The Application of the Theory of the Five Elements in TCM
1. Classifying the Body's Structure and Reflecting the Unity between the Internaland External Environment
By applying the method of analogous relationships to the five elements, the body'sstructure is classified into the system of the five elements respectively according to the natures and features of the viscera and tissues. This view takes the five zang-viscera (liver,heart, spleen, lung, and kidney) as its center, corresponding to the six fu-viscera (gall bladder, small intestine, stomach, large intestine, urinary bladder, and triple-jiao), controlling the five body constituents (the tendon, vessel, muscle, skin and hair, and bone), opening up into the five sense organs (the eye, tongue, mouth, nose, and ear),being manifested in the body exterior (the nail, face, lip, hair, and head-hair). Thislays the foundation for the visceral manifestation theory.
In addition, according to the perspective of "correspondence between man and
nature", TCM classifies the related things or phenomena in the natural world, and relatesthese things to the body's structure in accordance with the property of the five elements.For example, the body's five zang-viscera, six fu-viscera, five body constituents, five sense organs, etc. , are related to the five orientations, five annual divisions, five flavors,five colors, etc. , in the natural world. Thus, the body and natural environment are united, reflecting the mutual correspondence relationship between the body's internal and external environment. Thus it is pointed out in Chapter 9 of Plain Questions that liver-qi"corresponds to spring", heart-qi "corresponds to summer", lung-qi "corresponds to autumn", and kidney-qi "corresponds to winter". Chapter 22 also says, "Spleen-qi corresponds to latt-summer. " To illustrate this, spring corresponds to the east orientation,and wind-agent is predominant in spring. So the weather is warm and yang-qi begins to germinate and ascend, leading to the development of all things. Liver-qi of the body corresponds to these phenomena, hence liver-qi is exuberant in springĦ£
2. Illustrating the Visceral Functions and Mutual Relationships
In TCM, some physiological characteristics of the five zang-viscera are illustrated according to the features of the five elements. For instance, the features of wood are flex and extension, soft and smooth. Since the liver is attributable to wood, it likes smooth and dislikes being depressed, and has the functions of conducting and dispersing. The features of fire are warm, hot, and flaming-up. Since the heart is attributable to fire,heart-yang has the function of warming up, and heart-fire is likely to flame up. The features of earth are thick and solid, and earth can generate everything. Since the spleen is attributable to the earth, the spleen has the functions of digesting food and transporting the food-essence to nourish viscera, limbs, and bones, and thus it is regarded as the
source of generation and transformation of qi and blood. The features of metal are descending and astringing. Since the lung is attributable to metal, it has the functions of dispersing and depurative descending. The features of water are moisturizing, flowing downwards, and storing. As the kidney is attributable to water, it has the functions of dominating the evaporation and discharge of water, and of storing essence.
TCM holds that the functional activities of the five zang-viscera are not solitary, but interconnected. The five zang-viscera are the center of the body's physiological activities.They are mutually related and coordinated to fulfill the entire range of physiological activities together. That they correspond to the five elements illustrates not only some of their functional characteristics, but also the relationships of inter-generation and inter-restraint among the five zang-viscera. Furthermore, it shows that all of the five zang-viscera are related to one another. These inter-generation and inter-restraint relationships are discussed in the paragraphs that follow.
The mutual generation relationship among viscera goes like this. The kidney stores essence, and the liver stores blood. The kidney-essence can be transformed into liverblood, in a process known as kidney-water nourishing liver-wood (water generating wood). The liver stores blood and regulates its volume, and the heart dominates vessels.The liver's normal functions give rise to the heart's function of dominating blood vessels,thus allowing liver-wood to assist upward heart-fire (wood generating fire). The heart dominates vessels and mental activities, and the spleen dominates transportation and transformation, which is the source of generation and transformation of qi and blood, and also commands blood. Heart-yang can warm spleen-yang. Only when the heart performs its functions can blood nourish the spleen, and can the spleen perform its functions. This
is known as heart-fire warming spleen-earth (fire generating earth). The spleen can
transport food-essence to reinforce lung-qi, thus maintaining the lung's function of dominating qi, and ensuring that the lung dominates the dispersing and depurative descending functions normally. This is known as spleen-earth generating lung-metal (earth generating metal). Finally, the lung dominates qi and has the function of depurative descending,and the kidney stores essence and receives qi. Lung-qi descending contributes to the consolidation of kidney-essence and the reception of qi. The lung's role in regulating the passage of water can promote the operation of the kidney's function of dominating water.This is termed lung-metal generating kidney-water (metal generating water). It thus is clear that the mutual generation relationships among the five zang-viscera is expounded just by taking the theory of inter-generation among the five elements.
The mutual restraint relationship among viscera goes as follows: The depurative descending of lung-qi leads to the free flow of qi, suppressing the rushing up of liver-qi and the ascendant hyperactivity of liver-yang. This is known as metal restraining wood. The smooth of liver-qi can soothe the stagnation of spleen-earth, known as wood restraining earth. The transportation and transformation of spleen-qi can regulate the function of the kidney in dominating water, preventing the flooding of watery-dampness, known as earth restraining water. The moistness of kidney-water can reach upwards to the heart to check flaming-up of heart-fire, which is called water restraining fire. And heart-yang can limit the over-descending of lung-qi, which is fire restraining metal.
In summary, the generation and restraint relationships among the five zang-viscera illustrate that each of the zang-viscera gets assistance from the others in functioning, so that it is unlikely that it will become deficient. Conversely, each zang-viscera can restrain another one, making it unlikely that a zang-viscus will become hyperactive. If the original zang-visceral qi is excessive, it will be restrained by the other zang-visceral qi. And if it is deficient, it will obtain nourishment from the others. This close connection via generation and restraint maintains the body's internal environment of coordination and unity.
3. Generalizing the Laws of Pathogenesis and Transmission
1 ) Pathogenesis
The five zang-viscera correspond externally to the five annual divisions, so the laws of pathogenesis in the four seasons and six climatic agents generally is that the zang-viscus corresponding to the season will be first to be affected by the evil-qi. For example, in spring, the liver will be first attacked; in summer, the heart; in the late-summer, the spleen; in autumn, the lung, and in winter, the kidney. But sometimes it can cause the zang-viscus being surpassed, or the zang-viscus not being surpassed, to be attacked. For example, when the weather is abnormal, the climatic change is ahead of the season, resulting from excessive climatic change. Conversely, when the climatic change is behind the season, this results from the insufficiency of climatic change. The onset law of excessive climatic change is that the evil-qi not only invades the zang-viscus being surpassed by means of over-restrain, but also counter-restrains the zang-viscus not being surpassed.The onset law of insufficient climatic change is that the original zang-viscus will be attacked not only by the counter-restraint from the zang-viscus being suppressed, but also by the over-restraint from the zang-viscus not being surpassed. It should be pointed out that this is concluded according to the laws of the generation, restraint, over-restraint,and counter-restraint of the five elements. Although such a conclusion on the condition of pathogenesis cannot totally conform to the objective law of clinical pathogenesis, it shows that the onset of disease is actually subjected to the important influence of the climatic changes of the natural world.
2) The Transmission of Disease
The mutual affection and transfer of visceral disease are called the transmission. The original zang-visceral disease can be transmitted to other zang-viscera, and vice-versa.This pathological transmission is mainly incarnated by the mother-child relationships of inter-generation among the five elements, and the over-restraint and counter-restraint relationships among the five elements.
Transmission related to the mother-child relationship includes two patterns: "the mother disorder affecting the child" and "the child disorder affecting the mother. "
The mother disorder affecting the child is also called "the mother deficiency implicating the child. " The disease is transmitted from the mother-zang-viscus to the child-zangviscus according to the order of inter-generation. It is usually seen in the clinic that the symptoms of the mother-zang-viscus disorder appear first, and are followed by the symptoms of the child-zang-viscus disorder. An example is the syndrome of water failing to nourish wood, more specifically, the insufficient kidney-yin failing to nourish liver-yin causing yin to fail to restrict yang, thus creating hyperactivity of liver-yang due to yin deficiency. The clinical symptoms are soreness and weakness in lower back and knees, tinnitus, seminal emission, vertigo, amnesia, insomnia, irritability, dry throat and mouth,feverish sensation in the five centers, flush cheek, night sweat, and so on.
The child disorder affecting the mother is also called "the child stealing the motherqi." The disease is transmitted from the child-zang-viscus to the mother-zang-viscus.The symptoms of the child-zang-viscus appear first, followed by the symptoms of the mother-zang-viscus. One example is the syndrome of fire-flaring of the heart and liver,in other words, the hyperactivity of heart-fire leads to the flaming-up of liver-fire. The clinical symptoms are vexation, insomnia or restlessness with delirium, and erosion of the
mouth and tongue, further complicated by irritability, headache, vertigo, flush face,conjunctival congestion, and so on.
Transmission related to the over-restraint and counter-restraint relationship includes two patterns, the "transmission of inter-over-restraint" and the "transmission of intercounter-restraint. "Transmission of inter-over-restraint denotes excessive inter-restraint causing disease transmission. Example is the hyperactivity of wood over-restraining earth, also known as the syndrome of disharmony between the liver and spleen or the syndrome of disharmony between the liver and stomach. In clinic, this condition is seen when the liver-qi invades transversely the spleen and stomach, and causes a functional disorder in digestion and absorption. Generally, the symptoms of the liver disease appear first, and then the symptoms of insufficiency of spleen-qi or the failure of stomach-qi to descend appear subsequently. The syndrome of the invasion of the liver-qi may be marked
by irritability, oppressed feeling in the chest, hypochondriac pain, vertigo, headache,etc. If liver-qi transversely invades the stomach, there will be symptoms such as nausea,belching, acid regurgitation, vomiting, etc. If liver-qi transversely invades the spleen,there will be the symptoms of loss of appetite, anorexia, distention of the abdomen, loose or irregular stool, and so on.
Transmission of inter-counter-restraint implies that the opposite restraint causes disease transmission. An example is wood-fire impairing metal, i. e. , the syndrome of liverfire invading the lung. In clinic, it is usually seen when the hyperactivity of liver-fire invades upwards to the lung, scorching lung-fluid or the lung meridian. Generally, the syndrome of hyperactivity of liver-fire appears first, marked by pain in the chest and hypochondrium, oral bitter taste, irritability, taut and rapid pulse, etc. This is followed by the syndrome of the lung failing to descend depurative, with such symptoms as cough,hemoptysis, or sputum mixed with blood. Since the appearance of lung disease is behind that of liver disease, it is transmitted from the zang-viscus being restrained, and thus is classified as a transmission of inter-counter-restraint.
It should be pointed out that the transmission of the mother-child or over-restraint and counter-restrain relationship is not inevitable. Whether such a transmission happens is related to the deficiency or excess of the viscera-qi, the nature of the evil-qi, the nursing care and treatment, etc. Generally speaking, the deficiency of viscera-qi leads to transmission. If the.viscera-qi is not deficient, it will not transmit or will be difficult to transmit. One should be flexible in dealing with such conditions, as they cannot be understood rigidly.
4. Use in the Diagnosis and Treatment
The body itself is an organic whole. The disorder of the internal viscera can be refleeted in the body's exterior. As it is said in Chapter 47 of Spirit Pivot, " The internal viscera can be understood by observing outward manifestations, making the disorder clear. " The abnormality of the functional activities of the body's internal viscera and their mutual relationships can be reflected by their corresponding aspects such as color, sound,figure, taste, pulse condition, tongue coating, etc. So it is said in the Sixty-First Problem in The Classic on Medical Problems, " Knowing by means of listening denotes that the diseases can be differentiated by listening to the five sounds. Knowing by means of questioning means that the causes and locations of diseases can be mastered by asking the desired five flavors. Knowing by means of palpating indicates that the conditions of the visceral diseases can be obtained by feeling the cunkou pulse and judging the excessiveness
or deficiency. "
It thus is clear that the tiered structure of the five zang-viscera system establishes the theoretical basis for disease diagnosis, as the relationships between the five zang-viscera and the five colors, sounds, flavors, etc. , are classified according to the five elements theory. In clinical diagnosis, one an synthesize the data obtained through the four diagnostic methods and depend upon the properties of the five elements and the laws of generation, restraint, over-restraint, and counter-restraint to deduce the disease condition.For example, symptoms of green complexion, preference for sour flavor, distending pain in hypochondrium, and taut pulse can be diagnosed as liver disease; symptoms of red
complexion, oral bitter feeling, redness in the tip of tongue with erosion, and a surging or rapid pulse can be diagnosed as the hyperactivity of heart-fire; and patients with such symptoms as green complexion and acid regurgitation indicate the syndrome of disharmony between the liver and spleen due to liver-wood over-restraining earth.
Generally, TCM diagnostics pays more attention to the combined application of the color diagnosis and the pulse diagnosis, which can roughly reflect the disease condition.The use of these two indicators mainly applies the generation and restraint relationship among the five elements. If color is in conformity with pulse, it indicates that the development of the disease is normal. If the pulse restrains the color, it indicates that the prognosis is unfavorable, and if the pulse generates the color, it indicates a favorable prognosis.Taking liver disease as an example, green complexion with a taut pulse means that the color is in conformity with the pulse; if the pulse condition is not taut but floating instead, it belongs to the restraint-pulse, that is, the pulse restrains the color (metal restrains wood) and the prognosis will be unfavorable. If, on the other hand, the pulse condition is deep (the kidney pulse), namely, the pulse generates the color (water generates wood), and the prognosis will be favorable. Though this method of judging the prognosis by applying the generation and restraint relationship has a certain reference value in clinical practice, it should not be applied mechanically.
Clinical treatment has two aims: controlling the disease transmission and determining the treatment principle and method, both of which are discussed below.
1) Controlling the disease transmission
he onset of disease is due mainly to the disharmony between the visceral functions,yin and yang, and qi and blood. However, the visceral functional disharmony is inevitably reflected in the abnormality of the relationships of generation and restraint in the internal viscera. Thus, disease transmission often occurs when one zang-viscus is attacked and the other zang-viscus is involved, or the disease in the attacked zang-viscus is transmitted to the original zang-viscus. In clinic, in addition to dealing with the original attacked zang-viscus properly, the transmission relationship of the related viscera should be considered. The laws of generation, restraint, over-restraint, and counter-restraint of the five elements should be applied to regulate the excessive or the deficient in order to
control or prevent the disease transmission, and to return to normal functional activities.
For example, if the liver is diseased, one should strengthen the spleen and stomach in order to prevent transmission. If the spleen and stomach are not deficient, the disease will find it difficult to be transmitted, and will be cured easily. Thus it is said in the Seventy-seventh Problem of The Classic on Medical Problems, " The liver is diseased, and it should be clear that the disease may be transmitted to the spleen, so strengthening the spleen-qi must be considered first. " "Strengthening the spleen-qi" refers to regulating and tonifying spleen-qi. Such a treatment principle of treating the other zang-viscus for the original zang-viscus disease fully incorporates the holistic perspective in TCM's therapeutics.
2) Determining Principles and Methods of Treatment
The treatment principles and methods are mainly determined by relying upon the
laws of inter-generation and restraint. The main contents are as follows.
Determining the treatment on the basis of the inter-generation law: This is applied most often to the syndromes of the mother disorder affecting the child or the child disorder affecting the mother (namely, the child stealing the mother-qi). It is said in the Sixty-sixth Problem of The Classic on Medical Problems, "The child-deficiency is treated by reinforcing the mother, and the mother-excess is treated by reducing the child. " So the basic principle is to reinforce the mother or reduce the child.
Reinforcing the mother is mainly suitable for the deficient syndrome caused by the disharmony of the mother-child relationship. For instance, when the lung deficiency develops to a certain degree, it can affect the normal transportation function of the spleen, leading to spleen deficiency. Spleen-earth is considered to be the mother, and lung-metal is the child. Earth can generate metal, so it can be treated by the method of reinforcing the spleen to tonify the lung.
Reducing the child is suitable for the excessive syndrome due to the disharmony of the mother-child relationship. For example, when liver-fire is exorbitantly flaming-up,and is only ascending, not descending, the syndrome of liver-excess occurs, and can be treated by the method of reducing the heart. Liver-wood is considered to be the mother,and heart-fire is the child. Therefore, to reduce heart-fire contributes to reducing liverfire.
In addition to the mother disorder affecting the child and the child disorder affecting the mother, there also is the simple deficient syndrome of the child disorder. This can be treated by taking the same principle used above, combined with reinforcing the mother to strengthen its generation force, thus promoting the recovery of the deficient syndrome of the child-zang-viscus.
In clinic, therapeutic methods decided by relying on the inter-generation law of the five elements are as follows:
One method is enriching water to nourish wood. This refers to the treatment method of nourishing liver-yin by means of enriching kidney-yin in order to astringe liver-yang.It also is called the method of enriching the liver and nourishing the kidney, or Yi (the liver) and Gui (the kidney) sharing the same source. It is mainly suitable for the syndrome of insufficiency of liver-yin, and even for the partial hyperactivity of liver-yang,due to the impairment of kidney-yin.
The mutual promotion between metal and water is another treatment method which
refers to the nourishing of the yin-deficiency of the lung and kidney. This method is called both the method of tonifying the lung and nourishing the kidney, or the method of nourishing the lung and kidney. It is generally suitable for the syndrome of yin-deficiency of the lung and kidney. This is caused by a lung deficiency and failure to distribute bodyfluid which nourishes the kidney, or an insufficiency of kidney-yin, which results in a failure of the essential qi to nourish the lung.
The method of banking up earth to generate metal is also known as the treatment
method of reinforcing spleen-qi to tonify lung-qi. It is suitable for the syndrome of deficiency of both the lung and spleen due to the deficiency of spleen and the failure of the stomach in nourishing the lung.
Determining treatment principle according to the inter-restraint law: This technique is generally used regarding the over-restraint and counter-restraint syndromes which result from disorders of the inter-restraint relationship, including excessive inter-restraint,insufficient inter-restraint, and inter-counter-restraint (opposite restraint). The treatment principle is applied by relying on methods which inhibit the strong and strengthen the weak, and through emphasis on inhibiting the strong to ensure the easy recovery of the weak. Additionally, if necessary, treatment may in advance strengthen the force of that which is restrained, thereby preventing the development of the disease condition prior to an advanced state in which the strong will restrain the weak.
Inhibiting the strong.. It is generally suitable to invoke this approach with the syndrome of inter-over-restraint or inter-counter-restraint. For example, liver-hi transversely invades the stomach, or over-restrains the spleen. This results in a disharmony between the liver and stomach, or liver and spleen, and is termed the exuberant wood overrestraining earth. One method which should be taken is that of soothing or calming the liver. However, if the obstruction of spleen and stomach-qi affects the liver, there will appear a failure of the liver in conducting and dispersing, which will lead to the syndrome of earth obstruction and wood stagnation, known as the syndrome of inter-counter-restraint (opposite restraint). The method of strengthening the spleen and harmonizing the stomach should be employed here. By inhibiting the strong, the function of the one that is restrained is prone to becoming coordinated.
Strengthening the weak. This is suitable for application in the syndrome caused by an insufficiency of restraint force, or an occurrence of over-restraint due to deficiency.For instance, liver deficiency with qi stagnation affects the function of the spleen and stomach in their transporting ability. This is called wood failing to loose earth, and tonilying the liver while regulating the liver-qi should be done. Meanwhile, the method of strengthening the spleen should also be taken into consideration. If a syndrome of disharmony between the liver and spleen exists, or between the liver and stomach exist due to wood over-restraining earth-deficiency, then soothing the liver to regulate qi should be applied. Strengthening the weak is of great assistance to the recovery of the coordination in the relationship of mutual restraint.
In clinic, therapeutic methods are decided by relying on the inter-restraint law of the five elements and are commonly as follows.
The method of strengthening earth to inhibit wood. This is a method for treating a spleen deficiency with ascendant hyperactivity of liver-qi. This is done by applying herbs which strengthen the spleen and sooth the liver. It is mainly suitable for the syndrome of spleen deficiency with liver-qi stagnation.
The method of banking up earth to restrict water. This is referred to as the method for treating the syndrome of retention of water-dampness by applying herbs which warm up spleen-yang, or by strengthening the spleen to excrete water. It is mainly used for treating edema due to the syndrome of failure of the spleen in transportation, or for the insufficiency of spleen-yang leading to flooding.
The method of treating metal to calm wood: This is referred to as the method for subduing the hyperactivity of liver-fire by means of clearing lung-qi. This is also called the method of clearing the lung to reduce the liver. It is generally applied in the syndrome of "wood-fire impairing metal" due to the ascendant hyperactivity of the liver-fire scorching lung-metal and affecting the function of lung-qi in depurative descending.
The method of reducing south to reinforce north: This is the method of reducing
heart-fire and reinforcing kidney-water to harmonize the heart and kidney. It is also a method of reducing fire to tonify the kidney, and of enriching yin to lower fire. It is mainly suitable for treating the syndrome of disharmony between heart (fire) and the kidney (water), due to the insufficiency of kidney-yin and the partial hyperactivity of heartyang.
Also pertaining to the five elements, are the acupoints which are used in both
acupuncture and moxibustion therapy. These are located at the extremities of twenty regular meridians, (including the three yin and three yang of the hand and foot). The acupoints of ring (well), ying (spring), shu (stream), jing (river), and he (sea), pertain to wood, fire, earth, metal, and water respectively. In clinic, acupoints may be selected according to the different disease conditions, and through application of the generation and restraint law of the five elements.
The generation and restraint relationship among the five elements also has guiding significance in the treatment of mental disorders. In the clinic, the goal of treatment is attained through application of the mutual restraint relationship between emotions. As it is stated in Chapter 5 of the Plain Questions: "Anger impairs the liver, grief subdues anger;" "Joy impairs the heart, fear subdues joy;" "Pensiveness impairs the spleen,anger subdues pensiveness;" "Worry impairs the lung, joy subdues worry;" and "Fear impairs the kidney, but pensiveness subdues fear. " One must apply the restraint relationship among the five elements in order to regulate emotions, so that the goal of treating mental disorders may be attained.
