized with sperm and pregnancy can result. In TCM opinion, the
physiological functions of the uterus are closely related with the kidney, Chong and
Ren (Conception Vessel) meridians. This is because the functions of producing
menses and becoming pregnant are not irrelative to the blood and the productive
essence. What is more, the heart controls blood circulation, the liver installs and
regulates the blood, the spleen keeps the blood flowing within the vessels, the kidney
stores the reproductive essence, and two Meridians mentioned above supply the uterus
with the blood. Therefore, pathologically, abnormal function of the above organs and
meridians caused by various pathogenic factors will affect the functions of the uterus,

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resulting in menstrual disorders and sterility. In the treatment of these disorders, TCM
often pays great attention on adjusting and replenishing the above organs.
Note: From the foregoing physiology and pathology of the uterus, it can be seen that
uterus in TCM refers not only to the womb but also to the whole internal genital
system.
Chapter 3: The Theory of Essence, Qi, Blood and Body Fluids
The four basic substances of life are essence, Qi, Blood and body fluids, they are the
material bases which maintain the normal activities of the human body.
Section 1. Essence
Essence (Jing) is a fundamental material of the human body and the material basis for
various physiological functions of the human body. "Plain Questions" says, " Essence
is essential to the body."
Practitioners of past generations assumed there were two types of essence: the
congenital or innate essence and the acquired essence. In functional terms, the two
types are defined as the reproductive essence and the essence of the Zang-Fu organs.
The congenital essence is received from one's parents, and is stored in the kidney; it is
also known as "the prenatal essence", serving to promote the growth, development
maturity, and reproduction of the body, thus the congenital essence is also called the
"reproductive essence."
The acquired essence is derived through the functions of the Zang-Fu organs from the
nutritive substance of food and drink to nourish the body. In turn, it serves as the
material basis for the functional activities of the Zang-Fu organs. Consequently, it is
called "the essence of the Zang-Fu organs."
The essence stored in the kidney includes both the congenital essence and the
acquired one. The two are interdependent on and promote each other. Before birth, the
congenital essence prepares the material basis for the acquired one; and after birth, the
acquired essence continues to replenish the congenital one. Healthy congenital
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essence facilitates the formation of the acquired essence, while the growth,
development and reproduction are all based on the replenishment of the congenital
essence by the acquired essence.
Section 2. Qi
What is Qi? According to the ancient Chinese thought, Qi is described as the basic
particles which constitute the universe and produce everything in the world through
their movements and changes. In traditional Chinese medicine, Qi in its physiological
sense refers to the motive force or energy (which is produced by the basic particles)
required for various functional processes. Since Qi is invisible, and what can be
perceived is the result of energy, Qi often connotes the activity itself. For example,
deficiency of the kidney Qi means the deficiency of the energy required for the
functional processes of the kidney; it actually implies the status of the hypofunction of
the kidney.
1. The classification and generation of Qi
Certain qualitative terms differentiate Qi in the human body according to its source,
function, and distribution. The terms are: primary Qi (Yuan Qi), pectoral Qi (Zong
Qi), nutrient Qi (Ying Qi) and defensive Qi (Wei Qi). In terms of their source they
may be further classified into congenital Qi and acquired Qi. Primary Qi, which is
derived from congenital essence and inherited from the parents, is referred to as the
congenital Qi. After birth, pectoral Qi, nutrient Qi, and defensive Qi are all derived
from the refined essence of food, and are therefore known as the acquired Qi.
Congenital Qi and acquired Qi are dependent on each other for their production and
nourishment. Primary Qi stimulates and promotes the functional activities of the
Zang-Fu organs and the associated tissues of the body, which in turn produce the
acquired Qi. Thus primary Qi is the material foundation for the production of the
acquired Qi. On the other hand, the acquired Qi continuously nourishes and
supplements the congenital Qi. Therefore there is an interdependent relationship
between the two: the congenital Qi promotes the acquired Qi, which in turn nourishes
the congenital Qi. Qi may also be described as the functional activities of the Zang-Fu

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organs and meridians. It is then referred to, for example, as Qi of the heart, liver, lung,
spleen, stomach, kidney and that of various meridians. They are discussed further in
other relevant chapters.
1.1. Primary Qi (Yuan Qi)
Derived from the congenital essence, primary Qi needs to be supplemented and

nourished by the Qi obtained after birth from the essence of food and water. Primary
Qi takes root in the kidney and spreads to the entire body via the triple energizer (San
Jiao). It stimulates and promotes the functional activities of the Zang-Fu organs and
the associated tissues. The more abundant the primary Qi is, the more vigorously the
Zang-Fu organs and the associated tissues will function. The human body will then be
healthy and rarely suffer from disease. On the other hand, the congenital insufficiency
of primary Qi may lead to various pathological changes.
1.2. Pectoral Qi (Zong Qi)
Pectoral Qi is formed by the combination of the clean Qi (Qing Qi) which is inhaled
by the lung, and the essential Qi of the food and drink which is transformed by the
spleen and stomach. Pectoral Qi is stored in the chest. Its main functions are: the one
is to promote the lung's function of controlling respiration, so the strength or
weakness of speech and respiration are related to the quality of pectoral Qi; and the
other is to promote the heart's function of dominating the blood and vessels, so the
circulation of Qi and blood, and the coldness and warmth and the motor ability of the
four limbs and body trunk are all closely associated with the pectoral Qi.
1.3. Nutrient Qi ( Ying Qi )
Derived from the essential Qi of the food and drink transformed by the spleen and
stomach, nutrient Qi circulates in the vessels. Its primary function is both to produce
blood and to circulate with it to provide further nourishment. As nutrient Qi and blood
are so closely related, "Ying-blood" is the term commonly used to refer to their joint
functions.
1.4. Defensive Qi ( Wei Qi )

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Defensive Qi is also derived from the Qi of food essence, but unlike nutrient Qi it
circulates outside the vessels. Defensive Qi functions to protect the muscular surface,
defend the body against exogenous pathogenic factors, control the opening and
closing of the pores, moisten the skin and hair, readjust body temperature, and warm
up the Zang-Fu organs. Defending the body against exogenous pathogenic factors is
its principal function, hence the name defensive Qi.
As Defensive Qi is also derived from the Qi of food essence, but unlike nutrient Qi it
circulates outside the vessels. Defensive Qi functions to protect the muscular surface,
defend the body against exogenous pathogenic factors, control the opening and
closing of the pores, moisten the skin and hair, readjust the body temperature, and
warm up the Zang-Fu organs. Defending the body against exogenous pathogenic
factors is its principal function, hence the name defensive Qi.
As mentioned above, the Zang-Fu and meridians possess their own Qi. Originating
from primary Qi, pectoral Qi, nutrient Qi, and defensive Qi, the Qi of the meridians is
a combination of the essential Qi of food, the clean Qi inhaled by the lung, and
essential Qi stored in the kidney. The Qi of the meridians, therefore, is referred to as
Zheng Qi (vital Qi) flowing in the meridians. As the basis of the functions of the
meridians, the Qi of the meridians greatly influences the functions of the Qi, blood
and Zang-Fu organs of the entire body.
2. Function of Qi
Qi acts extensively in the human body by permeating all the parts. Abundance of Qi is
the basis of good health and weakness of Qi may lead to diseases. Qi, distributed to
various parts of the body, characteristically functions as follows:
2.1. Promoting function
The growth and development of the human body, the physiological activities of the
Zang-Fu and meridians, the circulation of blood and distribution of body fluid, are all
dependent on the promoting and stimulating effect of Qi. Deficiency of Qi impairs the
blood circulation, causes the dysfunction in transforming and distributing body fluid,
and gives rise to the production of damp-phlegm in the interior.
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2.2. Warming function
The normal temperature of the body is maintained and readjusted by Qi. The "Classic
on Medical Problems" says: "Qi has a warming action." A deficiency of Qi can cause
the lowered body temperature, intolerance to cold, and cold limbs.
2.3. Defending function
The defending function of Qi is embodied in two aspects: one is to guard the surface
of the skin against exogenous pathogenic factors and the other is to combat the
invading exogenous pathogenic factors so as to ward it off. When the defensive
function of Qi is normal, the exogenous pathogenic factors have difficulty in invading
the body, even though it may obtain the entry, it is not certain to cause any disease. If
it does cause a disease, this disease is easy to be cured. When the defensive function
of Qi becomes weaker, i.e. the ability of the human body to fight the exogenous
pathogenic factors is lowered, the body is easily invaded and diseases are caused. And
what is more, these diseases are hard to be cured.
2.4. Consolidating and governing function
By "consolidating and governing function", it is meant that Qi has the ability to

command, control and consolidate the liquid substances and organs in the abdominal
cavity. This is done by:
2.4.1. Keeping the blood flowing within, not extravasating out of, the vessels;
2.4.2. Controlling and adjusting the secretion and excretion of sweat, urine and saliva,
and preventing the body fluid from escaping;
2.4.3. Consolidating and storing sperm and preventing emission and premature
ejaculation;
2.4.4. Consolidating the organs so as to prevent them from descending.

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The weakening in the above functions of Qi may cause various kinds of hemorrhage,
spontaneous perspiration, polyuria, salivation, spermatorrhea, premature ejaculation,
prolapse of the stomach, kidney and uterus.
The consolidating and governing action and the promoting action of Qi oppose yet
also complement each other. On one hand, Qi has the function of promoting the
circulation of blood, and the transportation and distribution of body fluid, and on the
other hand, it also has the function of controlling and adjusting the movement,
secretion and excretion of liquid substances in the body. The coordination and balance
of these two functions are essential for maintaining the normal blood circulation and
water metabolism within the body.
2.5. Promoting the metabolism and transformation
"Qi Hua" is a specific term in the science of TCM. It refers, in general, to various
kinds of changes taking place in the body under the action of Qi. Specifically, it refers
to the metabolism of fundamental substances, vital Qi, blood and body fluids are
formed in the following manner: ingested food is changed into food essence, and food
essence is, in turn, transformed into vital Qi, blood or body fluids, and these can then
be changed into any one of the others according to the physiological need of the body.
The waste from the eaten food and the products produced in the course of metabolism
are changes, separately, into feces, urine and sweat which are ready to be removed
from the body. All of these are the specific manifestations of the actions of the
activity of Qi. The dysfunction of Qi in performing its action will affect the whole
metabolism of the body. That is to say, it will affect the digestion, absorption,
transformation and transportation of food and drink; the formation, movement and
transformation of vital Qi, blood and body fluids; and the excretion of feces, urine and
sweat; thus causing various symptoms due to the abnormal metabolism. In short, the
process in which Qi performs its functions is the process in which the substances in
the body are metabolized, and in which the substances and energy are transformed.
Section 3. Blood

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Blood is a red liquid circulating in the vessels, and is a vital nutrient substance in the
body.
1. Formation and circulation of blood
As the fundamental substances required in blood formation originate from the essence
of food and drink produced by the spleen and stomach, these two organs are regarded
as the source of Qi and blood. The "Miraculous Pivot" holds that "When the essence
of food and drink is received in the middle energizer it will be transformed into red
fluid which is called blood," and "nutrient Qi flows into the vessels to be transformed
into blood." Essence and blood may also transform into each other. The book
"Zhang's General Medicine" states: "If blood is not consumed, it turns into essence in
the kidney; if essence does not leak out, it is transformed into blood in the liver."
Taking the essence of food and drink and the essence stored in kidney as the material
basis, blood is formed by the functional activities of Zang-Fu organs such as the
spleen, stomach, heart, lung, liver and kidney.
After being formed, blood normally circulates in the vessels throughout the body, and
is taken charge of jointly by the heart, liver and spleen. The heart dominates the blood
and vessels, and propelling force of heart Qi is the basis of the blood circulation. The
spleen Qi has the function of controlling blood and preventing bleeding. The liver
promotes the free flow of Qi, stores blood and regulates its volume in circulation. The
coordination of the three organs ensures the continuous blood circulation in the
vessels throughout the body. Dysfunction of any of the three may cause abnormal
blood circulation. Deficiency of heart Qi, for instance, may lead to the stagnation of
heart blood. Dysfunction of the spleen in controlling blood may lead to the
blood-tinged stools, uterine or subcutaneous bleeding, and ecchymoses.
2. Functions of blood
Blood circulates throughout the body, passing through the five Zang and six Fu
organs in the interior, and the skin, muscles, tendons and bones on the exterior. In this
way blood nourishes and moistens the various organs and tissues of the body. "The
Classic on Medical Problems" generalizes this function of blood, saying: "Blood

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dominates nourishment and moisture." The nourishing and moistening function of

blood manifests clearly in the movement of the eye and four limbs. According to the
"Plain Questions", "When the liver receives blood, it gives rise to vision; when the
feet receive blood they are capable of walking; when the palms receive blood they are
capable of holding; and when the fingers receive blood they are capable of grasping."
Insufficiency of blood may lead to the impairment of vision, dryness of the eyes,
motor impairment of the joints, numbness of the four limbs and dryness and itch of
the skin.
Blood is the material foundation for the mental activities. A sufficient blood supply
ensures clear consciousness and a vigorous spirit. The "Plain Questions" states: "Qi
and Blood are the foundation for human mental activities." And the "Miraculous
Pivot" says: "Harmonious circulation of blood ensures a vigorous spirit." These
quotations could illustrate the close relationship between the blood and the mental
activities. Deficiency of blood, therefore, may lead to the mental disorders. An
example is deficiency of heart or liver blood resulting in the mental restlessness, with
symptoms such as palpitation, insomnia and dream-disturbed sleep.
Section 4. Body fluid
Body fluid is a collective term for all the normal fluid of the body, including saliva,
gastric juice, intestinal juice and the liquids in the joint cavities, as well as tears, nasal
discharge, sweat and urine.
1. Formation, transportation and distribution of body fluid
Body fluid is formed from food and drink after its digestion and absorption by the
spleen and stomach. The transportation, distribution and excretion of body fluid
principally rely on the spleen's function of transportation, the lung's function of
dispersing and descending and regulating water passages, and the kidney's function of
controlling urination and separating the clear and the turbid. Of the three, the kidney
is the most important. The "Plain Questions" explains the formation and distribution
of body fluid by the saying that "After food enters the stomach, the refined nutrient
essence of the food and drink is transmitted to the spleen, which will send it to the
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lung. The lung regulates the water passages and transmits the Qi of water to the
bladder below. The Qi of water then spreads in four directions and travels along the
meridians of the five Zang organs. When depicting the triple energizer as the pathway
of body fluid, the "Plain Questions" states: "The triple energizer is the irrigation
official who builds waterways."
In addition, the fluid sent downward from the stomach continues to be absorbed by
the small and large intestines. A part of the fluid, after passing through the spleen,
lung and triple energizer, is excreted from the skin and hair as sweat. Another part of
the fluid is sent downwards to the bladder via the waterways of the triple energizer,
and excreted from the body as urine, with the assistance of the Qi of the kidney and
bladder. By means of the actions of all these Zang-Fu organs, body fluid reaches the
skin and hair on the exterior, and penetrates the Zang-Fu in the interior, thus
nourishing all the tissues and organs throughout the body.
In short, the formation, distribution and excretion of body fluid is a complicated

process fulfilled by the coordinated activities of many Zang-Fu organs, especially the
lung, spleen, and kidney. Pathological changes of these organs may consequently
affect the formation, distribution and excretion of body fluid. For example, if there is
the insufficient formation or excessive loss, body fluid may be damaged or consumed.
A disturbance in distribution of body fluid may lead to its accumulation, resulting in
retained fluid and edema, or the formation of phlegm. Pathological changes of body
fluid may, in turn, impair the functions of many Zang-Fu organs. For example,
invasion of the heart by retained water would cause palpitations; retention of fluid in
the lung may result in cough with asthmatic breathing; dryness of the lung due to
consumption of body fluid brings on the unproductive cough; dryness of the intestines
leads to constipation.
2. Functions of body fluid
Body fluid moistens and nourishes various parts of the body. There are noticeable
differences, however, in the nature, form and location of different types of body fluid.
Clear and thin fluids are referred to as "Jin", whilst thick and heavy fluids are known
as "Ye". "Jin" is distributed on the muscular surface, and has the function of warming

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and nourishing the muscles and moistening the skin. "Ye" is stored in the joints and
orifices and has the function of moistening the joints, strengthening the brain and
marrow and nourishing the orifices. As both "Jin" and "ye" are normal fluids in the
body and are derived from the same source---the refined essence of food and drink
---they may be transformed into each other. Generally they are referred to together by
the term "Jin Ye" (body fluid).
Chapter 4. Meridians and Collaterals
The meridian-collateral theory focuses on studying the physiological functions and

pathological changes of the meridian-collateral system, as well as the relationship
between the system and the Zang-Fu organs. It is an important component of the
theoretical system of traditional Chinese medicine. The development of the
meridian-collateral theory is closely related to acupuncture therapy. It provides not
only the theoretical foundation for acupuncture, massage and Qigong, but also guides
the clinical practice of other related fields of traditional Chinese medicine.
Section 1. Concept and Formation of the Meridian-Collateral System
1. The concept of meridians and collaterals
The meridians (Jing) and collaterals (Luo) are pathways in which Qi and blood
circulates. They form a specific network which communicates with the internal organs
and limbs and connects the upper to the lower and the exterior to the interior of the
body. The meridians are the major channels of the system and they run lengthwise
within the interior of the body. The collaterals are the branches of the meridians and
they run crosswise from the meridians either on or just below the body surface. Since
they are distributed over the entire body, the meridians and collaterals link together
the Zang-Fu and other organs, the orifices of the body, the skin, muscles and bones.
They bring the body into an organic whole to carry on the systematic activities.
2. The composition of the meridian-collateral system

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The meridian system consists of the regular meridians, the eight extra meridians, as
well as the affiliated parts i.e. the twelve divergent meridians, the twelve
tendon-muscle meridians and the twelve cutaneous regions.
There are twelve regular meridians: the three Yin meridians of the hand, the three Yin
meridians of the foot, the three Yang meridians of the hand and the three Yang
meridians of the foot. They are called the twelve regular meridians, because they are
the chief pathways of Qi and blood. The twelve regular meridians start and terminate
at given parts, run along the regular routes and meet in a specified sequence. They are,
moreover, associated with the Zang-Fu organs. Though we say there are twelve
regular meridians, in fact these twelve meridians are doubled when counting
symmetrically on both the left and right sides of the body.
There are eight extra meridians: namely Du, Ren, Chong, Dai, Yinqiao, Yangqiao,
Yinwei and Yangwei meridians. The eight extra meridians are interlaced with the
twelve regular meridians, helping reinforce the communication between and
adjustment of the twelve regular meridians. The eight extra meridians are not directly
related to any of the internal organs.
There are twelve tendon-muscle meridians and twelve cutaneous regions. The former
is the system affiliated to the twelve regular meridians connecting with the tendons
and muscles and they are basically coincident with the superficial routes of the twelve
regular meridians and their function is to connect all the bones and joints of the body
and to maintain the normal motor functions of the joints. The latter are the superficial
portions of the body that respond to the distribution of the twelve regular meridians
and their collaterals. As their courses are similar to that of the twelve regular
meridians, they derive their names from the meridians.
As the collaterals are concerned, the big and small branches of meridians are known
as collaterals, including the major collaterals, superficial collaterals and tertiary
collaterals. The major collaterals are the bigger and chief collaterals. They extend
directly from the twelve regular meridians and the Du and Ren Meridians. Together
with the major collateral of the spleen they are called the "Fifteen Major
Collaterals" the principal function of which is to maintain the communication between

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the exterior-interior paired meridians. The superficial collaterals lie just beneath the
skin and the tertiary collaterals are the smallest and finest of all.
Section 2. The twelve principal meridians
The twelve regular meridians are symmetrically distributed on both sides of the body.
They run along the medial or lateral aspects of the upper and lower limbs, each
corresponding to either a Zang or a Fu organ. Their names are given on the basis of
three factors, hand or foot, Yin or Yang, and pertaining to a Zang or Fu organ. Those
that run on the upper limbs are hand meridians, while those that run on the lower
limbs are foot meridians. Those that run on the medial aspects of the limbs are Yin
meridians and they pertain to Zang organs, while those that run on the lateral aspects
are Yang meridians and they pertain to Fu organs.
1. The courses, connection and distribution of the twelve regular meridians
1.1. The linking connection among the twelve regular meridians
The three hand Yin meridians start in the chest and run to the end of fingers where
they meet the three hand Yang meridians. The three hand Yang meridians start from
the end of the fingers and ascend to the head where they meet the three foot Yang
meridians. The three foot Yang meridians start from the head and run down to the toes
where they meet the three foot Yin meridians. The three foot Yin meridians start from
the toes and ascend to the abdomen or chest where they meet the three hand Yin
meridians. Thus, a closed Yin and Yang circuit is formed. The three hand Yang
meridians terminate at the head where the three foot Yang meridians start. This
reflects the ancient saying that "the head is the juncture of all the Yang meridians."
1.2. The running and distribution of the twelve regular meridians
On the limbs, the three Yin meridians are distributed along the medial aspects while
the three Yang meridians along the lateral aspects. The Taiyin and Yangming
meridians run along the front fringe of the limbs, the Shaoyin and Taiyang meridians
run along the back edge, and the Jueyin and Shaoyang meridians run in between.

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On the head, the Yangming meridians are distributed on the face and forehead, the
Taiyang meridians are on the cheeks and on the top and back of the head; and the
Shaoyang meridians are on the lateral side of the head.
With regard to the body trunk, the three hand Yang meridians travel in the shoulders
and scapular region; among the three foot Yang meridians: the Yangming runs in the
front (the chest and abdomen), the Taiyang in the back, and the Shaoyang in the
lateral side; the three hand Yin meridians all come out of the armpits; and the three
foot Yin meridians run on the abdominal or the thoracic region where the meridians
run lengthwise from the medial to the lateral in such order as Foot-Shaoyin,
Foot-Yangming, Foot-Taiyin, and Foot-Jueyin.
2. The exterior-interior relationships between the twelve regular meridians and

cyclical flow of Qi and blood in them
2.1. The exterior-interior relationships
The three Yin and three Yang meridians of the hand and foot form six
exterior-interior pairs through the divergent meridians and major collaterals. The six
pairs of the meridians with exterior-interior relationships are as follows: the Bladder
Meridian of Foot-Taiyang and the Kidney Meridian of Foot-Shaoyin; the Gallbladder
Meridian of Foot-Shaoyang and the Liver Meridian of Foot-Jueyin; the Stomach
Meridian of Foot-Yangming and the Spleen Meridian of Foot-Taiyin; the Small
intestine Meridian of Hand-Taiyang and the Heart Meridian of Hand-Shaoyin; the
Triple Jiao Meridian of Hand-Shaoyang and the Pericardium Meridian of
Hand-Jueyin; and the Large Intestine Meridian of Hand-Yangming and the Lung
Meridian of Hand-Taiyin. These meridians, which are exteriorly-interiorly related,
meet at the ends of the four Limbs, run lengthwise side by side in the medial and
lateral aspects of the limbs (except the Liver Meridian of Foot-Jueyin and the Spleen
Meridian of Foot-Taiyin which cross each other at the place 8 cun above the internal
malleolus, switch courses, and finally go to pertain to their respective Zang-Fu
organs).

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The general exterior-interior relationship of the twelve regular meridians is

strengthened not only through the exterior-interior relationship of each specific pair,
but also through their pairing with the Zang-Fu organs. As a result of this system,
related Zang and Fu organs work harmoniously when healthy and affect each other
pathologically when diseased. In treatment, acupoints on the exteriorly-interiorly
related meridians could be alternately used. For example, points of the Lung Meridian
could be used to treat the disorders of large intestine, vice versa.
2.2. Cyclical flow of q and blood in the twelve regular meridians
The twelve regular meridians link one another in a fixed order and the circulation of
Qi and blood in the meridians is cyclical. It is usually said that the circulation starts
from the Lung Meridian of Hand-Taiyin, travels to the Liver Meridian of Foot-Jueyin,
and finally flows back to the Lung Meridian of Hand-Taiyin.
3. The routes of the twelve regular meridians
3.1. The Lung Meridian of Hand-Taiyin (LU) (see fig. 1)

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a) The meridian starts from the middle Jiao (energizer), the portion between the
diaphragm and the umbilicus of the body activity, and runs downward to connect with
the large intestine. Then it ascends along the upper orifice of the stomach and crosses
the diaphragm before pertaining to the Lung.
b) It emerges from the Lung system transversely (at point Zhongfu, LU l) and runs
down along the medial aspect of the upper arm and on the radial side of the Heart
Meridian of Hand-Shaoyin and the Pericardium Meridian of Hand-Jueyin. Then it
goes through the cubital fossa and enters Cunkou (on the wrist over the radial artery
where the artery is palpable) along the radial border of the medial aspect of the
forearm. It continues to run along the thenar eminence and the thenar border and
arrives at the radial side of the thumb tip (point Shaoshang, LU 11).

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c) A branch starts from Lieque (LU 7) and runs along the radial side to the tip of the
index finger.
3.2. The Large Intestine Meridian of Hand-Yangming (LI) (see fig. 2)
a) The meridian starts from the tip of the index finger (point Shangyang, LI 1). Then
it runs upward along the radial side of the index finger, passing the interspace of the
first and second metacarpal bones and the tendons of long and short extensor muscle
of the wrist. It continues to rise further along the radial side of the forearm and elbow,
and the radial side of the dorsal aspect of the upper arm, and arrives at the shoulder. It
runs along the anterior border of the acromion, then meets Dazhui (DU 14) and enters
the body cavity through the supraclavicular fossa.

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b) It runs down from the supraclavicular fossa to connect with the lung; further down
it crosses the diaphragm and pertains to the large intestine.
c) Starting from the supraclavicular fossa, it passes the neck, cheek, and the gums of
the lower teeth; then exiting the mouth cavity, it runs around the upper lip, crosses at
the philtrum, and ends at the alae nasi (point Yingxiang, LI 20)
3.3.The Stomach Meridian of Foot-Yangming (ST) (see fig. 3 and fig. 4)

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a) The meridian starts at the lateral side of ala nasi, runs up to the root of the nose
and meets the Bladder Meridian of Foot-Taiyang. Then it descends along the lateral
side of the nose (point Chengqi, ST l), enters the upper gum, curves around the lips
goes down to meet Chengjiang (RN 24) at the mentolabial groove, and then runs
along the posterior and lower part of the cheek to the acupoint Daying (ST 5). It
continues to travel along the angle of the mandible, passing the front of the ear
(Xiaguan, ST 7), ascends to the anterior hairline and finally reaches the forehead.
b) One of its branches descends from Daying (ST 5) to Renying (ST 9) and then
running along the throat, reaches Quepen (ST 12), at the center of the supraclavicular
fossa. It continues to go downward, through the diaphragm and then pertains to the
stomach and connects with the spleen.
c) A straight branch starts from the supraclavicular fossa, crosses the nipple and
reaches Qichong (ST 30), at the lateral side of the abdomen.
d) Another branch starts from the lower orifice of the stomach, through the abdomen,
and descends to Qichong (ST 30) where it joins the straight branch. Then it passes
Biguan (ST 3l), running along the anterior border of the thigh, Futu (ST 32), and then
descends to the lateral side of the knee. It continues to travel along the lateral side of
the crural tibia, reaches the dorsum of the foot and then enters the lateral side of the
tip of the second toe.
e) The tibial branch starts from Zusanli (ST 36), 3 Cun below the knee and goes down
to the lateral side of the lip of the middle toe.
f) The dorsal foot branch starts from the dorsum of the foot and ends at the medial
side of the tip of the great toe.
3.4. The Spleen Meridian of Foot-Taiyin (SP) (see fig. 5 and fig. 6)

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a) The meridian starts from the medial side of the great toe, along the dorso-ventral
boundary of the foot and passing the first phalanx and metatarsal joint, then reaches
the anterior border of the medial malleolus. It continues to ascend along the posterior
border of the medial side of the tibia, emerges from the place 8 Cun above the medial
malleolus, and runs in front of the Liver Meridian of Foot-Jueyin. Then passing
through the knee and the inner side of the thigh, it enters the abdomen, pertaining to
the spleen and connecting with the stomach. Finally, it goes through the diaphragm
and the pharynx, reaches the root of the tongue and further spreads under the tongue.
b) A branch starts from the stomach, passes the diaphragm and enters the heart.
3.5.The Heart Meridian of Hand-Shaoyin (HT) (see fig. 7)

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a) The meridian originates in the heart, spreading over the "heart system". It descends
internally passing the diaphragm to connect with the small intestine.
b) The ascending portion starts from the "heart system", running along the esophagus
to connect with the "eye system".
c) The straight portion go upward to traverse the lung, then runs downward and
emerges in the mid of the axilla (Jiquan, HT l). Then it goes along the posterior (the
ulnar) border of the medial aspect of the upper arm (behind the Lung Meridian of
Hand-Taiyin and the Pericardium Meridian of Hand-Jueyin) and reaches the elbow. It
runs further down along the posterior border of the medial side of the forearm to the
pisiform bone proximal to the palm, and enters the palm. It descends along the radial
side of the palm, terminating at the finger tip ( Shaochong , HT 9).
3.6. The Small intestine Meridian of Hand-Taiyang (SI) (see fig. 8)

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a) The meridian starts at the ulnar side of the little finger (Shaoze, SI l), running
along the ulnar side of the dorsum of hand, then enters the wrist. Passing the styloid
process of ulna, it ascends along the posterior border of ulnar side of the forearm and
emerges from between the olecranon and the medial epicondyle of humerus. It
continues to travel along the ulnar border side of dorsal aspect of the upper arm,
comes out from the shoulder joint, circles around the scapular region, and then meets
the Du Meridian on the shoulder. After that, it enters the supraclavicular fossa

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(Quepen, ST 12), connects with the heart, descends along the esophagus, passes the
diaphragm, reaches the stomach and finally goes into the small intestine, its pertaining
organ.
b) Another branch starts from the supraclavicular fossa (Quepen, ST 12), running
along the neck and past the cheek, and reaches the outer canthus. It terminates in the
ear (Tinggong, SI 19).
c) The third branch starts at the cheek, ascends to the infraorbital region, passes the
lateral side of the nose, and finally enters the medial canthus of the eye.
3.7. The Bladder Meridian of Foot-Taiyang (BL) (see fig. 9 and fig. 10)

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a) The meridian starts at the medial canthus of the eye (Jingming, BL l), ascends to
the forehead and then arrives at the vertex.
b) The cephalic branch descends from the vertex to the upper corner of the ear.
c) The straight cephalic branch descends from the vertex to the brain, exits along the
nape and the medial side of the scapula, moves down along the spine, and then

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reaches the lumbar region. It enters the abdomen and connects with the kidney and
pertains to the urinary bladder.
d) The lumbar branch starts at the lumbar and gluteal region and runs to the popliteal
fossa.
e) Another branch starts at the medial side of the scapula, running along the spine, and
reaches the greater trochanter of femur in the gluteal region. Then it descends along
the latero-posterior side of the thigh and meets the lumbar branch at the popliteal
fossa. It continues to descend along the posterior side of the calf and emerges from the
posterior side of the external malleolus. After passing the tuberosity of the fifth
metatarsal bone, it reaches the lateral side of the tip of the little toe(Zhiyin, BL 67).
3.8. The Kidney Meridian of Foot-Shaoyin (KI) (see fig. 11 and fig.12)

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a) The meridian starts at the plantar tip of the small toe and runs obliquely towards
Yongquan (KI l) in the center of the sole. Emerging from Rangu (KI 2) which locates
at the medial aspect of the tuberosity of the navicular bone, it circles behind the
medial malleolus and runs in the heel. Then it ascends along the medial side of the
calf, and emerges from between the semitendinous and semimembranous muscles in
the popliteal fossa. It further ascends along the medial side of the thigh, enters the
spinal column, terminates in the kidneys, its pertaining organ, and connects with the
urinary bladder.
b) The kidney branch starts from the kidney, passes the liver and diaphragm, enters
the lung, runs through the throat and finally reaches the root of the tongue.
c) Another branch starts from the lung, links with the heart and enters the chest.
3.9. The Pericardium Meridian of Hand-Jueyin (PC) (see fig. 13)

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a) The meridian starts from the chest where it pertains to the pericardium. Then it
passes through the diaphragm and moves down to connect with San Jiao (triple
energizer).
b) The thoracic branch starts from the chest and hypochondriac region and exits at
Tianchi (PC l), 3 cun below the axilla. Then it ascends to the axillary fossa, runs along
the medial side of the upper arm and between the Hand-Taiyin and Hand-Shaoyin
meridians, and enters the cubital fossa. Finally, it goes between the tendons of the
long palmar muscle and radial flexor muscle, enters the palm and terminates at the tip
of the middle finger (Zhongchong, PC 9).

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c) The palmar branch originates from the palm and runs to the tip of the ring finger.
3.10. The Sanjiao (Triple Energizer) Meridian of Hand-Shaoyang (SJ, TE) (see
fig.14)

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a) The meridian starts at the end of the ring finger on the ulnar side (point Guanchong,
SJ l), goes along the ulnar side of the ring finger and reaches the wrist through the
dorsum of the hand. Then it ascends along the lateral side of the forearm and between
the ulna and radius. Passing through the posterior cubitus and the lateral side of the
upper arm, it arrives at the shoulder. Traveling behind the Gallbladder Meridian, it
then enters the supraclavicular fossa and spreads in the chest to connect with the
pericardium. Finally, it crosses the diaphragm and pertains to Sanjiao.
b) One branch starts from the chest and comes out of the supraclavicular fossa. Then
it goes along the nape and reaches the back of the ear. Passing the upper corner of the
ear and the cheek, it terminates at the infraorbital region.
c) The other branch enters the ear from behind. Passing the front of the ear
(Shangguan, GB 3), it meets the above branch on the cheek and terminates at lateral
canthus (Sizhukong, SJ 23).
3.11. The Gallbladder Meridian of Foot-Shaoyang (GB) (see fig. 15 and fig. 16)

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a) The meridian starts at the outer canthus (Tongziliao, GB l), ascends to the corner of
the forehead (2) and reaches the retro-auricular region. Then it runs along the neck in
front of the Sanjiao meridian. After arriving at the shoulder, it runs behind the Sanjiao
meridian and enters the supraclavicular fossa.
b) The auricle portion arises from the retro-auricular region, enters the ear, comes out
in front of the ear and arrives at the posterior side of the outer canthus.
c) The canthus branch starts at the outer canthus and runs downward to the area near
the point Daying (ST 5). After meeting the Hand-Shaoyang meridian, it goes upward
to the infraorbital region. Passing Jiache (ST 6) in its descending course, it reaches the
neck and meets the auricle branch in the supraclavicular fossa. Then it further
descends into the chest, crosses the diaphragm, and connects with the liver and
pertains to the gallbladder. Running through the hypochondriac region, it comes out
from both sides of the lower abdomen (Qichong, ST 30) and runs along the margin of
the pubic hair. Finally, it reaches Huantiao (GB 30).
d) The straight portion starts at the supraclavicular fossa, passes the axilla, the lateral
side of the chest and the hypochondriac region, and meets the canthus branch at
Huantiao (GB 30). Then it travels along the lateral side of the thigh and the knee,
passes the anterior side of the fibula and runs directly downward to the lower end of
the fibula and above the external malleolus. Finally, it goes along the anterior border
of the external malleolus and the dorsum of the foot and enters the lateral side of the
tip of the fourth toe.
e) The dorsal branch starts from between the first and second metatarsal bones, enters
the tip of the great toe, turns back and penetrates the nail, and terminates in the hairy
region proximal to the nail.
3.12.The Liver Meridian of Foot-Jueyin (LR) (see fig. 17 and fig. 18)

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a) The meridian starts at the hairy region posterior to the nail of the great toe (Dadun,
LR l), goes upward along the dorsum of foot and passes through the area 1 cun in
front of the medial malleolus. It ascends along the medial side of the leg and in front
of the Spleen Meridian of Foot-Taiyin. Then it emerges from behind the Foot-Taiyin
Meridian at the level 8 cun above the medial malleolus. Passing the medial side of the
knee and the thigh, it enters the pubes and curves around the external genitals before
arriving at the lower abdomen. Continuing to run along the stomach on both sides, it
pertains to the liver and connects with the gallbladder. Further on it passes through the
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diaphragm and spreads in the chest and hypochondriac region. Finally it ascends
along the posterior side of the throat, enters the nasopharynx, connects with the eye
system, emerges from forehead, and meets the Du Meridian at the vertex.
b) One branch arises from the eye system, descends to the cheek, and curves around
the lips.
c) Another branch arises from the liver, goes through the diaphragm, and enters the
lung.
Section 3 The eight extra meridians
The eight extra meridians are the Du (Governor Vessel Meridian), Ren (Conception
Vessel Meridian), Chong, Dai, Yangqiao, Yinqiao, Yangwei and Yinwei meridians.
They are different from the twelve regular meridians in that none of them pertains to
or connects with any specific Zang or Fu organ and they are not exterior-interior
related. The eight extra meridians are distributed in between the twelve regular
meridians in a complex pattern and their major functions are to strengthen the links
between the regular meridians and to regulate their Qi and blood circulation. For
example, the Dai Meridian "control all the meridians" and strengthens the
communication between the meridians at the waist. The Chong Meridian connects
with the three Yin and three Yang meridians, thus is termed as the "sea of all the
twelve regular meridians " or "the sea of bloos". The Du Meridian meets all the Yang
meridians, so is described as the "sea of all the Yang meridians", while the Ren
Meridian is the "sea of all the Yin meridians". The surplus Qi and blood of the twelve
regular meridians flow into the eight extra meridians and are stored there. When the
Qi and blood in the twelve regular meridians are insufficient, the Qi and blood stored
in the eight extra meridians flow out to supplement them. Furthermore, the eight extra
meridians are closely related to the liver, kidney, uterus, brain and marrow. They
influence one another physiologically and pathologically.
1. The Du Meridian (DU, or GV) (see fig. 19)

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The Du Meridian (Governor Vessel Meridian) originates in the perineum. It ascends

along the midline of the spine to Fengfu (DU 16), where it enters the skull and
connects with the brain. From the nape of the neck, it continues to go up along the
midline to the vertex, then down along the midline of the forehead to the tip of the
nose and the upper lip. It terminates in the labial frenulum at a point between the
upper lip and upper gums.
One branch comes out from the spine, enters the abdomen and terminates in the
kidney.
Another branch originates in the lower abdomen, goes straight upward to the
umbilicus and heart, from where it runs to the throat and the chin. Curving around the
lips, it travels upward to just below the eyes.
Physiological Functions: Because the Du Meridian communicates with and governs

all the Yang meridians and the Yangwei Meridians, it is called the "sea of Yang
meridians". Moreover, because it runs along the midline of the spine and enters the
brain and its branches connect with the kidney, it is closely related to the brain, spinal
cord and kidney.
2. The Ren Meridian (RN, or CV) (see fig. 20)

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The Ren meridian starts from inside the lower abdomen and emerges from the
perineum. It goes anteriorly to the pubic region and ascends along the interior of the
abdomen and chest to the throat. Ascending further, it curves around the lips, passes
through the cheek, and enters the infraorbital region.
Physiological Functions: The Ren Meridian is known as the "sea of Yin meridians,
because it connects with all the Yin meridians of the body. The word "ren" also has
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the meaning of "pregnancy" in Chinese. In women, this meridian is thought to

originate in the uterus where the fetus is nourished. Consequently, traditional Chinese
medicine states, "The Ren Meridian governs the development of the fetus."
3. The Chong Meridian
The Chong meridian starts within the lower abdomen and emerges at the perineum,
where its superficial portion communicates with the Kidney Meridian of
Foot-Shaoyin at Qichong (ST 30). Running along both sides of the abdomen, it goes
up to the throat, encircles the lips and ends in the infraorbital area.
One branch emerges at Qichong (ST 30), descends along the medial side of the thigh,
enters the popliteal fossa and continues to run along the medial border of the tibia to
terminate in the sole of the foot. Another one extends from behind the internal
malleolus, runs obliquely into the dorsum of the foot and ends in the big toe.
The third branch ascends along the spinal column and communicates with the Du
Meridian.
Physiological Functions: Running from foot to head, the Chong Meridian is to serve
as the hub for Qi and blood of the entire body. Since it controls Qi and blood
circulation of the twelve regular meridians, it is called the "sea of the twelve regular
meridians". It is also called "sea of blood" because it is closely related to
menstruation.
4. The Dai Meridian
The Dai meridian starts just below the rib cage and appears as a belt, it runs around
the waist.
Physiological Function: to control and regulate all the longitudinal-running meridians.
5. The Yinqiao Meridian and the Yangqiao Meridian
The Yinqiao Meridian and Yangqiao Meridian originate from below the malleoli, on
the left and right symmetrically.
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The Yinqiao Meridian starts from the posterior aspect of the navicular bone at
Zhaohai (KI 6). It ascends behind the medial malleolus, then travels straight up along
the posterior side of the medial aspect of the leg to the external genitals. Traveling
along the surface of the abdomen, it reaches up into the supraclavicular fossa, then
further ascends to a point adjacent to the Adam' s apple and in front of Renying (ST 9).
From there, it reaches the inner canthus and communicates with the Yangqiao
Meridian and the Hand and Foot Taiyang Meridians.
The Yangqino Meridian originates under the external malleolus at Shenmai (BL 62)
and travels upward along the back of the body. It runs up along the external malleolus
and the lateral side of the leg and passes through the waist to travel along the
postero-lateral side of the rib cage. Running up to the shoulder and supraclavicular
fossa, it travels to the side of the neck and the corner of the mouth. At the inner
canthus, it communicates with the Yinqiao Meridian and the Hand and Foot Taiyang
Meridians. From there going upward into the hairline, it runs to the back of the ear
where it meets the Gallbladder Meridian of Foot-Shaoyang.
Physiological Functions: Both the Yinqiao Meridian and Yangqiao Meridian nourish
the eyes and control their opening and closing, and govern the movement of the lower
limbs. The ancients believed they "control Yin and Yang on the left and right of the
body".
6. The Yinwei Meridian and the Yangwei Meridian
The Yinwei Meridian originates on the medial side of the leg where the three Yin
meridians meet. Then it ascends along the medial side of the leg to the abdomen
where it runs parallel to the Spleen Meridian of Foot-Taiyin. It continues to ascend to
the hypochondrium to join the Liver Meridian of Foot-Jueyin. Then it terminates in
the pharynx and communicates with the Ren Meridian.
The Yangwei Meridian originates in the external malleolus. Running parallel to the
Gallbladder Meridian of Foot-Shaoyang, it ascends along the posterolateral side of the
trunk and the back of the axillary fold to the shoulder. It passes the neck and the back

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of the ear and travels to the forehead and then returns to the nape where it terminates
by meeting the Du Meridian.
Physiological functions: The Yangwei meridian is connected with all the Yang
meridians and dominates the exterior of the body; the Yinwei meridian is connected
with all the Yin meridians and dominates the interior of the body. The two regulates
the flow of Qi in the Yin and Yang meridians and help maintain coordination and
equilibrium between the Yin and Yang.
Section 4 The functions of meridians and their Application
1. The functions of meridians
Even though the five Zang and six Fu organs, and all the tissues and orifices each
perform their own physiological activities, they need another structure to integrate
their functions to maintain the body as an organic whole. The integration is
accomplished mainly by the network of meridians, of which the four functions are
involved with the meridian Qi.
1.1. Linking the exterior with the interior and the upper with the lower, and
linking up with the Zang-Fu organs.
The twelve meridians and their branches form a communicating network between the
internal organs. It connects the upper with the lower as well as the interior with the
exterior parts of the body. The eight extra meridians link with the twelve regular
meridians, while the twelve tendon-muscle meridians and the twelve cutaneous
regions link with the muscular portions and superficial portions of the body
respectively. These linkages ultimately integrate the body into an organic whole.
a) Communication of the Zang-Fu organs with the tendons, muscles and skin
The twelve regular meridians connect with the Zang-Fu organs. Meridian Qi spreads
to the tendons, muscles and the cutaneous regions, linking the skin and muscles to the
internal organs.

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b) Communication of the Zang-Fu organs with the five sense organs and nine body
orifices
Meridians run through the eyes, ears, nostrils, mouth, tongue, genitals and anus, in
addition, they connect with the Zang-Fu organs. Thus, the five sense organs and nine
orifices are linked up with the internal organs via meridians. For instance, the Heart
Meridian of Hand-Shaoyin is connected with the small intestine, it links, moreover,
with the eye system, and one of its branches travels upward to the tongue. The Liver
Meridian of Foot- Jueyin is connected with the gallbladder and the eye system. The
Stomach Meridian of Foot-Yangming is connected with the spleen and it curves
around the lips. The Spleen Meridian of Foot-Taiyin links with the tongue and spreads
under it. The Kidney Meridian of Foot-Shaoyin and the Liver Meridian of
Foot-Jueyin both connect with the root of the tongue.
c) Communication among the Zang-Fu organs
Each of the twelve meridians links with a particular Zang or Fu organ, which
strengthens the relationship between the exteriorly-interiorly related Zang-Fu organs.
Some meridians communicate with several Zang-Fu organs, e.g., the stomach
meridian corresponds to the stomach and links with the spleen, and its branch runs to
the heart. The spleen meridian links the spleen with the stomach and connects with
heart. The gallbladder meridian links the gallbladder with the liver and its branch runs
to the heart. The kidney meridian links the kidney with urinary bladder, heart, lung
and liver. The small intestine meridian links the small intestine with the heart and
stomach.
d) Communication among the meridians
Communication among the twelve regular meridians follows a regular pattern. The
convergences of the twelve regular meridians and the eight extra meridians, and the
communication among the latter, ensure the linkage of all of them. For instance, the
three Yang meridians of the hand and those of the foot all meet at Dazhui (DU 14)
and the Yangqiao Meridian and Du Meridian meet at Fengfu (DU 16), and so the Du
Meridian is called the "sea of Yang meridians." Because the Ren Meridian is where

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the three Yin meridians of the foot meet the Yinwei Meridian and the Chong Meridian,
and the three Yin meridians of the foot link with the three Yin meridians of the hand,
the Ren Meridian is known as the "sea of Yin meridians". The Chong Meridian meets
the Ren Meridian in the chest. It also links with the Du Meridian in the back. The Du
and Ren meridians also connect with the twelve regular meridians. The Chong
Meridian runs to the nasopharynx, linking with the three Yin and Yang meridians and
collecting the Qi and blood of the twelve regular meridians. Thus, the Chong
Meridian is called the "sea of blood". The Du, Ren, and Chong meridians all originate
in the uterus or the pelvis.
1.2. Transporting Q and blood, and nourishing the Zang-Fu organs and tissues
Qi and blood are two materials that ensure the functional activities of the Zang-Fu
organs and tissues. The meridians and collaterals are passages in which Qi and blood
circulate through the whole body, nourishing the organs and tissues, and protecting
them against the attack by the pathogenic factors.
1.3. Transmitting needling response
The meridian-collateral system can transmit the needling response and other
sensations. The phenomenon of the arrival of Qi is a manifestation of this function.
1.4. Regulating functional balance
The meridians and collaterals transport Qi and blood and regulate the balance between
Yin and Yang of the body, thus, bringing the relative balance of life activities. When
one falls ill, a disharmony of Qi and blood will be present as well as an excess or a
deficiency of Yin and Yang. Acupuncture therapy, through the mode of "the removal
of the excess and the reinforcement of the deficiency", is applied to regulate the
functions of the meridians and restore the balance of Yin and Yang. It has been
verified that placing needles on acupoints of the meridians can regulate the relevant
Zang-Fu organs by suppressing the hyperactivity or exciting the hypoactivity.
2. Clinical significance of the theory of meridians

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2.1. Indicating pathological changes
In terms of pathology, the meridians and collaterals are the transmission routes of
exogenous pathogenic factors. For example, exogenous pathogenic factors are
transmitted from the interstitial space between the skin and flesh to the five Zang and
six Fu organs through the meridian system. Since it provides the functional link
between the organs, the meridian system also becomes the route for the transmission
of diseases among them. For instance, liver disorders may affect the stomach and lung,
for the liver meridian curves around the former and runs into the latter. The Kidney
Meridian of Foot-Shaoyin runs into the lung and connects with the heart, and so water
retention due to deficiency of kidney Qi may affect the heart and lung. Disorders of
two exteriorly-interiorly related meridians may often affect the exteriorly-interiorly
related Zang and Fu organs. For instance, the heart fire may be transmitted to the
small intestine; and the excessive heat with a resultant obstruction in the large
intestine may bring about the impeded Qi flow in the lung, leading to asthma
coughing or stuffiness in the chest.
2.2. Serving as a guidance to diagnosis and treatment
a) Guiding diagnosis
The meridians have regular routes and connect with given organs, thus, they can
reflect the disorders of those particular organs. From a clinical perspective, when the
loci of the abnormality are considered in the light of the running courses of the
meridians, the physician can often tell which meridian and which Zang-Fu has been
affected. For example, hypochondriac pain suggests the disorders of the liver or the
gallbladder. Pain in the supraclavicular fossa indicates the disorders of lung. As for
headaches, pain in the forehead implies a morbid state in the Yangming Meridians;
pain on both sides of the head indicates the pathological changes in the Shaoyang
Meridians; pain in the occipital part of the head or the nape signifies the abnormality
in the Taiyang Meridians, while pain in the vertex of the head refers to the
pathological changes in the Jueyin Meridians. Furthermore, in some pathological
conditions, tenderness, node or cord like reactions may be found in the superficial
portion of the body through which the meridians run, or in places where meridian Qi

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accumulates. Sometimes, morphological changes in the skin are helpful in diagnosis.

With a lung disease, for example, nodes may be found at Feishu (BL 13) and
tenderness may appear at Zhongfu (LU l). With appendicitis or appendiceal abscess,
tenderness will be found at Lanwei points (2 cun below Zusanli ST 36). Abnormal
changes could be found at Pishu (B 20) in patients with prolonged indigestion.
b) Guiding treatment
The meridian-collateral theory has been widely used to guide treatment of various
diseases, especially in acupuncture, massage and herbal medicine. For instance, the
selection of the acupoints for the acupuncture and massage treatment are determined
by the theory. If a meridian is affected, the practitioner may choose local or distant
points on the diseased meridian to administer acupuncture or massage. Before
selecting the points, however, it is first necessary to differentiate the syndromes so as
to decide which meridian is in trouble. Points are then selected according to the
meridian routes and the scope of their connections.
The transmitting function of the meridians also determines the efficacy of a particular
drug, that is, through the transmitting function of the meridians, the curative elements
of the drug can be sent to the site of the disease promptly and thus cure it. Based on
the long-term observation of the affinity of certain drugs for particular Zang or Fu
organs, ancient practitioners developed a theory of "home meridians for medicines",
meaning that certain drugs in certain quantities are beneficial to the meridians of
certain organs.
Furthermore, the more recent practices of acupuncture anesthesia and ear and electric
acupuncture are all developed under the guidance of the theory of meridians.
Successful results have frequently been obtained in all of these therapeutic methods.
Chapter 5. Etiology and Pathogenesis
Section 1. Etiology
Numerous factors can cause diseases, but in general the factors include the six
climatic factors, emotional frustrations, pestilence, improper diet, excessive physical
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exertion or lack of appropriate exercise, traumatic injuries, insect and animal bites and
parasitic infections, under certain circumstances, all these may cause disease.
It is believed in traditional Chinese medicine (TCM) that there is no disease without

cause. Every disease must be the result of some pathogenic factors. In the study of
etiology, it is considered in TCM that clinical manifestations are of basic importance,
though other possible factors are also taken into account. By analyzing symptoms and
other indications, TCM is able to identify the causative factors of disease and to
administer the medications accordingly. This is known as "seeking the causative
factors through the differentiation of symptoms and signs." In order to provide a
better guide for diagnosis and treatment, traditional Chinese medicine studies not only
the nature of causative factors and their special characteristics, but also their clinical
manifestations.
1. The six exogenous factors
Wind, cold, summer heat, damp, dryness and fire (mild heat and heat) are the six
climatic changes found in nature. Under normal circumstances they do not produce
pathological changes in the body and are thus known as the six types of Qi" in the
natural environment. These six types of Qi will only cause diseases if either the
climatic changes are extreme or sudden, or the body's resistance is impaired. When
being involved in the process of inducing diseases, these six types of Qi are known as
"the six exogenous pathogenic factors."
All the six pathogenic factors, when affecting the body, invade from the exterior via
the skin, mouth or nose. For this reason, the pathological reactions they induce are
known as "the exogenous disease."
Diseases due to the six exogenous pathogenic factors are closely related to the
seasonal changes in the weather and to the living environment. For example, heat
syndromes mostly occur in summer, cold syndromes in winter, and damp syndromes
are usually caused by prolonged exposure to damp. Another term for these syndromes
is "seasonal diseases."

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Each of the six exogenous pathogenic factors may affect the body singly or in
combination. Examples are common cold due to pathogenic wind, cold and damp, etc.
In the process of causing disease, the six exogenous factors may influence each other,
and may also, under certain conditions, transform into each other. For example,
pathogenic cold may be transformed into heat in the interior of the body, and
prolonged summer heat may result in the dryness by consuming the Yin fluid in the
body, etc. The properties of the six exogenous factors and their specific pathological
influences on the body are described in the following.
1.1. Wind
Wind is the predominant Qi of the spring, although pathogenic wind and the diseases
it causes are not confined only in the spring. They can occur in any season. TCM
holds that wind is the most important pathogenic factor for exogenous diseases.
Wind has the following pathogenic influences on the body.
First, wind is a Yang pathogen and is characterized by "upward and outward

dispersion." Thus, it attacks the Yang parts of the body easily, i.e. the body surface
and the upper body; this leads to the loosening of the pores and the looseness of the
body surface and the symptoms such as headache, sweating or aversion to wind, etc.
usually appear.
Pathogenic wind, moreover, occurs in gusts and is characterized by rapid changes.

Thus, a second characteristic of diseases caused by pathogenic wind is that they begin
abruptly and symptoms spread to different parts of the body.
In sum, pathogenic wind is the leading causative factor of many diseases. Of the six
excesses, wind is the primary exogenous pathogenic factor since cold, damp, dryness
and heat may all depend on wind when attacking the body. Such cases give rise to
exogenous wind-cold, wind-heat and wind-damp.
1.2. Cold

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Cold is the predominant Qi in winter. In winter, being thinly clothed, or being

exposed to the cold after sweating, caught in the rain, and wading in water, may all
predisposes an individual to an attack of pathogenic cold.
Diseases caused by pathogenic cold can be divided into two types: an attack by cold
on the body surface and an interior attack. The former is due to a decrease in the
body's defensive Yang which reduces Yang dispersion on the body surface; the latter
is due to a sudden injury of the Zang-Fu organs' Yang Qi.
Cold has three specific properties and related pathological influences.
First of all, cold is a Yin pathogenic factor which impairs the body's Yang Qi. Since
"the predominance of Yin leads to cold," cold is an indication of the excess of Yin.
Because "Yin in excess makes Yang suffer," pathogenic cold, as manifested in cold
syndromes, tends to impair Yang Qi, resulting in the weakened power of the body's
for warming itself and in the lowering of the life activities. When the surface of the
body is attacked by pathogenic cold, the aversion to cold may occur. If pathogenic
cold directly attacks the spleen and stomach, pain and coldness in the stomach and
abdomen, and vomiting and diarrhea may occur. If it directly attacks the kidney, the
manifestations as aversion to cold, cold limbs, diarrhea containing undigested food,
profuse urination, lassitude, and a thready and weak pulse may all occur.
A second characteristic of cold is that it causes obstruction and pain. Freely moving
Qi, blood and body fluids depend on the warming and dynamic functions of the
body's Yang Qi. Once pathogenic cold gains access to the body, Yin will be
predominant and Yang impaired. Because of the impeded flow of Qi and blood in the
meridians, pain occurs. Thus, in cases in which pathogenic cold is the chief offender,
pain is often seen. Cold also causes the spasmodic contraction of the tendons,
meridians, and interstitial space.
If the pathogenic cold attacks the body surface, the pores become obstructed as does
the interstitial space, and the defensive Yang fails to disperse with the result of the
symptoms such as aversion to cold, fever and absence of sweat. If the pathogenic cold
attacks the blood vessels, the vessel contraction and the retarded flow of Qi and blood

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to the joints will occur, leading to cold, numbness and restricted movement of the
limbs.
1.3. Summer-heat
Summer-heat is the predominant Qi of summer. Diseases caused by summer-heat are

only seen in this season, particularly in the interval between the summer solstice and
the beginning of autumn.
Summer-heat is an exogenous pathogenic factor and there is no endogenous

summer-heat at all by the pathogenic process.
Summer-heat has three major properties and pathological influences.
First of all, summer-heat is a Yang pathogenic factor, transformed from fire and heat,
both of which correspond to Yang. When a person is attacked by summer-heat, an
excess of Yang occurs, leading to high fever, fidgeting, flushed face and a surging
(Hong) pulse.
Secondly, summer-heat is characterized by its dissipating action, which leads to the

consumption of Qi and body fluids. Summer-heat usually attacks the Qi system
immediately, causing the opening up of the body's interstitial space and profuse
perspiration. Massive sweating consumes body fluids, resulting in thirst and scanty
dark urine. A severe attack of summer-heat may disturb the mind, resulting in
fidgeting and restlessness. Sometimes shortness of breath, lassitude, or sudden loss of
consciousness may occur; all are due to the loss of Qi following the exhaustion of
body fluids.
Finally, summer-heat is often characterized by the accompanying of damp. Because

summer is rainy and hot, evaporating rainwater increases the humidity in the air.
Thus, summer-heat often combines with pathogenic damp to cause diseases.
Symptoms present are fever, fidgeting, thirst, a weakness in the limbs, stuffiness in
the chest, nausea, loose stools or sluggishness, etc.

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1.4. Damp
Damp is the predominant aspect of the climate at the end of summer. In China it is a
hot and rainy season, the year's most humid. Diseases caused by dampness might be
related to the wet weather, exposure to water or rain, or living in the damp
environment. Pathogenic damp can originate in the body's interior as well. In such a
case, the dysfunction of spleen in transportation and transformation leads to the
retention of water. This is known as internal or endogenous damp.
The pathogenic damp has four major properties and specific pathological influences.
First, the damp is a Yin pathogenic factor and is therefore apt to disturb the normal
flow of Qi, leading to a stuffy chest, scanty urine and difficulty in bowel movement.
Moreover, as excessive Yin impedes Yang, an attack of the body by damp tends to
impair Yang Qi. Since the spleen is the main organ responsible for the transportation
and transformation of water and responds favorably to dryness and unfavorably to the
damp, pathogenic damp is liable to impair the spleen Yang, resulting in the water
retention with the symptoms of diarrhea, scanty urine, edema, ascites, etc.
The second aspect of the damp is that it is weighty and turbid in nature. Pathogenic
damp in the body produces the feeling of sluggishness. The head often feels as though
it is tightly wrapped and the body and limbs feel heavy as if they are carrying a load.
If the meridians and joints retain the damp, the dispersion of Yang Qi is hindered and
the symptoms of soreness, pain and heavy sensations in the joints will occur. This is
known as "Bi-syndrome (e.g. rheumatism) due to the damp.'' Pathogenic damp also
tends to produce turbid excretions from the body: stickiness in the eyes, sticky stools,
turbid urine, massive foul-smelling vaginal discharge, or oozing eczema, etc.
Thirdly the damp is also characterized by the property of viscosity and stagnation.
Patients affected by pathogenic damp have a viscous stool that is difficult to excrete,
as well as other difficulties in excreting. Diseases due to pathogenic damp, such as
rheumatism, eczema or "damp fever", tend to be prolonged and intractable.
The last characteristic of the damp is that it tends to go downward and to impair the
Yin parts of the body. So, pathogenic damp more often attacks the lower parts of the
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body and can cause edemas in the lower limbs. Pathogenic damp also results in turbid
urine, morbid leukorrhea, diarrhea, and dysentery.
1.5. Dryness
Dryness is characteristic of autumn in North China. During this season, the

temperature and humidity gradually decrease. Lack of moisture causes many things in
nature to dry out. Pathogenic dryness usually attacks the lung via the mouth and nose.
Pathogenic dryness is divided into two types warm-dryness and cool-dryness.
Diseases caused by the former often occur in early autumn, when lingering
pathogenic heat and dryness simultaneously attack the body. In late autumn, cold
becomes predominant. At that moment, aided by the cold, pathogenic dryness attacks
the body, diseases resulted from pathogenic cool-dryness may occur.
Dryness has two major properties and specific pathological influences.
First, dryness depletes body fluids. Exhausting the body fluids, it causes such
symptoms as dryness in the mouth and throat, thirst, dry and cracked skin, lusterless
hair, scanty urine and constipation.
Secondly, pathogenic dryness often impairs the functions of lung, the "delicate organ"
which favors moisture over dryness, Though the lung does not tolerate the pathogenic
dampness, it reacts more adversely to the pathogenic dryness. Excessive damp gives
rise to phlegm and water retention, while excessive dryness consumes body fluids.
The lung dominates respiration, skin and hair, and opens to the nose. Consequently,
pathogenic dryness usually attacks the body through the mouth and nose, impairing
the fluids in the lung. When the dispersing and the descending functions of lung are
disturbed, the manifestations of dry cough with little sputum or expectoration of
blood-tinged sputum, shortness of breath, and chest pain may occur.
1.6. Fire (heat)
Fire and heat are caused by excessive Yang; yet fire, heat, and mild heat vary in
degree. Of the three, first is the most severe. Heat is an exogenous pathogenic factor
that can be classified into various types, such as wind-heat and damp-heat, whereas
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fire is a pathogenic factor internally produced. The symptoms seen in such a case are
a flaming-up of heat fire, hyperactivity of liver fire, and excessive stomach fire.
Fire has four major properties and specific pathological influences.
First of all, fire is a Yang pathogenic factor. Its central characteristic is its capability
of "flaring up". Consequently, diseases due to pathogenic fire tend to display
symptoms such as high fever, aversion to heat, fidgeting, thirst, perspiration, and a
surging and rapid pulse.
Secondly, pathogenic fire often consumes the body fluids and Qi. Pathogenic fire
tends to consume body fluids and vital essence, leading to the insufficiency of the
former. Apart from a high fever, thirst, a dryness sensation in the mouth and throat,
concentrated urine and constipation may occur.
Thirdly, pathogenic fire can stir up the wind and cause the disturbance of blood.
Excessive fire affects the liver Yin and deprives the tendons of nourishment. The
symptoms are high fever, coma and delirium, convulsions, upward staring of the eyes,
neck rigidity and opisthotonos.
Accelerated blood circulation is also a characteristic of the diseases due to pathogenic

fire.
Finally, pathogenic fire predisposes the individuals to carbuncles, furuncles, boils and
ulcers when it attacks the blood. In addition, ulcers and painful local red swellings are
also clinically diagnosed as Yang and fire syndromes.
2. Internal injury by emotional factors
The seven emotional factors recognized in Chinese medicine are excessive joy, anger,
melancholy, anxiety, grief, fear, and fright.
Under ordinary conditions, emotions are normal reactions to external stimuli and do
not cause diseases. However, if emotional frustration is extremely abrupt, intense or
persistent, and so exceeds the normal individual endurance, it may then produce
functional disorders of the Zang-Fu organs by upsetting the harmonious balance of the
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Qi and blood. Such emotions then become the pathogenic factors, bringing on
diseases and organic lesions. In terms of the pathogenesis, the emotional factors differ
from the six exogenous factors which attack the body via the mouth, nose or pores,
instead, the emotional factors results from the interior of the body and directly affect
the related internal organs.
From the perspective of physiology, emotional activities are closely related to the
manner in which the internal organs, Qi and blood function. The activities of the
internal organs depend on the warming and dynamic functions of Qi and on
nourishment provided by the blood. The essential Qi of the five Zang organs
constitutes the material basis of emotions. At the same time, emotional upsets have a
definite influence on the activities of the Zang-Fu organs. For example, good working
circumstances make a person cheerful and the harmony of Qi and blood results and
consequently, one will not fall ill. On the other hand, unfavorable working
atmosphere may cause mental frustration, leading to diseases.
From a pathological perspective, extreme emotional frustrations certainly affect the

internal organs, disturb their functions, and lead to diseases.
2.1. Anger causes an adverse flow of liver Qi, which brings blood upward. In such
cases, dyspnea, flushed face, red eyes, hematemesis or fainting may occur, or, in the
most severe cases, fainting.
2.2. Excessive joy causes the scattering of heart Qi. In normal cases, joy produces
harmony of Qi and blood and relaxation, excessive joy, however, adversely affects the
heart, causing its Qi to scatter. As a result, distraction may occur, or other mental
disorders in more severe cases.
2.3. Grief can lead to the melancholy which causes Qi to stagnate. The result is the
hypo-function of lung, as manifested by low spirits, difficult breathing and lassitude.
2.4. Fear harms the kidney, causing the normal upward flow of kidney Qi to reverse
its direction and to flow downward. The resulting symptoms include incontinence in
urination and bowel movement, soreness in the lumbar region, feebleness of the lower
limbs and nocturnal emission.
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2.5. Fright causes a general dysfunction of Qi. Then, heart Qi is said to "wander about,
adhering to nothing." Clinical manifestations include a tendency to be easily
frightened, panic and mental restlessness.
2.6. Anxiety causes spleen Qi to stagnate, resulting in its failure to transport nutrients
and water throughout the body. Prolonged anxiety which causes stagnation of the
spleen Qi leads to the reduced production of Qi and blood and then the deficiency of
the heart blood, as manifested by palpitation, amnesia, insomnia and dream-disturbed
sleep. Weakened spleen function, furthermore, can affect the stomach, as manifested
by poor appetite, abdominal distension, diarrhea and loose stools.
Again, what needs to be pointed out is that the human body is an organic whole, and
the heart is the "monarch organ among all the internal organs". The heart plays the
"king's role among the five Zang and six Fu organs", and because it is the " residence
of the spirit", abnormal changes of emotions affect the heart first, then the other
organs.
Clinical practice has evinced that the emotional abnormalities can give rise to the
functional disorders of the Zang-Fu organs when extremely abrupt or intense. Both
emotional factors and the individual's constitutional predisposition will determine
which particular organ will be harmed, as well as what pathological changes will
occur.
Therefore, the abnormality of the emotional activities can cause disturbances in the Qi
and blood of the Zang-Fu organs, which will, in turn, mirror the same emotional
disturbances.
The emotional abnormalities i.e. frustrations not only cause diseases, but also cause
the existing chronic diseases to be aggravated, and the intense emotional excitation
may also aggravate the patient's condition. With an outburst of anger, the blood
pressure of the hypertensive patients may shoot up, causing dizziness, sudden coma,
hemiplegia or the deviation of mouth and eyes. Also, patients with heart diseases
often have heart attacks due to the emotional upsets.

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Although abnormal emotions may harm all the five Zang organs, they mostly affect
the heart, liver and spleen.
Because the heart controls the mind, its malfunction may cause palpitation, insomnia,
dream-disturbed sleep, mental restlessness, involuntary laughing and weeping, mania,
hysteria, etc.
Liver trouble often leads to the disorders of depression, irascibility, hypochondriac

pain, sighing, the feeling hysteric globus in the throat, irregular menstruation, and the
distending pain of the breast the or lumps in the breast, the occurrence of these
manifestations is because that the liver fails in the function of maintaining the free
flow of Qi.
The spleen controls the transportation and transformation of nutrients. So, the
dysfunction of spleen gives rise to the symptoms of poor appetite, distending pain in
the stomach, and diarrhea.
Emotional activities may both disturb the functions of a single organ, or of several
organs simultaneously. Overthinking, for instance, could harm both the heart and
spleen and leads to the consumption of the heart blood and the impeded transportation
and transformation of food and drink. When anger harms the liver, the spleen is often
involved as well, resulting in the disharmony of both.
3. Irregular diet
Food was literally called " water and grain" by the ancient Chinese. They are the
source of the nutritive substances from which Qi and blood are derived, and are
indispensable for the maintenance of life processes. Irregular food intake is an
important pathogenic factor.
It should be eaten in proper amounts at regular intervals and both insufficient intake
and over-satiety of food can cause diseases.
Inadequate food intake leads to the malnutrition. An inadequate supply of materials

appropriate for the production of Qi and blood results in the weakened functioning of

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the Zang-Fu organs and reduced body resistance. This leaves the body susceptible to
the invasion by the exogenous pathogenic factors. Over-satiety taxes the stomach and
spleen beyond their digestive ability.
Digestive failure brings about distension and causes gastric and abdominal pain
intolerable with pressure, loss of appetite, belching, acid regurgitation and
foul-smelling stools. Over-satiety often occurs in infants because they tend to have
irregular feedings and their digestive function is weaker than that of adults.
Accumulated undigested food can transform into heat, while the damage due to the
cold food favors the accumulation of damp to produce phlegm.
Infantile malnutrition may also be caused by prolonged indigestion and is manifested

by heat in palms and soles, distention in the stomach and abdomen, lusterless
complexion and emaciation.
Too much fatty and sweet food can generate internal heat and result in carbuncles and,
in severe cases, in other pustular sores.
Spoiled or contaminated food can also cause gastrointestinal illness and intestinal
parasitic diseases. The former includes vomiting, diarrhea or dysentery; while the
latter include ascariasis, ancylostomiasis, enterobiasis and cestodiasis, all can cause
abdominal pain, a craving for unnatural substances other than food, emaciation, and
itching of the anus.
If roundworms enter the biliary tract, paroxysmal colic pain, clammy limbs or even
vomiting of roundworms can occur. Ingestion of spoiled or poisonous food gives rise
to the colic abdominal pain, vomiting, diarrhea etc. In severe cases, loss of
consciousness or death may occur.
A variety of food should be taken to ensure that the body receives all vital nutrients.
Personal preference often causes limited variety of diets which results in the
malnutrition or an imbalance of Yin and Yang in the body, both of which eventually
lead to diseases such as rickets, night blindness, etc. Excessive consumption of raw or

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cold food could cause the harm to the stomach and spleen. The endogenous
cold-dampness may lead to the abdominal pain and loose stools.
Pungent or spicy food taken in excess, or alcohol, may produce endogenous phlegm
and result in stagnation of Qi and blood. Symptoms associated with this condition are
bleeding hemorrhoids, ulcers, and carbuncles.
4. Excessive physical exertion and beck of physical work and exercise
Normal physical exertion and exercise are helpful to the spleen and stomach Qi,
promote the flow or Qi and blood and build up the physique. Appropriate rest can
ease the fatigue and restore the physical and mental energy. Excessive physical or
mental exertion or over-indulgence in sexual activity, as well as equally, a lack of
physical work and exercise, may cause diseases
Excessive physical exertion would consume Qi and blood and causes general debility,
emaciation, spontaneous sweating, etc.
Excessive mental strain impairs the heart and spleen, resulting in the consumption of
heart blood and spleen Qi, and may cause palpitations, poor memory, insomnia,
dream-disturbed sleep, poor appetite, abdominal distension and loose stools.
Excessive sexual activity undermines the essence and Qi of kidney. The result is
general debility, with aching and weakness in the lumbar region and knees, dizziness,
tinnitus, lassitude, hypo-sexuality, nocturnal emissions, premature ejaculation and
impotence.
Inadequate physical work and exercise may result in the impeded flow of spleen and
stomach Qi, and the reducing production of Qi and blood. The manifestations are loss
of appetite, lassitude, and feebleness in the limbs, listlessness, phlegm and damp
retention, obesity, as well as shortness of breath, spontaneous sweating and other
secondary illnesses.
5. Phlegm and fluid retention, and blood stagnation

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Phlegm, retained fluids, and stagnant blood are all pathological results of the
dysfunction of the Zang-Fu organs. Since they can further affect the Zang-Fu organs
and other tissues, either directly or indirectly, and can cause numerous diseases, they
are also regarded as the pathogenic factors.
5.1. Phlegm-fluid retention
Phlegm and retained fluids are pathological products of impaired local or general
water metabolism. The concept of phlegm and the retention of phlegm fluid in TCM
embrace a wide range of manifestations from the sputum produced in the respiratory
tract to other kinds as well. Phlegm and retained fluids are either substantial or
non-substantial.
Substantial phlegm and retained fluids are visible. The first refers to the condensed
morbid fluids and the second denotes the thin morbid fluids. Non-substantial phlegm
and retained fluids refer to the pathological manifestations such as dizziness, nausea,
vomiting, shortness of breath, palpitations or mania and semi-consciousness, all of
which are linked to invisible phlegm or fluid discharged from the body. Nonetheless,
these conditions respond well when being treated as substantial phlegm and retained
fluids.
Phlegm and retained fluids are caused by the influence of the six exogenous
pathogenic factors, irregular diet or abnormal emotional activities, all impair the
functions of lung, spleen, kidney for the water metabolism, and the Qi of triple
energizer.
The lung dominates the dispersion and descent of Qi and the distribution of body
fluids. The water retention resulting from a failure of these functions produces phlegm
and other retained fluids.
The spleen controls the transportation and transformation of water, the failure of
which causes an accumulation of water which then becomes the phlegm and other
retained fluids.

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The kidney is responsible for the evaporation of water. When kidney Yang is
insufficient, water cannot be transformed into Qi. It accumulates and, again, becomes
the phlegm and other retained fluids.
etained fluids and phlegm may also appear when Sanjiao (the triple energizer)
passages are blocked, then the normal transportation, distribution, and excretion of
body fluids are interfered with. Since that triple energizer houses all the Zang-Fu
organs, failure of the Qi activity of Sanjiao may result in the formation of the
pathogenic phlegm and the retained fluids and make them accumulate in the Zang-Fu
organs and, more superficially, in the tendons, bones, skin and muscles, causing
various pathological changes.
As syndromes caused by the phlegm-fluid retention has proved, it is believed in TCM

that "numerous diseases are caused by phlegm and retained fluids". Yet, phlegm and
retained fluids located in different place give rise to different clinical manifestation.
There are, in fact, several different phlegm syndromes.
Phlegm that blocks the lung results in coughing, asthmatic breathing and
expectoration of sputum.
When the phlegm mists the heart such manifestations are caused as suffocating
feeling in the chest and palpitations. If the heart meridian is obstructed by phlegm,
dementia and loss of consciousness may occur. If the heart is disturbed by phlegm-fire,
mania may occur.
Phlegm stagnating in the stomach causes the symptoms of nausea, vomiting and
fullness in the stomach. An accumulation of phlegm in the meridians, tendons and
bones may cause scrofula, subcutaneous nodules, and numbness of the limbs,
hemiplegia, or fistulous infection of the tissues.
When the phlegm attacks the head, there appears the dizziness.
The mixture of phlegm and Qi in the throat may produce the foreign-body sensation
therein.

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Retention of fluids also has different syndromes. Morbid fluid in the intestine
produces a gurgling sound. In the costal region, it produces a full sensation in the
chest and pain on coughing. If it accumulates in the diaphragm, it causes stuffiness in
the chest, coughing, dyspnea, difficulty in lying supine and puffiness. Morbid fluid in
the tissues and skin causes edema, absence of sweat and heavy feeling in the body.
Proper diagnosis of all the syndromes is often closely related to the accurate analysis
of the appearance of the tongue coating (slippery and smooth or not) and the pulse
(smooth or not), as well as the more characteristic symptoms.
5.2 Blood stagnation
Another pathological product of the dysfunction of the Zang-Fu organs is blood

stagnation. By blood stagnation, it is meant that local blood stasis is in the meridians,
Zang-Fu organs or other tissues, as well as the accumulation of extravasated blood
somewhere.
Blood stagnation is a pathological product that appears in the course of certain

diseases, yet, it becomes, in turn, the pathogenic factor of other diseases.
Blood stagnation is caused by the impaired blood circulation that results from
deficiency or stagnation of Qi as well as from cold or heat in the blood. Deficient and
stagnant Qi fails to propel blood circulation, because Qi is the commander of blood.
When pathogenic cold invades the blood system, the blood vessels will contract and
blood circulation is impeded. When heat enters the blood system and brings about a
mixture of blood and heat, blood circulation is also obstructed. Internal hemorrhage
resulting from pathogenic heat or traumatic injury may also cause blood stagnation.
The clinical manifestations of blood stagnation depend on the site and the cause of the
disease.
Stagnation of blood in the heart would cause palpitation, a suffocating sensation in the
chest, cardiac pain and the purplish-colored lips and nails. Blood stagnation in the
lung produces pain in the chest and expectoration of blood.

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Stagnation in the stomach and intestines causes hematemesis and constipation.
In the liver, the stagnation give rises to the pain and clots in the hypochondriac region.
When the heart is affected by the stagnant blood, there may appear the mania.
In the uterus, blood stagnation results in pain in the lower abdomen and menstrual
disorders, such as dysmenorrhea, amenorrhea, irregular menstruation, dysfunctional
uterine bleeding, and the dark purplish menstrual flow even with clots.
Blood stagnation in the limbs may cause gangrene of finger or toe, such as
thromboangitis.
Stagnant blood on the body surface may cause a local purplish or bluish skin color
(such as purpura) along with swelling and pain.
Blood stagnation not only weakens the nourishing function of blood, but also affects
the local or general blood circulation, resulting in pain, hemorrhage or obstructed
vessels.
Moreover, if it occurs in the internal organs, lumps or clots may become present.
Diseases due to stagnant blood, nonetheless, share certain common characteristics: a
localized stabbing pain which is aggravated by pressure and gets worse at night, local
purplish clots if the stagnation is caused by the external trauma, and a fixed tangible
clot if caused by the internal disorders, and dark purple hemorrhaging accompanied
with clots.
These symptoms may be associated with others, such as dark complexion, scaly and
dry skin, bluish and purplish lips and nails, purplish tongue, petechia, ecchymosis,
and varicose veins under the tongue, as well as thready and hesitant, deep and
string-taut, or intermittent pulses.
6. Traumatic injuries
Traumatic injuries include gunshot wounds, cuts, injures from falls, contusions,
strains, burns, frostbite, insect and animal bites.

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Gunshot wounds, knife-cuts, injuries from falls and sudden sprains due to carrying
heavy loads may cause skin and muscle wounds, bleeding, pain, swelling and bruises,
injuries to the tendons and bones, fractures or joint dislocation.
The severe cases may produce the internal injury or massive bleeding, resulting in the
loss of consciousness, convulsions, and prostration syndrome due to collapse of Yang.
Burns include the injuries caused by touching extremely hot objects, boiling water,
hot oil or the scorching flame. In mild case, a localized redness, swelling, pain, a
sensation of heat, burnt skin, and blisters might appear. The severe cases result in the
injuries of the muscles, tendons and bones, no feeling of pain, with large-sized
leather-like, deep yellow or carbonized surface of wound, accompanied by sharp pain,
exuding of body fluids, restlessness, fever, thirst with desire for drink, and scanty
urine may occur. In the most severe case, death may be caused.
Frostbite is frequently found in cold areas. The lower the temperature and the longer
the exposure, the more severe will be the case. General frostbite are manifested with
chills, reduction of body temperature, pallor, bluish and purplish lips and nails,
numbness, lassitude, lethargy, shortness of breath, and a slow and thready pulse; and
the lack of first aid may result in death.
Local frostbite is usually seen on the hands, feet, ears, tip of the nose or cheeks. In the
beginning, the blood vessels of the affected parts constrict, so the blood circulation is
impeded and symptoms such as pale skin and sensations of cold and numbness occur
because of the lack of heat and nourishment.
Gradually, an itching pain, a sensation of heat, and blisters of various sizes may
appear, the ulceration of which leads to the infection.
Insect and animal bites include bites by reptiles (poisonous snakes), wild beasts, rabid
dogs, scorpions and bees. In mild cases, a localized injury, swelling, pain and
bleeding may occur, while the severe cases may cause injury to the internal organs,
massive bleeding and death.

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Bites by poisonous snake produce generalized poisoning, and the lack of first aid may
cause death. Bites by rabid dogs usually lead to the localized pain and hemorrhage.
Nevertheless, after the healing of the wound and an incubation period, if a
prophylactic vaccine was not given on time, symptoms such as restlessness, lockjaw,
convulsions, hydrophobia and an abhorrence of wind may occur
Section 2. Pathogenesis
The onset of disease can be generalized as being due to the disharmony of Yin and
Yang and the conflict between the pathogenic Qi and the anti-pathogenic Qi.
Anti-pathogenic Qi, known as "Zheng Qi", refers to the functional activities of the
human body as well as to its ability to resist the diseases. Pathogenic Qi, known as
"Xie Qi", refers to all the various causative factors of diseases.
When diseases occur, there must be present both a relative insufficiency of the
anti-pathogenic Qi and the excessiveness of the pathogenic Qi. Whilst both together
constitute the two major factors underlying the occurrence of disease, however, the
anti-pathogenic Qi is primary, being the internal factor that allows the invasion of the
external factor i.e. the pathogenic Qi.
In TCM, practitioners pay attention to both internal and external conditions, in

particular, the former has played a major role in traditional Chinese medicine in
understanding the nature of diseases and guiding the clinical practice.
Although diseases may be very complicated and varied, they can be generalized and
understood in terms of pathogenic processes in the following three ways: the
disharmony of Yin and Yang, the conflict between the anti-pathogenic Qi and the
pathogenic Qi, and the abnormal descending and ascending of Qi. These three aspects
are closely interconnected in the course of developing the diseases.
1. Disharmony of Yin and Yang
Disharmony of Yin and Yang refers to the pathogenic changes involving either excess
or deficiency of Yin or Yang, occurring when the body is invaded by the pathogenic

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Qi. Diseases will not occur unless the body is invaded by pathogenic factors which
cause derangement of Yin and Yang in the interior.
Yin-Yang disharmony, i.e. excess or deficiency of either Yin or Yang, is mainly

manifested in the form of the syndromes of cold and heat and excess and deficiency.
In general, heat syndromes of the excess type will occur in cases of the excess of
Yang; cold syndromes of the excess type will occur in case of the predominance of
Yin; cold syndromes of the deficiency type will occur in cases of the insufficiency of
Yang, and heat syndromes of the deficiency type in cases of the deficiency of Yin. In
addition, in the course of the progression of diseases, cold syndromes may manifest
some symptoms of false heat, in which the excess of Yin walls off Yang, and heat
syndromes some symptoms of false cold in which excess of Yang walls off Yin.
All the contradictions and changes occurring in the disease process can be generalized
in terms of Yin and Yang. Thus all the Zang-Fu organs and meridians are classified in
terms of Yin and Yang; and Qi and blood, nutrient Qi and defensive Qi, exterior and
interior, ascending and descending of Qi reflect the contradictions of Yin and Yang.
Functional disturbance, derangement between Qi and blood and between nutrient and
defensive Qi all belong to the disharmony of Yin and Yang, which underlies the
whole process of disease and is the decisive factor in the occurrence and development
of diseases.
2. Conflict between anti-pathogenic Qi and pathogenic Qi
The conflict between the anti-pathogenic Qi and the pathogenic Qi refers to the
struggle between the resistance powers of the body and any of the pathogenic factors.
This struggle has significance not only in relation with the onset of disease, but also
with its progression and transformations. To some extent this struggle can be
described as the main focus for the onset, progression and transformation of diseases.
Invasion of pathogenic Qi destroys the Yin-Yang harmony of the body and causes
functional disturbance of the Zang-Fu organs and meridians, derangement of Qi and
blood and abnormal ascending and descending of Qi, leading to various pathogenic
changes. These are mainly manifested as the excess or deficiency syndromes.
Syndromes of the excess type are likely to occur if there is both the excessiveness of

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the pathogenic Qi and the vigorousness of the anti-pathogenic Qi. Excess here mainly
refers to the excessiveness of the pathogenic Qi, i.e. the pathogenic reaction
dominated by the excess of pathogenic Qi. It is commonly seen in the early and
middle stages of diseases due to invasion by the exogenous pathogenic factors, and
diseases caused by retention of phlegm fluid, stagnant blood and water dampness as
well as retention of food. Deficiency mainly refers to the insufficiency of the
anti-pathogenic Qi which is the pathological reaction dominated by the decline of the
anti-pathogenic Qi. It is commonly seen in disease resulting from prolonged weakness
of body constitution, hypo-function of the Zang-Fu organs, and deficiency of Qi,
blood and body fluid due to lingering diseases.
3. Abnormal Descending and Ascending Qi
Ascending, descending, outward and inward movements are the basic forms of the
transmission of Qi in its flow through the body. Abnormal ascending and descending
refers to the pathogenic states of the Zang-Fu organs, meridians, Yin and Yang, Qi
and blood in which they fail to maintain their normal state of governing ascent and
descent of Qi.
The functional activities of the Zang-Fu organs and meridians, and the relationships
between the Zang-Fu organs, meridians, Qi, blood, Yin and Yang are maintained by
the ascending, descending, outward and inward movement of the flow of Qi.
Examples of this are the descending and dispersing function of lung Qi; the function
of spleen of sending up the refined essence of food and drink to the lung; the function
of stomach in sending down the partially digested food; the harmony between the
heart and kidney (between the fire, the heart, and the water, the kidney). Abnormal
ascending or descending of Qi may affect the five Zang and six Fu organs, the interior
and the exterior of the body, the four limbs and the nine opening orifices, leading to a
variety of pathological changes. The common symptoms include cough, asthmatic
breathing, and suffocating sensation in the chest, belching and nausea, loose stools
and diarrhea, insomnia and palpitations, and syncope.

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Other examples are inability of the kidney to receive Qi, upward floating of Yang,
failure of clear Yang to ascend, and sinking of the Qi of the middle energizer.
All of these can be generalized as the pathological changes caused by the abnormal
ascending and descending of Qi.
Whilst all the Zang-Fu organs are involved in the ascending and descending of Qi, the
spleen and stomach Qi plays an especially important role. This is because spleen and
stomach provide the material basis for the acquired constitution.
The spleen and stomach lie in middle Jiao which connects with the other Zang-Fu
organs in the upper and lower Jiao (energizers), and forms the pivot of the mechanism
for the ascending and descending of Qi. The physiological functions of the human
body can be maintained only when both the ascending function of spleen Qi and the
descending function of stomach Qi are normal. Harmonious functioning of the spleen
and stomach is therefore essential to the ascending, descending, outward and inward
movements of Qi of the whole body. Neither aspect exists in isolation, however, the
ascending of spleen Qi and descending of stomach Qi must cooperate with the
ascending and descending movement of the Qi of the other Zang-Fu organs. If the
ascending and descending functions of spleen and stomach fail, the pure Yang will
not be disseminated, the acquired essence cannot be stored, the clean Qi in the
atmosphere and food cannot be received, and substances such as turbid phlegm will
not be dispelled from the body. Numerous diseases will result. The understanding of
the influence of the ascending and descending functions of spleen and stomach on the
physiological activities of the whole body is therefore essential in clinical practice
when regulating the functions of these two organs.

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16, Nanxiaojie, Dongzhimen Nei, Beijing, 100700, China

Course A: Basic Theories of Traditional Chinese Medicine

Chapter 1 The Theory of Yin-Yang and Five Elements

Section 1. The Theory of Yin-Yang

Section 2. The theory of the Five Elements

Chapter 2 The Theory of Zang-Fu System

Section 1. Five Zang Organs

Section 2 Six Fu Organs

Copyright by Beijing Mebo TCM Training Center 1

Section 3. The Extraordinary Fu Organs

Chapter 3 The Theory of Essence, Qi, Blood and Body Fluids

Section 4. Body fluids

Chapter 4 Meridians and Collaterals

Section 1. Concept and Formation of the Meridian System

Section 2. The twelve principal meridians

Section 3 The eight extra meridians

Section 4 The functions of meridians and their Application

Chapter 5 Etiology and Pathogenesis

Copyright by Beijing Mebo TCM Training Center 3

Traditional Chinese medicine (TCM) studies human physiology and pathology, it is

1. Foundation of the Basic Theoretical System of Traditional Chinese Medicine

Classic of Acupuncture and Moxibustion, by Huangfu Mi (215-282) of the Jin

2. Distinguishing Features of Traditional Chinese Medicine

2.1 The Concept of Integrity

2.1.1.Taking the Human Body as an Organic Whole

2.1.2. Integrity between Human Body and Nature

Copyright by Beijing Mebo TCM Training Center 8

climatic changes, so do humans.

locations, and seasons has become an important therapeutic principle of traditional

2.2. Treatment on the Basis of Differentiation of Syndromes

2.2.2. Relations between Differentiation of Diseases and Differentiation of

Copyright by Beijing Mebo TCM Training Center 11

In other cases, it may be appropriate to apply the principle of "same method of

Chapter 1. The Theory of Yin-Yang and Five Elements

Copyright by Beijing Mebo TCM Training Center 12

Section 1. The Theory of Yin-Yang

1. The concept of the theory of Yin-Yang

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2. Basic contents of the theory of Yin-Yang

2.1. The opposition and interaction of Yin-Yang

2.2. The interdependence between Yin and Yang

2.3. Dynamic equilibrium (inter-consumption-support) of Yin and Yang

2.4. Mutual transformation of Yin and Yang

Copyright by Beijing Mebo TCM Training Center 16

3. Application of the theory of Yin-Yang in traditional Chinese medicine

3.1. Explaining the tissues and structure of the human body

3.2. Explaining the physiological activities

3.3. Explaining the pathological changes

hyperfunction of the organism or the endogenous heat manifestations, while

3.4. Serving as a guide to clinical diagnosis and treatment

techniques of needling and moxibustion to be used. For instance, combining points

Section 2. The Theory of the Five Elements

1. Basic concepts of the theory of five elements

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2. Basic contents of the theory of the five elements

2.2.Categorization of things according to the five elements

The Classification of things according to the theory of five elements

Table 1: Human Body

Five Five Zang Six Five sense Five Emotional

wood liver gall bladder eye tendon anger

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earth spleen stomach mouth muscle over-thinking